Cannabis is made up of compounds called cannabinoids. The main ones studied for their therapeutic effect are tetrahydrocannabinol (THC), which gets you ‘high’, and cannabidiol (CBD), which doesn’t.
In November 2018, the Government legalised cannabis for medicinal use, but also put a strict criteria in place for who could access it. Only specialist doctors are allowed to prescribe medicinal cannabis.
There’s a medically approved cannabis-based treatment called Sativex, but it doesn’t work for everyone. In most parts of the UK you can’t get it from the Health Service (NHS). That’s because the good it does is seen as too small to be worth what it costs. And for many people it’s too expensive to buy privately.
Some people with MS get cannabis in a variety of ways to help ease their symptoms.
Different types of cannabis
Cannabis that’s grown and sold illegally comes in these main types:
- Marijuana or ‘weed’ (the plant’s dried leaves and flowers). These days the most common type is skunk, a very strong strain of cannabis with high levels of THC.
- Hash (the drug in its smokeable resin form).
- Cannabis oils.
Depending on the type, the main ways you take it are by smoking, vapourising (breathing in after heating it) or eating it in things like cakes.
Unlicensed medicinal cannabis
There are products made using the CBD chemical found in cannabis. These include oils you take by mouth (for example, under your tongue or with a mouth spray) or by vapourising. They won’t get you high as they have little or no THC in them. The law now says that these oils can be prescribed for medicinal use, but this is on a case-by-case basis and only when there is a special clinical need for individual people. You may see them still being sold as ‘food supplements’ (1). It’s not against the law to have these products if they only have CBD in them (and no THC). (2)
Licensed medical cannabis
In the UK there are two cannabis-based drugs that have gone through trials and have a licence:
- Nabilone (brand name Cesamet) – a drug cancer patients take to stop them feeling sick during chemotherapy. Nabilone has an artificial version of THC in it. It doesn’t have a licence to be used for MS but some doctors prescribe it for MS pain or muscle spasms.
- Sativex (brand name for the drug nabiximols) - the only drug made from cannabis that’s licenced to treat muscle spasms and stiffness in MS. It’s a mouth spray made from an equal mix of THC and CBD.
The benefits of Sativex are seen as too small to justify its cost to the Health Service. So you can’t get it on the NHS except in Wales (and even there, it’s not easy to get). Anywhere in the UK, a doctor can give you a private prescription for Sativex if you can afford the cost.
How cannabis can affect you
You can’t be sure how strong cannabis is when you buy it illegally or what it might be mixed with. So its effects might not always be the same. As well as the effects you might want, cannabis can cause less welcome changes:
- feeling drunk
- impaired driving
- feeling sick
- increased risk of seizures
- harm to unborn babies
High doses may slow down reaction time, change your blood pressure and heart beat and affect your sight and coordination.
Smoking cannabis long term can affect your lungs and raise your heart attack and cancer risk. It’s possible to become dependent on cannabis, especially if you use it regularly.
If you or your family have a history of mental health problems (such as schizophrenia or bipolar disorder) using cannabis can trigger these or make them worse.
Smoking cannabis mixed with tobacco has the well-known risks of tobacco smoking but has extra risks for people with MS. Smoking tobacco can:
- speed up how fast you go from relapsing MS to secondary progressive MS
- make some MS drugs (disease modifying therapies) work less well.
Some studies of people with MS who regularly smoke cannabis show they do worse in tests measuring their memory and how fast they process information. MRI scans have also shown abnormal brain activity. None of this is seen in people who use the cannabis-based drug Sativex.
Research into cannabis and MS
When they looked at the research in 2014, the American Academy of Neurology (AAN) didn’t find enough evidence that smoking cannabis was safe or effective against MS. They did find that people with MS said cannabis-based drugs (pills or sprays) helped with muscle stiffness (spasticity) and pain.(3)
A review by America’s National Academies of Sciences, Engineering and Medicine (NASEM) in 2017 found that patients who took cannabis-based treatment by mouth said it helped with their spasticity. (4) When their spasticity was tested it was less clear if it had got better.
Our medical advisors believe that about one in ten people with MS with pain or muscle spasticity might benefit from cannabis treatment, when other treatments for these symptoms have not worked. But smoking cannabis, especially if mixed with tobacco, is harmful to the health of people with MS.
Cannabis and the law
We believe everyone who might benefit from cannabis-based drugs like Sativex should be able to get them on the NHS. The makers of Sativex need to work with the NHS to find a way of making it widely available to people who need it. If this doesn’t work, the drug’s makers should look again at its price and/or do more research into its benefits to persuade the NHS to make it available.In November 2018, the UK Government made cannabis for medicinal use legal. This means that specialist doctors, like neurologists, are able to prescribe cannabis for medicinal use to some people with MS. Other treatment options have to be explored first.
Cannabis is a class-B drug in the UK. Possessing, producing and supplying it are against the law. ‘Supply’ includes sharing the drug with someone or giving it (even for free) to friends or relatives.
The law doesn’t allow you to use the fact you were using cannabis to help with your MS symptoms as a defence.
Accessing cannabis for medicinal use
As of November 2018, specialist doctors are able to prescribe cannabis for medicinal use. However, there is currently a strict criteria for who can access it.
If you experience spasticity with your MS, then you may be able to access cannabis for medicinal use, once other treatment options have been explored first.
GPs are not able to prescribe these products, but they may be able to refer you to a specialist.
We think that people with MS who could benefit from cannabis for medicinal use should be able to access it, and the new system should allow for this to happen.
- The Medicines and Healthcare products Regulatory Agency statement on products containing cannabidiol (CBD)
- Read 'Cannabis confusion – the legality of medicinal CBD in the UK' - on the Release website
- Visit the American Academy of Neurology website to read 'Medical marijuana in certain neurological conditions'. AAN: Minneapolis; 2014.
- Go to the US National Academies of Sciences, Engineering and Medicine website to read about 'The health effects of cannabis and cannabinoids: the current state of evidence and recommendations for research'. National Academies Press: Washington DC; 2017