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In this Sept. 13, 2016, file photo, In Grown Farms LLC medical marijuana grow house near Freeport shows some of its supply. 

A chronic disease of the central nervous system (brain, spinal cord and nerves), multiple sclerosis (MS) can range from relatively benign to somewhat disabling to devastating, as communication between the brain and other parts of the body is disrupted due to damage to the protective insulating sheath covering the nerves, called myelin. Many investigators believe MS to be an autoimmune disease -- one in which the body, through its immune system, launches a defensive attack against its own tissues. In the case of MS, it is the nerve-insulating myelin that comes under assault. Exactly what causes MS is still not clearly known. Some people have certain genes which make them more susceptible to developing MS. Certain viruses have been associated with it as well, including Epstein Barr virus and Human Herpes virus 6. Smoking is one risk factor. Low vitamin D levels is another, but exact reason and cause is not known.

Most people experience their first symptoms of MS between the ages of 20 and 40; the initial symptom of MS is often blurred, double vision or even blindness in one eye. Most MS patients experience muscle weakness in their extremities and difficulty with coordination and balance. These symptoms may be severe enough to impair walking or even standing. In the worst cases, MS can produce partial or complete paralysis. Most people with MS also have abnormal sensory feelings such as numbness, prickling or "pins and needles" sensations. Speech impediments, tremors and dizziness are other frequent complaints. Occasionally, people with MS have hearing loss. Approximately half of all people with MS experience cognitive impairments such as difficulties with concentration, attention and memory. Depression and anxiety are another common feature of MS. One of the most debilitating problems associated with MS is muscle spasms and stiffness with pain, which can be very severe.

The endocannabinoid system in our body regulates nerve impulse transmission and even the generation of new neurons (brain cells), so use of cannabinoid medications can affect and improve spasticity and other problems associated with MS. Some studies have shown cannabis might even be able to alter and reduce the progression of milder forms of MS. In 2003 and 2005, two large studies, Cannabinoids in Multiple Sclerosis Study (CAMS), show improvement in scores relating to spasticity in patients taking cannabis. In addition to mitigating the pain, there was also improvement in sleep, anxiety and depression.

Muscle spasm and pain is mainly caused by the exposed nerves and not muscles, therefore muscle relaxants and traditional pain medications are frequently ineffective and their side effects (including extreme drowsiness and cognitive impairment) can be very problematic for the patient. With whole cannabis, CBD (cannabidiol) and THC (tetrahydrocannabinol ) are provided. THC has strong pain-relieving properties, though it is also the component which has the psychoactive properties, while CBD also has anti-inflammatory and neuroprotective properties and works to decrease the psychoactive property of THC. Strains of cannabis with equal or more CBD than THC work really well in helping patients with MS to decrease their pain without excess sedation, therefore allowing them to function normally during the day.

Dosing always needs to be started low, usually 2.5 mg of THC and around 5-10 mg CBD and then slowly go up until the desired effect is reached. Both oral delivery and inhalation are effective. The advantage of an oral route is longer duration of action, but the disadvantage is a delay of around 45 minutes to an hour to see the effects. There is also unpredictability of onset and duration of action due to multiple factors, including absorption and a first pass metabolism through the liver. While inhalation is faster, with the effect occurring within 5 minutes, it is also shorter in duration, lasting around 90 minutes. It is easier to titrate to the desired dose with inhalation. Vaporization is the preferred method of inhalation.

Cannabis needs to be removed from the Schedule 1 drug restriction, so we can have more robust studies done and use this medicinal herb to its fullest potential!

Sayed Shah, MD, is a holistic medicine practitioner at Mandala Integrative Medicine.

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