Marijuana & MS: An interview with Dr. Robert Fox

This month, we sat down with Dr. John DeLuca and Dr. Robert Fox to discuss your questions about marijuana and MS, as part of our new Discussion of the Month feature. Read our interview with Dr. Fox of the Cleveland Clinic below. Our interview on marijuana and cognition with Dr. DeLuca can be found here.

Would you please briefly explain the research that you have conducted related to cannabis use for MS?

I am the managing director of the North American Research Committee on Multiple Sclerosis (NARCOMS). NARCOMS is a voluntary registry for research, treatment, and MS education that actively follows over 14,000 people living with MS. The main component of NARCOMS is a semiannual survey asking participants about their lives with MS, with occasional additional surveys. All NARCOMS surveys are confidential and some are anonymous. In one such recent survey we asked participants about their views and habits of marijuana use (including medical marijuana and medications derived from marijuana).

More than 5,600 of our NARCOMS participants responded to this special survey, conducted over the course of a month [August 2014]. Results indicated that 63% of respondents had tried marijuana at some point prior to their MS diagnosis, and 53% have thought about using it for MS. However, only 26% reported having used marijuana for their MS. And, less than half of those who have thought about using it for MS have spoken to their physician about it. Full results of this survey will be released in early 2015.

Do you have any advice for people who are considering using marijuana to manage their MS symptoms and not sure how to approach this topic with their doctors?

It isn’t uncommon for people to be reluctant to talk about private or personal issues regarding their healthcare. Topics that one generally keeps private — such as bladder, bowel or sexual difficulties — can be somewhat awkward to talk about with a physician. And I think marijuana can bring up similar feelings for some people. In many states marijuana is still illegal, and indeed under federal law marijuana is illegal, even though some state laws have legalized it in different fashions. I think altogether that does create a stigma around marijuana that can often make patients hesitant to bring it up with their physician. This reluctance can be overcome if the patient is just honest with his or her doctor about their interest in and perhaps concerns about the use of cannabis as a potential treatment for MS symptoms.

Is there any advice or cautions that you offer to people who may want to consider cannabis to treat symptoms of MS?

I think people who may consider cannabis for their MS symptoms should first talk to their physician about it. It’s important that their physician is aware of their interest, and can give them specific advice regarding the potential impact of cannabis on their health. That said, recently there has been some work to better understand the potential role of cannabis in treating MS. 

In April of this year, a panel of The American Academy of Neurology reviewed complementary and alternative medical treatments in MS. They found that oral cannabinoid therapies (either as pills or sprays) are effective in lessening patient-reported MS symptoms of spasticity (muscle stiffness from MS) and pain related to spasticity in MS. So there does appear to be good evidence supporting a benefit of cannabis on spasticity and pain from spasticity. On the other hand, there clearly can be cognitive effects of cannabis on people with MS. So, people need to recognize that while there may be some benefits of this line of treatment on some MS symptoms, it could impact cognition or thinking.

Of course, it is also important to recognize the local legality of cannabis whenever clinicians make recommendations to patients.

So, you mentioned pain and pain from spasticity – has it been studied in relation to other symptoms?

Yes, researchers looked at cannabis with tremor, and it was found not to be helpful. It has also been studied in slowing down MS disease progression, but that study was negative. So right now, we don’t have evidence to suggest that it slows down progressive MS. The only clear evidence we have to support a benefit in MS right now is patient-reported benefit on spasticity and pain from spasticity.

If someone were to consider using cannabis, should he or she still continue their other treatments?

Where appropriate, cannabis should only be considered a potential treatment for symptoms of MS. It should not be considered as a replacement treatment for disease modifying therapies of MS. We don’t have evidence that cannabis alters the underlying course of the disease. It should not be used instead of a disease modifying therapy that has been recommended by a patient’s physician.

Do we know anything about how cannabis may interact with other medications that people are taking?

There are a lot of things we don’t know about cannabis, which includes the long-term complications of cannabis with a particular focus on cognition, as well as its potential interactions with other medications that MS patients may be taking.

Is there an ideal dosage of marijuana that someone might take?

One of the challenges of smoked cannabis is regulating and standardizing the dose of cannabinoid that is delivered to a patient who takes it — and it is very hard to standardize that and to keep it consistent over a period of time, because of variation in the preparation of cannabis. The oral cannabinoid preparations have helped by standardizing the dose, but translating that to smoked marijuana is very difficult.

While we are on the topic of smoking, a lot of people are really concerned about the negative effects of smoking. Have there been any studies or information about the efficacy of other delivery systems?

Outside of the US there are some pharmacologic preparations of cannabinoids that do not involve smoking. I think it is reasonable to presume that they would be safer mechanisms of delivering cannabinoid therapies, since they don’t have the side effects of smoking. Smoking cannabis has the same potential risk as smoking tobacco. In fact, typical cannabis users will inhale more deeply and will hold the potential carcinogens (cancer-causing chemicals) in the lungs longer, which may further increase the safety risk with smoked cannabis.

How can people get involved in NARCOMS?

NARCOMS is open to any person with MS who is interested in participating in MS research. Visit www.narcoms.org for information. By participating in NARCOMS, patients can help contribute to research on their disease, all from the comfort of their own living room, kitchen, or wherever they happen to be. By completing surveys just twice a year — and occasional additional surveys — people with MS can help improve our overall understanding of MS. There are many ways that people can get involved in research, and this is perhaps one of the simplest.

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    21 Comments

  • marsha   Oct 31, 2014 7:00 PM
    I blog everywhere about the poor info that is written by who knows little. No one, who is a smoker of marijuana alone has gotten lung cancer. In many cases comprised immune system kills not only good cells but bad ones. When you smoke, one takes a few hits, sips and with the strength of the pot, no one holds it deep in their lungs, because one starts coughing. Try getting up to speed before reporting ignorant and old thought thinking.
    Like any vitamin, one checks to see if they are compatible with other meds. Eating grapefruit along with MS meds blocks the workings of the medicine. It takes time and trust to tell your spouse or doctor, friend or minister that you have a disease that causes incontinence. I was cured of my fear when I had accidents and yet, I survived. No one loved me less. It's a mind set to live well with progressive MS. If you want to try it; in any city it is available, legal or not. I believe my last 48 years of having a toke or more daily has eased the stress. That's what matters.
  • laurie   Nov 1, 2014 11:55 AM
    I need to see the proof. I know it is illegal for recreational use
  • Rakesh Kumar   Nov 1, 2014 2:18 PM
    I take Sativex, it helps me with my MS, nothing else helped. some people are jut not aware of the benifits of this natural plant. There is a lot of negative media in this.
    It is a ancient plant used in the past, from singers and artist and even holy people.
  • Michelle   Nov 1, 2014 2:34 PM
    I use cannabis everyday at night. I was dx 6 years ago it helps with pain I do have some cognition issues but during my last cognition test at my neuro I actually score higher. I read a lot and my job requires technical troubleshooting which keeps my brain active. Cannabis helps me more than any prescription I have taken. Just sayen.
  • Barbara Franklin   Nov 1, 2014 3:05 PM
    Thank you for touching on this topic. If MD's & FDA, don't study more about the use of marijuana we loose out. It's been around forever, yet due to it being illegal in the eyes of the Federal Government, folks cannot talk candidly with their MD's about it & MD's can't comfortably discuss marijuana with their patients, either because they have no information, or can't admit they do.
    I don't know why marijuana is illegal if it helps with ANY illness symptoms. It might reduce the need to continue using other meds for tremor, spasticity, pain & sleep. (Which would not please the pharmaceutical companies that produce them.) Clearly it helps with tremors, spasticity and pain from spasticity. I believe it also helps with sleep. It would be great if it could be available in pharmacies, so one doesn't have to guess about strengths, or feel like a criminal when trying to buy it.
    Right now marijuana is a huge racket. We pay for the fee's dealing with it & those funds could be spend on studying it. Where I live it is big business for folks across the border who smuggle it in, putting lots of people in danger. If it were legal there would be no need for smugglers, and the police agencies wouldn't be risking their lives trying to control it.
    We know the effects of too much alcohol, and that is damaging in many different ways, but that is legal over a certain age. Choices about alcohol, doses, strengths, are left up the individual. Why is this different for marijuana?
  • lis Maacks   Nov 1, 2014 3:05 PM
    I would so luv to try, this, i dnt think my neurologist would have a issue, with it, but my primary is against it, n bcause i take xanex which if i could stop i would, it is evil. But i have to take a urine test randomly, so cnt chance it,i also have spinal stenosis, disc protrusions , syrinx in my spine . with disc hernias, buldging. Torn. Every disc i n my back is SHOT except 1. Im a bleeping mess, n just dnt want to b in pain anymore. Also take loratab for pain. Which dulls the pain sometimes, but other than that, i just put one foot un front of the other
  • Beth Geiken   Nov 1, 2014 3:32 PM
    Any information will be greatly appreciated. Thank You
  • KELLIE UPRIGHT   Nov 1, 2014 11:03 PM
    I HAVE HAD REMITTING/RELAPSING MS FOR 20 YS AND BACK WHEN FIRST DIAGNOSED W/M.S I DID SMOKE IT,FOR ME IT DOES WORK IN MANY DIFFERENT WAYS BUT IM NOT ABLE TO SMOKE IN TX BECAUSE IM ON PAIN MANAGEMENT FOR A CAR ACCIDENT BREAKING MY HIP,KNEE,ANKLE,WRIST.SO WHAT TO DO TAKE A CLASS 2 PAIN PILL AND DRIVE OR JUST BE IN THE PAIN IM IN DUE TO SOMEONE WHO CLEARLY WAS NOT PAYING ATTENTION!IM A GENERALLY A HAPPY PERSON EVERYDAY AND THANKFUL TO BE ALIVE.I DEAL WITH SO MUCH PAIN THE ONE THING THAT COULD HELP WITH MY M.S PAIN I CAN NOT USE.ALMOST EVERYDAY MY BODY FROM M.S FELLS LIKE A CELL PHONE ON VIBRATE ON BAD DAYS PARTS OF MY BODY ARM,HAND,STOMACH ARE NUM DUE TO SMALL FLAIR UP OR STRESS,HEAT AND HUMIDITY.SO YES I WOULD.
  • Julie   Nov 2, 2014 1:23 AM
    I have smoked marijuana since I was diagnosed 27 years ago and find that it helps a lot of symptoms and I don't feel like my MS has had a lot of progression, not saying that pot has anything to do with that but I feel like I am doing well and hope to continue!!
  • Traci   Nov 2, 2014 7:44 AM
    I have never smoked pot once in my life, but being DX with MS over 17 years ago I am having such bad spasms at night I can barely sleep. I am constantly over medicating with muscle relaxer because the spasms don't stop until I take my meds. I asked my doctor and he okay'd it, but NJ only has 1 doctor who will prescribe it and you need to see him for 2 years!
    PS..I think Dr. Fox was my doctor in Phili before he went to Ohio!!
  • beth carter   Nov 2, 2014 7:58 AM
    The government won't allow the funds for research on cannibus because they know it has healing components. Not just with MS but some cancers as well. The government is profit conscious not people. The same as insurance companies not covering preventative measures but covering the "fix". There isn't much money to be made off of healthy ppl. It's disgusting & shameful. My mother's MS was extremely progressive & unrelenting. She suffered, truly suffered, for 20 years with 12 of those in a nursing home. She died at the age if 60. Way too young. Cannibus oil can change the course of many diseases if only it were researched more & made available. BTW as far cognition goes, my opinion is the lesions on the brain would be far more causative than the marijuana.
  • Sandra   Nov 2, 2014 9:07 PM
    I am also a NJ resident & have been approved for medical marijuana. There are definitely more than one Dr. in NJ who is licensed to prescribe & you need to see them for a year before you can be approved. I had been seeing a pain doctor for spinal stenosis for over a year. I initially met him when I was referred to him for my spinal tap to DX my MS. When the pain treatments didn't work I did some research about medical marijuana. While researching I discovered that my pain Dr. was liscensed to prescribe medical marijuana. My MS specialist, who is a neurologist, was totally in favor of my trying cannabis. I have to say it does help. It relieves my pain, relaxes me, eases my anxiety & depression in addition to helping me to sleep better. I use a vaporizer since that is the only available option in my state right now. NJ is still waiting for approval to manufacture pill form & produce food items. It is very confusing reading all the mixed information regarding this subject. We need more accurate information.
  • Marvin   Nov 3, 2014 12:23 PM
    I have been smoking weed for my ms and some the pain that I have has got better and my doctors tell that they can give a preception for it because it is still ill ligle in the state where i live I say man made booze and god made and who do you trust . ?
  • Tif  Nov 3, 2014 3:43 PM
    Hi Sandra,
    You can make the brownies, cookies, candies, cooking oils.....yourself. You can make the capsules also. Or, are the laws that individuals cannot make these things? If you have to buy from a dispensary, prices are generally high...
  • marsha   Nov 3, 2014 11:02 PM
    Happy to see many writings on the help pot gives. I live in San Francisco. Those of you who have neurologists who make you wait a year should change doctors. There is an underground everywhere. Seek and you will find. How dare a doctor or a state deny comfort. Write to your congress people, the newspapers. It's not easy to take on the pharmaceutical lobby. and that too is a problem. Be heard!
  • debiolson  Nov 5, 2014 9:29 AM
    I live in Florida where medical marijuana was on the ballet yesterday. We needed 60% and ended up with 57 or 58% depending on whose results you look at. I have been diagnosed with RR for 8 years now, followed by treatment for lung cancer via thoracotomy/bilobectomy and 4 rounds of chemo. I am against the use of Hydrocodone for pain relief, Xanax for nerves and to aide in the control of spasms/spasticity, Lunesta to battle insomnia, Provigil to help stay awake during the day, Prozac for depression..... I am sure there are others, but with the white spots on my brain, yunno. The ignorance of the few regarding the use of medical marijuana blows my mind. That one "weed", which is naturally grown, and a lot safer than alcohol and non-addictive, could replace ALL OF THE ABOVE!!! So what are we supposed to do when we can't get thru the day without the pain, the spasms, the lethargy, or thru the night being able to string together a couple of hours of sleep at once? The doctors have no problem KNOWINGLY passing out meds that are not only addictive but dangerous. They worry about it having an effect on our reaction time or our cognition? Seriously? What do they think all of the above are doing to us on a regular basis? If there are any doctors out there that can tell me that any of the scripts I am taking on a daily basis actually help my reaction time or my cognition, I would like to meet you and shake your hand. Then I would like to let you walk in my shoes for a day and tell me what you think about the possibility that there is something else out there that is safer and a lot more effective. Every doctor needs to treat every patient as though they are their parent, their sibling, their child...... would you want them to suffer the way that we do when there is a possible solution? If I have to spend the rest of my life in the pain that I endure on a daily basis, what is there to think about? And if you think it makes me dangerous behind the wheel of a car, that is just ridiculous, because when you are at this point, it's a rarity that you are able to drive. At least that is the case for me. Treat us like adults who have half a brain. If it's a child that you are dealing with, then allow that responsibly trained caregiver make the choices for that child until they are of an age that they can make the decisions for themselves. The whole thing is shameful. Absolutely shameful.
  • Wendy Behlen   Nov 6, 2014 10:58 PM
    I never used pot when I was young but learned of the benefits to people / MS, Cancer and Glocoma (sp) many many years ago from Time or Life magazine. the cover had a joint on it. As my condition worstened, medication increased along w/ my drug side effects. I then talked to all my doctors about pot. They ALL supported me trying it. I live in CA where it is legal. I really wish it was legal for everyone w/ MS. I have tried many forms. smoking, Cannabidiol CBD drops, gum, salve and paste. All but smoking is legal in 50 states. But honestly, the smoking is the fastest, cheapest and most effective for me. I'm on much less medication and have a better quality of life. POT helps w/ Pain, Spasticity, Promotes hunger, Calming, Relaxing, Sleeping, Improves mood and more. I used to think Pot was just another drug. Today I am so thankful for finding the many benefits and that all 4 of my doctors support my use.
  • Marge   Nov 10, 2014 4:55 PM
    I have been using cannabis to relieve the pain and spasticity in my legs from my MS. I only vaporize I do not smoke. Cannabis has been used for thousands of years as medicine. It is used in many other countries to treat Alzheimer's, cancer, symptoms of MS, Parkinson's, epileptic seizures and too many ailments to even list here. Unfortunately, the U.S. Is so far behind other countries in this research. All I can say is "follow the money", and do your own research. Put a simple search into google for cannabis & cancer and you will see what I mean. The United States is THE ONLY industrialized country that does not have a full Hemp industry. Hemp and marijuana are the same plant. (Cannabis) The only difference is that hemp refers to the whole plant except for the flowers on the plant which is where the psychoactive portions of the plant (THC) come from. Hemp is also an annual plant so it needs to be replanted every year. Hemp is used to make cars, biofuel, plastics, clothing, rope, paper and too many others things to even list. In 1941 Henry Ford built a car out of hemp which was stronger than steel, and he ran it on hemp oil. Hemp has natural components that deter insects, so it doesn't need pesticides. Marijuana is a Mexican slang term for the portion of the plant that people use to get high. The cannabis plant produces so many other cannabinoids that are not psychoactive and are used in medicine all over the world. It is the most amazing plant ever to grow on this earth, but as long as there are Steel, Oil, and pharmaceutical companies controlling the money in this country, we will never see a Hemp industry in the U.S.A. Do yourselves a favor and do your own research. Remember that most medical research is funded by Big Pharma. There is no way they want to see a plant like cannabis which is so easy and cheap to grow compete with their drugs. Go back into history and FOLLOW THE MONEY! Consider yourself forewarned, you WILL be angry.
  • Avatar
    TorontoMedPot  Nov 17, 2014 8:15 PM
    Hi, I'm a Cannabis Care Consultant working in Southern Ontario (Toronto), that helps people get their Medical Marijuana Prescription/License/Card and connects them with quality medical grade marijuana from a local, re*****ble dispensary. All services are completely legal, professional and confidential. Please contact me if you or someone you know is having difficulty getting their license or access to medical marijuana. Thanks.
  • Avatar
    garywithms  Jul 12, 2015 8:02 PM
    Almost every culture and popular governments in the Western World accepts cannabis as a natural medicine for ms, except one.
    My choices are move to a state to get the medicine I need, risking jail by staying here and medicating myself with cannabis or use the thirteen manmade chemicals that don’t work with side effects costing $6,000 to $7,000 a month. My doctors tell me there’s nothing more they can give me for my chronic nerve pain, muscle spasms, migraines, sleeplessness and all the other ailments from ms
    Last week JAMA (Journal of the American Medical Association) wrote an article titled “Medical Marijuana” saying marijuana is a medicine,
    “Use of marijuana for chronic pain, neuropathic pain, and spasticity due to multiple sclerosis is supported by high-quality evidence. Six trials that included 325 patients examined chronic pain, 6 trials that included 396 patients investigated neuropathic pain, and 12 trials that included 1600 patients focused on multiple sclerosis. Several of these trials had positive results, suggesting that marijuana or cannabinoids may be efficacious for these indications.”
    And concludes
    “Physicians should educate patients about medical marijuana to ensure that it is used appropriately and that patients will benefit from its use.”
    If natural medicine works I could possibly quit 5 or 6 medications, saving at least $1,000 a month. One out of approximately 450,000 people with ms, many of us disabled therefore on Medicare or Medicaid. If half are in the same position it’s $225,000,000 a month or $2,700,000,000 a year.
    What more does my government need for medical marijuana reform? Helping just one segment of the population and saving tax payers money.
  • Denise Hobbs   May 6, 2017 12:20 PM
    I have RPMS and I am looking into using CBD- and am wondering if there are any out there using CBD and if so how much do you take in drops or capsules each day?- is it"individual results vary" which I know but need to chat with someone who is taking CBD to find out where to start and if they have seen a difffernce in their spad\sticity.Thanks so much!
    ~denise