Use of cannabis-based products tied to severity of MS disability, pain | Online survey of patients in France, Spain

Cannabis-based products are more likely to be used by multiple sclerosis (MS) patients with higher levels of disability and pain than those with lesser disability or pain, according to a study of findings in Spain and France.

This “may encourage health authorities to consider relaxing the barriers to cannabis use for MS patients in need for relief from pain,” for which less evidence exists regarding the benefits of medical cannabis, its researchers wrote.

The study, “Symptom severity is a major determinant of cannabis-based products use among people with multiple sclerosis,” was published in the Journal of Clinical Nursing.

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Online survey of 641 MS patients to identify drivers of cannabinoid use

In recent years, researchers have been exploring the potential uses of cannabis-based medicines in MS and other diseases. Cannabinoids — chemical compounds in the cannabis plant with therapeutic effects — ­may help to ease certain symptoms of MS.

Sativex (nabiximols), an oral spray containing two cannabinoids, is approved in Canada and most of Europe for adult MS patients with moderate to severe spasticity, marked by muscle stiffness and involuntary spasms or twitches.

Other cannabis-based products also may help ease this symptom, but evidence as to whether medical cannabis can be used to alleviate pain is less compelling.

Despite its approval in both France and Spain, Sativex is not available in France due to failed price negotiations in the country. In Spain, it can only be dispensed at hospital pharmacies. The use of cannabis-based products for therapeutic and recreational purposes in both countries also varies according to local legislation.

Understanding which MS patients use cannabis-based products “constitutes a first step toward identifying persons most likely to benefit from them,” and broadening access to these patients, the scientists wrote.

Researchers in France conducted an online survey of cannabis use patterns by MS patients, along with an individual’s clinical and sociodemographic factors. The goal was to identify factors linked with the use of cannabis-based products.

The survey was made available to patients in France or Spain who were members of Carenity, a social network for people living with chronic diseases.

A total of 641 Carenity members reporting to have an MS diagnosis completed the survey, given between April and July 2019. Most were women (72.7%), with a mean age of 47.1, and the majority lived in France (69.7%).

Spasticity was experienced by 73.2% of the participants, and 54.5% reported moderate or substantial disability, as assessed with scores ranging from three to seven using a tool adapted from the Expanded Disability Status Scale (EDSS). Total disability, or scores from eight to 10, was reported by 16.8%.

Preference in Spain for Sativex and sprays, in France for oils or vaping

Differences were evident between patients in Spain or France. For example, those in Spain were significantly more likely to have relapsing-remitting multiple sclerosis (RRMS), more often did not know if they had spasticity, and had less severe disability scores.

Patients in Spain also had been diagnosed more recently, and at younger ages than those in France, and reported better health and lower pain levels.

Overall, 22.3% of all participants used cannabinoid-based products to alleviate their MS symptoms, and 70% of users did so daily. No differences were seen between participants in either country regarding cannabis-based product use and daily use.

Information about the type of cannabis products used was available for 143 people, 104 in Spain and 39 in France.

Spanish participants more commonly used Sativex, sprays, and edible formulations than those in France, while patients there showed a preference for vaping and oils. Dried herb or resin formulations also were in frequent use, with most patients in Spain (45.2%) favoring this form. In France, it followed oil as a favored formulation (46.1% reporting oils, 45.2% dried herb/resin).

To determine factors associated with use of cannabis products, the team analyzed patient characteristics.

After accounting for country of residence, the only factors that significantly associated use of these products were male sex, greater disability scores, and higher MS-related pain. In other words, people with greater disability and pain were more likely to favor such use than other MS patients.

Daily use of cannabis-based products was tied only to more severe disability.

“Despite the potential barriers to CBP [cannabis-based product] access, the prevalence of use we found here would suggest that patients use cannabis or CBP because they alleviate their symptoms, especially neurologic/walking impairments, and pain,” the researchers wrote.

“Our results add to the body of literature suggesting that cannabis and CBP use helps alleviate symptoms for patients with more severe MS,” they added. “However, in the context of France, none of this can happen before policy makers and law enforcers remove the legal barriers to cannabis and CBP use.”

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