Multiple Sclerosis and Marijuana Use Studies

Main Digest

The question of whether or not marijuana should be used to manage the symptoms of multiple sclerosis is complex. Generally, it is agreed that better therapies are needed for symptoms which include tremor, pain, as well as spasticity; ones that might not be sufficiently relieved by treatments which are currently available. Development of additional types of treatments for multiple sclerosis symptoms is important; however, there are some uncertainties about the benefits of marijuana related to its side-effects. The fact that marijuana remains an illegal drug in a number of states and by federal statute complicates the issue.

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Multiple Sclerosis is an autoimmune disease that affects the brain and spinal cord. MS is caused by damage to the myelin sheath, the protective covering that surrounds nerve cells. When this nerve covering is damaged, nerve signals slow down or stop. Multiple sclerosis (MS) affects women more than men. The disorder is most commonly diagnosed between ages 20 and 40, but can be seen at any age.

Some people who experience multiple sclerosis have reported that smoking marijuana relieved several of their symptoms. For any therapy to be recognized as an effective type of treatment, subjective and anecdotal reporting must be supported by carefully gathered and objective evidence regarding the safety and benefit of the treatment. Sadly, it has proven to be difficult to do carefully controlled clinical trials of marijuana. One of the reasons why is because marijuana is psychoactive and makes people feel, 'high.' What this means is that people who take the active drug during clinical trials commonly become aware of it therefore, 'un-blinding,' the study and potentially biasing results. Studies completed to date have not provided convincing evidence that marijuana or its derivatives provide substantiated benefits for the symptoms of multiple sclerosis through clinical trials.

Conflicting results from prior research, in combination with the need for additional therapies to treat the symptoms of multiple sclerosis, make it very important to pursue more research on the potential of marijuana and its derivatives. Marijuana is well-known for its mind altering properties and is produced from the flowering top of the hemp plant, 'Cannabis sativa.'

Early studies explored the role of, 'tetrahydrocannabinol (THC),' which is an active ingredient in marijuana, or smoked marijuana in treating tremor, spasticity, and balance control in a small population of people with multiple sclerosis. The majority of the studies were done with THC. Because THC can be administered orally it is easier to control the dosage. The results of the studies were mixed and the people who participated reported a variety of side-effects they found to be uncomfortable. Smoked marijuana presents certain health risks that are at least as significant as ones associated with tobacco use. What follows are descriptions of some of the side-effects people experienced.

Balance:

Smoked marijuana was actually shown to worsen balance and posture control in ten people with multiple sclerosis and ten others who did not experience this form of disability. All twenty of the participants reported feeling, 'high.'

Spasticity:

Studies of THC for spasticity found some people reporting a feeling of, 'looseness,' and less spasticity - something that could not always be confirmed by objective testing. At best, the effects lasted less than three hours. Side-effects, particularly at higher doses, included dry mouth, weakness, mental clouding, dizziness, space-time distortions, memory impairment, and a lack of coordination.

Tremor:

A small study of THC involving eight people with serious disabilities who experienced ataxia and significant tremor found two of them reporting improvement in tremor that could not be confirmed by an examination. Three others reported improvement in tremor which also could not be confirmed. All eight of the participants taking THC experienced a, 'high,' while two participants reported feelings of unease and discomfort.

A report by the National Academy of Sciences/Institute of Medicine from the year 1999 on medical uses of marijuana raised more questions. While the report concluded that smoked marijuana does not have a role in the treatment of multiple sclerosis, the possibility remained that specific compounds derived from marijuana might reduce some of the symptoms of multiple sclerosis - especially multiple sclerosis-related spasticity. Studies of the therapeutic potential of marijuana compounds referred to as, 'cannabinoids,' were indicated, in conjunction with the development of reliable and safe drug delivery technology.

Further Studies and Trials

Investigators in both the United States and the United Kingdom tested the ability of two marijuana derivatives and three synthetic cannabinoids to control tremor and spasticity, symptoms of the multiple sclerosis disease, 'EAE,' in mice. The results suggested that four different cannabinoids could temporarily relieve tremor and spasticity. Despite the study results suggesting that similar derivatives of marijuana may be developed for use by people, it was clear the psychoactive effects of the cannabinoids would need to be sufficiently reduced to make them safe and comfortable for people who experience multiple sclerosis.

A large, placebo-controlled clinical trial that involved six-hundred and sixty people with different forms of multiple sclerosis was conducted in Britain to determine whether administration of capsules of extracts of marijuana and THC could assist with controlling spasticity. The results of the study indicated that oral derivatives of marijuana did not provide objective improvement in spasticity. On the other hand, significantly more participants in the treatment group reported subjective improvements in pain and spasticity, yet not in tremor or bladder symptoms. In other words, the participants reported feeling improvements which could not be confirmed by the physicians involved in the study. The findings were further complicated by the fact that the study became, 'un-blinded.' Side-effects made it clear to many of the participants that they were receiving an active drug instead of a placebo.

Another study suggests that, 'nabiximols,' which is an oral spray derived from cannabis, significantly improved spasticity in a number of people with multiple sclerosis who had been identified as likely to respond to the type of therapy. One has to wonder if the study is biased in favor of the pharmaceutical industry. Yet another study highlighted the impact of cannabis on cognition. Multiple sclerosis may impair a person's thinking and prior studies suggest that smoking cannabis also impairs thinking. Investigators at the University of Toronto examined how cannabis use influenced cognition specifically in people with multiple sclerosis. The study measured cognitive function in twenty-five people with multiple sclerosis who did not use cannabis.

The participants were tested at least twelve hours after last using cannabis to their intoxication was minimized. By matching the groups and controlling for differences in terms of disease course and duration, gender, age, education and additional factors, the cannabis users were discovered to perform significantly worse on measures of information processing speed, executive functions, working memory and other cognitive functions. They were twice as likely as non-users to be considered, 'cognitively impaired.' The study confirmed that cannabis may worsen cognitive issues in people with multiple sclerosis.

The need for additional types of therapies is very real. Symptoms of multiple sclerosis are often painful and stubborn. Unfortunately, long-term use of marijuana may be associated with significant side-effects in people who experience multiple sclerosis according to some, who desire more studies and claim there is insufficient data on the subject. Research continues with the goal of determining if there is a potential role for marijuana or its derivatives in the treatment of multiple sclerosis. Meanwhile, other FDA-approved medications such as tizanidine and baclofen are available to reduce spasticity in multiple sclerosis.

Author Credentials:

Thomas C. Weiss is a researcher and editor for Disabled World. Thomas attended college and university courses earning a Masters, Bachelors and two Associate degrees, as well as pursing Disability Studies. As a Nursing Assistant Thomas has assisted people from a variety of racial, religious, gender, class, and age groups by providing care for people with all forms of disabilities from Multiple Sclerosis to Parkinson's; para and quadriplegia to Spina Bifida.

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