Several studies have demonstrated the therapeutic potential of cannabis and its derivate products to manage the symptoms of multiple sclerosis (MS) and other neurodegenerative diseases. But there is still much to be done to enhance their use and accessibility to patients who may benefit from these therapies, according to a recent presentation by Matthew Makelky, PharmD.
Makelky, a researcher at the University of Colorado, reviewed the current status and advances made in cannabinoids use for MS at the 2018 Annual Meeting of the Consortium of Multiple Sclerosis Centers (CMSC) in Nashville, Tennessee, May 30-June 2. The presentation was titled “Hashing it out: Cannabis for Multiple Sclerosis.”
Cannabis contains more than 100 pharmacologically active compounds (cannabinoids), with the most studied compounds being the tetrahydrocannabinol (THC) and cannabidiol (CBD). Both have been evaluated for their potential to modulate spasticity associated with MS, as well as to manage seizures, inflammation, pain, anxiety, and other conditions.
Theoretically, CBD holds greater therapeutic potential than THC, since the first does not have the psychoactive properties that accompany THC use. Still, this compound is linked to some adverse side effects, such as drowsiness, decreased appetite, diarrhea, fatigue, and convulsion.
According to the American Academy of Neurology, the use of oral cannabis extract (OCE) and synthetic THC improved spasticity-related symptoms and pain in patients with MS.
In contrast, AAN considers there is limited or insufficient evidence demonstrating the effectiveness of oromucosal cannabinoid spray, such as Sativex (nabiximols), or smoked cannabis for these indications.
There are some cannabinoid-based drugs already available on the market and others are under development. Because of the different effects of each cannabinoid compound, finding suitable dosages and methods of administration, as well as optimal frequency of use, may be both challenging and risky.
Also, cannabinoids may chemically react with other prescribed drugs — increasing or reducing their effects — which adds another layer of potential hazard that should be discussed between patients and clinicians.