Medical marijuana: hype or hope?

In practice
Long before the AAN study was published, Williamson says he educated himself extensively about the active components of medical marijuana and the various products that are available in Colorado. There, products are typically labeled with the ratio of cannabinoids, so he can seek out high-CBD and low- or no-THC products. He also prefers edible products or patches that are worn on the skin because he doesn’t want to be exposed to some of the bad effects of smoking, such as inhaling tars.

Dr. Bowling, who was on the AAN panel, adds that the clinical trials they reviewed show promising results, but that translating the data into recommendations for clinical practice for physicians who treat people with MS is extremely challenging. This is especially true for products typically on sale in dispensaries, such as edibles, which were not tested in these trials.

It’s not yet clear whether products are more effective when they have just a single active ingredient, such as the FDA-approved medication Marinol, or when they contain combinations of active components. Therefore, Dr. Bowling notes, much more research is needed to determine how the different components of marijuana may work together to produce desired results.

Given the paucity of strong clinical evidence, as well as his own experience with patients, Dr. Bowling rarely recommends medical marijuana to his patients. He believes that the side effects and risks may outweigh any small benefit and has found that generally those patients who have higher levels of disability and unpredictable muscle spasms or pain find that it helps. In these cases, he says, medical marijuana may be helpful on an “as-needed” basis—for example, when spasms or pain worsen unexpectedly, such as in the evening or during sleep.

Experts have differing views on whether medical marijuana is helpful for people with MS. Dr. Bowling weighs in.

• “There is some evidence for the use of medical marijuana and related products for pain and spasticity in MS.”
• While more research is needed, clinical trials show promising results.
• Though its side effects and risks outweigh the benefits for most people, medical marijuana can be used by some people with high levels of disability or unpredictable pain or spasms on an as-needed basis.

—Dr. Allen Bowling

While there is some promising data, Dr. Voth says, there isn’t enough to recommend the general legalization of medical marijuana in the U.S. However, Sativex may prove to be one of the best tools for studying the benefits versus risks of marijuana in long-term studies, he states, because it enables researchers to study the effects of carefully specified doses and ratios of cannabinoids. “Cannabinoids may provide real potential if they are used in conjunction with traditional medications to treat neuropathic pain,” but not instead of currently recognized medical treatments, Dr. Voth says.

The Society’s position
In March, the National MS Society posted an updated position on medical marijuana for MS on its website.

In short, the Society “supports the rights of persons with MS to work with their MS healthcare providers to access medical marijuana in accordance with legal regulations in those states where such use has been approved. In addition, the Society supports advancing research to better understand the benefits and potential risks of marijuana and its derivatives as a treatment for MS.”

The position statement explains that although research suggests that some of the active chemicals found in marijuana have the potential for management of certain MS symptoms such as pain and spasticity, much more research is needed. The Society also points out that the benefits of smoked marijuana remain unclear based on research studies that have been published to date. Side effects are of a real concern, too, so each individual, “in consultation with their healthcare provider, should make an informed risk-benefit decision regarding the use of marijuana and its derivatives.”

The path forward
The Society is actively advocating for additional research funding to study the safety and effectiveness of medical marijuana and related medicines.

Ted Thompson, the Society’s vice president for Federal Government Relations, explains that scientists who wish to study the effects of medical marijuana face restrictions that have too often formed barriers and bottlenecks for research. For example, researchers must get approval from both the FDA and the Drug Enforcement Administration, as well as additional approval from the National Institute on Drug Abuse (NIDA), “an agency that focuses on drug abuse and addiction, not the potential benefits,” Thompson notes. NIDA also controls access to the only approved source of marijuana for research studies, a federally sanctioned marijuana farm associated with the University of Mississippi. Completing all of these steps—before research even begins—can take years.

The Society is currently supporting a clinical trial of different forms of cannabis products. This study is designed to test the effectiveness in relieving spasticity in people with MS. Unfortunately, completion of this trial has been delayed due to challenges with recruiting patients able to adhere to the significant government requirements for trials using cannabis products. The Society is committed to funding additional research with cannabis products.

Thompson stresses that the Society is working to address the various government regulations that may be hindering research. The Society emphasizes the need for unimpeded, high-quality clinical trials to provide the conclusive results that people with MS and their physicians need. “Government policy does a disservice when it won’t allow researchers to provide these data about [the use of medical marijuana for] epilepsy, lupus, cancer and other conditions, as well as MS,” he states. “We and other patient groups advocate for the best and most promising research to be funded.”

Mary E. King, PhD, is a freelance medical writer from Boulder, Colorado.