My View – Medical Marijuana and MS
Don’t get me wrong, I am a child of the 60’s and the 1970’s, and I did more than my fair share of laughing at Cheech and Chong’s antics while they were stoned on marijuana. I think of this duo as the equivalent of the Three Stooges for my generation, good for a laugh or two at their mindless antics. And I believe our drug laws are outdated and obviously so do many lawmakers and voters, since marijuana, at least for medical purposes, has been legalized in at least 20 states and more are pending voter approval this fall.
The states that have legalized medical marijuana are: Alaska, Arizona, California, Colorado, Connecticut, Delaware, Hawaii, Illinois, Maine, Massachusetts, Michigan, Montana, Nevada, New Hampshire, New Jersey, New Mexico, Oregon, Rhode Island, Vermont and Washington and Washington, D.C
This is good news for people with Multiple Sclerosis. The preliminary studies show cannabinoids in various forms are useful in reducing MS spasticity and controlling pain.1 It also shows promise in relaxing the overactive bladder of people with MS. It is always significant for us to have another option for treatment, especially in states where medical marijuana is legal.
In addition to legalized cannabis, I am hopeful that nabiximol (tradename –Sativex), an oral spray blended from cannabinoids, will be approved for use in the US very soon. It is already in use in Canada and Europe and gets very high marks from patients and physicians. Dosage of marijuana is much harder to gauge if it is smoked and that form is not recommended by any of the medical experts. The oromucosal form of Sativex can be regulated by the user and is not variable according to strength of the marijuana.
I am very fortunate that my spasticity is fairly well controlled by baclofen, a muscle relaxing drug that works through the spine and is commonly prescribed for this purpose. But I know of others who suffer horribly from spasticity and the pain can be relentless. No pharmaceutical drug relieves their spasms and pain. Just my occasional cramps and spasms in my legs clues me in on what the pain must be like when this is an extended problem over time and involves larger parts of the body. I would probably do anything to turn off that errant signal and I would have no problem trying marijuana if my symptoms did not respond to other more traditional drugs.
I was hopeful that at the last ECTRIMS/ACTRIMS meeting, where almost all the MS doctors and researchers from around the world gathered to share their latest research, would give us more news on medical marijuana, but the topic was not well represented…there weren’t any great, new revelations and I only found a handful of presentations on the topic listed in the program.
The lack of overwhelming evidence leaves me with serious reservations about personal use of marijuana for my MS, even if it were legalized in my home state or at the federal level. Allow me to play devil’s advocate here for a moment and present my concerns about the use of marijuana to treat a neurologic disease such as MS:
Multiple Sclerosis has horrific side effects that we fight against all the time. Cognition and memory problems usually rank high up on the list of worries we have. Marijuana has been shown to create memory problems – isn’t it enough to do this on my own? In the paper Effects on cannabis on cognition in patients with MS: A psychometric and MRI study,2 the researchers compared 20 cannabis users vs 19 nonusers, all 39 with MS. The test subjects were matched demographically and also within the same levels of disability. In addition to the standard MRI, they also performed functional MRIs (fMRI). The fMRI reads the activity in the brain while it is doing specific tasks. The subjects took a number of tests that measured cerebral function and the results show the people who regularly smoke cannabis had a significantly lower performance than those who did not.
In another study, Smoked Cannabis for spasticity in multiple sclerosis: a randomized, placebo controlled trial,3 the researchers found that the people who smoked marijuana had a 30% decline in cognitive function, including short term memory and executive function (the ability to make decisions). Now I can come up with all sorts of questions and reasons to suggest more of these studies need to be completed, but the initial numbers show me enough memory drain with smoked marijuana to make me hesitate thinking cannabis might be useful for my MS.
Issues with my balance are another big concern – how many times have I joked about walking like I am drunk or stoned? Many times, and that side effect of marijuana can’t be ignored. Balance and coordination is diminished while under the influence of smoked cannabis. A while back someone with MS asked a neurologist why he walks better after he has had a few drinks. The answer was an obvious one – he only thinks he walks better but the reality is different. The same is probably true for marijuana smokers.
Got fatigue? I sure do and I don’t need to pile on more fatigue through the use of marijuana. It has been shown to cause an increase in fatigue. If I am thinking slower, walking more unsteady and throw extreme fatigue on top of it as side effects of Marijuana, it doesn’t sound too appealing.
And then there is the safety factor I can’t help but think of – Casual purchases from buyers where it is not legal, carries risks of not knowing what else might be in there. That could be anything from pocket lint and other gross stuff (who wants to smoke something that has been hidden in a person’s waistband or their boot?), to something as serious as heroin. It is no news flash that there are unscrupulous people out there, so this is not a purchase you want to make from just anyone. These are not the kind, gentle days of the 60’s. I would want to buy from a licensed supplier, which we don’t have yet in Ohio. The better option would be to grow my own which is definitely still illegal here and in many other states.
But if I could grow my own weed, which variety would I want to harvest to best handle my symptoms? It looks to be a more complex selection process than I would have thought because it appears there are distinct strains that handle clearly identified symptoms. You can see a chart about that from a licensed company in Canada – go to their website and click on the tab about products to read more about varieties and uses. They recommend either CBD Critical Mass or Afghan Hawaiian for neurologic created spasms at their government approved site. I have no clue what those might be.
Cannabis is a complex topic and I have researched and written quite a bit about its use in MS treatment. I believe marijuana should be an individual choice and hope we see change in our laws very soon. Just like everything else in our medical treatments, this needs to be an informed decision, looking at all the facts and possibilities and doing what’s best for each of us individually. But for now, the closest I’ll be getting to stoned is watching Cheech and Chong’s escapades and I can still laugh at those, even when not under the influence.
Wishing you well,
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- Tanasescu, Radu, Pharmakinetic evaluation of nabiximols for the treatment of multiple sclerosis pain. Toxicology Volume: 9, Issue: 9 (2013-09-01) p. 1219-1228.
- Pavisian, Bennis. Effects of cannabis on cognition in pateitns with MS: A psychometric and MRI study. Neurology, 2014 May 27; 82 (21): 1879-87.
- Corey-Bloom, J. Smoked cannabis for spasticity in multiple sclerosis: a randomized, placebo-controlled trial. CMAJ: Canadian Medical Association Journal = Journal De L'association Medicale Canadienne [CMAJ] 2012 Jul 10; Vol. 184 (10), pp. 1143-50.