A growing number of people with multiple sclerosis are finding that medicinal cannabis can help provide relief from symptoms.
Multiple sclerosis (MS) was the first condition for which THC-based medicinal cannabis was approved in New Zealand, which speaks to the evidence for its effectiveness.
Research has found that medical cannabis — particularly a THC:CBD blend — can help to improve common MS symptoms, such as spasticity (muscle tightening), pain, and sleep disturbance.
Anecdotally, there have been many cases of MS patients reporting that cannabis has had life-changing effects.
Studies have also indicated that there is a wide acceptance of cannabis among MS patients with 20-60% of MS patients currently using cannabis medicinally and 50-90% saying they’d consider usage if it were legal and more scientific evidence was available.
What is multiple sclerosis (MS)?
Multiple sclerosis is a disease of the central nervous system that affects movement, sensation and bodily functions.
It’s caused by damage to the protective cover (myelin sheath) around the nerves in the brain and spinal cord.
This can disrupt communication between the brain and the rest of the body.
Every patient experiences MS differently, but common symptoms include:
- Sleep disruption
- Bowel and bladder dysfunction
- Speech and swallowing problems
- Thinking and memory issues
Most MS patients experience relapses and remissions. However, some people are diagnosed with primary progressive MS (PPMS) where symptoms gradually get worse.
It’s estimated that one in 1000 people in New Zealand have MS. It affects women about three times more often than men and the average age of diagnosis is 37.
Many patients can lead a relatively normal life with the help of medication, such as Ocrevus, Gilenya, and Aubagio.
However, others can be resistant to conventional treatments or experience adverse side effects.
Many patients find medical cannabis to be more tolerable and effective for treating multiple sclerosis symptoms.
Cannabis and Multiple Sclerosis Research
There has been extensive research into the effectiveness of medicinal cannabis for treating multiple sclerosis, typically focussing on pain and spasticity.
The findings, so far, have been very promising for patients.
While there is no known cure for multiple sclerosis, studies have found that medicinal cannabis may help some patients to manage their symptoms.
Want to go deeper into the research? Register for Ora Support, our medicinal cannabis education platform for patients and caregivers.
MS and cannabis: Pain
Around 80% of multiple sclerosis patients will experience pain, which can be constant or intermittent.
Pain can be caused by damage to nerve cells (neuropathic pain or central pain), stiffening joints and muscles, or secondary causes like immobility and poor posture.
It is commonly treated with conventional painkillers and anti-inflammatory drugs such as ibuprofen, diclofenac, naproxen, and tramadol.
Patients who find these treatments to be ineffective, experience adverse side effects, or prefer natural medicines, may be inclined to consider cannabis for pain management.
A randomised control trial in 2005 found that a whole-plant cannabis medicine (THC and CBD), delivered via an oromucosal spray, was superior to placebo in reducing neuropathic pain in MS patients. It also helped to reduce sleep disturbance.
“Cannabis-based medicine is effective in reducing pain and sleep disturbance in patients with multiple sclerosis related central neuropathic pain and is mostly well tolerated.”
The most notable research on cannabis and MS-related pain is the 2003 study of 630 patients across 33 medical centres in the United Kingdom.
It found that a statistically significant proportion of patients who were treated with medicinal cannabis (both THC and whole-plant cannabis extract) reported greater improvements in pain than the placebo group.
A 2016 study looked at the effect of medical cannabis on chronic pain. The 274 participants had experienced chronic pain for at least three months and either had unsatisfactory pain relief or intolerable adverse effects from at least two painkillers.
Medicinal cannabis was added to the participants’ existing pain relief regime. The study found that 69.5% of them reported a significant reduction in pain scores and a significant improvement in quality of life. Additionally, 44% of the participants who were taking opioids at the start of the study had stopped using them by the end.
There’s more information on this study in a review compiled for Multiple Sclerosis New Zealand (page 4).
Much of the research on medicinal cannabis and pain is not specific to MS. For a general overview of cannabis and neuropathic pain, go here.
MS and cannabis: Spasticity
Spasticity is a symptom that affects between 60-90% of MS patients at some point.
Symptoms include continuous muscle stiffness, cramps, spasms and involuntary contractions, which can be painful.
The severity of symptoms can range from a slight increase in muscle stiffness to strong spasms that contract muscles and lock joints in a fixed position.
Drugs such as baclofen, diazepam, dantrolene and tizanidine are commonly used to manage spasticity, but they can have adverse effects.
The 2003 study mentioned above also looked at spasticity in MS patients. Patient assessments (using a grading method known as the Ashworth Scale) didn’t find any significant benefit of using medicinal cannabis. However, patient-reported measures for spasticity were significantly improved in the group treated with medicinal cannabis.
This suggests that patients felt that medical cannabis helped to improve their spasticity symptoms.
A 2004 study with 160 participants with MS found that medicinal cannabis (Sativex) significantly reduced spasticity symptoms. The study concluded that medicinal cannabis “is an effective treatment for spasticity associated with MS”.
A study in 2012 found that smoked cannabis was superior to placebo in symptom and pain reduction in participants with treatment-resistant spasticity.
A clinical trial in 2012 found that THC-based cannabis extract was almost twice as effective as placebo for relieving muscle stiffness in MS patients. Similar results were found for pain relief and sleep quality.
A 2019 review of the science concluded that cannabinoids have “modest efficacy” in reducing spasticity in adults with MS.
MS and cannabis: Sleep deprivation and insomnia
A majority of MS patients have difficulty sleeping, which contributes to fatigue and exacerbates other symptoms.
The effect of medical cannabis on sleep in MS patients has not been researched specifically, but it has been included in other studies.
The 2004 study mentioned above found that MS patients treated with cannabis-based medicine experienced a statistically significant improvement in sleep.
A 2005 study of 66 people found that cannabis-based medicine is effective in reducing pain and sleep disturbance in patients with MS-related central neuropathic pain and is mostly well tolerated.
While the research has largely focussed on MS-related pain and spasticity, which are among the most common and debilitating symptoms, there is also evidence that medicinal cannabis may help with incontinence, anxiety and stress.
Medicinal cannabis prescription for multiple sclerosis
Doctors in New Zealand have been able to prescribe medicinal cannabis (Sativex) for multiple sclerosis since 2016 and patients have been able to access other products with approval from the Ministry of Health.
It’s expected that more medical cannabis options will be available to MS patients in time, including varieties that specifically target MS symptoms.
Read our guide to getting a medicinal cannabis prescription in New Zealand here.
A better quality of life
The research into medicinal cannabis for multiple sclerosis is extensive and, as a patient, caregiver or healthcare provider, can be overwhelming.
Overall, the evidence suggests that medical cannabis can be effective for treating several common symptoms of MS.
The ability to manage pain, spasticity, improve sleep, and reduce stress and anxiety can be life-changing for anyone living with the disease.
Many MS patients are already using cannabis medicinally and have been sharing their experiences online and in the media.
As more cannabis-based medicines become available, it’s expected that usage will become even more widespread.
If you think medicinal cannabis may help you to manage your symptoms and improve your quality of life, you can talk to your doctor about getting a prescription.