The symptoms of multiple sclerosis (MS) are challenging to treat and manage. Pain, tremors and spasticity are hallmarks of the disease, and current treatment options are limited. But since the final regulations for the Massachusetts medical marijuana law went into effect on May 24, 2013, a new option for physicians and their patients has taken shape.

For physicians at the Partners Multiple Sclerosis Center, such as James Stankiewicz, MD, medical marijuana represents an important option to consider after evaluating a patient’s symptoms.

“We consider a patient’s symptoms, particularly pain and spasticity, and based on the individual’s symptoms, we’re open to the idea of prescribing medical marijuana for treatment because it seems to be clinically helpful for some of our patients,” said Stankiewicz.

Recent research studies support these observations.

In 2003, a research team reported in The Lancet on the results from a multi-center, randomized placebo-controlled study that tested the effectiveness of an oral cannabis extract versus a placebo on symptoms of spasticity among multiple sclerosis patients. The study found statistically significant improvements in patient-reported spasticity and pain (although they did not find a statistically significant benefit in total Ashworth score – a measurement of spasticity). In a 2012 study published in The Journal of Neurology, Neurosurgery and Psychiatry, researchers found an improvement in muscle stiffness, spasms, pain and sleep for participants who took oral cannabinoids. In a JAMA review article that assessed data from 40 clinical trials on the use of marijuana and cannabinoids, the authors found that several of the trials examining chronic pain and neuropathic pain among those with MS had positive results, suggesting that medical marijuana may be effective in treating these symptoms.

Stankiewicz notes that although there are some anti-spasmodic treatments available for patients, pain is very difficult to control. Opioids, which are sometimes prescribed to manage pain, have significant downsides and are highly addictive. Marijuana presents an important alternative.

In order to prescribe marijuana in Massachusetts, a licensed physician must first have a long-standing relationship with a patient. Six months after prescribing, Stankiewicz and his colleagues speak with their patients again to re-evaluate their symptoms and situation.

When evaluating whether to prescribe marijuana, Stankiewicz keeps the drug’s side effects – including memory and cognitive problems – in mind. He notes however that new research into the effectiveness of the marijuana constituents tetrahydrocannabinol (THC) and cannabidiol (CBD) is promising. The latter are less psycho-active but may still offer the same benefits for managing pain and spasticity. But more research is needed to fully understand the effects and the effectiveness of CBD for patients with multiple sclerosis as well as patients with other conditions.

“This is an important area for investigation and study, with the potential to help improve the lives of our patients,” said Stankiewicz.

Further reading:

-From the Massachusetts Medical Society: Overview of Physician Sections of Medical Marijuana Regulations

105 CMR 725.000: Implementation of an act for the Humanitarian Medical use of Marijuana (.pdf)

-From The Lancet: Cannabinoids for treatment of spasticity and other symptoms related to multiple sclerosis (CAMS study): multicentre randomised placebo-controlled trial

-From The Journal of Neurology, Neurosurgery and Psychiatry: Multiple sclerosis and extract of cannabis: results of the MUSEC trial

-From JAMA: Medical Marijuana for Treatment of Chronic Pain and Other Medical and Psychiatric Problems A Clinical Review

-From The Journal of Neuroimmune Pharmacology: Cannabinoids Decrease the Th17 Inflammatory Autoimmune Phenotype