Marijuana Use by Patients with Multiple Sclerosis
Multiple sclerosis (MS) is a neurologic disease of the central nervous system that causes physical and cognitive disability. Multiple sclerosis is also associated with a diverse range of symptoms, including pain, spasticity, fatigue, balance problems, heat intolerance, bladder problems, and tremors, all of which adversely affect quality of life.
Patients with MS often seek nonmainstream treatment options to alleviate their symptoms, such as complementary and alternative medicine (CAM), herbal supplements, and marijuana.
How to Use It
His best-known compound in cannabis is THC, or delta-9-tetrahydrocannabinol. It’s what gets you high when you smoke, eat, or vape it.
Another active ingredient is cannabidiol (CBD), which doesn’t make you high. Most states allow limited medical uses of CBD.
It most often comes in oil, which you can rub on painful spots or as an extract or tincture to put under your tongue. You also can swallow CBD capsules or vape, or inhale it. People sometimes buy CBD online from sellers without a license for medical marijuana.
Whether you smoke pot or dab on CBD oil, you may not always know exactly what you’re using, The FDA doesn’t regulate them, so the THC levels, for example, may vary a lot from one batch to the next.
You shouldn’t use any cannabis products if you:
- Are pregnant or breastfeeding
- Have heart disease
- Ever had psychosis
- Have Parkinson’s disease
- Take clobazam or valproic acid for seizures, bipolar disorder, or migraine headaches
More People with MS Turning to Cannabis for Help with Pain, Sleep
More than 40% of those with multiple sclerosis said they’ve used cannabis products in the past year, according to recently published results from a national survey on pain in people with MS.
And those who turned to products with some combination of compounds derived from the cannabis plant (CBD, or cannabidiol, and THC, or tetrahydrocannabinol) were most likely to try them for help with chronic pain and sleep—two symptoms that are common and often go together in this chronic neurological disease.
It represents an increase from previous studies of CBD/THC use in MS, as more states legalize marijuana use recreationally and/or medically. However, there’s a wide gap between the proportion of people with MS who have used a cannabinoid in the past year (42%) and the proportion who have spoken with their physician about it (only 18%).
Furthermore, less than 1% of cannabinoid users received information from their provider about the type of cannabinoid product recommended for their symptoms.
Immune System and Multiple Sclerosis
Multiple sclerosis is an autoimmune disease. That means that the symptoms of the disease occur because the immune system is attacking healthy cells in the way that it’s supposed to attack viruses and other pathogens.
In MS, the immune system targets the myelin sheath, a protective coating that wraps around nerve cells in the spinal cord and brain. When the immune system attacks this barrier, it causes inflammation and damage, which can impair the nerve signaling that facilitates movement, breathing, thinking, and more.
The severity of MS symptoms varies, depending on the location of the attack and the extent of the damage to the myelin sheath, but they most often include fatigue, muscle weakness or stiffness, and cognitive dysfunction.
Cannabinoids and the Immune System
Cannabinoids are a group of compounds found in the cannabis plant. The two main cannabinoids are THC (the psychoactive ingredients in marijuana) and CBD (which does not have a psychoactive component).
The body processes cannabinoids via cannabinoid receptors, which are found in the brain and in immune cells.
This is all part of the endocannabinoid system, which regulates inflammation, immune function, motor control, pain, and other bodily functions commonly affected by MS.
This connection helps explain why CBD can be beneficial for MS. Cannabinoids have been shown to reduce inflammation and regulate immune response.
CBD does this without mind-altering properties, making it appealing to people looking for relief from MS symptoms without the “high” of marijuana.
Benefits of CBD for MS
In a recent meta-analysis, researchers concluded that cannabinoids, including CBD, are “probably effective” at alleviating certain symptoms of MS, including pain and abnormal muscle tightness (spasticity), but “probably not effective” for treating muscle tremors or incontinence.
- A 2018 scientific review found that CBD supplementation reduced pain, fatigue, inflammation, depression, and spasticity in people with MS, while improving mobility. The authors concluded that recommending CBD supplementation for people with MS would be advisable.
- A 2014 scientific review found that Sati vex (nabiximols), a CBD nasal spray, can help reduce pain, spasticity, and frequent urination in patients with MS.
- Two different 2021 medical reviews found that in animal models, CBD helps regulate the immune system, reducing the autoimmune response that causes MS symptoms.
More research is needed, but in the future this may mean that cannabis-derived medications and CBD could be used to treat the progression of MS, not just the symptoms.
Are There Any Side Effects?
CBD is generally considered safe, and it does not have mind-altering properties. A dose of up to 300 mg daily of CBD is safe for up to six months. Higher doses are safe for a shorter amount of time.
However, like any other supplements or medication, CBD may have side effects in some individuals. These may include:
- Low blood pressure
- Damage to the liver
In addition, CBD may interact with many other prescription drugs. It’s best to speak with your healthcare provider before supplementing with CBD, especially if you are pregnant or breastfeeding.
Most doctors who treat MS are familiar with CBD, since at least 20% of MS patients are currently using CBD.
CBD is legal for consumption in the United States, but cannabis products that contain THC are illegal at the federal level. Be sure to understand the legal and professional implications of using CBD, especially if you are regularly screened for drug use.
How to Use CBD for MS
CBD is available in many different forms, including topical, tinctures, edibles, and nasal sprays.
You’ll also have to decide whether you want to take a full or broad-spectrum CBD, which contains other cannabinoids, or a CBD isolate, which contains just cannabidiol. Limited research suggests there may be a benefit to the “entourage effect”: It’s believed that having other cannabinoids present may make CBD more effective.
How to Buy CBD for MS
It’s important to deal with reputable dispensaries when purchasing CBD for MS. Here’s what you should consider when buying CBD to treat MS:
- The legal status of CBD in your state, including whether you need a medical cannabis card
- The possible impact of taking CBD on your professional licenses or other areas in your life
- Your goals in taking CBD, and the symptoms you would most like to address
- Whether you would like a CBD isolate or a full-spectrum product that contains other cannabinoids
- Whether the retailer is licensed in your state
- Where the product was sourced (grown)
- Whether the product has a COA, or certificate of analysis, which shows the chemical composition of a substance
Is CBD safe for MS?
CBD is generally considered safe, and some research shows that it likely helps treat pain and spasticity caused by MS. However, CBD is not FDA approved for treating MS or its symptoms. You should speak with your healthcare provider about using CBD to treat MS.
How do you use CBD for MS pain?
Much of the research on using CBD for MS pain has been done using oral supplements and nasal sprays. Some people also report benefits from smoking CBD flowers or cannabis. It’s best to speak with your healthcare provider and consider the legal standing of CBD and cannabis in your state as you decide how best to use CBD to treat MS pain.
Taking cannabis for MS may not always be appropriate, and there may be side effects.
Possible side effects include:
- confusion and possibly paranoia
- problems with thinking and reasoning
- nausea and vomiting
- dry mouth and eyes
- increased hunger
- problems with balance and coordination
- a raised heart rate
Smoking cannabis can also damage the lungs.
Types and forms of cannabis for MS
There are many different strains and forms of cannabis, and some may be more helpful than others.
Depending on legality, medical professionals may suggest different types of cannabis medications.
One such medication, Dronabinol a capsule made of synthetic THC. The other, nabiximols (Sati vex), is a mouth spray comprised of THC and CBD extracts.
If a person lives in a state where medical cannabis is legal, they can obtain a medical card allowing the use of a variety of cannabis products.
If a person lives in a state where recreational cannabis is legal, those products may be available without a medical card.
Licensed dispensaries sell cannabis products to the public in states where medical and recreational cannabis is legal.
Dispensaries carry a variety of cannabis products such as:
- Dry cannabis flower
- Edibles such as candy, drinks, and cookies
- Vape cartridges
There are many different strains of cannabis to choose from. Each cannabis strain may have a different percentage of THC and CBD, which can determine its effects.
Cannabis strains also have a variety of trepans, or aromatic compounds, which may determine its effects.
Cannabis is not legal in all states.
The FDA has approved three Trusted Source synthetic cannabis products, but not for use with MS. More research is necessary to confirm the effectiveness and safety of cannabis extracts before the FDA can approve them for MS.
A person should speak to their doctor about whether cannabis is legal and suitable for them to use and how to obtain an appropriate product.