Medical cannabis products are becoming increasingly available around the world for the treatment of various medical conditions. This progress, particularly in the UK, has been largely thanks to activists and campaigners who have pushed for meaningful government action on cannabis reform. However, over four years after the legalisation of cannabis in November 2018, prescriptions remain low in the UK. In fact, only three prescriptions have been granted through the NHS, with over a million patients left with the choice of sourcing illicit cannabis products from the black market or facing the high cost of private prescriptions.
In theory, medical cannabis can be prescribed by any specialist doctor in the UK. In practice, however, there are very few NHS doctors that are currently willing to prescribe cannabis-based medical products. In a recent article, we looked at how medical cannabis may be prescribed for treatment-resistant epilepsy. But what about other conditions that could benefit from medical cannabis treatments? For example, can medical cannabis be prescribed for Multiple Sclerosis in the UK?
What is Multiple Sclerosis?
Multiple Sclerosis (MS) is an auto-immune disease that affects the central nervous system (the brain and spinal cord). It causes complications in the function of the immune system causing it to attack the body, damaging the protective myelin sheath (a protective layer of fatty proteins) that surrounds the cells of the central nervous system – a process called demyelination. This damage disrupts the transmission of messages to and from the brain, resulting in the delay, or even failure, of messages reaching the brain and vice versa.
Demyelination causes scarring and the development of lesions in the affected area of the central nervous system. Depending on the area affected and the severity of the damage caused, patients with MS can experience a range of symptoms at different times. In the early stages of MS, the central nervous system is sometimes able to repair damaged myelin or send nerve transmissions through different channels. As a result, some patients may experience stages of remission, where symptoms improve or disappear, though remission stages are often followed by stages of relapse.
Common symptoms of MS can include:
- Optic neurosis (loss of vision, blurred, or double vision)
- Reduced coordination
- Weakness in limbs
- Numbness or pins and needles
- Unexplained pain
Multiple Sclerosis affects around 130,000 people in the UK alone. The cause of MS is still not completely understood, although there is evidence that both genetics and environmental factors may play a role in its development. There is currently no cure for the disease, with most treatment options focusing on symptom management. Treatments will be recommended depending on the stage of the disease and symptoms experienced. Common treatment options include steroids, muscle relaxants and medications (including gabapentin, tizanidine, diazepam, and clonazepam). These medications have an uncertain efficacy profile and all have side effects, such as dizziness, nausea and vomiting.
Medical cannabis and Multiple Sclerosis
The unfavourable side effect profile of many conventional MS treatments leaves many patients without effective options. As a result, many MS patients seek alternative therapies – including medical cannabis. Data collected by the MS Society showed that one in five patients surveyed used cannabis to help with their symptoms. According to the survey, patients experienced improvements in both muscle spasms and stiffness (spasticity) and pain associated with the disease.
A number of clinical trials support this anecdotal evidence. A review of existing literature published in 2022 found that treatment with nabiximols (Sativex) – an oral cannabis spray – “probably increases the number of people who report an important reduction of perceived severe spasticity compared with placebo.” Despite the apparent evidence for the potential of nabiximols, few trials have assessed the potential of other cannabis-based medicines for spasticity.
It is estimated that around three-quarters of patients with MS experience pain as a major symptom. Pain management is therefore an important consideration in the effective treatment of Multiple Sclerosis. There is abundant evidence that cannabis has been used medicinally to help manage pain for thousands of years. However, despite this historic precedent, relatively few trials have assessed cannabis medicines for their pain-relieving potential. Fewer still have focused on MS-related pain.
Nonetheless, there is some evidence that medical cannabis may be useful in this setting. The earlier mentioned review identified evidence that medical cannabis use was associated with improvements in pain when compared to placebo. Furthermore, a 2021 observational study also found that MS patients treated with medical cannabis oils experienced “a reduction in pain intensity, spasticity and sleep disturbances.”
How does it work?
Cannabis contains a huge number of active ingredients, the most well-known of which are cannabinoids. It is this category of compounds on which the basis of most medical cannabis products lies, with CBD and THC being the most researched and utilised. Cannabinoids, including CBD and THC, interact with a vast network of receptors and neurotransmitters in our bodies, known as the Endocannabinoid System (ECS).
The ECS plays an important role in a number of vital physiological and cognitive functions, including mood, temperature regulation, fertility, and pain signalling. As such, this system may be an effective target for the treatment of various conditions – including Multiple Sclerosis. While there is significant anecdotal evidence to support the use of medical cannabis for the treatment of Multiple Sclerosis symptoms, clinical evidence is still lagging behind.
How to access medical cannabis for Multiple Sclerosis
Since cannabis was rescheduled to allow for medicinal use in November 2018, doctors in the UK have been legally permitted to prescribe cannabis-based medical products for the treatment of Multiple Sclerosis. However, recommendations by the National Institute for Health and Care Excellence (NICE) state that this option should only be considered once other conventional treatments have proven ineffective. Under these guidelines, a specialist doctor can offer a 4-week trial of Sativex (THC:CBD) spray for the treatment of moderate to severe spasticity in adults with Multiple Sclerosis. Even after this point, the vast majority of patients with MS are still unable to access medical cannabis.
NICE’s guidelines only make recommendations for spasticity symptoms associated with Multiple Sclerosis. As a result, MS patients may not be considered for the prescription of medical cannabis for pain management. This has led to some debate among campaigners and patients who argue that medical cannabis treatments should be available to all who may benefit. Instead, like over a million other patients across the country, their only hope for medical cannabis access lies in a choice between expensive private clinics and the black market.
There is a growing number of medical cannabis clinics in the UK that can help patients to access both licensed and novel cannabis-based medicines. A number of these clinics have joined the Project Twenty21 initiative to offer reduced-cost prescription fees while gathering evidence of patient outcomes. The hope is that this evidence can be used to further progress access to medical cannabis in the UK.
If you would like to learn more about the process of obtaining a UK medical cannabis prescription, either for you or a loved one, take a look at leafie’s extensive guide.