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What is the Society’s position on the use of marijuana for medical purposes?
The Society supports the rights of people with MS to work with their health care provider to access marijuana for medical purposes in accordance with legal regulations in those states where such use has been approved. In addition, the Society supports the need for more research to better understand the benefits and potential risks of marijuana and its derivatives as a treatment for MS.
Although marijuana is still illegal at the federal level, federal legislation passed in 2015 clarified that the federal government would no longer use federal funds to enforce federal marijuana laws in states that enacted legislation prior to May 7, 2014 permitting medical marijuana use. This should reduce the existing legal confusion in those states listed in the legislation, where the use of marijuana was approved for medical purposes before May 2014.
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Does the Society advocate for access to medical marijuana?
The National MS Society supports the ability of people living with MS to make an informed choice about their treatments, including the use of medical marijuana, with their MS health care providers. Recognizing that additional research is still needed, we are evaluating ways we can remove the barriers to allowing research on medical marijuana at the federal level, which is complex due to government restrictions. We advocate in support of legalizing medical cannabis at the state level.
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What is the basis for the Society’s position?
In 2014, the American Academy of Neurology (AAN) released a “Summary of evidence-based guideline: Complementary and alternative medicine in multiple sclerosis.” The guideline was created by a panel of medical experts who evaluated all published research studies. Among studies of several forms of cannabis and its derivatives evaluated by the panel, evidence suggests:
The AAN findings state that smoked cannabis research studies have not produced enough evidence to assess its safety or effectiveness for treating MS symptoms including spasticity, pain, balance, posture and cognition changes.
- Oral cannabis extract and synthetic THC (tetrahydrocannabinol—a major active component of cannabis) are probably effective for reducing patient-reported symptoms of spasticity and pain, but not MS-related tremor or spasticity measurable by tests administered by the physician; and
- Sativex oral spray (GW Pharmaceuticals) is probably effective for improving patient-reported symptoms of spasticity, pain and urinary frequency, but not bladder incontinence, MS-related tremor or spasticity measurable by tests administered by the physician.
Oral cannabis extract, THC and Sativex are not currently approved by the US Food and Drug Administration (FDA) for use by people with MS. The FDA has approved only two forms of marijuana for medical use: dronabinol (Marinol) and nabilone (Cesamet). Dronabinol also is approved for loss of appetite associated with weight loss in patients with AIDS. At this time, the drugs are not approved for other uses.
Marijuana is a complex substance which may contain many different components affecting the body. Production of marijuana for medical use is not standardized or supervised by the FDA or any other agency for its quality, purity, or specific ingredients, hence, the effects of different batches of marijuana may not be the same.
The guideline notes that cannabis usage, as with any therapy, may result in both potential benefits and potential side effects. For these cannabis derivatives, the most commonly reported side effects were dizziness, drowsiness, difficulty concentrating and memory disturbance. The guideline also points out that the long-term safety of cannabis use for MS symptom management is not yet known.
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What have been the findings to date of research funded in this area by the Society?
The Society is supporting a clinical trial of different forms of cannabis products to test their ability to relieve spasticity in people with MS. Unfortunately, completion of this trial has been delayed due to challenges with recruiting patients able to adhere to the significant government requirements for trials using cannabis products.
The Society is committed to funding additional research with cannabis products and to addressing government regulations that may be impeding research progress.