Multiple Sclerosis (MS) is a disabling disease of the Central Nervous System (CNS: the brain and spinal cord) that results from disruption of the signaling systems that allow communication between your brain and the rest of your body. MS is considered to be a kind of autoimmune disease, because the damage to nerve cells that occurs is caused by your own immune system. Immune-system cells invade the CNS and cause the destruction of myelin; the substance that covers nerve fibers and enables messages to travel from one end to the other. Damage to and loss of myelin (and the cells that produce myelin), combined with the inflammation associated with nerve damage, lead to disruption in signaling and ultimately, the collapse of the basis for the coordinated actions of bodily systems.
The symptoms of MS vary widely because different nerve pathways are affected in different people, and nerve function can be affected to different degrees. Some people suffer from chronic and progressive manifestations of symptoms whereas others may experience relatively long periods of relief. Yet despite all of the reasons for possible differences, most MS patients share the common experience of dealing with issues related to movement: fatigue, muscle numbness, tingling, weakness, spasticity, tremors, paralysis and pain. Many MS patients also suffer from problems with sleep, vision, thermoregulation, and bladder, bowel and sexual function.
Cannabis and Multiple Sclerosis
Studies on the effects of cannabis on Multiple Sclerosis symptoms are not extensive and do not address many of the issues faced by MS patients, but a few findings are well supported: Cannabis is associated with a reduction in pain and sleep disturbances, offers relief of muscle and bladder dysfunction, and likely provides “neuroprotection” and so should slow the progression of the disease. Unfortunately, the trade-off is an increase in the reduction in cognitive functioning associated with MS.
Published studies differ in the methods used (e.g. the number of people involved, THC and CBD dosages, and whether the cannabis was administered via an oral spray or a smoked joint), and also in the indices of change (e.g. patient perception of pain or sleep disturbance, actual diaries of symptom occurrence, and clinical or experimental studies), yet all meet the rigorous criteria of scientific publication. Despite differences in study details, it has been shown repeatedly (e.g., 1, 3, 7, 8) that cannabis is effective in reducing neuropathic pain, and has the ability to reduce muscle spasticity (e.g., 1,2,3, 9) and sleep disturbance (e.g., 1, 8).
For patients with MS, cannabis has also been shown to reduce muscle stiffness (10), urinary urgency (1), and episodes of incontinence (1, 4), but is also associated with a reduction in daily total voided (1). Regarding the potential neuroprotective benefits of cannabis, studies suggest that it may be possible to slow the destruction of nerve fibers, and thus clinical progression of the disease (6 [synthetic cannabidiol, in mice], 7).
As above, there is a potential downside to the use of cannabis to treat MS symptoms. Although most patients experienced few adverse short-term, identifiable effects (some reported dizziness, dry mouth and sleepiness, in addition to intoxication), longer-term negative effects on cognitive function have been demonstrated. Of patients with MS, those who used cannabis performed more poorly than non-users in measures of information-processing speed (3, 5), working memory, executive functions, and visuospatial perception (5).
Going the Cannabis Route
Thinking of trying using cannabis for Multiple Sclerosis? First, there are legality issues to consider. Cannabis possession and use remains illegal under federal law, which means you cannot take it from one state to another. Within states, however, the situation is different, and each state has its own guidelines and laws. Some states make nuanced distinctions between products and uses and permissibility, and it would be a good idea to familiarize yourself with the details of your state’s policies.
- Brady, CM, R DasGupta, C Dalton, OJ Wiseman, KJ Berkley, and CJ Fowler. 2004. An open-label pilot study of cannabis-based extracts for bladder dysfunction in advanced multiple sclerosis. Multiple Sclerosis Journal. https://doi.org/10.1191/1352458504ms1063oa
- Collin, C, P Davies, and IK Mutiboko. 2007. Randomized controlled trial of cannabis‐based medicine in spasticity caused by multiple sclerosis. European J of Neurology. https://doi.org/10.1111/j.1468-1331.2006.01639.x
- Jody Corey-Bloom, Tanya Wolfson, Anthony Gamst, Shelia Jin, Thomas D. Marcotte, Heather Bentley and Ben Gouaux. 2012. Smoked cannabis for spasticity in multiple sclerosis: a randomized, placebo-controlled trial. European Journal of Neurology. 184 (10) 1143-1150. DOI: https://doi.org/10.1503/cmaj.110837
- Freeman, RM, O. Adekanmi, MR Waterfield, AE Waterfield,, D Wright, and J Zajicek. 2006. The effect of cannabis on urge incontinence in patients with multiple sclerosis: a multicentre, randomised placebo-controlled trial (CAMS-LUTS). International Urogynecology Journal. Volume 17, Issue 6, pp 636–641. https://link.springer.com/article/10.1007/s00192-006-0086-x
- Honarmand, K, MC Tierney, P O’Connor, and A Feinstein. 2011. Effects of cannabis on cognitive function in patients with multiple sclerosis. Neurology 76 (13). https://n.neurology.org/content/76/13/1153.short
- Pryce, G, DR Riddall, DL Selwood, G Giovannoni, and D Baker. 2015. Neuroprotection in Experimental Autoimmune Encephalomyelitis and Progressive Multiple Sclerosis by Cannabis-Based Cannabinoids. Journal of Neuroimmune Pharmacology
June 2015, Volume 10, Issue 2. https://link.springer.com/article/10.1007/s11481-014-9575-8
- Pryce, G, and D Baker. 2012. Potential Control of Multiple Sclerosis by Cannabis and the Endocannabinoid System. CNS & Neurological Disorders), Volume 11, Number 5. https://www.ingentaconnect.com/content/ben/cnsnddt/2012/00000011/00000005/art00014
- Rog, DJ, TJ Nurmikko, T Friede, and CA Young. 2005. Randomized, controlled trial of cannabis-based medicine in central pain in multiple sclerosis. Neurology September 27; 65 (6). https://n.neurology.org/content/65/6/812.short
- Wade, DT, P Makela, and P Robson, H House, C Bateman. 2004. Do cannabis-based medicinal extracts have general or specific effects on symptoms in multiple sclerosis? A double-blind, randomized, placebo-controlled study on 160 patients. Multiple Sclerosis Journal
Vol 10, Issue 4, https://journals.sagepub.com/doi/abs/10.1191/1352458504ms1082oa
- Zajicek, JP, JC Hobart, A Slade, D Barnes, and PG Mattison. 2012. Multiple Sclerosis and Extract of Cannabis: results of the MUSEC trial. J of Neurology, Neurosurgery, and Psychiatry 83:1125–1132. https://jnnp.bmj.com/content/83/11/1125.short