Cannabis and Multiple Sclerosis

Cannabinoids can modulate the function of immune cells. The first human in vivo study measuring immune function in 16 MS patients treated with oral cannabinoids. A modest increase of TNF-alpha in LPS-stimulated whole blood was found during cannabis plant-extract treatment (p=0.037), with no change in other cytokines. In the subgroup of patients with high adverse event scores, we found an increase in plasma IL-12p40 (p=0.002). The results suggest pro-inflammatory disease-modifying potential of cannabinoids in MS.

Multiple sclerosis (MS) is a chronic degenerative disease of the central nervous system that causes inflammation, muscular weakness, and a loss of motor coordination. Over time, MS patients typically become permanently disabled, and in some cases the disease can be fatal. According to the US National Multiple Sclerosis Society, about 200 people are diagnosed every week with the disease.

Clinical reports of cannabinoids‘ ability to reduce MS-related symptoms such as pain, spasticity, depression, fatigue, and incontinence are plentiful in the scientific studies leading many MS-associated patient organizations, including the Multiple Sclerosis Societies of Britain and Canada, to take positions in favor of the drug’s prescription use. Patients with multiple sclerosis typically report engaging in cannabis therapy, with one survey reporting that nearly one in two MS patients use the drug therapeutically.  Investigators at the University College of London’s Institute of Neurology reported that administration of the synthetic cannabinoid agonist WIN 55,212-2 provided “significant neuroprotection” in an animal model of multiple sclerosis. “The results of this study are important because they suggest that in addition to symptom prevention, cannabis may also slow the neurodegenerative processes that eventually lead to chronic disability in multiple sclerosis and probably other disease,” researchers decided.  Investigators at the Netherland’s Vrije University Medical Center, Department of Neurology, also reported for the first time in 2003 that the administration of oral THC can boost immune function in patients with MS. “These results suggest pro-inflammatory disease-modifying potential of cannabinoids MS,” they concluded. Cannabis has demonstrated effects on immune function that also have the potential of reducing the autoimmune attack that is thought to be the underlying pathogenic process in MS.

Clinical data reported in 2006 from an extended open-label study of 167 multiple sclerosis patients found that use of whole plant cannabinoid extracts relieved symptoms of pain, spasticity, and bladder incontinence for an extended period of treatment (mean duration of study participants was 434 days) without requiring subjects to increase their dose. Results from a separate two-year open label extension trial in 2007 also reported that the administration of cannabis extracts was associated with long-term reductions in neuropathic pain in select MS patients. On average, patients in the study required fewer daily doses of the drug and reported lower pain scores the longer they took it.  These results would be unlikely in patients suffering from a progressive disease like MS unless the cannabinoid therapy was its ceases progression.  As a result, the British government is now sponsoring a three-year clinical trial to assess the long-term effects of cannabinoids on both MS-associated symptom management as well as disease progression. Health Canada also recently approved the prescription use of cannabis abstracts for the treatment of MS-associated neuropathic pain. Similar approval of cannabis extracts is pending in Britain and Europe.  Many MS patients report that cannabis has a startling and profound effect on muscle spasms, tremors, balance, bladder control, speech and eyesight. Many wheelchair-bound patients report that they can walk unaided when they have smoked cannabis.  A House of Lords reports states that the British Multiple Sclerosis Society (consisting of some 35,000 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 risks associated with prohibition.  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.”  The BMA has requested that the synthetic cannabinoids Nabilone and Dronabinol be officially licensed for use in MS and other spastic disorders.

A recent review of all available medications for MS concluded that “forthcoming information relating to the use of cannabinoids in MS may result in there being better evidence of the effectiveness of new treatments than of any of the currently used drugs.”

Over 40 medicines are listed by the Multiple Sclerosis Society as commonly used by MS patients. Symptoms and medications prescribed include “acute exacerbations” (Decadron, Solu-Medrol); depression (Effexor, Paxil, Prozac, Wellbutrin, Zoloft); erectile dysfunction (Papaverine, Levitra, MUSE, Prostin VR, Viagra); fatigue (Amantadine, Cylert, Provigil, Prozac); itching (Atarax); nausea (Antivert); pain (Aventyl , Dilantin, Elvail, Neurontin, Gabapentin, Pamelor, Tegretol); urinary tract infections (Bacrtim, Cipro, Hiprex, Macrodantin, Nitrofurantoin, Pyridium); and urinary frequency or bladder dysfunction (DDAVP, Ditropan, Oxytrol, Pro-Banthine, Tofranil). Interferon-based medicines are also prescribed as “disease-modifying agents.”

Drugs commonly prescribed for muscle spasticity and tremor include KlonopinDantriumBaclofen(Medtronic), Zanaflex and Valium. Klonopin (Clonazepam) and Valium (diazepam) are both benzodiazepines, central nervous system (CNS) depressants maufactured by Roche. Overdoses of these medications, especially when taken with alcohol, may lead to unconsciousness and death. They frequently cause people to become drowsy, dizzy, lightheaded, clumsy, or unsteady. Other common side effects include slurred speech; abdominal cramps or pain; blurred vision or other changes in vision; changes in sexual drive or performance; gastrointestinal changes, including constipation or diarrhea; dryness of mouth; fast or pounding heartbeat; muscle spasm; trouble with urination; trembling. Studies in animals have shown that clonazepam and diazepam can cause birth defects or other problems, including death of the animal fetus. Overuse of clonazepam during pregnancy may cause the baby to become dependent on it and it may pass into breast milk and cause drowsiness, slow heartbeat, shortness of breath, or troubled breathing in nursing babies.

Dantrium is a muscle relaxant manufactured by Proctor & Gamble. It has been shown to cause cancer and non-cancerous tumors in animals, can cause liver damage, and should not be taken with alcohol. Common side effects include diarrhea, dizziness, drowsiness, weakness, nausea, unusual tiredness, abdominal cramps, blurred or double vision, chills and fever; constipation, frequent urination, headache, loss of appetite, speech difficulties, sleep difficulties and nervousness.

Baclofen (Medtronic) may be administered orally or with a surgically implanted pump in the spine. Its side effects include high fever, altered mental status, spasticity that is worse than was experienced prior to starting ITB Therapy, and muscle rigidity. Symptoms of overdose include shortness of breath or troubled breathing, vomiting, seizures, loss of consciousness and coma. Abruptly stopping implanted baclofen has been fatal.

Cannabis: By comparison, the side effects associated with cannabis are typically mild and are classified as “low risk.” Euphoric mood changes are among the most frequent side effects.   Many MS patients report that cannabis has a startling and profound effect on muscle spasms, tremors, balance, bladder control, speech and eyesight. Many wheelchair-bound patients report that they can walk unaided when they have smoked cannabis.

 

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Strona główna

 

The first human in vivo study measuring immune function in 16 MS patients treated with oral cannabinoids. The results suggest pro-inflammatory disease-modifying potential of cannabinoids in MS.