“I wish that I didn’t have to break the law in order to feel more normal but this is definitely better than how life was!”
In the UK alone, it is estimated that there are 130,000 people with MS and a further 7000 diagnoses made each year. A recent report from the Centre for Medicinal Cannabis indicates that between 20,000 and 90,000 MS patients consume cannabis as a way to alleviate their symptoms and some of these patients are sourcing their medication from the black market.
The UK has one licensed cannabis-based medication available for MS patients with moderate to high spasticity, produced by GW Pharamaceuticals called Sativex. MS patients with these symptoms may be recommended for this drug if other treatments they have tried have been unsuccessful in reducing their spasticity. Cannabis-based medicines often seem to be deemed ‘the last resort’. The MS Society states that Sativex does not work well for every MS patient but those patients who have found this medication successful, experience a significant reduction in spasticity.
Issues with pricing have meant that the cost of Sativex on prescription is significant and it may be difficult, though not impossible, to receive a prescription of Sativex through an NHS consultant. Some regions may refuse to pay the high cost of the product altogether.
Although Sativex can be prescribed for and paid for privately, many with MS find that they have insufficient funds to maintain the high cost of such a prescription so may look for alternative treatment. MS is a qualifying condition for a prescription through a private medicinal cannabis clinic, but these consultations and prescriptions are still costly- although, more recently, there has been a welcome reduction in price.
These costs are still higher than accessing cannabis through the black market but doing so may cause anxiety and worry about breaking the law for many who wish to consume cannabis as part of their routine to reduce their symptoms of spasticity. There is the additional concern that these products are not regulated. In 2017, 3994 people took part in a survey conducted by The MS Society. More than 22% of respondents had tried cannabis to help with their symptoms -equating to one in five respondents. A further 26% of respondents had considered the use of cannabis but had not done so owing to their concerns around the legality and the lack of regulation of cannabis on the black market. There is, undoubtedly, a need for further legitimisation of the use of cannabis as a treatment for MS yet there seem to be many obstacles in the way for patients in the UK.
Randomised control testing or RCT is deemed the ‘gold standard’ in testing for pharmaceutical medicines and are designed for single compound medicines. The issue with this method of testing and cannabis is that one cannabis plant contains more than 100 chemical compounds. If we consider that the compounds would need to be isolated in order to qualify for a randomised control trial -lasting three years on average for each compound- then we can begin to regard the issues. If we then add that there are over 4000 strains of cannabis then we arrive at a significant problem. RCTs require that the chemical compounds in cannabis are isolated and then tested over a three year period. Not only then is time a huge factor, but also the understanding that all the chemical compounds within cannabis work synergistically to create, what is known as, the entourage effect.
A well-known cannabis campaigner, Elizabeth Brice, also known as Clare Hodges, worked tirelessly to push the legalisation of cannabis for patients with MS and other conditions. Her own experience of how cannabis alleviated her MS symptoms filled her with the passion to challenge the system and to credit cannabis as an acceptable treatment. Though she was unsuccessful in bringing about a change in the law in the UK, she did effect change in Belgium through her address to the European parliament. Her work raised awareness here in the UK and one of her legacies was to guide Dr William Notcutt to ensure that a cannabis-based pharmaceutical medication was created. Sativex- containing the compounds THC and CBD- was created as a result of this. Although Sativex contains two cannabis compounds, it is missing many others. It would be interesting to surmise that the lack of synergy and entourage might be one reason for its limited effectiveness for some patients.
Even though many MS patients report improvement in their symptoms through the consumption of cannabis, it seems that there is further need to study cannabinoids and their effect on MS symptoms and progression. Perhaps this is to convince some medical bodies -and the government- that cannabis is indeed a viable treatment option for those with MS albeit that a number of promising studies have already taken place. A 2012 research paper detailing the MUSEC trial indicated that, of all the participants, those who received the cannabis extract -in this double-blind, placebo-controlled phase III study- experienced a significant reduction in muscle stiffness and spasms compared to those taking the placebo. In fact, the rate of relief was two times that of the placebo group.
A more recent study (2021) indicated that cannabis was helpful in reducing inflammation for those with MS. This study included 150 patients, 28 of whom consumed cannabis which we can assume was self-sourced because confirmation of cannabis consumption was via urine tests. Interestingly, cannabis consumption was associated with reduced signs of inflammation and a reduction in relapse. It is no surprise that many patients with MS are looking at cannabis and its potential with interest.
For many, the issue of sourcing cannabis illegally is indeed a concern but given anecdotal reports from patients detailing a significant reduction in their symptoms and a number of peer reviewed studies, it feels unjust that many patients fear the thought of discussing unregulated cannabis consumption with a consultant or GP. Of course, this is different for those of affluence who are able to afford a private prescription but for those who can not, the possible ramifications of a friendly chat with a consultant or GP are indeed concerning and some patients worry how this might negatively affect their lives- including illegality, child protection laws and cannabis, housing concerns and possible drug interactions- so for this demographic cannabis consumption may well be, unfairly, out of reach.
Super Sour Diesel