Survey shows many MS patients turning to cannabis or cannabis-based pharmaceuticals to manage symptoms, improve quality of life

Q1: I’ve got MS. What’s cannabis for?

—Lawrence H., via email

Lawrence is certainly not alone. An estimated one in every 385 Canadians are living with multiple sclerosis (MS), which both Statistics Canada and the MS Society of Canada report is one of the highest incidence in the world. An autoimmune disease of the central nervous system, MS inflames and damages the myelin sheath that protects the nerves, disrupting the signals transmitted along them.

The MS Society reports that about 85 percent of people with MS experience Relapsing Remitting MS (RRMS); the remainder experience various progressive forms of the disease. Most people diagnosed with the disease can expect to live a near-normal lifespan, but they may also experience a host of intermittent or progressive symptoms, including fatigue and weakness, spasms and cramps, poor co-ordination, pain, numbness, eye disorders, bladder problems, insomnia, cognitive impairment and depression.

“There are a variety of symptom management medications and non-medical interventions that can manage symptoms, including cannabis for medical purposes and the Health Canada-approved, cannabis-derived drug Sativex,” the MS Society of Canada notes. In a 2016 study conducted by Sunnybrook Health Sciences Centre in Toronto, Canadians with MS most commonly used cannabis to address sleep problems (86 percent of reported users), pain (75 percent), anxiety (73 percent) and spasticity (68 percent).

Additionally, a review of cannabis use in people with MS and Parkinson’s disease, released in August 2017, found the following: cannabis users reported lower levels of neurological dysfunction; cannabis was reported to have beneficial effects on mood, memory and fatigue; and users report reducing the amount of prescription medications they are taking. That said, the study also found that cannabis may negatively affect balance in people with MS.

“There is good science to show cannabis is effective in controlling pain and spasticity in MS patients,” says Dr. Michael Verbora, chief medical officer for Aleafia Health Inc., which operates a network of medical clinics across the country, as well as cannabis cultivation and distribution facilities. “It may also offer slight improvements in functioning or mobility, and because many patients experience depression and anxiety, cannabis can help with mood, Dr. Verbora told The GrowthOp.

Sativex is a sub-lingual spray and, while effective, can be expensive, he notes. The effects of alternative cannabis oils and capsule-based products, which are swallowed, are also long-lasting and provide pain relief through the day. If needed, cannabis vaporizers can be used to counter pain flares.

“Unfortunately, none of these options have been proven yet to reduce the number of flare-ups or change the progression of the disease,” Dr. Verbora reports.

A survey last year of MS patients across North America, results of which appeared in Neurology Clinical Practice, show many are turning to cannabis or cannabis-based pharmaceuticals to manage their symptoms and improve their quality of life. Of the 5,400 respondents, 42 percent have or are currently using marijuana (in some form) for their MS, 47 percent are considering it, and 20 percent have spoken with their healthcare provider about its use.

The usage stats are likely under-estimates because the participants were interviewed before legal medical marijuana was available in a number of jurisdictions.

Q2: What do you recommend for rheumatoid arthritis (RA) pain and vertigo?

—Peter B., via email

First things first: Cannabis is no cure. “THC and CBD (cannabidiol) are not meant to be disease-modifying agents,” cautions Dr. Danial Schecter, co-founder of the Canabo Medical Clinic and an expert on medical cannabis. “However, they are excellent tools to be used as part of a general pain management strategy that might also include physio or aquatic therapy, mindfulness and meditation, and possibly other drugs,” Dr. Schecter says.

“Cannabis is much more effective in relieving generalized pain… than pain in a specific joint,” he explains. “It can also be effective in countering several other common symptoms, such as difficulty sleeping, poor appetite and low mood,” he says. The effects are longer lasting if cannabis is consumed as an ingested oil, on average two to three times daily, Dr. Schecter advises. However, cannabis may be inhaled through a vaporizer to control breakthrough pain, he says, and some patients prefer topical applications.

“The idea is to start low and go slow to determine the lowest effective dose that addresses your symptoms without any unwanted side effects,” says Dr. Schecter. CBD-dominant/low-THC products will avoid the euphoric effects, while providing pain relief, he notes. But the night-time use of a product with a balanced CBD to THC ratio supplies a stronger analgesic agent and can also improve sleep, he adds.

The Arthritis Society estimates “two-thirds of Canadians who use cannabis for medical purposes do so to help manage arthritis symptoms.”

But despite the demand and largely positive anecdotal reports, there is limited clinical evidence on the relative benefits and risks of medical cannabis in treating arthritis.

There are some preliminary, but very promising, studies under way into the effectiveness of cannabinoids such as CBD in controlling inflammatory RA and osteoarthritis, reports Dr. Jason McDougall of the Department of Pharmacology at Dalhousie University in Halifax. “While these are still at the basic animal model stage—using laboratory rats and mice—CBD appears to be very effective in controlling pain, fatigue, inflammation and joint damage,” Dr. McDougall says.

Working under a grant by the Arthritis Society, he is in the midst of a three-year research program to better understand the benefits and potential limitations of using medical cannabis in the treatment of arthritis. “There are few clinical studies available, and our job is to put some science behind the claims and determine whether they are valid or misplaced,” he says.

It is reported other researchers are investigating alternative delivery systems to administer the drug without having to smoke it, maximizing the benefits without triggering the psychoactive components in cannabis. They are also looking at the effective dose, potential interactions with other drugs, and ways to extend the benefits and target the symptoms directly, perhaps by topical application or injection into the affected joint.

Q3: Why does cannabis work well to control nausea when prescription meds have not worked?

—Emile M., via email

Up to 40 percent of cancer patients experience chemotherapy-induced nausea and vomiting (CINV) despite their use of conventional antiemetic drug therapy. For these patients, oral cannabinoids that contain THC—such as dronabinol and nabilone—may be effective in reducing their CINV symptoms.

“Canadian guidelines recommend against the use of medical cannabis for the management of general nausea and vomiting,” cautions Angela Smith, PhD, founder and principal of Toronto-based Catalyst Life Science Consulting. The guidelines say clinicians “could consider” medical cannabinoids (and nabilone, in particular) for the treatment of CINV when antiemetic has not been successful. “However, they should never be used during pregnancy as they pose known and unknown harms to both a woman and her developing fetus,” Smith emphasizes.

“Although some patients may consider other methods of ingestion—including smoking dried cannabis or using cannabis oils—the manufactured products have been studied more, doses can be better controlled and a patient may have coverage under their health plan,” Smith says. “It’s very important for patients to have a conversation with their healthcare provider, as opposed to self-medicating with recreational cannabis,” she adds.

Whatever the source, cannabis use is widespread among cancer patients. Researchers with the Tom Baker Cancer Centre, at the University of Calgary, surveyed 2,040 cancer patients attending two comprehensive and two community cancer centres in the province about their cannabis use. Of the respondents, 356 reported using cannabis within the preceding six months—about one in eight—and more than one-third of these had never used cannabis before.

The reasons they turned to cannabis—respondents could select more than one answer—included relief of cancer-related pain (46 percent), cancer-related nausea (34 percent), other cancer symptoms (31 percent), other illnesses (21 percent) and other non-cancer reasons (44 percent). Other studies have reported cannabis may also alleviate anorexia and have positive impacts on mood and insomnia among cancer patients.

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