About cannabis and MS
There are different types of cannabis and cannabis products. One cannabis-based medicine, called Sativex, is licensed in the UK to treat spasticity (muscle spasms and stiffness) in multiple sclerosis (MS).
Cannabis is made up of compounds called cannabinoids. The main ones studied for their therapeutic effect are tetrahydrocannabinol (THC), which gets you ‘high’, and cannabidiol (CBD), which doesn’t.
Different types of cannabis
Cannabis that’s grown and sold illegally comes in these main types:
- Marijuana or ‘weed’ (the plant’s dried leaves and flowers). These days the most common type is skunk, a very strong strain of cannabis with high levels of THC.
- Hash (the drug in its smokeable resin form).
- Cannabis oils.
Depending on the type, the main ways you take it are by smoking, vapourising (breathing in after heating it) or eating it in things like cakes.
Unlicensed medicinal cannabis products
There are products made using the CBD chemical found in cannabis. These include oils you take by mouth (for example, under your tongue or with a mouth spray) or by vapourising. They won’t get you high as they have little or no THC in them.
The law now says that these oils can be prescribed for medicinal use, but this is on a case-by-case basis and only when there is a special clinical need for individual people. You may see them still being sold as ‘food supplements’ (Reference 1).
It’s not against the law to have these products if they only have CBD in them (and no THC). (Reference 2)
Licensed medical cannabis products
In the UK there are three licensed cannabis-based medicines:
Epidyolex – licensed for use in two rare kinds of epilepsy.
- Sativex(brand name for the drug nabiximols) – the only drug made from cannabis that’s licensed to treat spasticity (muscle spasms and stiffness) in MS. It’s a mouth spray made from an equal mix of THC and CBD.
As of late 2021 Sativex is approved on the NHS in England for ‘moderate’ to ‘severe’ spasticity – if other treatments don’t work. In Wales it has been approved like this since 2014, and in Northern Ireland since 2021. We hope it’ll soon be approved in Scotland, too.
Getting treatments on the NHS doesn’t just depend on a recommendation from NICE or from the Scottish Medicines Consortium, which makes these decisions in Scotland. It might still be difficult to get because the NHS in some regions might not agree to pay for it, or local prescribers decide not to give it to people.
How cannabis can affect you
You can’t be sure how strong cannabis is when you buy it illegally or what it might be mixed with. So its effects might not always be the same. As well as the effects you might want, cannabis can cause less welcome changes:
- feeling drunk
- impaired driving
- feeling sick
- increased risk of seizures
- harm to unborn babies
High doses may slow down reaction time, change your blood pressure and heart beat and affect your sight and coordination.
Smoking cannabis long term can affect your lungs and raise your heart attack and cancer risk. It’s possible to become dependent on cannabis, especially if you use it regularly.
If you or your family have a history of mental health problems (such as schizophrenia or bipolar disorder), using cannabis can trigger these or make them worse.
Smoking cannabis mixed with tobacco has the well-known risks of tobacco smoking but has extra risks for people with MS. Smoking tobacco can:
- speed up how fast you go from relapsing MS to secondary progressive MS
- make some MS drugs (disease modifying therapies) work less well.
Some studies of people with MS who regularly smoke cannabis show they do worse in tests measuring their memory and how fast they process information. MRI scans have also shown abnormal brain activity. None of this is seen in people who use the cannabis-based drug Sativex.
Research into cannabis
When they looked at the research in 2014, the American Academy of Neurology (AAN) didn’t find enough evidence that smoking cannabis was safe or effective against MS. They did find that people with MS said cannabis-based drugs (pills or sprays) helped with muscle stiffness (spasticity) and pain.(Reference 3)
A review by America’s National Academies of Sciences, Engineering and Medicine (NASEM) in 2017 found that people who took cannabis-based treatment by mouth said it helped with their spasticity. (Reference 4) When their spasticity was tested it was less clear if it had got better.
Our medical advisers believe that about 1 in every 10 people with MS who have pain or muscle spasticity might benefit from cannabis treatment, when other treatments for these symptoms haven’t worked. But smoking cannabis, especially if mixed with tobacco, is harmful to the health of people with MS.
Top 5 tips to ensure you’re buying quality CBD products
In our latest guest blog Henry Vicenty, CEO of cannabidiol (CBD) oil producer Endoca, walks us through his top 5 tips to buying quality CBD products for managing your multiple sclerosis (MS).
1. Does the company have publically accessible, easy to understand lab reports?
Companies such as Endoca selling quality products will be proud of their lab reports, and will want their customers and the general public to have easy access to information regarding what is in their products. Do a quick search of the company website, or reach out to their customer services team who should be able to point you in the right direction. You want to see cannabinoids listed, as well as terpenes and evidence of absent chemicals and pesticides.
2. Are the products organic and whole plant?
If the products are certified organic, you will see the logo on the website. Some companies will grow organically but may not have a certification, which isn’t ideal but even without certification, a quick glance over their lab reports should show the testing for, and subsequently negative levels of a variety of chemicals or toxins.
Research and anecdotal reports support the claim that whole plant CBD extracts are more therapeutically potent than isolated CBD extracts alone. Make sure the lab reports of your products show terpene and other trace cannabinoid levels, otherwise you may be buying an isolated CBD product, which means the company is using only the CBD molecule in a carrier oil and no other beneficial plant molecules.
3. Is the CBD amount of the product clearly labelled and verifiable?
As the industry is yet to be standardised, bottle sizes and CBD levels are all dependant on the company, so it’s hard to truly know if the product you’re using is good value for money. Endoca have created this CBD calculator, which helps you work out the monetary amount per milligram of CBD, which is important when trying to decide between products.
4. Are there clear quality standards in place?
Without clear quality standards there is no guarantee of safety in the product you are purchasing so make sure you ask the company for proof of the quality standards they have in place. Ask if the products are Good Manufacturing Practice (GMP) certified (when products are of pharmaceutical quality) and for any other certifications they hold that show their product is safe for consumption.
5. Is their website content clear and informative and do they have many online reviews?
As CBD is a new industry for many people, there is an abundance of misinformation online, including information that you can find on many CBD company websites. Unfortunately, it’s very easy to buy CBD in bulk and rebrand it as your own, so if the company you’re buying from provides limited information, or is not clear in giving you all the tools you need to make an informed decision or purchase, steer clear. Also, finding online sources of product reviews is vital to hearing about the experiences of others using the same products.
You can read more about cannabis in our Cannabis and MS Choices leaflet online.
Medicinal Cannabis and MS – What you need to know
Living with multiple sclerosis (MS) is a unique experience for everyone, including the range of symptoms someone might have and or the treatments that are available to them. Medicinal cannabis is a treatment that people up and down the UK need access to, and not just those living with MS.
It was legalised for medical purposes in 2018, but unfortunately, it’s renowned for being difficult to access. This has improved over time, and we’ll be running through some of the changes in access to medicinal cannabis, which are explained in detail in our latest edition of the Cannabis and MS Choices booklet that you can read and download for free.
Despite the government legalising medicinal cannabis, getting access to affordable private prescriptions is a hurdle for many, since getting it on the NHS is also quite tricky. The methods in which medicinal cannabis can be obtained in the UK include cannabis flowers, which would be taken via a vaporiser or tinctures administered under the tongue, similarly to high-street CBD oils. Sativex is an oral cannabis-based spray that can be accessed in the UK, with detailed information inside the Cannabis and MS Choices booklet.
A new study is underway in the UK with 20,000 patients to have a further look at the benefits and clinical effects. Project Twenty21 is being led by Professor David Nutt, who also runs the organisation Drug Science, to lead studies without political or commercial influence. The study comes in response to the National Institute for Health and Care Excellence (NICE) saying that there is not enough evidence to prescribe medicinal cannabis on the NHS.
Some people living with MS may benefit from CBD products available to buy on the high street. These are made using cannabinoids and do not contain THC – the psychoactive element of cannabis – and is found in hemp. The primary use of CBD is for pain relief and is available in topical creams or as tinctures that can be put under the tongue or mixed in food and drink.