Multiple Sclerosis and Use of Medical Cannabis- a Retrospective Review Evaluating Symptom Outcomes

Background: MS is an immune mediated disorder which affects the central nervous system. The result of the demyelination that occurs is a wide array of symptoms that can be difficult to manage. There are limitations in the pharmacological management which commonly requires the use of copious medications. Many patients have reported using multiple complimentary therapies and polypharmacy to improve symptom management and enhance their quality of life. New York State approved the use of medical marijuana on July 5^th 2014; however the dispensaries in Western New York did not open until January 2016. One of the first diseases accepted into the program was multiple sclerosis, with the main original goal of targeting spasticity and pain. There has been increased acceptance of the use of medical cannabis (MC) and we have started to use it more in our practice. After initiating the therapy, clinically there have been some other perceived improvements that have also been reported.   MC is a newer therapy that had not yet been extensively researched. Because of the lack of larger clinical trials and the barriers to obtaining the medication, long term and real world data are not available.  There are some limitations to starting this alternative therapy. In our practice, the most reported barrier is the out-of-pocket cost. Currently the prescription is pharmacist managed with a board certified provider’s authorization which does have some limitations. Due to potential side effects, including both fatigue and mood alteration, the patient needs to be closely monitored. 

Objectives: The purpose of our study was to investigate the role of MC in improving spasticity and other potential symptomatology in patients diagnosed with MS.

Methods: This is a retrospective and ongoing chart review of approximately 160 patients diagnosed with MS who have utilized MC for symptom management. We used multiple scales to examine our patient reported outcomes, including MOCA, Becks Depression, Medical Pain and Zung Self-Rating Anxiety. 

Results: The data will be continually tabulated and presented with statistical analysis giving percentile improvements on all studied outcomes. Patient reported outcomes will be compared to baseline and statistical analysis will be performed and documented.  We specifically looked into response regarding pain, muscle spasms, fatigue, sleep difficulty, anxiety, restless legs, depression, headache, appetite and cognition. We took into consideration the different ratios and formulations of MC used by the patients.  Additional information regarding THC and CBD ratios are and ongoing and dynamic process. 

Conclusions: The use of medical cannabis for symptom management for patients diagnosed with MS is becoming more widely accepted. This study, although subjective, demonstrates patient reported benefits in all of the above measured metrics.  Additional studies can help confirm these results.