Multiple Sclerosis and Use of Medical Cannabis: A Retrospective Review of a Neurology Outpatient Population

Overview

Journal Int J MS Care

Date 2023 May 30

PMID 37250194

Authors

Michelle M Rainka

Traci S Aladeen

Anna G Mattle

Emily Lewandowski

Denis Vanini

Katelyn McCormack

Laszlo Mechtler

Affiliations

Soon will be listed here.

Abstract

Background: Patients diagnosed as having multiple sclerosis (MS) experience a wide range of symptoms requiring pharmacologic management, and many do not achieve adequate symptom control. The purpose of this study was to evaluate the role of medical cannabis (MC) as part of a comprehensive treatment plan for patients with MS.

Methods: A retrospective medical record review of 141 patients with MS receiving MC for symptom management was conducted. Data were collected for up to 4 follow-up appointments after initiation of MC. Outcomes included changes in MS symptoms, medication changes, adverse events, and changes in cognition and mobility.

Results: Patients experienced extensive MS symptom improvement after initiation of MC, with alleviation of pain (72% of patients) and spasticity (48% of patients) and improvement in sleep (40% of patients) the most common. There was a significant reduction in concomitant opioid use after initiating MC as evidenced by a significant decrease in daily morphine milligram equivalents among patients prescribed opioid analgesics ( = .01). Decreases in muscle relaxant use and benzodiazepine use did not reach significance ( > .05). The most common adverse reaction to MC was fatigue (11% of patients).

Conclusions: In many patients with MS, MC was well tolerated, eased pain and spasticity, improved sleep and other symptoms, and reduced use of concomitant opioid analgesics. Prospective studies are needed to further investigate the role of MC in the treatment of patients with MS.

Citing Articles

The Use of Compounds Derived from in the Treatment of Epilepsy, Painful Conditions, and Neuropsychiatric and Neurodegenerative Disorders.

Stasilowicz-Krzemien A, Nogalska W, Maszewska Z, Maleszka M, Dobron M, Szary A Int J Mol Sci. 2024; 25(11).

PMID: 38891938 PMC: 11171823. DOI: 10.3390/ijms25115749.

References

Wade D, Collin C, Stott C, Duncombe P . Meta-analysis of the efficacy and safety of Sativex (nabiximols), on spasticity in people with multiple sclerosis. Mult Scler. 2010; 16(6):707-14. DOI: 10.1177/1352458510367462. View

ZUNG W . From art to science. The diagnosis and treatment of depression. Arch Gen Psychiatry. 1973; 29(3):328-37. DOI: 10.1001/archpsyc.1973.04200030026004. View

Browne P, Chandraratna D, Angood C, Tremlett H, Baker C, Taylor B . Atlas of Multiple Sclerosis 2013: A growing global problem with widespread inequity. Neurology. 2014; 83(11):1022-4. PMC: 4162299. DOI: 10.1212/WNL.0000000000000768. View

Wiese B, Wilson-Poe A . Emerging Evidence for Cannabis' Role in Opioid Use Disorder. Cannabis Cannabinoid Res. 2018; 3(1):179-189. PMC: 6135562. DOI: 10.1089/can.2018.0022. View

Rae-Grant A, Day G, Marrie R, Rabinstein A, Cree B, Gronseth G . Practice guideline recommendations summary: Disease-modifying therapies for adults with multiple sclerosis: Report of the Guideline Development, Dissemination, and Implementation Subcommittee of the American Academy of Neurology. Neurology. 2018; 90(17):777-788. DOI: 10.1212/WNL.0000000000005347. View

van Steenoven I, Aarsland D, Hurtig H, Chen-Plotkin A, Duda J, Rick J . Conversion between mini-mental state examination, montreal cognitive assessment, and dementia rating scale-2 scores in Parkinson's disease. Mov Disord. 2014; 29(14):1809-15. PMC: 4371590. DOI: 10.1002/mds.26062. View

Costa B . On the pharmacological properties of Delta9-tetrahydrocannabinol (THC). Chem Biodivers. 2007; 4(8):1664-77. DOI: 10.1002/cbdv.200790146. View

Olek M . Multiple Sclerosis. Ann Intern Med. 2021; 174(6):ITC81-ITC96. DOI: 10.7326/AITC202106150. View

Wallin M, Culpepper W, Campbell J, Nelson L, Langer-Gould A, Marrie R . The prevalence of MS in the United States: A population-based estimate using health claims data. Neurology. 2019; 92(10):e1029-e1040. PMC: 6442006. DOI: 10.1212/WNL.0000000000007035. View

10.

Chen X, Cowan A, Inan S, Geller E, Meissler J, Rawls S . Opioid-sparing effects of cannabinoids on morphine analgesia: participation of CB and CB receptors. Br J Pharmacol. 2019; 176(17):3378-3389. PMC: 6692585. DOI: 10.1111/bph.14769. View

11.

Nielsen S, Germanos R, Weier M, Pollard J, Degenhardt L, Hall W . The Use of Cannabis and Cannabinoids in Treating Symptoms of Multiple Sclerosis: a Systematic Review of Reviews. Curr Neurol Neurosci Rep. 2018; 18(2):8. DOI: 10.1007/s11910-018-0814-x. View

12.

Milinis K, Tennant A, Young C . Spasticity in multiple sclerosis: Associations with impairments and overall quality of life. Mult Scler Relat Disord. 2016; 5:34-9. DOI: 10.1016/j.msard.2015.10.007. View

13.

Brown A . Novel cannabinoid receptors. Br J Pharmacol. 2007; 152(5):567-75. PMC: 2190013. DOI: 10.1038/sj.bjp.0707481. View

14.

Koch-Henriksen N, Soelberg Sorensen P . The changing demographic pattern of multiple sclerosis epidemiology. Lancet Neurol. 2010; 9(5):520-32. DOI: 10.1016/S1474-4422(10)70064-8. View

15.

Lunde H, Aae T, Indrevag W, Aarseth J, Bjorvatn B, Myhr K . Poor sleep in patients with multiple sclerosis. PLoS One. 2012; 7(11):e49996. PMC: 3498191. DOI: 10.1371/journal.pone.0049996. View

16.

Devinsky O, Cilio M, Cross H, Fernandez-Ruiz J, French J, Hill C . Cannabidiol: pharmacology and potential therapeutic role in epilepsy and other neuropsychiatric disorders. Epilepsia. 2014; 55(6):791-802. PMC: 4707667. DOI: 10.1111/epi.12631. View

17.

Beck A, Ward C, Mendelson M, Mock J, ERBAUGH J . An inventory for measuring depression. Arch Gen Psychiatry. 1961; 4:561-71. DOI: 10.1001/archpsyc.1961.01710120031004. View

18.

Lewis M, Yang Y, Wasilewski E, Clarke H, Kotra L . Chemical Profiling of Medical Cannabis Extracts. ACS Omega. 2018; 2(9):6091-6103. PMC: 6044620. DOI: 10.1021/acsomega.7b00996. View

19.

Lake S, Walsh Z, Kerr T, Cooper Z, Buxton J, Wood E . Frequency of cannabis and illicit opioid use among people who use drugs and report chronic pain: A longitudinal analysis. PLoS Med. 2019; 16(11):e1002967. PMC: 6863529. DOI: 10.1371/journal.pmed.1002967. View

20.

Hauser S, Cree B . Treatment of Multiple Sclerosis: A Review. Am J Med. 2020; 133(12):1380-1390.e2. PMC: 7704606. DOI: 10.1016/j.amjmed.2020.05.049. View