Using Marijuana to Relieve Your MS Spasticity

A Promising MS Symptom Drug, But Still Many Questions

Marijuana for Spasticity in MS
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While there is no cure for multiple sclerosis (MS), there are medications that can help slow the disease down—these medications are called disease-modifying treatments. Additionally, there are therapies that can ease symptoms and truly improve a person's daily quality of life and functioning.

One MS symptom-soothing therapy you have likely heard of is cannabis, also known as marijuana.

Let's take a closer look at the emerging role of marijuana in MS, as well as the controversy encompassing this increasingly popular drug.

Marijuana's Role in Easing Spasticity in MS

Marijuana has classically been used in MS to relieve spasticity, which is a debilitating and often painful symptom that affects about two-thirds of people with MS.

Spasticity refers to increased muscle tone, which means that certain muscles (especially those in the legs) have a hard time relaxing. Spasticity can be severe, cause painful muscle spasms and stiffness, impair walking or other movements, and lead to falling.

Unfortunately, traditional medications used to treat spasticity in MS (for example, muscle relaxants, benzodiazepines, or anticonvulsants) often do not work well and carry side effects like sleepiness, which can worsen MS-related fatigue—a double whammy. Moreover, like these medications, non-drug therapies for treating spasticity in MS (for example, physical therapy and electromagnetic therapy) have also been found to be minimally helpful.

This is why MS doctors have turned to therapies like marijuana in order to give their patients the relief they deserve.

One Study on Marijuana for Spasticity in MS

One study in the Journal of Neurology, Neurosurgery, and Psychiatry examined nearly 300 participants with MS. The participants had stable disease for the prior six months and reported bothersome and persistent muscle stiffness for at least three months before enrolling in the study.

Half of the participants received oral cannabis extract (marijuana) and the other half received a placebo. The participants and the investigators were both blind to who received the marijuana versus who received the placebo, as both substances were administered through a soft gelatine capsule.

The participants reported various symptoms, like muscle spasms, as well as their level of improvement prior to treatment and then twelve weeks after treatment (or placebo) began.

Relief from muscle stiffness after twelve weeks improved by almost twice as much in the marijuana group compared to the placebo group. There were also significant improvements in muscle spasms and sleep disturbances in those who received marijuana versus those who received placebo.

Adverse Effects

In terms of safety, adverse effects were higher in the cannabis extract group than the placebo group, with the highest rate of reported adverse effects occurring at the end of the cannabis dose escalation phase (which was a bit fast). This led to a fairly high rate of withdrawals from the study.

Some of the adverse effects seen at a higher rate in the marijuana versus placebo group included:

  • Dizziness
  • Fatigue
  • Dry mouth
  • Weakness

That said, the majority of adverse effects were mild or moderate and most diminished by the end of the study.

Second Study on Marijuana Use for Spasticity in MS

In another study, people with more advanced MS whose spasticity did not get better with traditional medications were treated with Sativex (nabiximol), a mouth spray that contains both tetrahydrocannabinol (THC) and cannabidiol (CBD), with each dose of Sativex delivering THC and CBD in a near 1:1 ratio.

As an aside, marijuana comes from the hemp plant Cannabis sativa, which contains sixty or more cannabinoids. Of those cannabinoids, the two most abundant are THC and CBD, both of which can help relieve spasticity by easing pain and relaxing muscles.

The participants first underwent a 4-week trial of the spray, and if they achieved a 20 percent or greater improvement in their spasticity, they moved on to a 12-week trial. At this second trial, the participants were randomized to receive either nabiximol or a placebo.

Results of the study revealed that those who received nabiximol had a significantly higher improvement in spasticity (defined as at least a 30 percent improvement from their baseline) than the placebo group. There were also improvements in spasm frequency and sleep disruptions in the treatment versus placebo group.

Adverse Effects

It's worthy to note that of the 124 participants who moved on to the 12-week trial and were assigned nabiximol, there were only 15 who withdrew from the study (a much lower percentage than the above study). This could be because the dose titration regimen (meaning how quickly the dose of marijuana was increased) was slow and cautious.

Likewise, there were also a low rate of adverse effects noted in this study—another bonus. Of those taking nabiximol, the most common adverse effects were:

  • Vertigo
  • Fatigue
  • Muscle spasms
  • Urinary tract infection

The take-home message from this study is that marijuana (for the right person, hence the "4-week trial period") does appear beneficial, safe, and well-tolerated in the short-term for treating spasticity in multiple sclerosis.

What Professional Societies Say

The National MS Society supports the rights of people to work with their MS doctor to obtain marijuana for medicinal purposes, "in accordance with legal regulations in those states where such use has been approved." Moreover, the National MS Society supports research that examines the possible benefits and risks of using marijuana as a treatment for MS.

That said, unfortunately, research on marijuana use in MS is often hindered due to government regulations, as marijuana is still illegal at the federal level.

According to the National MS Society, the basis for their position on marijuana stems from a 2014 statement released by the American Academy of Neurology (AAN). The AAN statement provides suggestions on using various complementary and alternative medical therapies in MS based on an examination of research studies.

With regards to marijuana, the AAN suggests that oral cannabis extract and synthetic tetrahydrocannabinol (THC) are probably effective for reducing spasticity and pain.

The statement also notes that the oral spray Sativex (naxibimol) is probably effective for improving spasticity, pain, and urinary frequency; although Sativex is not currently available in the United States.

On the other hand, according to the AAN, there is not enough scientific evidence to support the benefit or safety of smoked cannabis for treating MS symptoms.

Lastly, the long-term risks of using marijuana for treating various symptoms in MS are simply unknown at this time due to the small number of studies. In fact, one of the biggest worries about the long-term use of marijuana is impaired cognitive functions, like memory and executive functioning.

A Word From Verywell

With the legalization of marijuana use for various medical conditions in twenty-nine states and the District of Columbia (and likely more on their way), the number of people with MS who use marijuana to ease their MS symptoms is likely going to rise.

However, to truly determine marijuana's short and long-term safety and benefit, and to tease out issues, like which symptoms are best treated with cannabis or which dosage or route of administration is ideal, we need more scientific evidence.

Until then, if you are considering marijuana for your spasticity, please ensure you are using it under the guidance of your MS doctor. This way, you can optimize its benefit and minimize its adverse effect. Often, this entails a careful and thoughtful marijuana dosing and titration plan.

Sources:

Amatya B, Khan F, La Mantia L, Demetrios M, Wade DT. Non-pharmacological interventions for spasticity in multiple sclerosis. Cochrane Database Syst Rev. 2013 Feb 28;(2):CD009974. doi: 10.1002/14651858.CD009974.pub2.

National MS Society. Medical Marijuana (Cannabis) FAQs.

Novotna A et al. 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. Eur J Neurol. 2011 Sep;18(9):1122-31. doi: 10.1111/j.1468-1331.2010.03328.x.

Rudroff T, Honce JM. Cannabis and multiple sclerosis—The way forward. Front Neurol. 2017;8:299.

Zajicek JP, Hobart JC, Slade A , Barnes D, Mattison PG, MUSEC Research Group. Multiple sclerosis and extract of cannabis: results of the MUSEC trial. J Neurol Neurosurg Psychiatry. 2012 Nov;83(11):1125-32. doi: 10.1136/jnnp-2012-302468.