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Medical Marijuana as reported at the Consortium of Multiple Sclerosis Centers

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    Medical Marijuana as reported at the Consortium of Multiple Sclerosis Centers

    Medical Marajuana: Consortium of Multiple Sclerosis Centers
    Faculty: Allen Bowling, MD PhD and Mark A. Ware MD
    Reported by Cherie C. Binns RN BS MSCN

    This is the first in a series of articles on topics covered in classes I attended at the annual Meeting of the Consortium of Multiple Sclerosis Centers (CMSC) in Orlando, Florida between May 29 and June 1, 2013. In a symposium entitled “Complementary and Alternative Medicine: Controversial and Unconventional Therapies”, Drs Bowling and Wade discussed the history and use of Medical Marijuana and canniboid derivatives currently approved by the FDA.

    In his introduction, Dr. Bowling told us that the use of Medical Marijuana is now legal in 19 States, the District of Columbia and Canada. Its legality has also been legislated for any adult wishing to use it for other reasons in the States of Colorado and Washington. HOWEVER, it is still illegal to cross State lines or International borders in possession of prescription Marijuana in any amount and is subject to high fines and even imprisonment if caught. This is true even if crossing from one legal domain into another. Therefore, he asks patients using this product to let him know prior to travel and he will see to it that they have a prescription for a legal canniboid derivative such as Marinol®.

    For centuries and in countries around the globe, Humans have identified the medicinal benefits of pain relief, sleep enhancement, relief of spasticity , relief of nausea and a number of other properties of smoking or eating portions of the marijuana plant. It was freely used in the United States until the 1930s when a National Law was enacted vetoing its use. Many people continued to use the Plant in medicinal ways until the 1960s when it gained favor in higher doses with greater frequency as a recreational drug. The struggle between users of this drug and Federal and State Governments continues as States are, one by one, approving the use of it in certain populations for specific purposes.

    Currently there are two drugs on the Market , Cannador® and Sativex®, that use an extract of the Cannabis plant to treat the pain and spasticity of Multiple Sclerosis (MS) in patients and have also been found useful in reducing nausea, and enhancing sleep in those with disordered sleep patterns. Sativex® has been available by prescription in Canada for many years and is anticipated to be approved for use in the USA later this year. It comes in the form of a nasal spray , while Cannador® comes in an oral form. THC, a derivative of cannabis, is medically available in the drug Marinol®. Marinol® was approved to manage the nausea of chemotherapy several years ago but has also been reported by some to reduce the pain and spasticity of Multiple Sclerosis.

    Over the past decade and a half, multiple clinical trials have been performed using various forms of the cannabis plant (smoked, extract, THC only ) against placebo, and all have shown mild to moderate benefit over placebo. Smoked or inhaled (and vaporized) product reaches the Central Nervous system and blood stream the fastest (within a few minutes) and ingested comes next with a point of therapy reached in 45 minutes on average. This latter category includes Cannador® and Marinol® while Sativex®, a nasal spray, reaches the blood stream and effectiveness within minutes of administration. The two drugs noted that are derived from extract also appear to be more effective in managing pain and spasticity and promoting sleep than does the medication that is only derived from THC.

    While legal amounts vary from State to State, Bowling made the point that, on average, persons using Marijuana and its derivatives for medicinal purposes (pain and spasticity relief specifically) use 20 times less than the average recreational user and an average of 4 joints daily is generally the maximum intake of the Person with Multiple Sclerosis (PWMS). Often 1-3 inhaled and held puffs with give relief from pain and spasticity then the “joint” may be extinguished and relighted 2-4 hours later as symptoms begin to build again.
    Used as a sleep therapy, it appears to be helpful for those who have problems falling asleep but is not seen to be effective in keeping people asleep and the dosing may need to be repeated throughout the night when spasticity peaks or bladder issues wake the PWMS. Caution must be exercised (as with any smoked product) to avoid fire while smoking (dosing) in bed or in a compromised level of alertness.

    Regarding mental impact, Medical Marijuana appeared to have significantly less impact on alertness and cognitive decline than did prescription drugs such as Neurontin®, anti-depressants and anti-spasmodics such as Baclofen®or Zanaflex®. Dr. Wade brought up the point that if patients are able to use canniboids such as Marijuana or Sativex® , often they are able to decrease the use of prescription drugs with higher side effect profiles and their alertness improves as does cognition so they are actually seeing what looks like people improving their alertness for driving. This, however needs further closely monitored study. He did caution those of us listening to this presentation NOT to suggest our patients use it as an aid to improved driving skill!
    Whereas 5 years ago, we were seeing literature in the Medical Community stating that Marijuana had no documented Medical benefit, now we are seeing an improvement in patient reported pain and spasticity relief and a resultant objective improvement in function across several levels (walking, fatigue, cognition) when patients are switching from some of the standard pharmaceuticals to occasional use of canniboids for symptom relief.

    Dr. Wade noted that Canada has had a program in place for twelve years now to administer Medical Marijuana to persons with various medical disorders including Multiple Sclerosis. HOWEVER, it is goal directed. One must show improvement in symptoms for which they use Marijuana and (hopefully) reduce the need for or dependence upon prescription symptom management drugs. If need for prescriptive medication is not reduced or quality of life and function not improved, prescriptions for Marijuana are not renewed.

    This was a lengthy and informative discussion and I do have references available upon request. If you need references to these talks as they were being prepared, you can contact me through the “Ask the MS Nurse Link under the Information Tab on the home Page of MS Views and News or email me at cheriemscn@gmail.com and I will send the referenced articles to you via email.
    June 4, 2013
    Reported by Cherie C. Binns RN BS MSCN


    References on Use of Medical Marijuana
    Bowling, AC Marijuana and MS: An Unfinished Story,MMomentum Fall 2010 pp 33-35

    Iversen, LL The Science of Marijuana Oxford Press 2010

    Corey-Bloom J. et al Smoked Cannabis for spasticity in Multiple Sclerosis: A randomized placebo controlled Trial. CMAJ 2012;184:1143-1150

    Greenberg HS, et al. short term effects of smoking marijuana on balance in patients with MS and normal volunteers Clin Pharm Ther 1994;55:324-328

    Petro DJ, Ellenberger C. treatment of human spasticity with tetrahydrocannabinol. Journal Clinical Pharm 1981; 21: 413S-416S

    Ungerleider JT. Therapeutic issues of marijuana and THC. Int Jour Addictions 1985;20:691-699

    Ungerleider JT. Delta-9-THC in the treatment of spasticity associated with multiple sclerosis. Pharm issues and Substa Abuse 1988;7:39-50

    Vaney C, et al. efficacy, safety, tole5rability of an orally administered cannabis extract in the treatment of spasticity in patients with multiple sclerosis. Mult Scler 2004;10:417-424

    Wade DT, et al. long term use of a cannabis-based medicine in the treatment of spasticity and other symptoms in multiple sclerosis. Mult Scler 2006;12:639-645

    Wade DT, et al. do cannabis-based medicinal extracts have general or specific effects on symptoms in multiple sclerosis? Mult Scler 2004;10:434-441

    Zajicek JP, Apostu VI. Role of canniboids in multiple sclerosis. CNS drugs 2011;25:187-201

    Zajicek JP, et al. canniboids for treatment of spasticity and other symptoms related to multiple sclerosis (CAMS study) Lancet 2003;362: 1517-1526

    #2
    Cherie, I can't tell you how ready I am for medical marijuana.
    It has been several years since I was gifted with small amounts for...
    CHRISTMAS......Hohoho.

    Slept like my golden through a house shaking earthquake. Zzzzzzz.

    C'mon New York State- NJ already beat you to it.
    Shame shame shame.

    Comment


      #3
      I predict it will pass in Ohio in 2014.
      If that happens, I will have my first joint in 2014.
      Yes, I lived a sheltered Catholic life and didn't get any....LOL
      Love, Sally


      "The best way out is always through". Robert Frost






      Comment


        #4
        It will take a long time before it will pass in the state of Georgia but I am ready. I predict all the southern states will be the last to pass just as they were the last to make any civil rights laws visible.

        Prejudices run deep here in the south.....as I am more aware every passing day.

        Blessings,
        Gabriella
        Last edited by Gabriella7; 06-13-2013, 09:37 AM.
        Progressive/Relapsing MS, Myasthenia Gravis, Spinal Stenosis, Degenerative Disc Disease, Diabetes, Hypertension, Hashimoto's Thyroiditis
        Advocate for ADA, Artist's Community for Change, ADAPT, Universal Living in Place, HopeKeepers, Complementary and Alternative Medicine

        "Life is mostly froth and bubble, two things stand like stone. Kindness in another's trouble, Courage in your own"........Adam Lindsay Gordon

        Comment


          #5
          It's been legal here for some time but I have never tried it. Last few years (since it has been legal) my spasticity and pain have ramped way down.

          Comment


            #6
            In the past couple days, the Canadian Health Minister announced that the medical marijuana program here will change as a result of the large # of people using it (30,000); the government will no longer provide medical MJ and it will no longer be possible to grow it at home...an individual allowed to use it will have to obtain it from a licensed seller.

            I watched a very interesting tv program recently on marijuana and how people, but teens especially are at a much higher risk of developing schizophrenia from marijuana use than ever before. The reasoning is that marijuana and specifically THC concentrations are much stronger now than previously (giving a greater 'high'), while cannabidiol levels are not increasing at the same concentrations. Cannabidiol is thought to be the ingredient that tempers the schizophrenic/paranoia effects of THC on the brain and its biochemistry. Pot is not the same animal that it was a couple of decades ago. So it is important to learn and understand the makeup of the medical MJ you access as schizophrenia is no laughing matter and can destroy your future.

            FYI - Sativex is a mouth spray, not a nasal spray.

            Miss you, Grassman. :(

            Comment


              #7
              dumblonde, it's so nice to see you here again! Hope you'll let us know how life has been treating you.
              SPMS diagnosed 1980. Avonex 2001-2004. Copaxone 2006-2009. Glatopa (glatiramer acetate = Copaxone) since December 2020.

              Comment

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