Cannabis and Multiple Sclerosis: Beneficial or Dangerous?

Multiple Sclerosis (MS) is the most common disabling disease of the central nervous system in young adults. It most commonly causes worrisome symptoms such as depression and spasticity. Although there are medical treatment options, complementary and alternative medicine (CAM) is also frequently sought by patients.

Key takeaways:
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    There’s ever-increased pressure on cannabis legalization, and the purported benefit claims include MS.
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    Science has demonstrated no clear evidence of the benefit of cannabis for MS, except for possibly easing muscle stiffness/spasticity.
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    Cannabis use is associated with increased suicidal ideation in those with depression, as well as other possible side effects.
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    Doctors don’t normally recommend cannabis for patients with MS except in unique circumstances.

Cannabis and the 21st century

Cannabis is one of the highly-advocated therapeutics for those adhering to CAM treatments. Additionally, some countries have approved cannabis for treating some diseases. In the same context, there has been a push to legalize cannabis in the US over the last several decades, with enrollments in medical cannabis programs quadrupling between 2016 and 2020.

Cannabis (aka marijuana) is the third most commonly used psychoactive substance after alcohol and tobacco worldwide. Its use elicits psychoactive effects mainly due to a single cannabinoid — delta-9-tetrahydrocannabinol (THC). However, the cannabis plant has more than 100 other cannabinoids, and the most commonly cited therapeutic one is cannabidiol (CBD).

The FDA approved CBD in the US as a medication for Lennox-Gastaut Syndrome, an epilepsy disorder. Furthermore, an oral spray with THC plus CBD called Nabiximols has been approved in various countries — but not yet in the US.

Cannabinoids as MS medication

Though Nabiximols is approved for the treatment of MS-related spasticity in Canada and other countries, research data has not consistently shown a benefit. A meta-analysis (a study analyzing all available studies) on over 2000 patients with MS failed to show any statistically significant benefit of Nabiximols or dronabinol for spasticity compared to a placebo. Dronabinol is an FDA-approved synthetic THC used primarily for chemotherapy-associated nausea and vomiting.

Are cannabinoids effective for MS?

In the same context, a randomized controlled trial looked at whether Nabiximols had any effect on pain in patients with MS but failed to elucidate any statistically significant difference. Furthermore, a 36-month placebo-controlled trial (CUPID) on almost 500 patients with primary or secondary progressive MS failed to show any benefit from dronabinol on MS progression.

Furthermore, no available scientific data has demonstrated a benefit from cannabis for depression, a common MS symptom. Additionally, a meta-analysis of over 1600 patients showed comparable improvement with placebo in those taking cannabis, as well as a National Academies of Sciences, Engineering, and Medicine report demonstrating an increased incidence of suicide attempts and deaths in those using cannabis.

However, a 12-week randomized controlled trial named MUSEC on over 250 patients with MS, found better relief of muscle stiffness with cannabis extract, elucidating that there may be some benefits.

Is recreational cannabis safe for MS?

Although cannabis is generally considered safe, there have been reports of increased risks of heart failure, stroke, hypertension, and sudden cardiac death. Furthermore, concerns about using cannabinoids for treating depression have led to the American Psychiatric Association publishing a document opposing the use of cannabis as medicine.

Though cannabis is mostly illegal, it’s commonly illegally cultivated. Such cultivation may involve adulterants, pesticides, or other contaminants. Such substances may interact with MS medications or put patients at risk of opportunistic infections.

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