Though still controversial—and not wholly understood—cannabis has gained some support for use in MS—but only for certain symptoms and only in certain forms.
by Mary E. King, PhD
People living with multiple sclerosis often are anxious to try the latest treatment to see if it will help ease their symptoms, and in this regard, medical marijuana is no different. But even though it’s gaining mainstream acceptance, its use remains very controversial—and very complicated.
A brief history
Marijuana, also called cannabis, has been used for medicinal purposes for centuries, beginning in 2900 B.C. in China. Western medicine first adopted the use of marijuana in the 19th century to relieve pain, inflammation, spasms and convulsions, until concerns about its safety arose in the 1940s and ’50s. In 1970, it was listed as a Schedule 1 controlled substance, along with other drugs such as heroin and LSD, and remains restricted as such today.
In 1978, New Mexico became the first state to approve marijuana for compassionate medicinal use in a research setting. As of press time, 23 states and the District of Columbia now allow some medical use. That number is increasing, however, as more states consider medical marijuana legislation.
A complicated discussion
Just defining “medical marijuana” is quite complicated. The term distinguishes its intended use from recreational marijuana, but it does not imply any clinical acceptance or a difference in its composition. Like recreational marijuana, medical marijuana is often available in a variety of strains for smoking or other “whole plant” uses such as vaporization, as well as a in a wide array of plant extracts, and foods (“edibles”) and drinks that contain marijuana extracts. The amounts that an individual can possess at any given time are usually regulated.
Despite any intended medical use, marijuana possession is still illegal under federal regulations, although the current administration is leaving most decisions about prosecution to the states, where medical marijuana legislation can vary widely. (For more information, see the sidebar at right.)
Even though marijuana is increasingly available in the U.S. for medical purposes, its benefits and risks are a long way from being fully understood. Medications approved by the U.S. Food and Drug Administration are carefully evaluated for safety and effectiveness in treating specific symptoms and diseases before they are allowed on the market. However, medical marijuana has never been officially evaluated by the FDA—a fact that plays into the concerns some opponents of medical marijuana raise regarding its use.
Michael Williamson is squarely in the advocates’ camp. Now 29, Williamson was diagnosed with MS as a teenager and treated with conventional MS therapies. He recognized the potential for marijuana to help with his spasticity and nerve pain when he used it sparingly in college. He registered for a medical marijuana card once he moved to Colorado, where medical marijuana has been legal since 2000, and where registered users can purchase a variety of products from state-licensed dispensaries.
“I tried a lot of alternative therapies, but marijuana gives me a better quality of life, with more normalcy and less lethargy,” he says, noting that the medical marijuana he purchases is formulated not to produce the high or listlessness often associated with recreational strains.
However, physicians have differing views on whether medical marijuana is helpful for people with MS. “There is some evidence for the use of medical marijuana and related products for pain and spasticity in MS,” says Dr. Allen Bowling, a member of the Colorado Neurological Institute and clinical professor of neurology at the University of Colorado. He has been involved in research related to complementary and alternative medicine (CAM) and MS for the past 35 years, and adds that studies of smoked marijuana are too limited to allow any firm conclusions to be drawn. Some of his patients with MS started telling him in the early 2000s that marijuana helps improve various MS symptoms, especially pain, spasticity and sleep. Others, he says, have tried it but not found it helpful. He emphasizes that “because marijuana is legal [in many states] for MS, there is a common misunderstanding that its safety and efficacy are known.” Instead, he adds, “We have many unanswered questions.”
Dr. Eric A. Voth, an internist and pain and addiction specialist at Stormont Vail HealthCare in Topeka, Kansas, and chairman of the Institute on Global Drug Policy, is a strong opponent of legalizing marijuana for medical use. He says that in order for something to be called a medicine, doctors and patients should have some idea of “how it works, what the proper dosing should be, and its adverse effects.” A medicine should meet all FDA requirements for safety and efficacy. And with the exception of synthetic pharmaceutical products, marijuana does not meet these standards, he says. “It has become a medicine by popular vote instead,” he asserts.
Experts have differing views on whether medical marijuana is helpful for people with MS. Dr. Voth weighs in.
- Marijuana does not yet meet all FDA requirements for safety and efficacy.“It has become a medicine by popular vote instead.”
- Cannabinoids may prove useful for treating neuropathic pain when used in conjunction with traditional medications, but not instead of them.
- Active ingredients vary from sample to sample. Also, contaminants such as bacteria and fungi may be present in smoked marijuana.
—Dr. Eric Voth
To see comments from Dr. Allen Bowling, see page 3.