Multiple Sclerosis and Cannabis

By Tami Tabatabai

My uncle recently passed away from multiple sclerosis (MS).  He was diagnosed over 30 years ago and was an early proponent of using cannabis to manage his MS symptoms.  In his memory, I chose to write on MS and the therapeutic use of cannabis. Tami Tabatabai

What is Multiple Sclerosis (MS)?

MS is a neurological disease affecting the central nervous system (CNS).  It affects approximately 2.3 million people worldwide and in young adults, is considered the most common neurological disorder and more common in women than men by 3:1 (Gado, Digiacomo, Macchia, Bertini & Manera, 2018).  The cause of MS is not known, but factors such as genetics, immune system abnormalities and the environment are thought to play a role in its onset and subsequent development (Gado et al., 2018).

An immune-mediated process directed at the central nervous system (CNS), MS is characterized by chronic inflammation that causes demyelination of the axons that reside in the CNS (Gado et al., 2018).  This leads to continuous neurodegeneration that damages the myelin in the CNS, causing neuronal dysfunction and multiple neurological symptoms in the spinal cord and in the brain (Gado et al., 2018).  Recent evidence points to MS being a neurodegenerative disease that starts in the brain and further develops due to inflammation (Gado et al., 2018).

Weakness, dysphagia, fatigue, sensory alterations, bladder dysfunction, tremors, optic neuritis, painful spasms and spasticity are symptoms of MS (Gado et al., 2018).  Spasticity is a distressing and disabling symptom of MS, along with the chronic pain (Gado et al., 2018).  Medications typically prescribed for neuropathic pain include anticonvulsants and muscle relaxants for spasticity (Gado et al., 2018).  However, these medications can come with adverse reactions and limitations as to their effectiveness in treating the complex symptoms that come with MS (Gado et al., 2018).

Spasticity is a common and significant problem for many people with MS (Corey-Bloom et al., 2012).  Evidence has shown that cannabinoid receptors CB1 and CB2 may be involved with the management of spasticity and pain that comes with MS (Corey-Bloom et al., 2012).

Cannabinoids

Cannabis, a flowering plant, has over 500 different chemical compounds that include hundreds of cannabinoids and non-cannabinoids (Papaseit et al., 2018).  There are up to 110 cannabinoids in the cannabis plant, with tetrahydrocannabinol (THC) and cannabidiol (CBD) being the main constituents and focus for its medical use (Rudroff & Honce, 2017).

Cannabinoid receptors are found throughout the CNS and in various peripheral tissue, including the immune system, gastrointestinal and reproduction tracts, endocrine glands, lungs, heart, arteries and sympathetic ganglia (Grotenhermen, 2005).  Cannabinoids can exert the neuroprotective effects that are found in all significant cellular functions for neuronal survival and also in vital brain structures, which are activated by receptors, CB1 and CB2 (Gado, et al., 2018).

CB1 receptors and found in the CNS (brain and nervous system), liver, lungs and kidneys (Papaseit et al., 2018).  The CB2 receptors are found in hematopoietic and immune cells (Papaseit et al., 2018).

The therapeutic benefits of CB receptor agonists include muscle relaxation, anti-inflammation, stimulation of appetite, neuroprotection, analgesia, improvement of mood and antiemesis effects (Papaseit et al., 2018).

THC is the major psychoactive constituent of cannabis that binds to cannabinoid receptors CB1 and CB2 (Papaseit et al., 2018).  CBD is the non-psychoactive constituent, mostly binding non-cannabinoid receptors providing anti-inflammatory, immune-modulating, neuroprotective, analgesic, anticonvulsant, anti-anxiety, antiemetic, immune-modulating and anti-tumorigenic properties (Papaseit et al., 2018).

Cannabinoids and MS

Cannabinoids have the ability to influence neurological symptoms, such as spasticity and pain in MS (Baker, Jackson & Pryce, 2007).  Studies indicate that within the MS community, there is a large acceptance of cannabis use to mitigate symptoms with 20-60% of people with MS currently using cannabis (Rudroff & Honce, 2017).

For people with MS, cannabis is mainly used for control of MS symptoms (Baker, Jackson & Pryce, 2007).  Additionally, studies have shown that cannabis use may slow the process of progressive neurodegeneration (Baker, Jackson & Pryce, 2007).  Clinical studies have shown that symptoms associated with MS might be diminished with cannabis use (Suryadevara et al., 2017).

With strains containing CBD levels at or higher than THC levels, it is known to have positive effects on pain and muscle spasticity in people with MS, which effects have also been endorsed by the American Academy of Neurology (Rudroff & Honce, 2017).

A beneficial effect was seen when treating spasticity with smoked cannabis, along with a “significant reduction in pain” (Corey-Bloom et al., 2012).  The active compounds that are in cannabis could potentially be effective in treating neurologic conditions and “should be tested rigorously in clinical trials,” per a report from the Institute of Medicine (Corey-Bloom et al., 2012).

Contraindications

Generally well tolerated, acute cognitive effects were seen with chronic cannabis use indicating prolonged and heavy use may lead to cognitive impairments (Suryadevara, et al., 2017).

References

Baker, D., Jackson, SJ. & Pryce, G. (2007). Cannabinoid control of neuroinflammation related to multiple sclerosis. British Journal of Pharmacology. 152: 649-654. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2190016/

Corey-Bloom, J., Wolfson, T., Gamst, A., Jin, S., Marcotte, T.D., Bentley, H. & Gouaux, B. (2012). Smoked cannabis for spasticity in multiple sclerosis: a randomized, placebo-controlled trial. Canadian Medical Association Journal. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/22586334

Gado, F., Digiacomo, M., Macchia, M., Bertini, S. & Manera, C. (2018). Traditional uses of cannabinoids and new perspectives in the treatment of multiple sclerosis. Medicines. 5(3). Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/30111755

Grotenhermen, F. (2005). Cannabinoids.  Formerly: Current Drug Targets – CNS & Neurological Disorders. 10;4(5): 507-30.  Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/16266285/

Papaseit, E., Perez-Mana, C., Perez-Acevedo, AP., Hladun, O., Torres-Moreno, M.C., Muga, R., . . . Farre, M. (2018). Cannabinoids: from pot to lab. International Journal of Medical Sciences. 15(12): 1286-1295. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6158663/

Rudroff, T. & Honce, J.M. (2017). Cannabis and multiple sclerosis – the way forward. Frontiers in Neurology. 8:299. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5481305/

Suryadevara, U., Bruijnzeel, D.M., Nuthi, M., Jagnarine, D.A., Tandon, R., & Bruijnzeel, A.W. (2017). Current Neuropharmacology. 15(6): 800-814. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5652027/