In November 2018, the UK government legalised cannabis for medicinal use, but also put a strict criteria in place for who could access it. Only specialist doctors are allowed to prescribe medicinal cannabis, and so far only a handful of people have benefited from the change in law.
One in five people with multiple sclerosis (MS) surveyed in 2014 told us they’d used cannabis to help with their symptoms. They said it can help with muscle spasms or stiffness (spasticity) and pain.
Cannabis is made up of compounds called cannabinoids. The main ones studied for their therapeutic effect are tetrahydrocannabinol (THC), which gets you ‘high’, and cannabidiol (CBD), which doesn’t.
There’s a medically approved cannabis-based treatment called Sativex, but it doesn’t work for everyone. In England, Wales and Northern Ireland it’s approved for use on the NHS for ‘moderate’ to ‘severe’ spasticity (muscle spasms and stiffness). But you can have it only if other treatments haven’t worked. It’s not yet approved in Scotland but we hope it soon will be.
Some people with MS use cannabis in a variety of ways to help ease their symptoms.
Braley adds many publications about cannabis in MS, including this one, have had populations that skew female-identifying and white, highlighting a need for more diverse perspectives from racial and ethnic minorities that have been historically underrepresented in MS research.
When it comes to selecting a cannabinoid product, survey respondents who had a preference tended to use CBD products, which don’t have the same psychoactive effects of THC and tend to be easy to find online or in stores in many different forms.
“Reasons for the disconnect between respondent use and provider guidance in our sample requires further study, but reinforces a longstanding concern that research focused on the use of cannabinoids for MS symptoms has not caught up with consumer use of these products,” says lead author Tiffany Braley, M.D., M.S., an associate professor of neurology and an MS specialist at Michigan Medicine.
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, fewer than 1% of cannabinoid users received information from their provider about the type of cannabinoid product recommended for their symptoms.
Senior author Anna Kratz, Ph.D., an associate professor in the department of Physical Medicine & Rehabilitation, said “patients are looking for guidance from their providers to make informed choices about whether cannabis compounds should be used at all, and if so, which formulations would be most beneficial.”
A new survey shows high usage rates of cannabinoids like CBD for multiple sclerosis, but most patients are figuring out these new products on their own.
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.
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.
However, providers still don’t have a lot of good evidence to help them advise patients who plan to explore a cannabinoid for their chronic MS symptoms. It’s frustrating, Braley says, because symptoms like chronic pain and some sleep disturbances in MS can be challenging to treat with existing options, and new, safe, more personalized approaches would be welcomed. “However, provider guidance for patients must be informed by research focused on the benefits and harms of both CBD and THC, and potential mechanisms that underlie the effects of cannabinoids on MS symptoms.” she says.