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Multiple Sclerosis

In the condition known as MS the normal functioning of the nerves in the brain and spinal cord is disrupted, probably caused by abnormal activity in the immune system. Debilitating attacks, which last for weeks, come and go unpredictably, with gradual deterioration and eventual disability. Because the central nervous system controls the entire body, the effects may appear anywhere. Common symptoms include tingling, numbness, impaired vision, difficulty in speaking, painful muscle spasms, loss of co-ordination and balance, fatigue, weakness or paralysis, loss of bladder control, urinary tract infections, constipation, skin ulcerations and severe depression.

There is no known effective treatment. Almost all MS patients experience some degree of spasticity, including stiffness, muscle spasms, cramps or muscle pain. The standard drugs used to treat the muscle spasms are addicitve, have severe short-term side effects and worryingly damaging long-term side effects. Many MS sufferers find that they don't even work.

Animal studies have shown that cannabinoid receptors are densely populated in the areas of the brain which control movement, which suggets that cannabis may have anti-spastic effects. It seems indeed that cannabis has a startling and profound effect on the symptoms of MS. It stops muscle spasms, reduces tremors, restores balance, restores bladder control and restores speech and eyesight. Many wheelchair-bound patients report that they can walk unaided when they have smoked cannabis. Patients also report that they find smoked herbal cannabis better at controlling their symptoms that synthetic derivatives. It is now thought that cannabis may even retard the progression of the disease.

A certain degree of efficacy can be shown purely in the huge amounts of anecdotal evidence that abound. A House of Lords reports states that the Multiple Sclerosis Society (consisting of approximately 35000 MS-suffering patients) estimates that as many as 4% of their population already use cannabis for the relief of their symptoms despite the considerable legal and health risks associated with the seemingly inhumane current prohibition of cannabis for any condition. The chairman of the committee went on to state that 'we have seen enough evidence to convince us that a doctor might legitimately want to prescribe cannabis to relieve...the symptoms of multiple sclerosis and that the criminal law ought not to stand in the way.'

Many of the witnesses for that report shared the British Medical Association's view that 'A high priority should be given to carefully controlled trials of cannabinoids in patients with chronic spastic disorders'. Indeed, at the current time a BMA report requests that the synthetic cannabinoids Nabilone and Dronabinol are officially licensed for use in MS and other spastic disorders.

Patients' testimonies

For the complete collection of testimonies from medical users of cannabis, see our medical testimony database.

Do you find that cannabis helps you with this, or any other, medical condition? If so, please tell us about how it benefits you via this form. Anonymous submissions welcome!

Scientific evidence

In 1995 Mills reviewed all the scientific evidence of MS treatment using cannabis, and discussed all the surrounding issues. He concluded that the evidence is sparse and of poor quality and that a proper clinical trial of smoked cannabis for MS, was needed. Dr Roger Pertwee of the Department of Biomedical Sciences at Aberdeen University wants to carry out such a study. Unfortunately he still needs proper funding and a source of legal cannabis.

A biological basis for the relief of MS symptoms was found in a review article by Growing et al (1998) who noted that the distribution of the brain's cannabinoid receptors is such that they are probably somehow involved in the control of movement. The same article suggested that cannabinoids could have an effect on the immune-system cause of the illness, and as such it is feasible that cannabis could additionally even slow the progress of MS in potential sufferers.

In 1997 Dr Pertwee, along with Consroe et al (1997). carried out a survey of MS patients who are using cannabis to see how cannabis helped their condition. The patients reported that cannabis helped the following conditions: spasticity, chronic pain of extremities, acute paroxysmal phenomenon, tremor, emotional dysfunction, anorexia/weight loss, fatigue states, double vision, sexual dysfunction, bowel and bladder dysfunctions, vision dimness, dysfunctions of walking and balance, and memory loss (these results are ranked in order, 97% of the patients said cannabis helped the first condition, spasticity, down to 30% reporting the last condition, memory loss.

Greenberg et al (1994) conducted a study on both MS and non-MS sufferers. The 10 MS patients all felt that smoking cannabis improved their condition significantly. Some impairment was found in the posture and balance of both MS and non-MS patients however.

Although there has never been a clinical trial of MS patients, that used smoked herbal cannabis, there is some direct evidence of cannabis' effect on tremor. Both Clifford (1983) and Meinck et al (1989) reported that cannabis reduced tremors and provided graphic evidence of this, in the form of before and after tremor recordings and handwriting samples. Meinck et al found that smoking cannabis 'acutely improved' their patient's condition. Dell'Osso et al (2000) did a study on one MS patient, and found that inhaled cannabis had several positive effects.

During the 80's there were three trials of oral synthetic THC in small numbers of MS patients. All were placebo-controlled, and involved various doses of THC from 2.5 to 15 mg daily. Many of the patients claimed to get a beneficial effect from THC, but the doctors, looking on objectively could find no effect in most of them - perhaps cannabis has a psychological benefit rather than a muscular one. Petro and Ellenberger (1981) found that THC improved spasticity compared with placebo, and that half their 8 patients had a 'substantial' improvement. Clifford (1983) found that 7 of his 9 patients claimed a benfefit, but doctors could only confirm that 2 patients had benefited. Ungerleider et al (1987) studied 13 patients with MS that proved untreatable with standard drugs. Although the patients said their spasticity had improved significantly, the doctors could noat spot an improvement. Large THC doses were poorly tolerated by the patients, with weakness, dry mouth, dizziness and psychoactive effects the common complaints - interestingly none of the patients asked to keep a supply of THC after the trial ended.

A recent letter in the Lancet from Martyn et al (1995) reports the synthetic cannabinoid, nabilone being of benefit in a single patient study. Weeks of placebo and nabilone were alternated, and muscle spasm, general well-being and sleep all improved when nabilone was given.

There is also evidence from animal experiments. EAE is an artificial disease that has been used as a laboratory model of MS in guinea pigs. Lyman et al. reported that when animals were exposed to the disease and treated with a placebo, they all developed severe EAE and 98% died. The animals that were treated with THC had no or mild symptoms and 95% survived.

Another animal model of MS, experimental allergic encephalomyelitits was studied by Baker et al (2000). They found that cannabinoids reduced spasticity and tremor in mice. A reduction in MS symptoms was also noted by Achiron et al (2000) when animals were treated with a synthetic cannabinoid, Dexanabinol.

Both Consroe (1998) and Grinspoon and Bakalar (1993) have reviewed much evidence, including a large body of reported anecdotal evidence. Whilst not a definitive answer to the problems of spasticity in MS patients, they were convinving enough to make a report from the Institutes of Medicine (1999) suggest that further 'carefuly designed clinical trials testing the effects cannabinoids on muscle spasticity should be considered'. A National Institutes of Health Workshop concurred, claiming that the effect that cannabis has on spasticity and pain resulting from nerve damage was such that it could be used in an adjunctive role in future treatments for MS.

References

Achiron A. et al (2000) Dexanabinol (HU-211) effect on experimental autoimmune encephalomyelitis: implications for the treatment of acute relapses of multiple sclerosis. Journal of Neuroimmunology 102: 26-31.

Baker D. et al (2000) Cannabinoids control spasticity and tremor in a multiple sclerosis model, Nature 404: 84-87.

Clifford, D.B. (1983) Tetrahydrocannabinol for tremor in multiple sclerosis. Annal. Neurology 13 669-671.

Consroe, P., Musty, R., Rein, J., Tillery, W., and Pertwee, R. (1997) The perceived effects of smoked cannabis on patients with multiple sclerosis. European Neurology 38 (1) 44-48.

Consroe P. (1998). Clinical and Experimental Reports of Marijuana and Cannabinoids in Spastic Disorders.

Dell'Osso L. et al (2000) Suppression of pendular nystagmus by smoking cannabis in a patient with multiple sclerosis. Neurology 54: 2190-2193.

Greenberg H.S., Werness S.A.S., Pugh J.E., et al. (1994) Short-term effects of smoking marijuana on balance in patients with multiple sclerosis and normal volunteers. Clinical Pharmacology Ther. 55 324-328.

Grinspoon L, Bakalar JB. (1993) Marijuana, the forbidden medicine. New Haven: Yale University Press

Growing L. et al (1998) Therapeutic use of cannabis: clarifying the debate, Drug and Alcohol Review 17: 445-452.

House of Lords Select Committee on Science and Technology (1998) Science and Technology - Ninth report. Science and Technology Committee Publications, UK.

Institute of Medicine (1999) Marijuana and medicine: Assessing the science base. National Academy Press

Lyman W.D., Sonett J.R., Brosnan C.F., Elkin R. and Bornstein M.B. (1989) Delta-9-tetrahydrocannabinol: A novel treatment for experimental autoimmune encphalitis. J. Neuroimmunology 23 73-81.

Martyn C.N., Illis L.S., & Thom J. (1995) Nabilone in the treatment of multiple sclerosis [letter]. Lancet 345 579.

Meinck, H.M., Schonle, P.W. and Conrad, B. (1989) Effect of cannabinoids on spasticity and ataxia in multiple sclerosis. J. Neurology 226 120-122.

National Institutes of Health (1997) Workshop on the Medical Utility of Marijuana: Report to the Director. Washington, D.C.

Petro D.J. (1980) Marijuana as a therapeutic agent for muscle spasm or spasticity. Psychomatics 21 (1) 81-85.

Petro D.J. & Ellenberger C. (1981) Treatment of human spasticity with delta(9)tetrahydrocannabinol. J. Clinical Pharmacology 21 413S-416S.

Ungerlieder J.T. Andyrsiak T., Fairbanks L. et al. (1987) Delta-9 THC in the treatment of spasticity associated with multiple sclerosis. Adv. Alc. Substance Abuse 7 39-50.

Wills, S. (1995) The use of cannabis in multiple sclerosis. The Pharmaceutical Journal 255 237-238.

Judge Youngs ruling - Docket 86-22
The US Drug Enforcement Agency held hearings in 1987 to determine whether cannabis should be allowed as medicine. Doctors, nurses, patients and academics testified that they had witnessed people using cannabis as a medicine sucessfully. A large part of the report is concerned with multiple sclerosis, and it makes astonishing reading.

The Multiple Sclerosis Society site contains information about MS, advice for living with it, and research news.