{"id":5081,"date":"2021-05-28T15:39:42","date_gmt":"2021-05-28T15:39:42","guid":{"rendered":"https:\/\/www.santecannabis.ca\/?p=5081"},"modified":"2023-01-23T13:44:29","modified_gmt":"2023-01-23T17:44:29","slug":"multiple-sclerosis-and-cannabinoid-based-medicines","status":"publish","type":"post","link":"https:\/\/www.santecannabis.ca\/en\/multiple-sclerosis-and-cannabinoid-based-medicines\/","title":{"rendered":"Multiple Sclerosis and Cannabinoid-based Medicines"},"content":{"rendered":"

No two cases of Multiple Sclerosis (MS) look the same – the trajectories, outcomes, symptoms and experiences of those living with MS vary from person to person. As such, no two people will necessarily require or be interested in trying the same treatments. At Sant\u00e9 Cannabis we believe in giving patients and healthcare professionals access to make informed decisions that are right for their specific cases.\u00a0<\/span><\/p>\n

On World MS day (May 30th), we\u2019re exploring <\/span>the latest on Multiple Sclerosis and cannabinoid-based medicines (CBM).\u00a0<\/span><\/p>\n

As clinicians and researchers, we\u2019re sharing our takeaways for healthcare professionals, up-to-date literature on MS and CBMs, information from our clinics and the perspective from one of our active patient advocates.\u00a0\u00a0<\/span><\/p>\n

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What is Multiple Sclerosis (MS)?<\/span><\/h2>\n

Multiple Sclerosis is an autoimmune and neurodegenerative disease affecting the spinal cord and the brain, which can lead to a variety of symptoms depending on what exact part of the central nervous system is affected. An autoimmune disease is a disease in which the immune system attacks healthy parts of the body.\u00a0<\/span><\/p>\n

In MS, cells involved in neuro-inflammation mistake myelin (the protective barrier around neurons) for a foreign antigen and attack it repeatedly. As the myelin sheath can be repaired but not seamlessly, the accumulation of scars in multiple areas causes a wide range of symptoms.\u00a0<\/span><\/p>\n

Most frequent symptoms include spasticity, pain, tremor, impaired balance and coordination, gait difficulties, fatigue, depression, bowel and bladder dysfunction, cognitive impairment, sensory impairment. No two cases are exactly alike, and different people will experience different symptoms in different severities.\u00a0<\/span><\/p>\n

MS is separated into <\/span>four subtypes<\/span><\/a> according to the disease progression including the frequency of relapses (attacks): clinically isolated syndrome (CIS), relapsing-remitting (RRMS), secondary progressive (SPMS) and primary progressive (PPMS).\u00a0<\/span><\/p>\n

Multiple sclerosis is one of the most common neurological diseases affecting <\/span>2.8 million people worldwide<\/span><\/a>. Multiple sclerosis can occur at any age, however is typically diagnosed in individuals aged 20 to 49 years old. It is most frequently seen in <\/span>women<\/span><\/a> compared to men.\u00a0<\/span><\/p>\n

Canada has one of the highest rates of MS with an estimated prevalence of <\/span>250 per 100,000 inhabitants<\/span><\/a>.\u00a0<\/span><\/p>\n

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Top 9 takeaways for clinicians from the clinicians at Sant\u00e9 Cannabis:<\/b><\/span><\/h2>\n
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  1. In Quebec, medical cannabis should be considered only after first-line treatments are deemed ineffective. After attempting other treatments, you may want to discuss cannabinoid-based medicines\u00a0 with your patient. If you don\u2019t know where to start, you can <\/span>sign up<\/span><\/a> for our Prescriber Training Program for educational resources and access to a medical hotline.\u00a0<\/span><\/li>\n
  2. There is conclusive scientific evidence that supports the use of medical cannabis for MS related spasticity. (<\/span>GW Pharma Ltd 2012<\/span><\/a>)<\/span><\/li>\n
  3. Delta-9-Tetrahydrocannabinol (THC) is the cannabinoid identified in studies as being beneficial for spasticity in MS patients. Clinically, we typically see that THC can help with spasticity and MS related pain. However, cannabidiol (CBD) can help some patients with spasticity or pain. CBD has the advantage of not having many side effects and does not include the typical \u201ceuphoric\u201d side effect associated with cannabis.\u00a0<\/span><\/li>\n
  4. THC has more side effects than CBD, including euphoria and the feeling of being \u201chigh\u201d. However, it is possible to take THC medically without having side effects or being high: the key is starting at very low doses and titrating up very slowly.<\/span><\/li>\n
  5. The different treatment plans for the various MS-related symptoms are described in the educational material we offer within our <\/span>Prescriber Training Program<\/span>.\u00a0<\/span><\/li>\n
  6. Because of the very low amount of cannabinoid receptors in the medulla, it is impossible to die from a cannabis overdose (<\/span>World Health Organization<\/span><\/a>). However, accidents can be associated with impaired faculties due to cannabis side effects.\u00a0\u00a0<\/span><\/li>\n
  7. Cannabis has contraindications like many other medications, it is important to know the contraindications and to assess patients prior to initiating a cannabinoid-based medicines treatment.<\/span><\/li>\n
  8. Capsules are concentrated oil placed in a capsule at specific doses and can replace cannabis oil for an ingested method of administration (long acting). This can make it a preferred method for certain patients.<\/span><\/li>\n
  9. Patients with multiple sclerosis often have trouble sleeping, cannabis at bedtime may help with sleep without worrying as much about side effects consequences (<\/span>Zajicek et al. 2003<\/span><\/a>; <\/span>Schabas et al., 2019<\/span><\/a>).\u00a0<\/span><\/li>\n<\/ol>\n

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    \u201cAs a nurse myself, I know how important it is to seek out and research treatment options for the patients I see. As healthcare professionals we all have the responsibility to keep ourselves well informed for the sake of our patients\u2019 safety and quality of life and this includes educating ourselves on cannabinoid-based medicines.\u201d\u00a0<\/span><\/i><\/p>\n

    -Andr\u00e9e Charbonneau, RN, Nurse coordinator<\/span><\/p>\n

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    Current available treatments<\/b><\/span><\/h2>\n

    There is currently no cure for MS however several pharmaceutical treatments exist to control inflammation, manage relapses and concomitant MS symptoms. Disease-modifying therapies alter the course of the disease; they are generally effective for RRMS and early treatment may\u00a0 be helpful to prevent long-term disability. Symptomatic therapies are used to alleviate specific symptoms, notably neuropathic pain may be treated with antidepressants, antiepileptics and opioids and spasticity may be treated with muscle relaxants.\u00a0<\/span><\/p>\n

    General lifestyle recommendations such as exercise and balanced nutrition may also benefit patients.<\/span><\/p>\n

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    Cannabinoid-based Medicines in MS\u00a0<\/b><\/span><\/h2>\n

    Research on MS and cannabinoids started over fifteen years ago with a large randomized, placebo-controlled trial on 630 patients with stable multiple sclerosis and muscle spasticity (Zajicek et al. <\/span>2003<\/span><\/a>, <\/span>2005<\/span><\/a>). Patients were randomized to placebo, oral cannabis extract (THC:CBD), or delta-9-THC, starting with a daily dose of 5 mg to a maximum dose of 25 mg\/day of active medication for a total duration of 15 weeks.\u00a0<\/span><\/p>\n

    The objective of the study was to ascertain the efficacy of cannabis extract or delta-9-THC for the treatment of spasticity and other MS symptoms. The findings indicated a reduction in patients\u2019 perceptions of the effect of spasticity.\u00a0 An unexpected secondary outcome result was a reduction of hospital admissions for relapses in both cannabis extract and delta-9-THC groups. Authors mentioned that trial patients had a slowly progressing MS, and since there are cannabinoid receptors on immune system cells, the reduced relapse rate in such an autoimmune condition is a finding that would benefit from further investigation.<\/span><\/p>\n

    Spasticity, pain, bladder dysfunction<\/span><\/span><\/h3>\n

    Since then, the potential efficacy of cannabinoid-based medicines has been investigated mostly for spasticity, pain and bladder dysfunction symptoms (read more about MS spasticity and cannabinoid treatments <\/span>here<\/span><\/a>). Cannabinoids, and the endocannabinoid system, have been demonstrated to play a role in reducing spasticity in animal models (<\/span>Chiurchi\u00f9 et al. 2018<\/span><\/a>; Baker et al. 2001; <\/span>Nielsen et al. 2018<\/span><\/a>; Zettl et al. 2016). Delta-9-Tetrahydrocannabinol (THC) appears to be effective in reducing spasticity in animal models and humans (<\/span>Nielsen et al. 2018<\/span><\/a>).<\/span><\/p>\n

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    Systematic Reviews\u00a0<\/span><\/span><\/h3>\n

    Two recent systematic reviews provide details:\u00a0<\/span><\/p>\n

    Nielsen and colleagues (2019)<\/b><\/a> reviewed 27 studies <\/b>and examined spasticity in adult patients with a range of conditions including multiple sclerosis (21 studies).\u00a0<\/span><\/p>\n