One in five people with multiple sclerosis (MS) surveyed in 2014 told us they’d used cannabis to help with their symptoms. They said it can help with muscle spasms or stiffness (spasticity) and pain.
There’s a medically approved cannabis-based treatment called Sativex, but it doesn’t work for everyone. In England, Wales and Northern Ireland it’s approved for use on the NHS for ‘moderate’ to ‘severe’ spasticity (muscle spasms and stiffness). But you can have it only if other treatments haven’t worked. It’s not yet approved in Scotland but we hope it soon will be.
In November 2018, the UK government legalised cannabis for medicinal use, but also put a strict criteria in place for who could access it. Only specialist doctors are allowed to prescribe medicinal cannabis, and so far only a handful of people have benefited from the change in law.
Cannabis is made up of compounds called cannabinoids. The main ones studied for their therapeutic effect are tetrahydrocannabinol (THC), which gets you ‘high’, and cannabidiol (CBD), which doesn’t.
Some people with MS use cannabis in a variety of ways to help ease their symptoms.
A major concern is the often labeling accuracy of CBD extracts. Bonn-Miller et al. (23) found a wide range of CBD concentrations among CBD products purchased online. The tested products contain 26% less CBD than labeled, which could negate any potential clinical benefit. The over labeling of CBD products and that THC was detected (up to 6.43 mg/mL) in 18 of the 84 samples tested suggest that there is a need for federal and state regulatory agencies to take steps to ensure label accuracy of CBD products sold online and in dispensaries.
Based on the following considerations, it is our opinion that CBD supplementation maybe advisable for PwMS to reduce fatigue, pain, spasticity, and ultimately improve mobility. An overview of the potential impacts of CBD on mobility of PWMS is show in Figure Figure1 1 .
Despite the common use of and interest in cannabis by people with MS (PwMS), there is very limited empirical data pertaining to its impact on physical mobility. The benefits related to cannabis use in PwMS are still under investigation. However, data indicates that cannabis, with 1:1 or greater CBD:THC ratio, reduces muscle spasticity (11) and pain in PwMS (12). The American Academy of Neurology (13) has highlighted cannabis’ safety profile as well as these benefits. However, there are currently no studies, which investigated the effects of cannabis on mobility in PwMS, some studies have suggested that cannabinoids may exert positive effects on health by decreasing inflammation and decreasing pain (6). Furthermore, inflammation plays an important role in the generation of MS related fatigue (14). Specifically, chronic peripheral inflammation and a resulting overactivity of the vagus nerve are related to fatigue in PwMS (14). There is indirect evidence that reductions in spasticity, pain, and fatigue may result in improvements in the mobility of PwMS (15–17). Furthermore, it is suggested that CBD showed a dose-dependent antidepressant-like effect in the animal model (18). The exact mechanism underlying such activity is still unknown. Depression is an important contributory factor to the observed impaired mobility in PwMS (15). Based on extant evidence we propose that the impact of cannabidiol (CBD) on mobility to be investigated.
Can a Cannabidiol User Test Positive for Marijuana?
9% of individuals utilizing cannabis will become dependent on the drug (20). Although a significant risk, this incidence of dependency is significantly lower than that of approved chronic pain management pharmaceuticals (21). Observing for cannabis dependency is suggested for all patients.
However, CBD and other plant cannabinoids can potentially interact with many pharmaceuticals. For example, the activity of liver enzymes such as cytochrome P450 is impacted. More than 60 percent of marketed pharmaceuticals are metabolized by this group of enzymes. At high enough dosages, CBD will temporarily deactivate these liver enzymes, thereby altering how a wide range of compounds is metabolized. The exact mechanisms are unknown and more human studies, which monitor CBD-drug interactions are needed (22). PwMS who are taking any prescription medications are strongly advised to consult with a medical professional.
TR and JS contributed to drafting the article and revising it critically for important intellectual content. All the authors approved the final version of the manuscript.
Serious drug interactions have not been seen with CBD in combination with any other drugs.