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Marijuana for Multiple Sclerosis

Posted on January 24, 2021
Medically reviewed by
Evelyn O. Berman, M.D.
Article written by
Amanda Agazio, Ph.D.

People have used marijuana (or cannabis) medicinally for thousands of years. Based on some of the properties of marijuana, the drug has the potential to treat several symptoms associated with multiple sclerosis (MS). Medicinal marijuana has been studied in people living with MS and has revealed hopeful, but sometimes inconsistent, results.

Some members of MyMSTeam have shared their experiences with using marijuana to help with MS symptoms. One member said they use it “in the evenings to sleep and for pain and muscle cramps.”

Other MyMSTeam members have noted drawbacks to using cannabis. One cited “laziness” as a side effect: “I can't use it when I have plans to get something done,” they wrote. “But it works miracles for pain, tremors, and spasticity. I have to weigh the side effects against the benefits and only use it when I don't mind having a mellow day.”

Understanding the potential benefits and risks of using marijuana to treat your MS symptoms can help you make an informed decision. Before trying any new treatments, including marijuana, you should speak with your health care provider.

The Basics of Medicinal Marijuana

There is conflicting information available about how medical marijuana can help alleviate MS symptoms. Moreover, people are sometimes confused about the legality of medical marijuana, its effects, and what synthetic cannabinoids are.

Is Medicinal Marijuana Legal?

In the United States, medical marijuana is legal at the state level in select states and territories. As of November 2020, 36 states and four territories have approved the use of medical marijuana. Additionally, 15 states and the District of Columbia have authorized the recreational use of marijuana. Marijuana remains illegal under federal law and is classified as a Schedule 1 substance in accordance with the Controlled Substance Act.

Marijuna laws vary from state to state, including rules around acquiring a medicinal marijuana recommendation from a doctor. One MyMSTeam member who had acquired a recommendation said they were forced to choose between receiving prescription pain pills and continuing to use marijuana medicinally. “My pain meds doctor did a drug screen and found it in my system and discontinued my pain meds,” they wrote. “The pills help one of my issues and the marijuana helps with so many others. I was forced to make a choice, and I chose to discontinue my pain meds.”

What’s the Difference Between THC and CBD?

You may have heard the terms CBD and THC used in regard to medical marijuana. THC (tetrahydrocannabinol or delta-9-tetrahydrocannabinol) and CBD (cannabidiol) are two of the major cannabinoids — active chemicals — in marijuana. They bind to receptors in the human body, known as cannabinoid receptors, which are located primarily in the central nervous system (CNS) — the brain and spinal cord. When cannabinoids bind to cannabinoid receptors in the brain, they change how cells in the brain communicate by altering the exchange of neurotransmitters.

The main difference between THC and CBD relates to psychoactivity, which is how a substance affects the brain, mood, thoughts, awareness, and behavior. THC is a more psychoactive cannabinoid, which creates an altered mental state. CBD is considered a nonpsychoactive cannabinoid and is thought to have a wide range of beneficial effects on the body.

THC uses include:

  • Helping with sleep
  • Stimulating appetite
  • Relieving pain
  • Preventing nausea and vomiting

CBD uses include:

  • Relieving pain
  • Reducing anxiety
  • Preventing convulsions and spasms
  • Acting as an antipsychotic
  • Reducing inflammation

What Are Synthetic Cannabinoids?

Synthetic cannabinoids are human-made versions of cannabinoids. The U.S. Food and Drug Administration has approved two synthetic cannabinoid drugs for use in the United States: Marinol (dronabinol) and Cesamet (nabilone). These synthetic cannabinoids come in capsule form and are generally used to treat nausea, vomiting, and appetite suppression.

Marijuana and MS Symptoms

Although there have been some studies on the effects of marijuana on MS, the drug’s legal status in the United States has greatly hindered scientific research. Some studies have come from the U.S., but many come from other countries. Some of these countries have studied the effects of synthetic cannabinoids that have not been approved for use in the United States. For example, the drug Sativex (nabiximols) is not approved for use in the United States but has been used in other countries — such as Canada and New Zealand — to treat people living with MS.

Research regarding cannabinoids and MS has focused on several symptoms of the disease and has revealed varying results. A systematic review published by the American Academy of Neurology analyzed the use of cannabinoids for symptoms related to neurological disorders, including MS. The results of their review found that cannabinoids had effects on spasticity, pain, and bladder control, while other research suggests marijuana can impact cognition.

Spasticity

Spasticity is a symptom of MS that causes stiff and tightened muscles. Studies demonstrated that treatment with cannabinoids reduced the amount of patient-reported symptoms of spasticity. However, when spasticity was measured objectively by a doctor, little difference in spasticity was observed.

Pain

Studies have found that cannabinoids can be effective in reducing the amount of pain experienced by individuals living with MS. Most of that pain — referred to as central neuropathic pain — originates from damage that occurs in the CNS during MS. People with the condition may also experience pain related to muscle spasms.

A member of MyMSTeam shared that they use CBD oil — with no THC — for muscle spasms and cannabis cream for muscle and nerve pain. “They both work great,” the member wrote. “You can buy both online in FL since canna creme isn't ingested but rubbed on. And neither one causes any reaction in the mind of feeling high in any way.”

Bladder Control and Frequent Urination

The damage that occurs to the CNS during MS can cause incontinence (bladder control problems) and urinary tract infections. People living with MS may also struggle with the need to urinate frequently. Although scientists are unsure how cannabinoids can improve incontinence, they do know that cannabinoid receptors are expressed in the bladder.

“I just know that my THC marijuana allows me to empty my bladder because all day I retain my urine,” a MyMSTeam member wrote.

Evidence for how cannabinoids affect bladder control related to MS is mixed. Some studies suggest the cannabinoids do not help, while other studies suggest they do. Several studies have demonstrated that cannabinoids may help reduce the frequent urination in MS.

Cognition

Studies have shown that marijuana can worsen cognitive symptoms — including memory and processing problems — in people living with MS.

Common Side Effects of Marijuana

Although there may be some medicinal benefits to marijuana and cannabinoid use, there are some adverse side effects that can occur when using this substance, including:

  • Nausea
  • Dizziness
  • Drowsiness
  • Vomiting
  • Headache
  • Psychosis in people who have already experienced psychosis or are at risk

A member of MyMSTeam said they experience symptom relief using marijuana — but that they avoid using it during the day to avoid the side effects. “I'm not a smoker, so I only know edible MJ. I keep thinking to use it when I have pain, but I don't want to feel stoned and I'm kind of a lightweight, so only before bed if I have muscle pain, migraine or tremors,” they wrote.

Drug Interactions and Marijuana

Marijuana may affect the way some drugs are broken down, or metabolized, by the liver and lead to drug interactions.

THC may increase the breakdown of some drugs, including:

  • Aleve (naproxen)
  • Clozapine (versacloz)
  • Cymbalta (duloxetine)
  • Flexeril (cyclobenzaprine)
  • Haldol (haloperidol)
  • Thorazine (chlorpromazine)
  • Zyprexa (olanzapine)

CBD can inhibit enzymes in the liver, leading to the buildup of certain drugs in the blood, including many antidepressants that are classed as serotonin reuptake inhibitors and tricyclic antidepressants.

THC and CBD have also been shown to affect Coumadin (warfarin) metabolism, resulting in increased levels of Coumadin in the blood, which can increase an individual's risk for bleeding.

You should consult your doctor before adding any new supplement to your routine. Marijuana can affect the metabolism of other prescription drugs and could lead to adverse side effects. Your doctor should know if adding cannabinoids or marijuana to your routine would be safe.

Talk With Others Who Understand

MyMSTeam is the social network for people with MS and their loved ones. On MyMSTeam, more than 164,000 members come together to ask questions, give advice, and share their stories with others who understand life with MS.

Has using marijuana helped with your MS? Share your experience in the comments below, or start a conversation by posting on MyMSTeam.

All updates must be accompanied by text or a picture.
Evelyn O. Berman, M.D. is a neurology and pediatric specialist and treats disorders of the brain in children. Review provided by VeriMed Healthcare Network. Learn more about her here.
Amanda Agazio, Ph.D. completed her doctorate in immunology at the University of Colorado Anschutz Medical Campus. Her studies focused on the antibody response and autoimmunity. Learn more about her here.

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