cbd oil ms society

December 15, 2021 By admin Off

There’s a medically approved cannabis-based treatment called Sativex, but it doesn’t work for everyone. In England, Wales and Northern Ireland it’s approved for use on the NHS for ‘moderate’ to ‘severe’ spasticity (muscle spasms and stiffness). But you can have it only if other treatments haven’t worked. It’s not yet approved in Scotland but we hope it soon will be.

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.

In November 2018, the UK government legalised cannabis for medicinal use, but also put a strict criteria in place for who could access it. Only specialist doctors are allowed to prescribe medicinal cannabis, and so far only a handful of people have benefited from the change in law.

One in five people with multiple sclerosis (MS) surveyed in 2014 told us they’d used cannabis to help with their symptoms. They said it can help with muscle spasms or stiffness (spasticity) and pain.

Some people with MS use cannabis in a variety of ways to help ease their symptoms.

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:

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.

Cannabis that’s grown and sold illegally comes in these main types:

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.

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).

Licensed medical cannabis products.

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.

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.

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.

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.

High doses may slow down reaction time, change your blood pressure and heart beat and affect your sight and coordination.

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.

It’s not against the law to have these products if they only have CBD in them (and no THC). (Reference 2)

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.

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)

How cannabis can affect you.

Epidyolex – licensed for use in two rare kinds of epilepsy.

In the UK there are three licensed cannabis-based medicines:

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).

Smoking cannabis mixed with tobacco has the well-known risks of tobacco smoking but has extra risks for people with MS. Smoking tobacco can:

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.

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.

Different types of cannabis.

There are some products which are not Medsafe approved but which the Ministry of Health believes are of pharmaceutical grade or are GMP certified; Tilray (oil and capsual products), Bedrocan (vapor), Marinol (liquid). For more information about these see the Medsafe website. To prescribe and import any of these products applications must be made to the Ministry of Health.

Our research has not looked into the different types of Medicinal Cannabis products and their benefits over each other but focusses on reviewing the proven benefits and risks associated with cannabis use for medicinal purposes in MS.

Side effects can include hypertension, increased pain, anxiety, disorientation, difficulty concentrating, headache, dry eyes, burning sensation, dizziness, numbness, increased appetite, dry mouth, constipation and diarrhoea. In most trials these are described as mild and tolerance to the common known side effects of cannabis can be developed over time.

The report is designed to contribute to an informed debate about the information and research into the benefits that cannabis can provide medicinally. The information is intended to allow the reader to formulate their own informed decision as to their support or otherwise for use. This supporting executive summary has been compiled by the Multiple Sclerosis Society of New Zealand and focusses on the impact to people with MS only as we do not have the mandate to speak on behalf of other organisations or conditions.

In 2019 Pain Specialist Dr John Alchin shared a report with the Society on the latest research into cannabinoids, MS and Neuropathic Pain: Cannabinoids and MS. Alchin 31.10.19.

Is smoking the only way to use cannabis medicinally?

MSNZ supports regulated, pharmaceutical grade, medicinal cannabis products being made available, free and legally, to people with MS for the management of pain and spasticity , on prescription from their GP or neurologist .

Much of the illegally grown cannabis has focussed on breeds that contain a high level of THC and almost negligible levels of CBH. It is due to the high concentrations of THC that driving under the influence is not recommended, and illegal in NZ and many countries. There is a proven relationship between THC concentration in the blood and driving performance; control, concentration and reaction times. Studies have shown the overall risk of a driver being involved in a motor vehicle accident if intoxicated by cannabis is twice that of a driver who is not.

Cannabis has been a controlled drug in New Zealand since 1927, when it became listed in The Dangerous Drugs Act. In 1965 New Zealand passed the Narcotics Act which banned the use of many drugs, including cannabis. This was passed in accordance with international obligations under the 1961 Single Convention on Narcotic Drugs.

With the increasing interest in Medicinal Cannabis for managing pain and spasticity in MS and other chronic conditions Multiple Sclerosis NZ and Motor Neurone New Zealand jointly commissioned, in 2017, the attached written report to:

The majority of medicinal cannabis studies have researched spasticity in muscles where they involuntarily contract. This causes tightness, stiffness and pain in muscles and can interfere with normal movement. However, it should be noted that spasticity also affects other internal organs including the bladder which have not been studied. It has been known since 2000 that cannabinoids can control spasticity in MS. Studies have shown that patients have reported a 29.4% improvement in muscle stiffness through cannabis use. In New Zealand the only pharmaceutical grade cannabis product, Sativex, has been approved by MedSafe for use in MS spasticity but not pain.

Short-term memory, impaired motor coordination and altered judgement are all considered temporary side effects while the individual is intoxicated following use. These side effects may last for 5-120 minutes following use and are cause by the THC compound. The CBD compound works to reduce these symptoms.

Only one pharmaceutical cannabis products, Nabiximols (trade name Sativex), has been approved by Medsafe, the NZ regulating body, to date. PHARMAC have declined to fund Sativex for use in MS spasticity and currently must be paid for privately. Medsafe states on their website (as at 25 January 2018):

As cannabis is a crop there is a potential for contamination by microorganisms, fungi and pathogenic organisms which can cause possible infections. There has been a case of a cannabis smoker with a compromised immune system contracting a pulmonary fungal infection. Cannabis plants are often treated with pesticides. Because of the way cannabis is smoked or heated to be vaped, this could change the availability of the pesticide and many medicinal cannabis patients could be more susceptible to the toxic effects of the compounds due to their illness.

Users can become substance dependant which is a brain-based disorder characterised by compulsive use, inability to desist in the face of negative consequences, and withdrawal symptoms upon cessation. This may come from the THC compound which has been shown to stimulate dopamine release, a feature common to all addictive substances.

Currently, the cannabis seed and plant is classified as a Class C illegal drug under the Misuse of Drugs Act 1975. Under this Act, it is an offence to possess, cultivate or traffic cannabis.

What pharmaceutical grade cannabis products are available in NZ?

Pain can be neuropathic (arising from damage to the nervous system ), related to muscle spasms, nerve damage or a combination. Studies have shown cannabis can reduce neuropathic ( nerve damage) pain by 30% and is more effective than gabapentin, the current frontline therapy for neuropathic pain. In a 2016 study of chronic pain (both neuropathic and non-neuropathic), 69.5% of patients reported a significant reduction in pain scores and improvement in quality of life. Additionally, 44% of participants who were taking opioids at the start of the study had completely discontinued use by the end.

Although cannabis smoke doesn’t contain nicotine it does contain known carcinogens (chemicals), such as ammonia, hydrogen cyanide, nitric oxide, aromatic amines and hydrocarbons. However while there is sparse evidence to draw a strong link between cannabis smoking and lung cancer specifically some studies do to suggest higher rates of respiratory issues.

Not all cannabis users will develop dependence and the rates are lower compared to other drugs at approximately 9.1% of users. Those who start using cannabis younger than 18 years old also have 2-4 times greater risk of developing dependence within 2 years of their first use.

Medicinal cannabis can come in several different methods, each with their own risk/benefit profiles. These include ingestion of the raw product, smoking, inhalation of vapour, and oral administration via tinctures (extracts) and cannabis oil.

The Society recommends people with MS educate themselves about the benefits and potential risks of any treatment option and make decisions in consultation with their families and primary health care providers.

The Bill is now being reviewed by the Health Select Committee. As MS is a chronic condition, not a terminal one, it not covered under the proposed new legislation and cannabis use for medicinal purposed would still be illegal under the law. MSNZ is advocating for the inclusion of MS as a chronic condition.

Sativex is indicated as add-on treatment for symptom improvement in patients with moderate to severe spasticity due to multiple sclerosis who have not responded adequately to other anti- spasticity medication and who demonstrate clinically significant improvement in spasticity related symptoms during an initial trial of therapy. Sativex for other indications is unapproved.

How long do the side effects of cannabis last?

All other cannabis-based products are unapproved in New Zealand.

Studies have shown that there are poorer cognitive outcomes for early-onset cannabis users (use by 15 years old) which is in line with what is known about brain development in adolescents. Early-onset users have shown to have, poorer verbal memory and fluency, sustained attention, impulse control and executive functioning coinciding with visible differences in brain scans.

In 2017 MSNZ and Motor Neurone Disease NZ commissioned an independent review of the evidence for Sativex: Medicinal Cannabis Research Report December 2017 MSNZ and MND.

In our understanding of the term ‘Medicinal Cannabis’ MSNZ refers to cannabis or cannabis based products that:

Cognitive impairment occurs in 40-65% of PwMS impacting attention, information processing speed, memory and executive functions. A small study showed that users of cannabis perform significantly worse in these cognitive areas and are twice as likely to be considered cognitively impaired than non-users.

In January 2017 the Government approved at First Reading a Bill to make changes to the Misuse of Drugs Act 1975 with the Misuse of Drugs (Medicinal Cannabis) Amendment Bill. The bill currently aims to :

Pharmaceutical cannabis products are those derived from the cannabis plant, in a pharmaceutical laboratory, or comprised of synthetic compounds analogous to those known to exist in the cannabis plant. They usually contain one or two of the pharmacologically active compounds (cannabinoids) which are unique to the cannabis plant; delta-9 tetrahydrocannabinol (ΔTHC) and cannabidiol (CBD). There are a multitude of randomised controlled trials which illustrate the efficacy of pharmaceutical cannabis products for a variety of symptoms.

Cannabis is prepared from the dried flowering tops and leaves of the female Cannabis plant, which belongs to the Cannabaceae family.