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Multiple sclerosis is an often-debilitating disease of the central nervous system. Studies have shown cannabis is effective in managing symptoms associated with the disease and may also be beneficial for limiting the disease’s progression.
Overview of Multiple Sclerosis
Multiple sclerosis (MS) is a disease of the central nervous system that often leads to disablement. The body’s immune system mistakenly attacks and destroys the myelin sheath that protects and insulates the nerve fibers. Myelin increases the speed at which electrical impulses move between the brain and the rest of the body and are essential for the nervous system to function properly. A loss of myelin causes signals between the brain and the body to become disrupted.
Common symptoms associated with multiple sclerosis include fatigue, walking difficulties, numbness, muscle spasms, weakness, vision problems, dizziness, bladder and bowel problems, pain, depression, and emotional and cognitive changes. In rare cases, seizures can occur.
The most common type of multiple sclerosis is relapsing-remitting MS (RRMS), which is characterized by day or weeklong relapses that can feature new symptoms, followed by periods of quiet remission that can last for months or years. Patients with RRMS will commonly transition into secondary-progressive MS (SPMS), in which the disease progresses more steadily, with or without relapses. Other types include primary-progressive MS (PPMS), which is characterized by neurological function progressively worsening over time, and progressive-relapsing MS (PRMS), which features a steady progression but has occasional exacerbations along the way.
The cause of multiple sclerosis is unknown, but the disease mostly affects women and those between the age of 15 and 60.
There is no cure for multiple sclerosis. Treatment efforts, including the administering of corticosteroids to reduce nerve inflammation and plasma exchange, can help to manage symptoms and potentially limit the disease’s progression.
Findings: Effects of Cannabis on Multiple Sclerosis
Research findings suggest that cannabis could slow the neurodegenerative process of multiple sclerosis. Studies have shown that cannabinoids are involved in the regulation of the immune system by way of acting upon the cannabinoid receptors of the endocannabinoid system. Cannabinoids have shown they can modulate the inflammatory reaction and assist in neuroregeneration7,13,22. In one study, cannabinoids demonstrated neuroprotective effects during an animal model of multiple sclerosis, reducing the damage to myelin caused from inflammation23. Another study found that cannabinoids administered to animals with a model of multiple sclerosis reduced neurological disability, improved motor coordination and limited the progression of the disease8.
Cannabis can help multiple sclerosis patients manage the symptoms associated with their disease. Cannabis has shown to be effective at reducing pain, muscle stiffness and spasms in multiple sclerosis patients11,30. In one study, multiple sclerosis patients saw significant improvements in muscle spasticity and reduced sleep disturbances after four weeks of cannabis treatment19. A similar study found that multiple sclerosis patients experienced pain and sleep improvements after five weeks of treatment with cannabis containing both tetrahydrocannabinol (THC) and cannabidiol (CBD)24.
There is some evidence that suggests that cannabis may worsen cognitive problems in multiple sclerosis patients. Multiple sclerosis patients that were regular users of street cannabis have scored significantly worse on cognitive function tests10,21.
States That Have Approved Medical Marijuana for Multiple Sclerosis
Currently, 15 states have approved medical marijuana specifically for the treatment of multiple sclerosis. These states include Alaska, Connecticut, Georgia, Illinois, Louisiana, Maine, Massachusetts, New Hampshire, New Jersey, New Mexico, New York, Ohio, Pennsylvania, Vermont, and West Virginia. In Washington D.C., any condition can be approved for medical marijuana as long as a DC-licensed physician recommends the treatment.
A number of other states will consider allowing medical marijuana to be used for the treatment of multiple sclerosis with the recommendation from a physician. These states include: California (any debilitating illness where the medical use of marijuana has been recommended by a physician), Nevada (other conditions subject to approval), Oregon (other conditions subject to approval), Rhode Island (other conditions subject to approval), and Washington (any “terminal or debilitating condition”).
Several states have approved medical marijuana specifically to treat “chronic pain,” which is a symptom commonly associated with multiple sclerosis. These states include: Alaska, Arizona, California, Colorado, Delaware, Hawaii, Maine, Maryland, Michigan, Montana, New Mexico, Ohio, Oregon, Pennsylvania, Rhode Island, Vermont, and West Virginia. The states of Nevada, New Hampshire, Ohio and Vermont allow medical marijuana to treat “severe pain.” The states of Minnesota, Ohio, Pennsylvania, Washington, and West Virginia have approved cannabis for the treatment of “intractable pain.”
Several states will allow medical marijuana for the treatment of spasms, which can arise in those with multiple sclerosis. These states include: California, Colorado, Delaware, Florida, Hawaii, Louisiana, Maryland, Michigan, Minnesota, Montana, Nevada, Oregon, Rhode Island and Washington.
Patients whose multiple sclerosis causes seizures can use medical marijuana to treat that specific symptom in several states, including Alaska, Arizona, California, Colorado, Delaware, Florida, Hawaii, Louisiana, Maryland, Michigan, Minnesota, Montana, Nevada, New Hampshire, Ohio, Oregon, Pennsylvania (intractable seizures), Rhode Island, Tennessee (intractable seizures), Vermont, Washington, and West Virginia.
Recent Studies on Cannabis’ Effect on Multiple Sclerosis
- Aragona, M., Onesti, E., Tomassini, V., Conte, A., Gupta, S., Gilio, F., Pantano, P., Pozzili, C., Inghilleri, M. (2009, January-February). Psychopathological and cognitive effects of therapeutic cannabinoids in multiple sclerosis: a double-blind, placebo controlled, crossover study. Clinical Neuropharmacology, 32(1), 41-7. Retrieved from http://journals.lww.com/clinicalneuropharm/pages/articleviewer.aspx?year=2009&issue=01000&article=00009&type=abstract.
- Arevalo-Martin, A., Vela, J.M., Molina-Holgado, E., Borrell, J., and Guaza, C. (2003, April 1). Therapeutic Action of Cannabinoids in a Murine Model of Multiple Sclerosis. Journal of Neuroscience, 23(7), 2511-6. Retrieved from http://www.jneurosci.org/content/23/7/2511.long.
- Baker, D., Pryce, G., Croxford, J.L., Brown, P., Pertwee, R.G., Huffman, J.W., and Layward, L. (2000, March 2). Cannabinoids control spasticity and tremor in a multiple sclerosis model. Nature, 404(6773), 84-7. Retrieved from http://www.nature.com/nature/journal/v404/n6773/full/404084a0.html.
- Barnes, M.P. (2006, April). Sativex: clinical efficacy and tolerability in the treatment of symptoms of multiple sclerosis and neuropathic pain. Expert Opinion on Pharmacotherapy, 7(5), 607-15. Retrieved from http://www.tandfonline.com/doi/full/10.1517/146565184.108.40.2067?needAccess=true.
- Centonze, D., Bari, M., Rossi, S., Prosperetti, C., Furlan, R., Fezza, F., De Chiara, V., Battistini, L., Bernardi, G., Bernardini, S., Martino, G., and Maccarrone, M. (2007, October). The Endocannabinoid System Is Dysregulated in Multiple Sclerosis and in Experimental Autoimmune Encephalomyelitis. Brain, 130(Pt10), 2543-53. Retrieved from https://academic.oup.com/brain/article-lookup/doi/10.1093/brain/awm160.
- Corey-Bloom, J., Wolfson, T., Gamst, A., Jin, S., Marcotte, T.D., Bentley, H., and Gouaux, B. (2012). Smoked cannabis for spasticity in multiple sclerosis: a randomized, placebo-controlled trial. CMAJ : Canadian Medical Association Journal, 184(10), 1143–1150. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3394820/.
- Croxford, J.L., Pryce, G., Jackson, S.J., Ledent, C., Giovannoni, G., Pertwee, R.G., Yamamura, T., and Baker, D. (2008, January). Cannabinoid-mediated neuroprotection, not immunosuppression, may be more relevant to multiple sclerosis. Journal of Neuroimmunology, 193(1-2), 120-9. Retrieved from http://www.jni-journal.com/article/S0165-5728(07)00396-7/fulltext.
- de Lago, E., Moreno-Martet, M., Cabranes, A., Ramos, J.A., Fernandez-Ruiz, J. (2012, June). Cannabinoids ameliorate disease progression in a model of multiple sclerosis in mice, acting preferentially through CB1 receptor-mediated anti-inflammatory effects. Neuropharmacology, 62(7), 2299-308. Retrieved from http://www.sciencedirect.com/science/article/pii/S0028390812000500.
- Fox, P., Bain, P.G., Glickman, S., Carroll, C., and Zajicek, J. (2004, April). The effect of cannabis on tremor in patients with multiple sclerosis. Neurology, 62(7), 1105-9. Retrieved from http://www.neurology.org/content/62/7/1105.long.
- Honarmand, K., Tierney, M.C., O’Connor, P., Feinstein, A., (2011, March 29). Effects of cannabis on cognitive function in patients with multiple sclerosis. Neurology, 76(13), 1153-60. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3068013/.
- Koppel, B.S., Brust, J.C. M., Fife, T., Bronstein, J., Youssof, S., Gronseth, G., and Gloss, D. (2014). Systematic review: Efficacy and safety of medical marijuana in selected neurologic disorders: Report of the Guideline Development Subcommittee of the American Academy of Neurology. Neurology, 82(17), 1556–1563. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4011465/.
- Kozela, E., Lev., N., Kauschansky, N., Eilam, R., Rimmerman, N., Levy, R., Ben-Nun, A., Juknat, A., and Vogel, Z. (2011, August). Cannabidiol inhibits pathogentic T cells, decreases spinal microglial activation and ameliorates multiple sclerosis-like disease in C57BL-6 mice. British Journal of Pharmacology, 163(7), 1507-19. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3165959/.
- Kubajewska, I., and Constantinescu, C.S. (2010, August). Cannabinoids and experimental models of multiple sclerosis. Immunobiology, 215(8), 647-57. Retrieved from http://www.sciencedirect.com/science/article/pii/S0171298509001442.
- Lahkahn, S.E., and Rowland, M. (2009, December 4). Whole plant cannabis extracts in the treatment of spasticity in multiple sclerosis: a systematic review. BMC Neurology, 9, 59. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2793241/.
- Leussink, V.I., Husseini, L., Warnke, C., Broussalis, E., Hartung, H.P., and Kieseier, B. C. (2012). Symptomatic therapy in multiple sclerosis: the role of cannabinoids in treating spasticity. Therapeutic Advances in Neurological Disorders, 5(5), 255–266. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3437528/.
- Lorente Fernandez, L., Monte Boquet, E., Perez-Miralles, F., Gil Gomez, I., Escutia Roig, M., Bosca Blasco, I., Poveda Andres, J.L., and Casanova-Estruch, B. (2014, June). Clinical experiences with cannabinoids in spasticity management in multiple sclerosis. Neurologia, 29(5), 257-60. Retrieved from http://www.elsevier.es/en-revista-neurologia-english-edition–495-articulo-clinical-experiences-with-cannabinoids-in-S2173580814000674.
- Malfitano, A.M., Proto, M.C., and Bifulco, M. (2008). Cannabinoids in the management of spasticity associated with multiple sclerosis. Neuropsychiatric Disease and Treatment, 4(5), 847–853. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2626929/.
- Mecha, M., Feliu, A., Inigo, P.M., Mestre, L., Carrillo-Salinas, F.J., and Guaza, C. (2013, November).Cannabidiol provides long-lasting protection against the deleterious effects of inflammation in a viral model of multiple sclerosis: A role for A2A receptors. Neurobiology of Disease, 59, 141-50. Retrieved from http://www.sciencedirect.com/science/article/pii/S0969996113001939.
- Mechoulam, R., and Hanus, L. (2001). The cannabinoids: An overview. Therapeutic implications in vomiting and nausea after cancer chemotherapy, in appetite promotion, in multiple sclerosis and in neuroprotection. Pain Research and Management, 6(2), 67-73. Retrieved from http://downloads.hindawi.com/journals/prm/2001/183057.pdf.
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- Novotna, A., Mares, J., Ratcliffe, S., Novakova, I., Vachova, M., Zapletalova, O., Gasperini, C., Pozzilli, C., Cefaro, L., Comi, G., Rossi, P., Ambler, Z., Stelmasiak, Z., Erdmann, A., Montalban, X., Klimek, A., Davies, P. (2011, September). A randomized double-blind-placebo-controlled, parallel-group, enriched-design study of nabiximols* (Sativex(®), as add-on therapy, in subjects with refractory spasticity caused by multiple sclerosis. European Journal of Neurology, 18(9), 1122-31. Retrieved from http://onlinelibrary.wiley.com/wol1/doi/10.1111/j.1468-1331.2010.03328.x/full.
- Pavisian, B., MacIntosh, B.J., Szilagyi, G., Staines, R.W., O’Connor, P., Feinstein, A. (2014, May 27). Effects of cannabis on cognition in patients with MS: a psychometric and MRI study. Neurology, 82(21), 1879-87. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4105254/.
- Pertwee, R.G. (2002, August). Cannabinoids and multiple sclerosis. Pharmacology & Therapeutics, 95(2), 165-74. Retrieved from http://www.sciencedirect.com/science/article/pii/S0163725802002553.
- Pryce, G., Ahmed, Z., Hankey, D.J., Jackson, S.J., Croxford, J.L. Pocock, J.M., Ledent, C., Petzold, A., Thompson, A.J., Giovannoni, G., Cuzner, M.L., and Baker, D. (2003, October). Cannabinoids inhibit neurodegeneration in models of multiple sclerosis. Brain, 126(Pt 10), 2191-202. Retrieved from https://academic.oup.com/brain/article/126/10/2191/314489/Cannabinoids-inhibit-neurodegeneration-in-models.
- Rahimi, A., Faizi, M., Talebi, F., Noorbakhsh, F., Kahrizi, F., and Naderi, N. (2015, April 2). Interaction Between The Protective Effects Of Cannabidiol And Palmitoylethanolamide In Experimental Model Of Multiple Sclerosis In C57BL/6 Mice. Neuroscience, 290, 279-87. Retrieved from http://www.sciencedirect.com/science/article/pii/S0306452215000858.
- Rog, D.J., Nurmikko, T.J., Friede, T., and Young, C.A. (2005). Randomized, controlled trial of cannabis-based medicine in central pain in multiple sclerosis. Neurology, 65(6), 812-19. Retrieved from http://www.neurology.org/content/65/6/812.long.
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