Sativex has been all over the news recently in the UK - what is it and what is its link to cannabis and MS?

cannabis

The use of cannabis to treat certain medical conditions was legalised in the U.K. on 1st November 2018, and had previously already been legally available for medicinal purposes in many countries around the world, including Australia, New Zealand, Canada, certain states of the U.S.A., as well as many European countries. 

This was seen as a great success for those that had been advocating its potential benefits, and campaigning for many years to allow doctors to prescribe cannabis-based drugs for specific conditions.  These are namely in certain severe forms of epilepsy, and you guessed it – multiple sclerosis.

There have been anecdotal reports of symptom improvement in some and of miraculous recoveries for others, attributed to cannabis. But for many years there was little clinical evidence for usage, and the limited medicinal forms that were available were always felt not to be cost-effective. So the law remained unchanged.

This treatment “vacuum” left many pwMS having to look elsewhere for the medication that they felt helped them to live better with MS. This may have been in the form of CBD oil / balm / lozenges from a local health food store, or even for cannabis itself for other sources; sometimes risking criminal prosecution for possession of an illicit substance. In any form, it was technically either a food supplement or illegal drug, and therefore not subject to the strict regulations of medicines for therapeutic use.

Cannabis and MS symptoms

It is felt that 1 in 10 pwMS could benefit from the use of cannabis.  It is well known that in certain people the cannabinoid compound cannabidiol (CBD) can improve spasticity, reduce muscle spasms and help with MS-related pain symptoms.  

It is another well-known compound, tetrahydrocannabinol (THC), that has caused some of the problems with legalisation. THC is responsible for the narcotic effect of cannabis, or “the high”. This has links to mental health issues such as depression, anxiety and paranoia, and there have been concerns over its recreational use, especially in teenagers and young adults.   

That said, the vast majority of pwMS were using CBD, for genuine medical purposes, yet risking stigma and even a criminal record.  It is worth mentioning that all forms of cannabis will have varying concentrations of CBD and THC, but in most doses and forms, the CBD products have very low levels of THC and do not cause any significant side effects.

Cannabis-based medications

So legalisation in these circumstances can only be seen as a good thing. The problem has now become how to actually prescribe it for patients. Only certain specialists can actually issue a prescription anyway, but there has been widespread confusion and concern amongst the medical profession as how best to do this, which formulation, and how to monitor its ongoing use and effectiveness.

Now the U.K regulator NICE has approved two cannabis-related products, for use on the NHS in England, with the rest of the U.K. hopefully following suit. Epidyolex will be available for children with two rare and severe forms of epilepsy, and Sativex spray will be licensed for use in MS, specifically to treat spasticity, but NOT for the treatment of pain. At present it is felt there is insufficient evidence for Sativex’s cost-effectiveness in MS-related pain. 

What does this mean for people in the UK with MS? 

Whilst many MS charities, including OMS, welcome this news, it has been seen as somewhat of a missed opportunity to really help all those people with MS that might benefit from this treatment. There are also concerns that the funding for Sativex will come from local bodies, and some areas may simply not be able to offer the drug in an era of ever-increasing demands and over-stretched resources.

So in the U.K. at least, it is good news for those in need of publicly-funded, appropriately regulated cannabis -based products, but there is still perhaps some way left to go before it is readily available for all those who could really benefit from it.  

OMS will of course be watching for any further developments that can help our community to live well with MS.

Please note our advice on smoking


Glossary 

  • Cannabis - generic term refering to a group of three plants, known as Cannabis sativa, Cannabis indica, and Cannabis ruderalis. The dried flowers of these plants contain 120 components including THC and CBD. 
  • Medical cannabis - refers to cannabis and cannabinoids that are prescribed by physicians for their patients. 
  • Cannabis sativa / marijuana - a plant originating from Africa, Central America, Southeast Asia, and west Asia. It has high levels of THC and lower doses of CBD. 
  • Hemp - commonly used word for a strain of cannabis sativa. Hemp has many industrial uses including clothing, body care, food products, rope etc. Rich in CBD with trace amounts of THC. 
  • Cannabis indica - a plant native to Afghanistan, India, Pakistan, and Turkey. Indica strains often have higher levels of CBD and less THC.
  • Cannabinoid - Refers to every chemical substance, regardless of structure or origin, that joins the cannabinoid receptors of the body and brain and that have similar effects to those produced by the Cannabis Sativa plant.THC and CBD are the two most common cannabinoids. 
  • THC - tetrahydrocannabinol. The main psychoactive compound in cannabis sativa which is responsible for the 'high' (state of euphoria). This is the compound that has links to mental health issues. 
  • CBD - cannabidiol. A nonpsychoactive compound usually extracted from cannabis sativa and hemp plants that acts on certain parts of the brain. The mechanism of action for biological effects has yet to be determined. 
  • CBD oil - once extracted, CBD is diluted with a carrier such as olive or coconut oil. In the UK it has a maximum THC content of 0.2% and is available in health food shops and online.  Worth noting that the UK CBD oil industry is currently unregulated.
  • Other cannabinoids - CBN, CBG, CBGA and CBDA (small percentages) and all the terpenes inside.The other cannabinoids are included in what CBD products refer to as 'full spectrum'. 
  • Sativex - an oral spray containing both THC and CBD compounds. This is used to relieve the pain of muscle spasms in multiple sclerosis.

References:

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Lawrence R Graham (not verified)

I have lupus and MS and living in ohio cant get pain medication due to the overdose crisis here i use weed for the thc to deal with the pain it feels like at times my body is at war with itself there are days i cant walk very well because of the pain and i have a headache that never goes away im 2 yrs into this nitemare and its hell sometimes i need help im 51 yrs old