Multiple sclerosis (MS) is a debilitating neurological disease that can cause problems with mobility, speech, co-ordination, and continence. Up to 50% of those with the condition are affected by chronic pain – and this can prove difficult to treat.
Dr Mark Weatherall is a consultant neurologist at Sapphire Medical Clinics
At Sapphire Medical Clinics, we have a novel medication in our arsenal for MS pain – medical cannabis. We have now prescribed medical cannabis to 168 patients with MS, with encouraging results.
MS affects the central nervous system (the brain and spinal cord). It is a major health problem in the UK. 130,000 people in the UK have MS, and every week 100 more people are diagnosed. Most people are diagnosed in their 20s and 30s, but it can be diagnosed in younger and older people. It is nearly three times more common in women than in men.
The idea of using medical cannabis in MS dates back more than two decades. Sativex, a cannabis-derived medication, is licenced to treat spasticity, a common problem in MS that causes muscle stiffness and spasms.
Like most medicines, Sativex does not work in all patients. In addition, it is not licensed for pain, and there are barriers to accessing it on the NHS, despite it having been approved in England in 2019 for MS patients where other treatments have not helped.
At Sapphire Medical Clinics, we are exploring new ways of prescribing medical cannabis. Different methods of administration exist, such as mouth sprays, and different extracts of the cannabis plant are used in various preparations. All patients are different, but medical cannabis is normally started at a low dose and then slowly increased, to reduce the risk of side-effects. This process can take anywhere between 1-3 months, or longer, to achieve the optimum dose and combination of products to address an individual’s specific health complaints.
Medical cannabis is not a panacea, and not all patients respond to therapy. However, we do know from the latest review of the literature published in the British Medical Journal of medical cannabis oils in chronic pain that they produce, on average, a 10% improvement in pain scores in patients.
At Sapphire Medical Clinics, we have set up the UK Medical Cannabis Registry – one of biggest studies in the world of the clinical use of cannabis for various conditions, including MS. So far, we have so far collected outcomes of over 3,500 patients. Results have been published from the Registry, showing statistically significant improvements in patient outcomes, not just for pain, but also for anxiety, sleep quality, and quality of life.
Stigma plays a huge role in preventing appropriate access to medical cannabis in the UK. We know that some of our patients perceive stigma from all sections of society including healthcare professionals, law enforcement, and other government bodies. In some cases, patients themselves may associate cannabis with a lifestyle with which they do not wish to be associated.
Scepticism amongst doctors persists largely because there is little education about the effectiveness of medical cannabis, from medical school through to postgraduate training.
Both of these barriers – stigma and scepticism – can be overcome with better facts and figures about medical cannabis – and more evidence of the effectiveness and safety of therapy. This is why we believe so strongly in providing education for healthcare professionals and the public alike, via the Sapphire Institute for Medical Cannabis Education, which produces and disseminates balanced, research-based information about medical cannabis.
The key to unlocking appropriate access for patients to receive medical cannabis for MS is through randomised controlled trials, comparing medical cannabis with placebo treatments or existing standard therapy. This is the gold-standard evidence against which the medical community assesses all medications.
Through performing randomised controlled trials to see exactly which conditions benefit most from medical cannabis, it is possible that it may in time be utilised earlier in treatment pathways than it is currently for long-term conditions, including MS.