Oregon Medical Marijuana Program
Cannabis Helps - MS
MS patients report that cannabis gives symptom relief
..by Professor John Marshall CBE (retired), Emeritus Professor of Clinical Neurology, Univ. London.
Taken from Medical Monitor magazine.
There has been much controversy about the use of cannabis to relieve the symptoms of multiple sclerosis (MS), not least because of the legal implications.
A total of 230 patients with MS were sent an anonymous questionnaire containing 68 questions about their experience, if any, of cannabis used therapeutically. The study was conducted by the Alliance for Cannabis Therapeutics. Replies were received from 132 (57 per cent), of whom 14 had never used cannabis. The respondents ranged from 22 to 67 years in age and had suffered from MS for between two and 38 years; 46 were bed or wheelchair-bound.
They had used cannabis for 0.2 to 28 years, taking it on average 2.7 times a day on 5.6 days per week; 107 took it in the evening or before going to bed, the object in 103 cases being to relieve specific symptoms. These were (in descending order of effectiveness) spasticity, chronic pain in the extremities, acute paroxysmal phenomena and tremor.
Other specific symptoms to benefit included slurred speech, numbness and paraesthesiae, weakness and sphincter problems. A non-specific symptom that was greatly helped was depression.
However, the study has serious defects. There is no indication as to how the patients were recruited, or of how firm was the diagnosis of MS.
Despite this, the results do suggest that cannabis may help to relieve some of the symptoms in MS and that the effect may be specific to certain symptoms rather than a general uplift caused by the drug.
The authors conclude that it provides a justification for mounting properly controlled clinical trials. MS is such a devastating disease that any drug that has been shown objectively to be of value should be available and any legal difficulties removed.
There is some evidence that smoked cannabis can relieve specific symptoms in MS
Most benefit is found with spasticity and chronic pain
In the condition known as MS the normal functioning of the nerves in the brain and spinal cord is disrupted, probably caused by abnormal activity in the immune system. Debilitating attacks, which last for weeks, come and go unpredictably, with gradual deterioration and eventual disability. Because the central nervous system controls the entire body, the effects may appear anywhere. Common symptoms include tingling, numbness, impaired vision, difficulty in speaking, painful muscle spasms, loss of co-ordination and balance, fatigue, weakness or paralysis, loss of bladder control, urinary tract infections, constipation, skin ulcerations and severe depression.
There is no known effective treatment. Almost all MS patients experience some degree of spasticity, including stiffness, muscle spasms, cramps or muscle pain. The standard drugs used to treat the muscle spasms are addicitve, have severe short-term side effects and worryingly damaging long-term side effects. Many MS sufferers find that they don't even work.
Animal studies have shown that cannabinoid receptors are densely populated in the areas of the brain which control movement, which suggets that cannabis may have anti-spastic effects. It seems indeed that cannabis has a startling and profound effect on the symptoms of MS. It stops muscle spasms, reduces tremors, restores balance, restores bladder control and restores speech and eyesight. Many wheelchair-bound patients report that they can walk unaided when they have smoked cannabis. Patients also report that they find smoked herbal cannabis better at controlling their symptoms that synthetic derivatives. It is now thought that cannabis may even retard the progression of the disease.
A certain degree of efficacy can be shown purely in the huge amounts of anecdotal evidence that abound. A House of Lords reports states that the Multiple Sclerosis Society (consisting of approximately 35000 MS-suffering patients) estimates that as many as 4% of their population already use cannabis for the relief of their symptoms despite the considerable legal and health risks associated with the seemingly inhumane current prohibition of cannabis for any condition. The chairman of the committee went on to state that 'we have seen enough evidence to convince us that a doctor might legitimately want to prescribe cannabis to relieve...the symptoms of multiple sclerosis and that the criminal law ought not to stand in the way.'
Many of the witnesses for that report shared the British Medical Association's view that 'A high priority should be given to carefully controlled trials of cannabinoids in patients with chronic spastic disorders'. Indeed, at the current time a BMA report requests that the synthetic cannabinoids Nabilone and Dronabinol are officially licensed for use in MS and other spastic disorders.
Billy Gartside - Multiple Sclerosis - Tuesday 30 Oct 2001
My name's Billy Gartside and I've been using cannabis medicinally since 1992.
It works very well, it's not 100% effective but the 80-95% relief from symptoms it gives me does allow me to play golf 3-4 times a week and I've broken 100 for 18 holes, 48 out and 45 in so it's quite good for stamina too.
February 2002 Mr Gartside was found quilty at Liverpool Crown Court for possession of cannabis, he said the £10,000 cost of a crown court trial was not in the public interest. I agree, he was fined £35.00 and bound over for 3 months.
Cannabis Based Medicine (Sativex®) Relieves Spasms And Stiffness In People With Multiple Sclerosis
28 Feb 2007
Today, a leading neurology journal - European Journal of Neurology (EJN) reports a study1 which shows that Sativex, a cannabis based medicine, significantly reduces intractable spasms and stiffness (spasticity) in people with Multiple Sclerosis (MS).
Spasticity is one of the most common symptoms of MS, occurring in up to 84% of patients1. Spasticity can severely impact quality of life and is one of the most difficult symptoms of MS to treat1.
The study, a randomised, double-blind trial, led by Professor Christine Collin from the Royal Berkshire and Battle NHS Trust, Reading, UK, saw Sativex or placebo added to existing anti-spasticity medication. Sativex demonstrated significant superiority to placebo in reducing spasticity (p<0.05). Further, the addition of Sativex produced a more than 30% improvement in spasticity in 40% of the people treated1.
Fern Andrews, a person with MS who has participated in clinical trials with Sativex, commented: "Spasticity can make the simple daily activities that most people take for granted, seem daunting. Just dressing and moving around the home can be difficult and I often have to rely on a carer for support. With Sativex, I'm able to choose how much I take depending on how bad my symptoms are - which is a real benefit".
Christine Jones, Chief Executive of the MS Trust said, "Effective relief of spasticity is extremely important to people with MS. Spasticity and muscle spasms are not only distressing and painful, they can have a negative impact on quality of life. The results of this study add to the growing body of evidence that cannabis-based medicines can be effective in helping to relieve this common symptom of MS."
About the study published in the European Journal of Neurology:
The six week study was conducted in 189 MS patients, all of whom were experiencing significant levels of spasticity and had failed to gain adequate relief from currently available anti-spasticity medications. Patients enrolled in the study continued to take their existing medication throughout the trial1.
Sativex (THC:CBD), an endocannabinoid system modulator, is derived from whole plant extracts of two specifically bred cannabis plant varieties. The extracts are combined to produce a standardised formulation containing two major components of cannabis, the cannabinoids D9-tetrahydrocannabinol (THC) and cannabidiol (CBD).
Sativex is formulated into a pump action oromucosal (mouth) spray designed for self-administration by the patient This formulation allows for flexible dosing, ideal for the variable nature of MS. Each spray of Sativex delivers a fixed dose of 2.7mg THC and 2.5mg CBD. Sativex was generally well tolerated in the study.
Sativex has been developed by UK-based GW Pharmaceuticals plc. It is approved as a prescription medicine in Canada for the symptomatic relief of neuropathic pain in adults with MS. Sativex is currently being reviewed by European regulatory authorities for the symptomatic relief of spasticity in MS and, on approval, will be exclusively marketed by Bayer HealthCare in the UK.
Spasticity results from more than one group of muscles contracting incorrectly, causing spasms or stiffness. Spasms are uncontrollable muscle contractions and can be painful. They can be a particular problem at night causing disruption of sleep. Limbs may shoot away or bend upwards towards the body and severe spasms may make the back arch off the bed or chair.
Stiffness of the limbs is common and can make it difficult to perform normal activities, particularly delicate movements of the hand and fingers. If the leg muscles are affected it can make walking difficult. Pain can be associated with spasticity. Current treatments are often only partially helpful.
About Bayer HealthCare:
Bayer HealthCare, a subsidiary of Bayer AG, is one of the world's leading, innovative companies in the healthcare and medical products industry and is based in Leverkusen, Germany. The company combines the global activities of the Animal Health, Consumer Care, Diabetes Care, and Pharmaceuticals divisions. The Pharmaceuticals division, Bayer Schering Pharma AG, comprises the following business units: Women's Healthcare, Diagnostic Imaging, Specialized Therapeutics, Hematology/Cardiology, Primary Care, and Oncology. Bayer HealthCare's aim is to discover and manufacture products that will improve human and animal health worldwide. The products enhance well-being and quality of life by diagnosing, preventing and treating diseases. http://www.bayerhealthcare.com
About GW Pharmaceuticals plc:
GW Pharmaceuticals plc is licensed by the UK Home Office to undertake a pharmaceutical research and development programme to develop non-smoked cannabis-based prescription medicines. GW's shares are publicly traded on AiM, a market on the London Stock Exchange.
GW's clinical research program is being carried out by a team of pharmaceutical professionals experienced in drug development and, in particular, the development of plant-based medicines and drug delivery systems. http://www.gwpharm.com
1. Collin C et al. Randomised controlled trial of cannabis based medicine in spasticity caused by Multiple Sclerosis. European Journal of Neurology, March 07
Marijuana and Multiple Sclerosis
In the condition known as MS the normal functioning of the nerves in the brain and spinal cord is disrupted. Dibilitating attacks, which last for weeks, come and go unpredictably, with gradual deterioration and eventual disability. Because the central nervous system controls the entire body, the effects may appear anywhere. Common symptoms include tingling, numbness, impaired vision, difficulty in speaking, painful muscle spasms, loss of co-ordination and balance, fatigue, weakness or paralysis, loss of bladder control, urinary tract infections, constipation, skin ulcerations and severe depression.
There is no known effective treatment. The standard drugs used to treat the muscle spasms are addicitve, have severe short-term side effects and worryingly damaging long-term side effects. Many MS sufferers find that they don't even work.
Cannabis has a startling and profound effect on the symptoms of MS. It stops muscle spasms, reduces tremors, restores balance, restores bladder control and restores speech and eyesight. Many wheelchair-bound patients report that they can walk unaided when they have smoked cannabis. Patients also report that they find smoked herbal cannabis better at controlling their symptoms that synthetic derivatives. According to Marijuana - The Forbidden Medicine cannabis may even retard the progression of the disease.
In 1995 Mills reviewed all the scientific evidence of MS treatment using cannabis, and discussed all the surrounding issues. He concluded that the evidence is sparse and of poor quality and that a proper clinical trial of smoked cannabis for MS, was needed. Dr Roger Pertwee of the Department of Biomedical Sciences at Aberdeen University wants to carry out such a study. Unfortunately he still needs proper funding and a source of legal cannabis.
In 1997 Dr Pertwee, along with Consroe et al. carried out a survey of MS patients who are using cannabis to see how cannabis helped their condition. The patients reported that cannabis helped the following conditions: spasticity, chronic pain of extremities, acute paroxysmal phenomenon, tremor, emotional dysfunction, anorexia/weight loss, fatigue states, double vision, sexual dysfunction, bowel and bladder dysfunctions, vision dimness, dysfunctions of walking and balance, and memory loss (these results are ranked in order, 97% of the patients said cannabis helped the first condition, spasticity, down to 30% reporting the last condition, memory loss.
Although there has never been a clinical trial of MS patients, that used smoked herbal cannabis, there is some direct evidence of cannabis' effect on tremor. Both Clifford and Meinck et al. reported that cannabis reduced tremors and provided graphic evidence of this, in the form of before and after tremor recordings and handwriting samples.
During the 80's there were three trials of oral synthetic THC in small numbers of MS patients. All were placebo-controlled, and involved various doses of THC from 2.5 to 15 mg daily. Many of the patients claimed to get a beneficial effect from THC, but the doctors, looking on objectively could find no effect in most of them - perhaps cannabis has a psychological benefit rather than a muscular one. Petro & Ellenberg found that THC improved spasticity compared with placebo, and that half their 8 patients had a "substantial" improvement. Clifford found that 7 of his 9 patients claimed a benfefit, but doctors could only confirm that 2 patients had benefited. Ungerleider et al. studied 13 patients with MS that proved untreatable with standard drugs. Although the patients said their spasticity had improved significantly, the doctors couldn't spot an improvement. Large THC doses were poorly tolerated by the patients, with weakness, dry mouth, dizziness and psychoactive effects the common complaints - interestingly none of the patients asked to keep a supply of THC after the trial ended.
A recent letter in the Lancet from Martyn et al. reports synthetic cannabinoid, nabilone being of benefit in a single patient study. Weeks of placebo and nabilone were alternated, and muscle spasm, general well-being and sleep all improved when cannabis was given.
There is also evidence from animal experiments. EAE is an artificial disease that has been used as a laboratory model of MS in guinea pigs. Lyman et al. reported that when animals were exposed to the disease and treated with a placebo, they all developed severe EAE and 98% died. The animals that were treated with THC had no or mild symptoms and 95% survived.
Cannabis could hold the key to ending multiple sclerosis misery
April 2nd, 2007 in Medicine & Health / Research
Researchers investigating the role of cannabinoids - chemical substances contained within cannabis – in the treatment of multiple sclerosis (MS), have found they could significantly enhance therapy, not only by reducing nerve damage and erratic nerve impulses, but perhaps even by hindering development of the condition.
The findings, published online today (1 April, 2007) in Nature Medicine demonstrates for the first time how cannabis might actually slow down the progression of MS and could have major implications for the estimated 2.5 million sufferers worldwide.
Using a mouse model, a team of UK, European, Japanese and US scientists, led by David Baker, Professor of Neuroimmunology at Queen Mary, University of London, found that doses of the active component within cannabis, tetrahydrocannabinol (THC) could significantly inhibit the development and severity of MS.
Cannabis works because it stimulates molecules known as cannabinoid receptors within the body. The group had previously reported that THC could alleviate disease symptoms, and also save nerves from the damaging effects of the disease - thus potentially, via the cannabinoid receptor CB1, slowing down the development of progressive disability. They had not previously examined the influence of cannabinoids on immune aspects of the disease.
Now their most recent study has successfully separated the roles of cannabinoid receptors CB1 and CB2 on neurons and T cells, and investigated their effect in controlling central nervous system autoimmunity. It showed that CB1 receptor expression by nerves in the brain, but not T cells, could suppress the development of an experimental MS-like disease, by stimulating the release of anti-inflammatory molecules, whilst in contrast direct stimulation of CB2 receptors by T cells was also able to control inflammation associated with the condition. This suggests that cannabis-like drugs may have the potential to block the autoimmune response which drives disease development.
Professor David Baker said: “Whilst targeting CB1 receptors for therapy runs the risk of causing the unwanted “high” to achieve these effects, we can get the same result by targeting CB2 receptors, which avoids these risks. Therefore, we can start to think about using new drugs that harness the potential medical benefits that cannabis has to offer but move away from the issues over the legality and recreational use of the plant product”.
Source: Queen Mary, University of London