Can Cannabis Help Multiple Sclerosis?
An International Debate Rages
Multiple Sclerosis is a disabling neurological disorder that afflicts approximately 350,000 Americans and well over one million patients worldwide. The disease is chronic and progressive. In MS the fatty covering of nerve tracts within the brain and spinal cord called myelin is gradually degraded leading to severe problems. The attack on the "coating" of nerves seems to be autoimmune and may be triggered by virus. The symptoms of MS are numerous and can include:
Lack of coordination
Multiple Sclerosis is commonly described as "relapsing/remitting", "primary progressive", or "secondary progressive". In the first case symptoms come and go.
Primary progressive is where the symptoms just gradually get worse without remission and secondary progressive affects roughly half of the patients initially diagnosed with relapsing/remitting disease when remission ceases and progression remains constant.
MS is treated with a wide variety of medications depending upon the presenting symptoms. Many of these medications are powerful and have a multitude of side effects. Cannabis has been reliably reported to help alleviate many symptoms of MS including spasticity, seizures, neuropathy, and depression.
Normally, these symptoms are addressed with anti-seizure drugs like gabapentin, carbamazepine, and valproic acid, relaxants like valium and baclofen, and anti-depressants like the SSRI’s.
The primary immune attack on myelin is often treated with immunosuppressive drugs like Interferon Beta, methotrexate, cyclophosphamide, and glatiramer acetate.
Recent research indicates that although cannabis cannot replace these medications, in addition to symptomatic relief, cannabis is a selective immunosuppressant and protects the integrity of myelin. Cannabis increases levels of Interleukin 6 which in turn provides a selective
immunomodulating effect while cannabis also serves as a powerful anti-inflammatory and anti-oxidant (see Cannabis and Neuroprotection)
In view of the fact that current medicines used to treat MS are often toxic and addicting, why is there a controversy over cannabis which is nontoxic and not addicting in any physical sense? A review and search of major American MS websites including those of the National Multiple Sclerosis Society and the Multiple Sclerosis Foundation, finds scant information about cannabis combined with opposition to cannabis as medicine because: Cannabis is smoked There is a lack of research.
Cannabis may aggravate the problems with coordination MS sufferers may experience
In contrast, a review of major English or Canadian websites including the Multiple Sclerosis Society of Great Britain reveals more than a dozen references to cannabis and a far more open attitude to the utilization of cannabis.
Large scale clinical trials of cannabis are underway in Britain to ascertain scientifically whether or not cannabis assists the symptoms of neuropathy and spasticity.
The Multiple Sclerosis Society of Great Britain prefers that non-smoked forms of the medicine be utilized. They have advocated strongly for large scale clinical trials which are now underway including the use of the sublingual spray developed by GW Pharmaceuticals.
The debate seems to revolve around the two major points:
Can a smoked whole herb be considered medicine? [/background]
Do the negative side effects of cannabis outweigh its therapeutic benefit?
American medicine and the Pharmaceutical Industry prefer single molecule drugs with "limited" mechanisms of action. These are the type of drugs that are usually synthesized and patented.
American physicians are taught about these drugs by Pharmaceutical company detail personnel who provide free samples and company generated literature and studies. Most of our new pharmaceuticals are wildly expensive and not necessarily improvements over older safer preparations.
Whole cannabis preparations are more difficult to characterize and study yet they may be effective medicine just the same. Cannabis can easily be vaporized, eliminating the hazards of smoking, or used either in a sublingual spray or tincture, or even in food products.
When evaluating the risk/benefit ratio of a drug, American science is strongly influenced by cultural taboos and beliefs. The risks, for example, of baclofen or Valium are numerous and severe including addiction, overdose, and sedation yet these drugs or ones like them are routinely prescribed because they provide relief from spasticity.
Cannabis, though, while essentially nontoxic and nonaddicting, is ridiculed because it produces euphoria and might serve as a gateway to harder drugs (like Valium?).
It is important to point out that much of the problems with "euphoric" side effects that American medicine finds unwanted are produced by the synthetic drug Marinol not whole cannabis preparations.
It is indeed strange that American physicians would prefer the single molecule synthetic THC (the psychoactive ingredient of cannabis) while dismissing the whole herb preparations that contain compounds like cannibidiol that attenuate THC effects.
Scientific and medical decisions made with culturally prejudicial attitudes are bound to harm MS patients (and others) and they do. The therapeutic effects of cannabis in the relief of MS symptoms has been demonstrated scientifically in peer reviewed major Journals for decades yet American policy makers and traditional American MS Societies and Foundations either are unaware or dismissive of this research.
As early as 1981, DJ Petro and C Ellenberger Jr. reported in the Journal of Clinical Pharmacology (1) that THC "significantly reduced spasticity by clinical measurement…" Shortly after this (in 1983), DB Clifford reported in the Annals of Neurology (2) that patients with MS related tremor and ataxia "demonstrated improved motor coordination".
In 1989, Dr. Ungerleider and fellow researchers at the University of California at Los Angeles reported in Advances in Alcohol and Substance Abuse (3) that a double blind placebo controlled study of 13 MS patients experienced "…significant improvement in patient ratings of spasticity compared to placebo".
The authors went on to state that, "These positive findings in a treatment failure population suggest a role for THC in the treatment of spasticity in multiple sclerosis". This is just the type of sound, peer reviewed placebo double blind trial that opponents of medical cannabis claim haven’t been conducted.
The same year, Dr. WD Lyman and fellows at the Albert Einstein College of Medicine in the Bronx, New York reported in the Journal of Neuroimmunology (4) that placebo controlled studies in an animal model of multiple sclerosis revealed, "a marked reduction of inflammation in the THC treated animals." They went on to say that, "…it may prove to be a new and relatively innocuous agent for the treatment of immune-mediated diseases".
It should be noted that the animals with EAE (the animal MS condition) that received placebo died 98% of the time while those treated with THC survived more than 95% of the time.
More current research validates the promise of cannabis or cannabinoids (endogenous or exogenous) both to treat the symptoms of MS and to delay its progression. Much of the current research has been conducted oversees (Scotland, England, Spain) due to the refusal of the United States Government to allow cannabis research to any significant degree.
A great deal has been learned about the basic mechanisms of the cannabinoids. These natural substances turn out to be fundamental in the regulation of a variety of biological processes.
In 1998 F. Molina-Holgado, E. Molina-Holgado, and C. Guaza of the Instituto Cajal in Madrid, Spain, reported (5) the discovery that anandamide (an endogenous cannabinoid that binds to the THC receptor), "…caused an enhancement of the release of IL-6…in a concentration dependent manner." Noting that IL-6 is both anti-inflammatory and immunosuppressive, the authors went on to state that, "…the physiological implications…may be related to the hypothesis of the protective effects of cannabinoids on neurological disorders like multiple sclerosis".
An elegant and sophisticated follow-up to the Madrid research was published by Baker, Pertwee, and fellows in March of 2000 in no less than the prestigious journal Nature (6). In their work at the Institute of Neurology at the University College of London, the authors found that their results, "…indicate that the endogenous cannabinoid system may be tonically active in the control of tremor and spasticity.
This provides a rationale for patients’ indications of the therapeutic potential of cannabis in the control of the symptoms of multiple sclerosis…"
MS patients have not been well served in the United States by either their government or MS Foundations and Societies. Other nations unencumbered by the cultural baggage of the Drug War have moved ahead to develop cannabis medicines to help relieve the suffering of multiple sclerosis.
Hopefully, science and reason will prevail and patients suffering from MS will soon be able to legally grow or receive medicines that will markedly improve both their condition and prognosis.