Multiple Sclerosis and Nabiximols: What to Consider When Treating Spasticity

Multiple sclerosis is a progressive, chronic neurodegenerative disease that impacts over 80,000 people in Canada, and more than 2.3 million people globally. 

In August 2010, nabiximols -trade name Sativex- became the first natural cannabis-based medication to be fully approved by Health Canada for a specific indication. An adjunctive treatment for spasticity in multiple sclerosis, the drug has over the years gained approval from regulatory bodies in France, Germany, the U.K. and several other countries.

Recent studies suggest a wide acceptance of medical cannabis within the MS patient community. Yet still today, the large majority of M.S. patients who use medical cannabis continue to favor oils, sprays and other medical cannabis products over nabiximols. 

Why do so many multiple sclerosis patients and their healthcare providers still rely on unapproved medical cannabis treatments when a natural pharmaceutical cannabinoid is available?

The answer lies in a combination of factors, particularly economic barriers to access and the importance of personalized, adaptable treatments. 

Multiple Sclerosis and Spasticity

Multiple Sclerosis is characterized by demyelination, a process that sees cells involved in neuro-inflammation mistake the myelin sheath covering the nerves for a foreign antigen and attack it. While the myelin sheath can be repaired, the attacks nonetheless leave scars, the accumulation of which cause a wide range of symptoms. 

Approximately 50% of MS patients experience some pain associated with the disease.

Most frequent MS symptoms include neuropathic pain, spasticity, bladder dysfunction, and fatigue. Spasticity is thought to affect about 80% of M.S. patients, with symptoms ranging from light muscle tightness to painful involuntary spasms and contractions. 

Baclofen, a muscle relaxant and anti-spastic medication, is often prescribed to treat spasticity but research suggest as many as 25-30% of M.S. patients do not respond to the drug. 

For these patients, nabiximols could be a potential option. 

Nabiximols and Treatment Resistant Spasticity

Nabiximols is an oromucosal spray that consists primarily of a controlled dosage of THC and CBD extract from the cannabis plant. It is usually the first cannabis treatment option Santé Cannabis physicians consider for M.S. patients with treatment resistant spasticity.

But nabiximols isn’t covered by provincial health insurance plans in Canada, and is only covered by a handful of private health insurers. With the monthly cost of treatments ranging anywhere from 226$ to 903$, the drug is rarely an affordable option for patients. To counter this barrier to access, Santé Cannabis has developed effective alternatives using medical cannabis sprays and oils to treat spasticity in M.S.


Testing Different Ratios: The Importance of A Personalized Approach

Nabiximols is a product with a balanced ratio of THC to CBD (2.7mg to 2.5 mg). At Santé Cannabis, the majority of treatments are initiated with products that have balanced THC:CBD ratios, particularly if patients are inexperienced with cannabis as CBD is thought to lessen some of the psychoactive effects of THC. 

But medical cannabis requires a highly-personalized approach to be effective. While balanced THC:CBD products may be effective for many, they aren’t necessarily the optimal ratio for every patient. 

Indeed, some patients may benefit from an increase in CBD or THC levels. The use of medical cannabis oils allows patients to test different ratios to find the right combination that meets their therapeutic goals, something that isn’t possible with pharmaceutical cannabinoids.

The Need for More Research

A 2019 review of 27 different studies on spasticity in adult patients with a range of conditions, including 21 studies on multiple sclerosis patients, demonstrated support for the trial of cannabinoids as a treatment for spasticity or pain in patients with M.S, 

This review “found evidence that THC and THC:CBD products may reduce spasticity or concluded that it generally favoured cannabinoids to treat spasticity based on the results of individual studies or trends towards significant effects.” (Nielsen et al. 2019)

Discrepancies in the scales used to assess the effectiveness of treatments have at times made comparing findings from different studies difficult. Although the Ashworth scale has been used to measure the efficacy of treatments on spasticity, researchers have over recent years suggested the 88-item Multiple Sclerosis Spasticity Scale (MSSS-88) as a more accurate approach. (Nielsen et al 2019) (Fu et al. 2018)

Carefully conducted, high-quality studies that focus specifically on the activity of different cannabis compounds are still required to further expand understanding of the benefits of cannabinoids for M.S. patients.

For more information about the potential of medical cannabis treatments for MS symptoms and improved quality of life, reach out to us