Robby: Why is cannabis not being researched as a treatment for MS?
Dr Giles Elrington, Consultant Neurologist: Well, there have been some researches into cannabinoids in MS. I think we need to be clear that cannabis is a plant in a range of plants, cannabis plants, so people use them for making rope and I believe that doesn’t contain too much psychoactive ingredient, we’re not talking about that. We’re talking about the chemicals which change things in your body which are in cannabis plants and they’re called cannabinoids, in the same way as in the opium poppy you have opiates, of which there are many, they’re not all the same. There’s a range of opinion, I think, about which cannabinoids, if any, might be helpful for people with MS. There’s been research done that’s not sponsored by the pharma or drug industry, so I think quite unbiased research. Two big studies, one looking at spasticity with an oral cannabinoid and one looking at whether it changes the progression of progressive MS with an oral cannabinoid. The spasticity study, it showed possibly a modest benefit, but not much. And the progressive study was big fat negative.
Now, there are other studies sponsored by the drug, or pharma industry as they want to be called now, pH Pharma, and the problem is that any study sponsored by the industry may have a bias. For example, you’ve got the sort of BMW versus Mercedes study, sponsored by BMW, guess what the result’s going to be? You know, so if you have a study sponsored by a person who manufactures a drug, they may have a bias towards the drug, and so there’s a worry there. I think people who are into evidence based medicine will worry about industry sponsored trials. But the trouble is, that’s where all the data is. Now, the industry trials on the Sativex spray show some benefit in some MS symptoms, but the size of benefit has been thought insufficient to justify the really very high cost of the drug. And the difficulty is, I think, the data is out there, the cost is a bit on the high side, that’s where we are. It’s been said that the NHS has said no, why then would the company go and do more data.
Robby: Right. How much evidence is anecdotal and how much is researched?
Dr Giles Elrington: Okay, so there’s a lot of anecdotal evidence. There are many people using cannabis legally or illegally and who are saying that that helps their MS, and my patients tell me that, or some of them do. I suspect there are some who try it and don’t think they can tell me, which is a pity because I think people should be open with me. I think part of the difficulty is we know why cannabis is used recreationally and illegally, because it brings euphoria for some people. It does upset some people, some people get anxious and paranoid, it doesn’t suit everybody. But it makes some people abnormally happy and we like that, we want to be happy. Let’s say that I give you a legal cannabinoid for your MS and you feel great, is that because you’re high or is it because it helps your symptoms? That’s a really big problem in trying to decide.
The other difficulty is that people aren’t going to try cannabis or cannabinoids for MS unless they already think it’s likely to help, and that brings a bias, particularly if you come to me and I say sorry, can’t prescribe, and then you get upset and it makes you want it more. It stimulates demand if I say no and then people want it and of course it’s then going to work for them. If we go back to a less sort of naughty drug, you think about drugs like interferon in MS, I remember when they first came out about 20 years ago, patients were gagging for it and the government wouldn’t let them have it, and it stimulated demand. When you can have interferon for MS, actually it’s not a very strong drug and we don’t really want that any more, we want stronger drugs. So I think that part of the enthusiasm for cannabinoids in MS is generated by the NHS and by doctors saying no. As soon as you say you can have it, I don’t want it any more.
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