woman sits at the breakfast table exhaling smoke

Can Cannabis Help MS Symptoms? Here’s What Experts Know

By Kerry Weiss
Reviewed by Dana Cooper, M.D.
May 31, 2024
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Although federal law prohibits the use of marijuana, many states allow medical use to treat pain, nausea, and other symptoms. This means that in some states, those living with certain chronic conditions, including multiple sclerosis, may qualify to use medical marijuana.

According to a 2020 survey of more than 1,000 people living with MS, 42% of respondents reported recent use of cannabinoids (compounds derived from the cannabis plant) to help with MS symptoms.

Perhaps you, too, have been wondering whether medical marijuana could be a helpful treatment for your MS symptoms. If so, be sure to talk to your medical provider and educate yourself on the potential pros and cons. Here’s some information to help you know what to ask.

The Role of Cannabis in MS

Cannabinoids have been studied for a variety of neurologic disorders, but the strongest evidence is in support of treatment of spasticity and neuropathic pain in multiple sclerosis.

According to the National Multiple Sclerosis Society, cannabis is thought to help with managing MS symptoms such as:

  • Pain
  • Spasticity (including muscle stiffness and involuntary muscle spasms)
  • Bladder problems

Cannabis may also help some people manage mental health issues, such as anxiety and insomnia.

Cannabis in Palliative Care

For a small proportion of people with MS, medical marijuana has another role, says James W. Stark, M.D., a board-certified neurologist at the International Multiple Sclerosis Management Practice, in New York City: It’s used in palliative care. “If there are patients that are very advanced, there's not a lot we can do,” Stark says. “[Medical marijuana] is a better option than chronic pain medications and opioids for helping those people cope.”

Stark emphasizes that this is becoming much less common because the options for MS treatment have increased over the years, leading to fewer cases of end stage MS.

What the Research Says

There have been several studies of the effect of cannabis on MS, but not a lot of definitive answers about its effectiveness. “Interestingly, MS is one of the diseases for which we have the most data on using cannabis,” says Jordan Tishler, M.D., a part-time instructor of medicine at Harvard Medical School, in Boston, and president of the Association of Cannabinoid Specialists.

Despite the large number of studies, many of them have involved relatively small numbers of people with MS, and it’s hard to draw conclusions on the true benefits of cannabis as a treatment, says Julie Fiol, associate vice president of healthcare access for the National MS Society.

For example, an opinion article published in 2019 in the journal Frontiers in Pharmacology notes that cannabis may help relieve MS pain for some people, but there’s not enough evidence to recommend guidelines for maximum effectiveness. A 2012 trial found inhaled cannabis can help with MS-related spasticity, but it involved only 30 participants. A 2010 trial investigating the use of cannabis for bladder dysfunction found that it may help, but results were not statistically significant.

Therefore, guidelines around cannabis use are still lacking.

“Despite its use by humans for thousands of years, the scientific study of cannabis and its components is still in its infancy,” Fiol says. “High-quality research on this topic in the United States remains limited.”

One reason: Federal laws limiting marijuana use make it difficult for researchers to fully investigate the drug’s effects, as well as its potential. “You can't really study marijuana the right way,” Stark says. “So, we just don't know the answers to a lot of things.”

Risks of Cannabis Use for People with MS

Using cannabis to alleviate MS symptoms comes with a risk of side effects such as the following:

  • Anxiety or paranoia
  • Confusion
  • Cognitive impairment
  • Dry mouth or eyes
  • Headache
  • Increased heart rate
  • Impaired balance or coordination
  • Nausea or vomiting
  • Sedation

Despite marijuana’s known ability to affect memory and cognition, Tishler says that patients often don’t seem to report worsening brain fog.

There is some overlap between typical MS symptoms and cannabis side effects. “Some of the side effects of chronic use of marijuana—cognitive problems, fatigue—those are MS concerns, as well,” Stark says, explaining that if you use medical marijuana, it can be difficult to determine whether these issues are related to cannabis or the MS itself.

Cannabis use by the general population appears to be associated with increased risk of psychosis, cardiovascular diseases, and cannabinoid hyperemesis syndrome (severe nausea, abdominal pain, and/or vomiting).

However, a 2018 review suggested that cannabis products were generally well tolerated in people with MS, and serious adverse side effects were rare.

That said, the long-term safety of using cannabis for MS is still unknown. More robust research is needed on this topic.

Cannabis for MS: Special Considerations

Cannabis is usually administered or experienced in various ways, including:

  • Smoking
  • Vaping
  • Consumption (edibles)
  • Topical application

Smoking cannabis is not recommended for people who have MS. “We know that the inhalation of smoke is bad for MS patients,” explains Stark, who notes that vaping is not a healthier or safer choice. “A few years ago, there was an issue with vape pens and marijuana in particular, where people were getting some respiratory syndrome.”

Those who want to try marijuana to see how it affects their MS symptoms may want to consider the edible variety. Not only are they smokeless, but Stark says it’s clearer how much cannabis is included in edibles, and a doctor can adjust the dosing based on an individual’s needs.

“Also, edibles tend to last longer and have more of a steady state, whereas when you smoke, you tend to feel it right away, then you kind of need to use it more frequently,” adds Stark, because it tends to wear off more quickly.

Like with other prescription drugs, it’s important to follow your doctor’s orders with medical marijuana. “The safety and efficacy is tied to using it properly,” Tishler says. “Focus on dose and timing is critical.”

The FDA on Cannabis Products for MS

It’s important to note that no cannabis products have been approved for use in MS by the U.S. Food and Drug Administration.

The FDA has approved two synthetic cannabinoids only for use in cancer and HIV, to help alleviate nausea and vomiting or stimulate appetite.

In Canada and the United Kingdom, a nasal spray containing THC and cannabidiol (CBD), known as nabiximols (marketed as Sativex), has been approved for use in MS to help with neuropathic pain, spasticity, and overactive bladder. But this medicinal product has not been approved by the U.S. FDA. “It's not available in the U.S. because there is slightly too much THC in it to be legal on a federal level,” Stark says.

How to Obtain Medical Marijuana for MS

Whether cannabis is a good option for your MS is a very individualized decision—and one that you should discuss with your doctor.

If your doctor determines cannabis is appropriate, you can work with your healthcare provider to access cannabis for medical purposes in accordance with local legal regulations, Fiol says. Search the Americans for Safe Access website for the most up-to-date information pertaining to your state.

Consider meeting with a cannabis specialist before heading to the dispensary. Check out the Association of Cannabinoid Specialists directory to help you find a qualified specialist near you. Members of this advocacy organization provide evidence and experience-based education for patients, cannabis clinicians, referring clinicians, and lawmakers to help inform decision-making.

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