Cannabinoids and MS Spasticity
My most dominant MS problem, after the tap dancing bladder, has been spasticity – that fight among my muscles where instead of being in a cooperative relationship of give and take, my legs are in a constant tug of war with both sides pulling as hard as possible to win. The problem is, this is not a game and it is affecting my walking. I once heard an MS speaker describe spasticity as applying our feet while driving a car to press on both the brake and accelerator pedals simultaneously. It is estimated that up to 75% of people with MS are bothered by spasticity, making it a symptom that many are desperate to find effective relief for. The standard for treating MS spasticity is predominantly Baclofen, either oral pills or for difficult to control cases – intrathecal baclofen delivered directly into the spine via an implanted pump.
Through the wonder of the internet and Twitter, I was able to eavesdrop on the proceedings as the European Committee for Treatment and Research in MS (ECTRIMS2013) held their annual convention in early September. Over 7,000 medical personnel who specialize in MS from around the world were present in Copenhagen to hear the latest MS news – they reviewed treatments for the disease as well as for symptoms. They discussed ways to help patients be compliant, improve quality of life, and addressed some of the emotional and psychological problems that accompany living with a chronic disease.
A topic that appeared in a number of posters, papers and even the display area was spasticity, and in particular the effective use of cannabinoids for the control and relief of MS spasticity. Some of you are already shaking your head in agreement and may live in one of the 20 states and the District of Columbia, where medical marijuana is legal. The use of medical marijuana for Multiple Sclerosis and other diseases has long created a sometimes heated debate as to its effectiveness and assorted safety issues.
Cannabinoids for MS spasticity (and symptoms of other diseases) have been in use in Canada and Europe for a number of years, in the form of Sativex, an oral spray made from extracts of marijuana plants. There have been synthetic drugs modeled after marijuana, including Marinol, but Sativex is the first to be extracted from the natural marijuana plant. Sativex is an endocannabinoid system modulator, and works on the cerebellum in some way that you need a chemistry or doctor degree to understand but it has to do with blocking pain, stopping muscle tightening and even appetite. Sativex is legal in Canada, New Zealand and a number of European countries, but you cannot get it in the United States.
GW Pharmaceuticals, the UK based grower of the marijuana plants that are harvested to make Sativex, presented information at ECTRIMS based on studies they have done of people with MS who remained on Sativex in trials after its release and general acceptance in Europe. It appears the study was meant to address some of the social questions often posed in the argument against the use medical marijuana, such as the safety profile and its effects on cognitive function and motor skills.
Before you conjure up far-out images of Cheech and Chong and their comic portrayal of potheads, I would like to share some of the results found with the use of Sativex through a study performed by the manufacturer. Neurologists in the UK who prescribe Sativex, along with a number of neurologists in Germany, maintain records of their patients use of Sativex and monitor for side effects. They were particularly interested in “the long-term safety of Sativex® for the potential for a) addiction, abuse and misuse b) long-term psychiatric effects including suicidality and psychosis c)mood changes/psychological effects (such as confusion/disorientation) d) memory impairment e) effect on driving ability f) falls.”
This ongoing longitudinal study of people using Sativex since its initial approval in 2010 demonstrates there is no negative effect on any of these targeted outcomes – but it does have a positive effect on spasticity, especially when it has not responded to traditional drugs. Overall, it appears that this drug, a derivative of marijuana, has a positive influence of the quality of life for people with MS, without the feared side effects of being stoned on pot. Sativex is in FDA approved Phase III trials in the US for use in cancer pain and also MS spasticity, but may still face overcoming the objection that it is marijuana based and leads to the moral and physical decline of its users.
The effectiveness numbers for relief of spasticity among people who were not getting relief from other methods are convincing (over 70%) and from this company’s display and scientific presentation, it appears they can make a very strong case for the approval of Sativex elsewhere, particularly here in the United States.
We can also put aside the images of Cheech and Chong driving down the highway in their convertible, enjoying the fresh air and sharing hits off a joint, wandering aimlessly in a stupor, illuminating questions about safety behind the wheel while using marijuana. German researchers looked at the specific question of whether Sativex influences the user’s ability to safely drive an automobile and found it has absolutely no effect on reflex time, attentiveness and other concerns. Driving under the influence of Sativex is not a problem, but I didn’t read how this might show up in our blood in a toxicology screening.
There is growing scientific evidence that taking a hit off a Sativex inhaler, much like those inhalers used for asthma relief, is a safe way to deliver the benefits of marijuana therapy without having to light up a joint. There is also growing hope that the FDA will see the demonstrated benefits of Sativex and make the use of this form of medical marijuana legal across all states and US territories.
Wishing you well,