Insights into Cannabis and Multiple Sclerosis: Essential Information to Consider

With the continuous advancement of research on medical cannabis, an increasing number of patients are being granted access to this plant. Ongoing studies are actively exploring the potential of cannabis and its compounds in effectively managing the symptoms associated with multiple sclerosis. In several countries, patients can now avail cannabis-based medications specifically designed for this purpose. The question that arises is whether cannabis truly provides relief in such cases.

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The evolving global cannabis market has led to increased accessibility of cannabis for patients with various medical conditions, including multiple sclerosis, with fewer restrictions. Even in countries where cannabis is prohibited, there are often allowances for multiple sclerosis patients to access medical marijuana in some form. Considering this, it is important to explore the relationship between marijuana and multiple sclerosis, as well as the potential benefits of CBD in managing the symptoms of this autoimmune condition. In the following discussion, we delve into whether cannabis may offer potential relief for individuals with multiple sclerosis.

What Is Multiple Sclerosis

Multiple sclerosis (MS) is a chronic condition that affects the central nervous system, which comprises the brain and spinal cord. It is an autoimmune disease characterized by an abnormal immune response in which the immune system mistakenly attacks the body’s own cells. Normally, our immune system safeguards us against external threats like viruses and bacteria. However, in certain cases, immune cells fail to recognize the body’s cells as part of itself and instead perceive them as foreign invaders.

In MS, the immune cells target a protective covering of nerve cells called the myelin sheath. This sheath, consisting of proteins and fats, surrounds nerve fibers and aids in the transmission of electrical impulses. These electrical signals, known as action potentials, play a crucial role in various physiological processes, including muscle contraction and the release of neurotransmitters.

When the immune system targets the myelin sheaths, it disrupts the transmission of signals within the nervous system. This interference leads to communication problems that hinder the brain’s ability to effectively send messages to the rest of the body. In severe cases, this attack can result in permanent damage to the nerve fibers. Over time, the damaged areas may develop scar tissue as the myelin attempts to repair itself.

Types of Multiple Sclerosis

There are two main forms of multiple sclerosis (MS) that individuals can experience. The most common type is relapsing-remitting MS, which affects approximately 80% of MS patients. This form is characterized by periods of worsening symptoms, known as relapses, that can last for varying durations, ranging from days to months.

However, after each relapse, there is a period of remission where the symptoms improve to some extent. These remission periods can be relatively long, lasting for years in some cases. It is important to note that around 50% of individuals diagnosed with relapsing-remitting MS eventually transition to secondary progressive MS within 15-20 years. Unlike the relapsing-remitting form, secondary progressive MS is characterized by a gradual worsening of symptoms without distinct periods of relapse and remission.

Approximately 10% of individuals with multiple sclerosis (MS) are diagnosed with primary progressive MS. Unlike other forms of MS, this type follows a different course. It is characterized by a steady progression of symptoms over the course of several years, without the fluctuation of relapses and remissions that are seen in other forms of the disease.

Causes of Multiple Sclerosis

The precise cause of multiple sclerosis (MS) is still not fully understood. While it is classified as an autoimmune disease, the specific triggers that lead to immune system attacks on myelin sheaths are yet to be determined. However, certain risk factors are thought to play a role in the development of the condition. These risk factors include:

• Age: Multiple sclerosis (MS) can occur at any age, although it predominantly affects individuals between the ages of 20 and 40.
• Sex: The likelihood of experiencing relapsing-remitting MS is approximately three times higher in women.
• Family history: The risk of developing MS significantly increases if an individual has a parent or sibling with the condition.
• Race: Individuals of Northern European descent have a higher predisposition to developing MS, while Asians, Africans, and Native Americans have a notably lower risk of the condition.
• Vitamin D levels: Insufficient sunlight exposure leading to decreased vitamin D levels could potentially elevate the risk of developing MS.
• Infections: The presence of certain viral pathogens, such as Epstein-Barr virus, has been linked to the development of MS.

Symptoms of Multiple Sclerosis

The deterioration of myelin can lead to the emergence of various symptoms. The primary symptoms commonly associated with MS include:

Current Treatments for Multiple Sclerosis

While there is no cure for MS at present, there are numerous treatments available to address the individual symptoms of the disease. The primary treatments for the main symptoms include:

• Muscle pain: The primary approach to addressing this problem involves the use of pain medications and physiotherapy.
• Emotional problems: Cognitive behavioral therapy can be effective for some patients, while others may benefit from the use of antidepressant medications.
• Nerve pain: Gabapentin and similar medications are effective in managing nerve pain.
• Mobility issues: Mobility issues can be effectively managed through various approaches such as exercise, physiotherapy, the use of wheelchairs, and stairlifts.
• Spasms: Physiotherapy modalities, including stretching exercises, can help alleviate muscle spasms, while medications like clonazepam and gabapentin are commonly prescribed to address this symptom.

Medical Cannabis and Multiple Sclerosis Symptoms

With its extensive array of symptoms, multiple sclerosis (MS) raises the question of how medical marijuana fits into the equation. Before delving into the research on cannabis and MS symptoms, it is important to understand the mechanisms of cannabis in the body.

A Word on the Endocannabinoid System

Similar to our nervous system and cardiovascular system, the human body also possesses an endocannabinoid system (ECS). Just like other physiological systems, the ECS plays a crucial role in our overall functioning. While the respiratory system facilitates breathing and the nervous system coordinates bodily functions, the ECS is responsible for maintaining homeostasis, ensuring a balanced biological state. Essentially, it helps optimize the functioning of other bodily systems.

Scientists have discovered ECS components throughout the body, ranging from the nervous system to the skin and bones. These components serve various functions, including regulating neurotransmitter activity and supporting bone health. The key elements of this vital system consist of cannabinoid receptors, endocannabinoids (signalling molecules), and enzymes responsible for producing and breaking down these signalling molecules.

What makes cannabis intriguing is its composition of cannabinoids, a family of chemicals. These unique molecules have the ability to interact with and modulate the ECS, exerting varying effects and influencing one of the body’s most vital systems. By engaging with the ECS, cannabinoids play a significant role in shaping its functioning.

Emerging evidence suggests that the ECS is implicated in various health conditions. When this intricate system experiences disruption, it can lead to a deviation from the state of homeostasis, potentially resulting in the development of certain diseases. In the case of individuals diagnosed with MS, studies have indicated an association between a dysregulated ECS and the manifestation of the condition.

A study conducted at Università Tor Vergata in Italy examined endocannabinoid levels in 26 MS patients, 25 healthy controls, and mice serving as a preclinical model of MS[1]. The findings revealed that individuals with relapsing MS had higher levels of anandamide, a key endocannabinoid, in samples of cerebrospinal fluid and peripheral lymphocytes (immune cells). Similarly, elevated levels of anandamide were observed in the mice, leading to the conclusion that MS is associated with notable changes in the ECS.

However, further human trials are necessary to determine how precisely modulating the ECS could address the underlying causes of MS. Currently, most studies have focused on exploring whether cannabis could potentially alleviate some of the symptoms associated with the condition.

• Cannabis and Spasticity

Muscle spasticity is a common symptom experienced by individuals with MS, causing stiffness and impairing mobility. This debilitating symptom, often accompanied by pain and weakness, significantly affects the quality of life of MS patients. Current research is focused on investigating the potential of cannabis in alleviating spasticity and improving the overall well-being of individuals with MS.

In a randomized, placebo-controlled trial conducted in 2012, the effectiveness of smoked cannabis was examined in patients with treatment-resistant spasticity, demonstrating promising results compared to the placebo group. Further studies are underway to replicate and expand upon these findings, aiming to gain a deeper understanding of how cannabis can effectively manage this symptom and enhance the lives of those with MS.

The efficacy of marijuana in alleviating muscle spasms and spasticity has prompted several governments worldwide to legalize cannabis-based medications for this specific purpose. An illustrative example is the United Kingdom, where the government has granted access to the oral spray Sativex (nabiximols) for individuals with moderate to severe spasticity. Sativex is composed of equal amounts of THC and CBD. While it may not be effective for every patient, the MS Society has reported that Sativex has a positive impact on the majority of individuals with spasticity[3].

• Cannabis and Pain

For millennia, humans have turned to cannabis as a remedy for pain management. It comes as no surprise that the endocannabinoid system (ECS) is intricately involved in the signaling pathways of pain. Numerous anecdotal testimonies from individuals dealing with chronic pain highlight the potential of THC in alleviating discomfort and enhancing their overall well-being. However, it is crucial to examine the scientific research to gain deeper insights into this matter.

A comprehensive analysis published in the journal Frontiers in Pharmacology delves into previous research exploring the analgesic properties of cannabis[4]. According to the authors, cannabinoids interact with nerve endings to influence the release of neurotransmitters, leading to pain relief. Meta-analyses of clinical trials have demonstrated moderate evidence supporting the use of cannabis for chronic pain management. However, further well-designed clinical trials are necessary to investigate the specific analgesic effects of different cannabinoids in individuals with multiple sclerosis.

• Cannabis and Bladder Control

As multiple sclerosis (MS) advances, the immune system can inflict damage on the regions of the brain and spinal cord that regulate bladder function. This condition, referred to as bladder incontinence, leads to a loss of control and can result in frequent and urgent needs to urinate among patients. Researchers are actively investigating the potential of cannabis in managing bladder control issues in individuals with MS[5]. Various cannabinoids, such as cannabigerol (CBG)[6], are demonstrating promising effects in this domain.

• CBD and Mobility

By now, it’s hard to come across someone who hasn’t heard of CBD (cannabidiol). This non-psychoactive cannabinoid has gained significant popularity due to its calming and relaxing effects without inducing a high. CBD operates through a different mechanism compared to THC. However, given its inclusion in Sativex, there appears to be a potential compatibility between CBD oil and multiple sclerosis.

A comprehensive review article[7] published in the journal Frontiers in Neurology examines various studies that investigated the effects of CBD on mobility, fatigue, inflammation, depression, and spasticity, utilizing relevant models. While this ongoing research provides intriguing insights, it is important to note that conclusive evidence regarding the effectiveness of CBD is still lacking.

The Difference Between Medical Cannabis and Sativex

While certain countries permit MS patients to access Sativex, they are often restricted from utilizing cannabis flowers, extracts, and other preparations. But does this restriction truly make a difference? Most likely, yes.

Sativex provides a balanced ratio of THC and CBD (1:1), which has shown effectiveness for some patients. However, cannabis offers a wide array of benefits beyond these two cannabinoids. With over 100 additional cannabinoids and 200 terpenes, the herb presents a diverse range of compounds. These compounds not only possess their own unique effects but may also synergize with THC and CBD to yield more favorable outcomes. Although research in this area is still in its early stages, it is foreseeable that customized extracts and selectively bred chemovars specifically tailored for MS patients will emerge in the future.

THC vs CBD for Multiple Sclerosis

Both THC and CBD exhibit promising potential in ongoing studies. THC produces a psychoactive effect that some patients may find undesirable, while others appreciate its positive impact on their mental state.

When it comes to their effects on the endocannabinoid system (ECS), THC and CBD have distinct differences. THC directly binds to the primary receptors, while CBD influences endocannabinoid levels and interacts with additional receptors that researchers classify as part of the “expanded endocannabinoid system.” Cannabis and its components can have varying effects on individuals. While many MS patients are limited to prescribed cannabis-based medicines, some may discover a preference for one cannabinoid over the other if they have the opportunity to explore different options.

How To Use Medical Cannabis for Multiple Sclerosis

There are numerous methods for consuming cannabis, and the choice ultimately depends on personal preference and accessibility. Here are some of the most common methods:

What Are the Risks of Using Medical Cannabis for Multiple Sclerosis?

While cannabis is generally considered safe, it is not without its potential side effects. Let’s explore the side effects associated with the two most common cannabinoids: THC and CBD.

As research progresses and unveils more information about the use of cannabis and its components in MS treatment, it is expected that patients will have access to customized products and precise dosing recommendations, ensuring the safe use of medical cannabis.

If you have any concerns or inquiries regarding the use of medical cannabis for MS, it is always advisable to consult with a doctor or physician to address them firsthand.