Juan Esteban Perez, MD

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Tags:  Medical cannabis; neurology; multiple sclerosis; MS.

 

The problem: Cannabis consumption for medical purposes has increased, partly because of the increased availability of medicinal formulations as well as the increasing amount of evidence that supports medicinal cannabinoids for a diverse array of medical conditions. Multiple Sclerosis (MS) is a chronic and debilitating medical condition that affects close to 800,000 people in the USA alone. Studies have found that cannabis is effective in relieving pain and spasticity, two of the most common symptoms among MS patients. However, there is no information regarding how many patients with MS are aware of this association and use cannabis for their MS symptoms.

 

Why do this study? Despite the benefit of medicinal cannabis in the management of MS symptoms, little is known about how many patients are aware of this treatment alternative of the respective availability due to individual state legislation. This study aimed to elucidate the current status of medicinal cannabis among patients with MS in the USA and Canada.

 

 

The study: Can Do MS (Non-Profit Organization) hosted an informational webinar for patients with MS in the United States and Canada. During the webinar, a 3 question survey was administered to participants:

1. Have you ever used marijuana to help control your MS symptoms?

2. Have you used marijuana in the past year to help control your MS symptoms?

3. Do you live in a state where medical marijuana is legal?

 

A total of 1,015 patients participated in the webinar. 600 completed at least one of the questions administered. 29.6% reported using marijuana to help control their MS symptoms, while 23.7% reported cannabis use for MS symptoms within the past year. 63% of the patients who answered reported that they live in a state where medical marijuana is legal.

 

Logistic regression models were used to test the associations between variables. Odds of cannabis use for MS symptoms were highest in places where cannabis was legal for medical and recreational use (OR 4.55; 95% CI 1.70 – 12.14), compared to states where cannabis use is not legal. Odds of cannabis use increased 6% with every increased year after legalization in the corresponding states (OR 1.06; 95% CI 1.02 – 1.10). Participants who reported more severe symptoms of MS had increased odds of cannabis consumption (3.41; 95% CI 1/23-9.46) when compared to patients with mild symptoms.

 

The participant's accuracy in the knowledge regarding local cannabis legal status was also examined using a regression model. 502 patients answered the legality question, among which 78 (14%) answered incorrectly. Patients who live in areas where cannabis is legal for medicinal and recreational use had higher odds of being correct regarding the legal status (OR 4.98; 95% CI 1.09 – 22.81) compared to states where cannabis is not legal. Patients who live in states where cannabis is legal only for medical use had lower odds of being correct regarding the legal status of cannabis (OR 0.30; 95% CI 0.15 – 0.60) compared to states where cannabis is not legal.

 

Conclusions:  The main conclusion drawn from this study is that approximately 1 out of 4 people with MS in the USA and Canada have used cannabis as a treatment for their disease. This is more likely in places where cannabis is legal for medical and recreational use and is, therefore, more accessible.

 

What does this study add? MS is a chronic and debilitating condition, with highly variable treatment strategies. Studies have found that medicinal cannabis is a viable treatment option for some symptoms of MS. This study found that approximately 1 out of 4 patients with MS have used cannabis in the past for their MS symptoms, but these patients more commonly come from states where cannabis is legal for both recreational and medical use. Patients who come from states where only medical use is legal had decreased odds of awareness of the legality of this particular option and therefore decreased odds of using cannabis for their symptoms. It is clear from this study that increased awareness and education regarding medicinal cannabis as a treatment option can increase the number of people who resort to this novel treatment option.

 

Funder:  This study did not receive any specific grant from funding agencies in the public, commercial or not-for-profit sectors.

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Author conflicts:  Andrea Hildebrand and Jessica Minnier have no declarations of interest. Michelle Cameron has provided consulting for Greenwich Biosciences and for Adamas Pharmaceuticals, Inc.

 

Commentary: (David Casarett MD). These sorts of web surveys are always difficult to interpret, because we don’t know anything about who is answering questions, except (in this case) that they have MS (or say they do).  Still, these results are interesting because they paint a picture of how cannabis use for a condition like MS—for which there is good evidence that cannabinoids can relieve symptoms—are influenced by social factors.  For instance, these patients were more likely to use cannabis if they lived in a state in which cannabis had been legal for a longer period of time.  That suggests that access is a slow process—maybe slower than it should be.  And many patients didn’t know whether cannabis was legal.  Another results was that many patients who reported using cannabis lived in states in which it was not legal.  That’s hardly surprising, and my patients tell me the same story. (I practice in a state in which cannabis is not legal).  But it emphasizes the important point that, despite its legal status, many patients eventually find a way to obtain cannabis because they believe it helps them.

The problem:  Although patients need a health care provider’s recommendation in order to get access to legal medical cannabis, little is known about how well prescribing providers know about cannabis laws.