Multiple Sclerosis (MS) is a chronic inflammatory disease of the central nervous system. MS affects approximately 3.0 million people globally, with about 300,000 cases in the United States. Twice as many women as men have MS. The average ages for onset of MS is 20-40 years. In MS, cells in the immune system attack and destroy myelin, the fatty tissue surrounding nerve cells (http://www.phylomed.com/MS.html). Scar tissue replaces the myelin, interfering with the transmission of nerve signals and leading to numbness, fatigue, spasticity, loss of muscle control, and various other debilitating symptoms. There are four broad theories concerning the etiology of MS. The immune system, environment, viral infections, and genetics are possible factors attributed to the cause of MS (http://www.nmss.org/msinfo/cmsi/etiology.html). Although there are no cures for MS, this disease is not fatal. Advancements in technology and medicine enable people with MS to live 90-95% of the normal life span (Sibley, 12).
What is Spasticity?
Spasticity refers to an increase in muscle tone that causes muscle stiffness or spasms (Sibley, 105). There are two types of spasticity prevalent in people with MS: phasic spasms and a sustained increase in muscle tone. Phasic spasms sub-categorize into two types of spasticity: flexor and extensor. In flexor spasticity, the hips and knees of the person bend forward, due to tightening of the hamstrings. In extensor spasticity, the legs of the patient cross over at the ankles or lock together, with the hips and knees remaining rigid (http://www.nmss.org/msinfo/cmsi/spasticity.html). Spasms also occur less frequently in the arms, backs, and necks of people with MS. Both types of spasticity debilitate patients and lead to difficulties in performing daily tasks. Phasic spasms disrupt the balance of the patient and can cause severe pain. Steady increases in muscle tone inhibits ambulatory abilities, forcing patients to rely on walkers and wheelchairs for transportation (Sibley, 106).
The Medical Marijuana Controversy
The use of marijuana for medicinal purposes is a long-standing controversy. For centuries marijuana was prescribed to alleviate symptoms associated with a variety of illnesses. Anti-medical marijuana sentiments began with the Marijuana Tax Act of 1937. In 1970, the Controlled Substances Act banned the use of marijuana completely, categorizing it as a drug with no medicinal value, high abuse rates, and detrimental health effects (http://www.farmacy.org/prop215/apha.html). Since 1996, numerous states including California, Alaska, Arizona, Nevada, Oregon and Washington have passed medical marijuana initiatives supporting the right to prescribe marijuana for seriously or terminally ill patients (http://www.marihemp.com/marimed.html). The American Public Health Association and the Institute of Medicine represent two organizations that have recently researched and endorsed advancements in the study of medical marijuana. Both groups support the use of marijuana for specific treatments, such as reducing nausea in cancer patients receiving chemotherapy, stimulating the appetites of AIDS victims, and limiting spasticity in MS patients.
How Marijuana Alleviates Spasticity
Research providing the breakdown of all the chemicals in marijuana and their specific physiological and psychological effects is scarce. When analyzing the medicinal effects of marijuana on spasticity, researchers focus primarily on two main active ingredients in the marijuana plant: tetrahydrocannabinol (THC) and cannabinoids (chemicals related to THC) (http://www.marihemp.com/marimed.html). Recently, scientists discovered that cannabinoids closely resemble a chemical in the body called anandamide. Anandamide “turns on” nerve receptors throughout the Central Nervous System that effect motor functioning, nausea, and various other biological functions (http://www.marijuanamyths.com/med-myths.php3). This development suggests that cannabinoids have similar effects to anandamide and justifies further research on the therapeutic value of marijuana for muscle spasms attributed to MS.
Marijuana is taken either by smoking or ingestion. Debates over the form in which marijuana should be administered have recently gained popularity. In 1986, the FDA approved oral THC for use as a medicine (http://www.marijuanamyths.com/med-myths.php3). Doctors hesitate to support smoked marijuana because of the health risks attributed to smoking. However, experiments suggest that smoked marijuana is more effective than oral THC. Smoked marijuana allows THC and other chemicals to be directly absorbed into the blood stream, whereas the liver filters ingested THC before it enters the circulatory system. In addition to being timelier, this filtering process converts THC into a more potent form of the drug and, therefore, causes negative side effects (http://www.marijuanamyths.com/med-myths.php3). Furthermore, it is not known whether THC is the sole contributor of marijuana relieving spasticity. The Institute of Medicine acknowledges that “until a non-smoked, rapid-onset cannabinoid drug delivery system becomes available…there is no clear alternative for people suffering from chronic conditions that might be relieved by smoking marijuana” (http://www.marihemp.com/marimed.html, pg. 13). Although there is a demand for extensive research of medical marijuana, current evidence supports its distribution for medical purposes.
Associated Health Risks When Using Medical Marijuana
The health concerns associated with medical marijuana relate to the same risks associated with smoking any type of tobacco. However, proof to legitimize these concerns has yet to surface. There is no evidence that chronic illnesses result from smoking marijuana. Medical reports have not linked marijuana to typical chronic diseases associated with smoking tobacco, such as lung cancer and emphysema (http://www.marijuanamyths.com/med-myths.php3). Another concern regarding the medicinal use of marijuana is the possibility that patients will develop dependence for THC. The risk of experiencing withdrawal symptoms, however, is possible for patients who rely on any chemical to maintain daily functioning and is not limited to marijuana use. The short-term risks associated with marijuana use consist of dysphoria, diminished psychomotor performance, restlessness, irritability, nausea, and cramping (http://www.marihemp.com/marimed.html). Compared with the side effects of other medicines prescribed to MS patients, however, these short-term risks are mild. The Institute of Medicine reported that “except for the harms associated with smoking, the adverse effects of marijuana use are within the range of effects tolerated for other medications… for certain patients, such as the terminally ill or those with debilitating symptoms, the long-term risks are not of great concern” (http://www.marihemp.com/marimed.html, pg. 11-12). Risks associated with the use of medical marijuana remain unclear and unsubstantiated.
Is Medical Marijuana the Solution to Treating MS Patients?
Medical marijuana is a justifiable treatment for spasticity in patients with MS. Interviews indicate that many patients choose marijuana over other medicines because they experience minimal side effects and rapid improvements in motor functioning (Grinspoon and Bakalar, pg. 67-80). One man details the positive results he experienced from using marijuana: “Most MS patients grow progressively weaker and more crippled; I have improved…This may seem insignificant to someone who has never been bedridden, crippled, and unable to move or speak, but to me it is a miracle…Compared to the steroids, tranquilizers, and sedatives usually prescribed for MS patients, marijuana is remarkably safe and benign” (Grinspoon and Bakalar, pg. 75). There is a lack of evidence for long-term risks associated with marijuana use. The short-term risks are minimal and short-lived. Studies verify the positive relationship between medical marijuana use and reduced spasticity. Voters are realizing the cruelty associated with robbing a terminally or chronically ill patient from the medicine that most relieves their pain. MS is a chronic disease that can lead to severe pain and disability if untreated. For these reasons, medical marijuana should be available to patients who understand the risks associated with its use. Until medical research develops an equally effective oral drug, marijuana will remain a reasonable option for patients suffering from MS.
Grinspoon, L., Bakalar, J. (1993). Marijuana, the Forbidden Medicine. New Haven: Yale University Press.
Sibley, William A. (1996). Therapeutic Claims in Multiple Sclerosis: A Guide to Treatments (4th ed.). New York: Demos Vermande.