For the more than 400,000 Americans suffering from multiple sclerosis ― an autoimmune disease that affects the brain and spinal cord ― the currently available treatments often fall woefully short.
There’s no cure for MS, and frequently prescribed immunosuppressant drugs such as corticosteroids aren’t always effective in addressing common symptoms like weakness, tingling, numbness, blurred vision and cognitive difficulties. They can come with significant side effects such as increased risk of infection, weight gain, emotional changes and high blood pressure.
Increasingly, many people with MS are turning to medical marijuana to ease their symptoms. A growing number of anecdotal reports describe the drug’s benefits for treating common symptoms like fatigue, muscle weakness, anxiety and sleep deprivation, according to Dr. Thorsten Rudroff, a Colorado State University neurophysiologist who has conducted research on the effects of marijuana on multiple sclerosis symptoms. One patient even called cannabis a “miracle cure” for MS.
But these reports haven’t yet been verified by scientific research. Scientists have had a hard time conducting the clinical trials necessary to determine efficacy and dosing guidelines for the drug because of its status as a Schedule 1 drug.
Medical marijuana is legal in 28 states and recreational use is allowed in a handful of others, BUT cannabis research has been heavily obstructed ― even in states where medical use is allowed. A National Academies of Sciences report including data from over 10,000 studies, which was published Jan. 12, noted that scientists who want to study cannabis have to seek approval from federal, state and local agencies for their research, and are only able to get their samples from a single lab.
Because of these restrictions, Rudroff’s team at the Integrative Neurophysiology Laboratory has been able to conduct only observational studies rather than clinical trials.
In a recent observational study, Rudroff’s team analyzed data on the health status, symptom severity and use of medical marijuana from 139 MS patients in Colorado who were already using cannabis. The results showed that the majority of users showed fewer signs of neurological disability, and they were also able to reduce or discontinue their use of other medications as a result of their cannabis use.
The Scope caught up with Rudroff to learn more about the potential of cannabis for treating multiple sclerosis, and why the drug has been so difficult for scientists to study.
What are the most striking findings so far from your studies on patients who have been using cannabis to treat their MS symptoms?
Our experience here is that these patients reported less pain, less muscle spasticity compared to other patients with multiple sclerosis.
Also, we looked at some physical functions, and they performed better. These patients were stronger in the legs, they were less fatigable, and they also showed better balance. These are some of the preliminary findings we’ve had so far, but of course we need more subjects to validate this and to make sure that this is really an effect of cannabis.
I have a lot of interactions with these patients, and they have reduced other medications, they have less pain, they are more physically active. It’s very exciting for me.
Do we have a sense of why, at least anecdotally, cannabis seems to work so well for MS symptoms? Is it that the drug is acting as an anti-inflammatory agent?
The exact mechanisms we don’t know, and this is what I want to find out. Some people say it’s anti-inflammatory, but we don’t know.
Another study we are doing right now is using brain imaging. So we look at some patients with MS who are regularly using cannabis, and put them into a PET/CT scanner to investigate which brain areas are more or less active. Then, we can say something about what the mechanisms are here. This is an ongoing study that we just started here.
What are the most common currently available treatment options for MS? What are some challenges with current treatments?
Well, many patients have pain, so they are using opiates, for example. Opiates have many side effects ― you can get addicted to these dangerous drugs and often they are not even working very well. I know many patients who stopped using opiates and switched to cannabis products, and this is working much better for them.
And in many cases, when the patients start taking cannabis, they don’t stop using the other medication. They are using these other kinds of drugs in addition to cannabis. The problem is that we don’t know the interactions between all the drugs, and this is an area that needs further research. Usually these patients are using many drugs at the same time.
There’s a clear need for more research, as you suggest. So why is it so difficult for scientists to conduct trials using medical marijuana?
The thing is that it’s a Schedule 1 drug, so it’s at the same level as heroin and all these other dangerous drugs. We’re not allowed to do intervention studies ― I can’t give patients cannabis, and I can’t tell them how to use cannabis. You need a special license to do this, which I applied for from the Drug Enforcement Administration and hopefully will get within the next year so that then I can do these intervention studies. Right now, I can only do observational studies. So I invite patients who are currently using cannabis to the lab for some experiments.
It’s difficult to give this drug to patients. It takes time and lots of special requirements are there. For example, we have to order the products from the National Institutes of Health, then we have to have a safe room to lock them in. There are very strict rules.
There are so many promising results out there, so why is it still a Schedule 1 drug? Why has it not been reclassified to Schedule 2? I really don’t know.
What do we know about the importance of THC versus CBD [the two main active compounds in marijuana] when it comes to treating MS symptoms?
My impression right now is that THC has more of the psychoactive effects, and the medical benefits are coming from the CBD (cannabidiol). So right now, I’m thinking the more CBD, the better in a cannabis product.
CBD binds to the receptors in the human body and alters the way the receptors act to our body’s natural signals. In MS, we have too much activity of the immune system. CBD may inhibit this increased activity, which may result in the medical benefits.
What needs to happen for doctors to be able to prescribe medical cannabis to patients who need it?
We’re getting closer and closer. In Colorado, doctors can provide the patients with a medical card, and then the patients can go to the shop and buy these products. But what we need is more guidelines for these patients. They don’t know how much they should take, the best ratio of THC to CBD, or how often they should take it. Should they smoke cannabis or use edibles?
These are all things we have to figure out, and then doctors can prescribe cannabis and give their patients proper guidelines. Right now it’s all self-medication, and that can be dangerous. For example, some patients are using cannabis with opioids and we don’t know the interactions between these drugs. We really need some guidelines to provide these patients.