Multiple Sclerosis and Spray Marijuana, An Important Update
Anyone who has multiple sclerosis and who has thought about using marijuana for symptom relief, especially for spasticity, should consider the results of three new reports on the oromucosal spray marijuana (Sativex®).
What is Sativex?
Sativex is a marijuana product that consists of 9-delta-tetrahydocannabinol and cannabidiol (THC:CBD). You might recognize THC as the psychoactive ingredient in marijuana.
Cannabidiol, however, does not have the mind-altering properties of THC, but it does have anti-inflammatory powers that are beneficial for people with MS. The combination of THC and CBD, which are both present in Sativex, results in a drug that can provide benefits for MSers with a reduced risk of side effects associated with THC.
Because Sativex is delivered in an oral spray, THC does not enter the bloodstream too quickly, which reduces the chances of mind-altering side effects. In addition, the presence of CBD cuts the risk of headache, dry mouth, and rapid heart beat associated with THC as well.
Currently the marijuana product is available in about 30 countries around the world (including Canada) but not in the United States. However, Sativex is in phase III trials in the US and on the road toward approval by the Food and Drug Administration.
Three new studies on MS and marijuana
One review identified which MS patients are most likely to benefit from using the THC:CBD combination in spray form. The investigators considered patients who had moderate to severe spasticity that had resisted usual therapies.
They found that use of the marijuana product resulted in relevant improvements in both the quality of life and in the ability to perform typical daily activities in some patients. The benefits were significant enough to allow the MSers to return to social and physical activities.
The second study evaluated data from more than 1,000 patients with spasticity who participated in clinical trials (most participants were in post-marketing studies) of the THC:CBD combination versus placebo. In addition to positive results, the researchers reported that use of spray was not associated with depression or significant mood changes nor cognitive problems after 1 year of treatment.
The authors of this second study also noted that in a pilot study, use of Sativex did not have a negative impact on driving ability among users. They also pointed out that among the studies reviewed, patients tended to use lower dosages than what was reported in clinical studies (average of 5-6.4 sprays vs more than 8) and that they still were able to achieve significant improvements.
In the third study, the authors reported on 166 patients with resistant MS spasticity who used the THC:CBD combination over a 15-month period. A total of 120 patients completed the study. Most of the patients who dropped out did so before completely 60 days of treatment and primarily because of mouth discomfort, dizziness, fatigue, or lack of benefit.
Most of the patients (95) used the spray along with other treatment for MS while 25 used it as the only therapy. The average number of sprays per day was four.
Overall, Sativex was found to be safe and effective in both groups of patients. Spasticity improved on the 1-10 numerical rating scale by 57 percent; that is, it went from 7.0 before treatment to 3.0 within 10 days of starting THC:CBD.
The bottom line
The oromucosal spray marijuana product Sativex has been shown to provide benefits for people with MS spasticity while being associated with what are generally regarded as tolerable side effects (which of course depends on the individual). Although available in more than two dozen countries, the spray marijuana is not yet available in the United States, but the possibility looks promising. Stay tuned.
Koehler J. Who benefits most from THC:CBD spray? Learning from clinical experience. European Neurology 2014; 71 Suppl 1:10-15
Koehler J et al. Clinical experience with THC:CBD oromucosal spray in patients with multiple sclerosis-related spasticity. International Journal of Neuroscience 2014 Jan 24
Rekand T. THC:CBD spray and MS spasticity symptoms: data from latest studies. European Neurology 2014; 71 Suppl 1:4-9
Thompson R. Is Sativex the same as marijuana?
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