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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,

Laura

This article represents the opinions, thoughts, and experiences of the author; none of this content has been paid for by any advertiser. The MultipleSclerosis.net team does not recommend or endorse any products or treatments discussed herein. Learn more about how we maintain editorial integrity here.

Comments

  • Schrodie
    6 years ago

    What can we do to get this available and push the FDA to approve this well-tested drug? I would love to have it; I know what one hit of marijuana does for menstrual cramps, it’s like a miracle. I can only imagine what relief it would offer for me now that I have MS. But an approved, non-stoner drug still made from marijuana would be ideal; given the medieval attitudes regarding this natural drug in our country, the alternative of obtaining medical marijuana is difficult, time-consuming, expensive, and not entirely legal.
    I am now in a progressive phase of this disease, and I feel like no one is listening. I just want to be able to manage my symptoms better.

  • zenhead
    6 years ago

    Excellent description of spasticity! I will (try to) remember that one. I have been using medical marijuana for about a year, and while I don’t think it does a whole lot for spasticity, it does help with sleep. I’d be very interested to give Sativex a try – maybe someday the US will step into the 21st century and evolve!

  • north-star
    6 years ago

    I also live in a state where medical marijuana is legal. My neurologist gave her okay for me to try it, which was a prerequisite in the coop I participate in. I have the usual issues with spasticity and pain and I use marijuana a couple of times a month when spasticity won’t go away. It’s tough getting to sleep when my leg is tensing,releasing,tensing,releasing, or I have that random MS pain that starts up for no reason and won’t go away.

    I use an inhaler and can keep myself from going over the top if I stop when I feel time has slowed down all of a sudden, the primary affect marijuana has on me. The “high” doesn’t last that long if I miscalculate. And in any case, I never use it during the day. I can’t imagine driving or going anywhere safely until after I’ve had a good night’s sleep. Maybe Sativex will be worth a try if it becomes available in the US.

    A recent article in The Scientist goes over recent research and concludes it’s unlikely there is significant damage caused by marijuana use, some studies have even concluded cannabis has protective qualities:
    http://www.the-scientist.com/?articles.view/articleNo/34110/title/Is-Cannabis-Really-That-Bad-/

    I’m with Danielle and Neva, let us decide for ourselves whether or not to try alternative therapies. MS has its own unique course with each of us, and not all medications work the same way in different people. I can say that in my case I don’t crave it, nor have friends and family noticed any change in behavior or loss of memory. It just gives me a break from wayward crazy-making muscle action and random MS pain– result: a good night’s sleep without the side effects of a drug like Ambien.

  • Neva
    6 years ago

    I am lucky that I live in a state that allows medical marijuana. I suffer from excruciating nerve pain, and have found the only thing that will relieve it completely is marijuana. The only thing that I don’t like about it though is that it makes me high. I would very much like to try Sativex.

    It boggles my mind that when studies show how horrible alchohol is for our bodies, it is legal, and yet when marijuana is shown to not be detrimental to our health, it is not legal.

    I really believe it is the pharmaceutical companies that are fighting against the legalization of natural cures, and frankly I am really tired of it!

    As Danielle stated we are the ones suffering, and so we should be able to be the ones to determine what treatments we want to try whether it is a pharmaceutical or a plant.

  • Danielle Stone
    6 years ago

    What a great blog. I do know a person on one of my MS groups that uses Sativex, she is in the UK. She loves it. As a country we should take the examples from other countries whose treatments show continuing proof and very high percentages for help, usefulness and a better quality of life for MS sufferers.

    We should be able to use our own stem cells for treatments if we want to and we should get a shot at trying Sativex for our spasticity for relief. I must admit I was not thrilled initially, hearing about cannabinoids being used in treatments. But if they offer relief for this painful spasticity that affects my daily gait and walking, and it doesn’t make you high or stoned or affect driving ability or mental cognitive function, we should be given the choice to try it.

    Especially in lieu of the Baclofen that has started giving me some allergy side effects like most of the treatments I have tried to treat my MS and MS symptoms. I just don’t want my mental or cognitive function to be affected. If it doesn’t I for sure would like the option to try it.

    Why in the USA is it so acceptable to push pharmaceutical pills and medications with pages of scary and unacceptable side effects but treatments like Sativex and using our own stem cells or using LDN (low dose naltrexone)all of which have much less if any side effects is not legal? We are the ones suffering, we should be the ones to decide the treatments we want to take. Sorry didn’t mean to get off topic. I hope we can have the same options other countries have for safer effective treatments.

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