Monday, October 1, 2018

Cannabis and Multiple Sclerosis



Cannabis and Multiple Sclerosis


Multiple Sclerosis (MS)can produce a variety of symptoms ranging from spasticity (stiffness, muscle spasms, and tremor), issues with mood and cognition, bladder and bowl problems, neuropath pain, and insomnia. Evidence supports the use of cannabis medicines to treat most of these symptoms.

Spasticity in Multiple Sclerosis is one of the few diagnoses that meets the most rigorous standards of evidence-based medicine supporting the medical use of cannabis. Since endocannabinoids regulate neurotransmission, cannabis-based medicines mimic endocannabinoids and regulate the dysfunctional neurotransmission that underlies spasticity.

Evidence has not yet proven that cannabis medicines slow advanced MS, but they may reduce the progression of early or less severe multiple sclerosis.

Study reports of Cannabis and MS provide evidence of significant improvements in the areas of pain, sleep, and spasticity, results were noted on a subjective scale. The Patients’ reports showed significant differences for either active treatment for spasticity, pain, sleep, and spasms. A year later, those patients reported statistically significant improvements in symptoms of pain, shaking, spasms, spasticity, sleep, energy, and tiredness in the active treatments. There was no difference between CBD with THC or THC alone. Patients noted that they felt that cannabinoids were useful in treating their disease.

The actions of endocannabinoids (your body’s natural cannabinoids) and administered cannabinoids (plant cannabinoids) on multiple pathways at a cellular level in the brain make a convincing argument that cannabinoids are neuroprotective Cannabinoids reduce the inflammation that occurs when overstimulated macrophages and microglial cells (the brain’s own inflammatory cells) cause demyelination and cell death. Cannabinoids act as vasodilators resulting in increased blood flow to the injured cerebral areas. They also promote neurogenesis to potentially encourage healing in the injured areas. Cannabinoids are powerful antioxidants, which could reduce oxidative damage that leads to the death of neurons.

Axons and neurons carry signals in the brain and spinal cord, so damage to them disrupts central nervous system signaling throughout the body. The ability of cannabinoids to reduce inflammation and act as antioxidants within cellular structure of the brain has led to attempts to prove their value as neuroprotective agents in MS.

There are however, impacts of smoking cannabis on brain volume in MS patients and corresponding deficits in cognition. Dry mouth, red eyes, coughing (if smoking), light headedness, rapid heartbeat, and psychosis (with THC only) are other adverse effects of cannabis. Taking cannabis medicines that have both CBD and THC could reduce or eliminate the psychosis effects, depending on the ratio of the two and dose size.

Partial relief of nerve pain, muscle pain and cramps, dysphoria, anxiety, and insomnia are reasonable expectations from using THC. Trials with multiple preparations and dosing are needed to achieve optimal results. Patients would like to take small doses of cannabis. Enough to help ease symptoms, but not too much to feel unwanted psychosis from THC alone. Varieties of cannabinoids and terpenes are significant to each individual’s preference, finding this preference will take time.


Dosing Cannabis for Multiple Sclerosis

For the management of spasticity and pain, take 2 – 6 mg each of THC and CBD every three to four hours, sublingually or inhaled using a vaporization device. An 18:1 CBD to THC tincture is recommended for anxiety, in 5 mg doses, as needed until 5 p.m. Take 5 to 7 mg of THC orally, before bed, for insomnia.

There is strong evidence in patient reports, that cannabis medicines which contain both THC and CBD, when taken orally, reduce spasticity and spasms. Taking a mixed cannabis medicine would perform best during day time use, and a THC alone medicine works best for nighttime use. Taking 2.5 mg of THC orally before bed is recommended for sleep.

Inhaled forms are felt immediately; 2.5 to 7.5 mg of vaporized or inhaled THC is recommended for faster onset than with oral administration. MS patients should use the lowest effective dose to void the development of a tolerance. Start with no more than 2.5 mg of THC and wait 10-15 minutes to see how you feel before adding more.

When purchasing Cannabis varieties, look for cannabis medicine that contains both THC and CBD cannabinoids. The terpene, Beta-caryophyllene, is also an anti-inflammatory, neuroprotective, antioxidant, and immune-modulator action, all aspects that could be extremely helpful in treating neurodegenerative diseases like MS.

This information was gathered from the amazing book: 
Cannabis Pharmacy – The Practical Guide to Medical Marijuana
written by Michael Backes, fwd by Andrew Weil, M.D., and Jack McCue, M.D. Medical Editor



Scientific Research

Cannabinoids in multiple sclerosis (CAMS) study: safety and efficacy data for 12 months follow up
Intention to treat analysis of data from the 80% of patients followed up for 12 months showed evidence of a small treatment effect on muscle spasticity as measured by change in Ashworth score from baseline to 12 months (Δ9-THC mean reduction 1·82 (n = 154, 95% confidence interval (CI) 0.53 to 3.12), cannabis extract 0.10 (n = 172, 95% CI –0.99 to 1.19), placebo –0.23 (n = 176, 95% CI –1.41 to 0.94); p = 0.04 unadjusted for ambulatory status and centre, p = 0.01 adjusted). There was suggestive evidence for treatment effects of Δ9-THC on some aspects of disability. There were no major safety concerns. Overall, patients felt that these drugs were helpful in treating their disease.

Endocannabinoids in Multiple Sclerosis and Amyotrophic Lateral Sclerosis.
Experimental studies into the biology of the endocannabinoid system have revealed that cannabinoids have efficacy, not only in symptom relief but also as neuroprotective agents which may slow disease progression and thus delay the onset of symptoms. This review discusses what we now know about the endocannabinoid system as it relates to MS and ALS and also the therapeutic potential of cannabinoid therapeutics as disease-modifying or symptom control agents, as well as future therapeutic strategies including the potential for slowing disease progression in MS and ALS.


Effects of Cannabis and Cannabinoids in the Human Nervous System
The functional effects of the EC system [Endocannabinoid System] and of exogenous cannabinoids are compared with respect to neuronal growth and maturation, neuroprotection against toxic and traumatic damage, sensory pathways, nausea and vomiting, appetite and food intake, the sleep/wake cycle, affective responses and mood states, motor control, seizure activity and cognitive functions. Effects in laboratory animals are compared to those in humans, including both actual and potential therapeutic effects and adverse effects. The therapeutic effects in most instances correspond to the low-dose actions of the EC system, whereas the adverse effects generally correspond to the high-dose range. The exogenous cannabinoids are less selective in their actions than the EC system because they act on a much wider range of EC receptors throughout the nervous system. It is concluded that for most potential therapeutic applications the future will lie with the development of highly selective site-specific agents that act on individual components of the EC system, rather than on the whole system.

Systematic review: efficacy and safety of medical marijuana in selected neurologic disorders: report of the Guideline Development Subcommittee of the American Academy of Neurology
The following were studied in patients with MS: (1) Spasticity: oral cannabis extract (OCE) is effective, and nabiximols and tetrahydrocannabinol (THC) are probably effective, for reducing patient-centered measures; it is possible both OCE and THC are effective for reducing both patient-centered and objective measures at 1 year. (2) Central pain or painful spasms (including spasticity-related pain, excluding neuropathic pain): OCE is effective; THC and nabiximols are probably effective. (3) Urinary dysfunction: nabiximols is probably effective for reducing bladder voids/day; THC and OCE are probably ineffective for reducing bladder complaints. (4) Tremor: THC and OCE are probably ineffective; nabiximols is possibly ineffective. (5) Other neurologic conditions: OCE is probably ineffective for treating levodopa-induced dyskinesias in patients with Parkinson disease. Oral cannabinoids are of unknown efficacy in non-chorea-related symptoms of Huntington disease, Tourette syndrome, cervical dystonia, and epilepsy. The risks and benefits of medical marijuana should be weighed carefully. Risk of serious adverse psychopathologic effects was nearly 1%. Comparative effectiveness of medical marijuana vs other therapies is unknown for these indications.


Effect of dronabinol on progression in progressive multiple sclerosis (CUPID): a randomised, placebo-controlled trial
Our results show that dronabinol has no overall effect on the progression of multiple sclerosis in the progressive phase. The findings have implications for the design of future studies of progressive multiple sclerosis, because lower than expected progression rates might have affected our ability to detect clinical change.


Neurological Aspects of Medical Use of Cannabidiol
Pre-clinical evidence largely shows that CBD can produce beneficial effects in AD, PD and MS patients, but its employment for these disorders needs further confirmation from well designed clinical studies. CBD pre-clinical demonstration of antiepileptic activity is supported by recent clinical studies in human epileptic subjects resistant to standard antiepileptic drugs showing its potential use in children and young adults affected by refractory epilepsy. Evidence for use of CBD in PD is still not supported by sufficient data whereas only a few studies including a small number of patients are available.

Meta-analysis of cannabis based treatments for neuropathic and multiple sclerosis-related pain
The cannabidiol/THC buccal spray decreased pain 1.7 +/- 0.7 points (p = 0.018), cannabidiol 1.5 +/- 0.7 (p = 0.044), dronabinol 1.5 +/- 0.6 (p = 0.013), and all cannabinoids pooled together 1.6 +/- 0.4 (p < 0.001). Placebo baseline-endpoint scores did not differ (0.8 +/- 0.4 points, p = 0.023). At endpoint, cannabinoids were superior to placebo by 0.8 +/- 0.3 points (p = 0.029). Dizziness was the most commonly observed adverse event in the cannabidiol/THC buccal spray arms (39 +/- 16%), across all cannabinoid treatments (32.5 +/- 16%) as well as in the placebo arms (10 +/- 4%). Cannabinoids including the cannabidiol/THC buccal spray are effective in treating neuropathic pain in MS.

For more studies on Cannabis and Multiple Sclerosis patients, we highly recommend the website for research gatherings on cannabis Project CBD.org

Videos on Cannabis and Multiple Sclerosis

The Use of Cannabis in Multiple Sclerosis - https://www.youtube.com/watch?v=uWIwiD4tY_g


Medical marijuana effectively treats MS symptoms, review finds
https://www.cbsnews.com/news/medical-marijuana-effectively-treats-ms-symptoms-review-finds/

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