Marijuana and Multiple Sclerosis

August 04, 2014

Marijuana and Multiple Sclerosis 

 Reference:   American Academy of Neurology Guidelines 2014 

 Time to get serious about this strange plant, cannabis.  In this review, Dr. Koppel reviews 33 studies of  cannabis, THC or oral cannabis extract in the treatment of MS, seizures, Parkinson’s and other disorders.  It included multicenter trials that also had placebo-controlled studies. Conclusion of the report: there is clearly a place for cannabis in the treatment of spasticity, non-neuropathic pain, urinary dysfunction and patient-perceived quality of life in people with multiple sclerosis.   

So far there hasn’t been enough evidence to support its use in Huntington’s disease or Tourette’s syndrome, and suggests that it may not be useful in epilepsy (flying in the face of strong evidence for children with some specific forms of intractable epilepsy.) This column wrote a series of articles about the endocannabinoid system in our brains several years ago (search in  We have found CB-1 receptors in the hippocampus, basal ganglia, cerebellum, spinal cord and peripheral nerves, but not in the brainstem.  The lack of receptors in the brain stem may be why there have been virtually no reported fatalities from “overdosing” with marijuana, as your brainstem is the source of consciousness and breathing.  You may be mellow, but now out.  CB-2 receptors are found mostly outside the brain.  

Cannabis has about 60 active compounds of which THC or tetra-hydrocannabinol is the most famous.   Each of them appears to have variable activity in the various receptors.   Considering the neuro activity that has been discovered, it’s likely going to be a while figuring out just what compound does what.    Studying one at a time is probably going to be the final determinant of what does what.  However, the mix of all of them is what the plant offers and that’s what we know for now. With MS, oral cannabis extract was found to clearly help central pain or painful spasms.  It also was found to be helpful at reducing bladder voids per day, something that is the bane of bedbound patients.  

And finally, some MS patients appeared to have an improved sense of well-being when taking cannabis, though not all.   And that may be the most valuable of all. Is the use of MS without risk?   If there are no receptors in the brainstem, and you can hardly overdose, is it dangerous?  Very high doses of THC have been known to induce psychosis, dysphoria and extreme anxiety.  Dr Koppel quotes a risk of about 1% for serious neurological or psychiatric side effects.   The cannabinoids do inhibit the P-450 enzyme system of the liver, which may radically alter pain medication effectiveness.   Because so many drugs are processed through the P-450 system, we may not know all the side effects yet.  Once legalized, this is a topic that can be further studied. 

 WWW.  What will work for me.  Marijuana is now bursting on the scene with the legal changes happening in America.  I personally know several folks who have travelled to Colorado to get relief from all their systems of various illnesses.  To some beneficial effect.   There seems to be a whole new chapter of opportunity opening up as we discover the “endocannabinoid” system in our brains, and how we can manipulate it to our benefit.  Interesting the source!  Time for more research.  I’m intensely interested, and hopeful.  I want to be helpful, when it makes clinical, legal sense. 

 Pop Quiz

  1. Marijuana is an illegal drug and should remain that way.  T or F                  Answer:  Whoa Nellie, it’s becoming legal in multiple venues.  Times are changing and there is evidence it may be a useful drug for much more than Saturday night parties
  1. Marijuana has some serious side effects.  T or F                      Answer:  True. This review article estimates that about 1% of folks have serious psychiatric symptoms, up to and including pyschosis.
  1. With Multiple Sclerosis, marijuana helps reduce painful spasms.  T or F                    Answer:   True
  1. In MS, marijuana helps increase an overall sense of well being.  T or F                 Answer:  True
  1. Marijuana has at least 60 known neuro-active compounds.  T or F                          Answer: True
  1. Marijuana may block the effectiveness of some pain killers. T or F                          Answer:  True – and many other drugs – not known yet until it is legal.
  1. My opinion, for what it’s worth – it’s better to legalize it and stop pumping money into the drug gangs, and educate our kids to its dangers.  But make it regulated, legal, medically available and taxed – not illegal and unavailable.