Where Do Medical Marijuana and Multiple Sclerosis (MS) Intersect?
According to the National MS Society, nearly one million people in the U.S. live with multiple sclerosis (MS). This condition leads to symptoms that significantly disrupt everyday life.
Although there isn’t a cure for MS, it is considered a qualifying condition under Pennsylvania’s medical marijuana program. That means patients can obtain a medical marijuana ID card to access products that may help them manage their symptoms related to MS.
Below, you’ll learn about the science on medical marijuana and MS from our dispensary pharmacists, how to consume medical marijuana to potentially make symptoms more manageable, and how to obtain a medical marijuana card for MS in Pennsylvania.
What is multiple sclerosis (MS)?
Multiple sclerosis (MS) is a condition in which autoreactive T-cells (a component of the immune system) target the protein comprising the myelin sheath around nerve cells. The myelin sheath thus breaks down, similar to if the insulation around electrical wires were to degrade. Without this “insulation,” nerve cells “short” as the nervous system incorrectly transmits information.
Common symptoms of this myelin sheath breakdown include but aren’t limited to numbness, tingling, muscle spasticity and stiffness, fatigue, pain, sleep disruptions, and mood changes. Many patients find that medical marijuana helps manage these symptoms.
The science on MS and medical marijuana
The National Multiple Sclerosis society notes that some randomized controlled trials have shown medical marijuana to be effective for managing MS-related muscle spasticity. Indeed, in a clinical trial conducted in 2012, people with MS who consumed medical marijuana via inhalation experienced less discomfort from muscle spasticity than those in a placebo group.
Another study from 2012 uncovered that medical marijuana may also help lessen muscle stiffness. And, in 2014, a review of clinical trials suggested medical marijuana could have the potential to help with all manner of MS-related muscular symptoms.
The results of these studies taken together suggest that although pharmaceutical prescriptions may help manage these symptoms, they don’t have to be the only part of your treatment plan if you live with MS.
“Traditional treatment approaches often address symptoms with standard pharmaceuticals,” said Dr. Christy Ottavio, pharmacist at Vytal Options’ Kennett Square location. “In certain situations, [medical marijuana] may be considered as an adjunct option to help manage symptoms while potentially minimizing some medication-related side effects.”
Dr. Ottavio noted that, despite patients with MS often having positive experiences with medical marijuana, more research is needed to fully understand how medical marijuana affects MS patients. For now, anecdotal evidence from consumers remains an important supplement to empirical evidence.
“Because medical [marijuana] therapy is often highly individualized, observational and real-world patient data can provide valuable insights,” Dr. Ottavio said. “Improving how we capture patient-reported outcomes, such as symptom relief and side effects, could help strengthen our understanding of how medical cannabis works in practice. While randomized controlled trials remain the gold standard, observational data may help fill important gaps in the current evidence base.”
Anecdotal evidence from consumers hints at where empirical research may go from here. According to Dr. Kevin Shea, pharmacy manager and pharmacist at Vytal Options’ Fogelsville dispensary, consumers often report favoring full-spectrum medical marijuana products that contain the full array of cannabinoids and terpenes found in the plant.
“Patients often find that medical marijuana products that are considered full-spectrum, containing many of the components of the plant instead of isolated molecules, tend to give more robust medicinal effects. That’s the entourage effect,” Dr. Shea said. “Instead of [THC or CBD] isolates, we should research more full-spectrum products. I think we’d find great overall symptom relief.”
How can patients with MS get a medical marijuana card?
If you are living with MS, you can work with a physician to get certified for the Pennsylvania Medical Marijuana Program and obtain your ID card. Here’s how the process works:
- Register with the state. Create an account on the Pennsylvania Medical Marijuana Registry at the Department of Health website. You’ll need a valid Pennsylvania driver’s license or PennDOT-issued state ID with your current address and a working email. Make sure your name and address match your ID exactly since mismatches can delay your card.
- Get certified by an approved physician. All patients in the program must obtain a certification from an approved practitioner confirming their qualifying condition. This can be your primary care doctor or neurologist if they’re registered with the program, or you can see a medical marijuana physician. Pennsylvania permits telehealth evaluations, so you can complete this consultation via secure video from home.
- Pay the $50 state fee. After obtaining your physician’s certification, return to the Medical Marijuana Registry and pay $50 for your medical marijuana ID card.
- Receive your card and visit a dispensary. A physical card will be mailed to you. Once you have it, you can purchase medical marijuana from any licensed dispensary in the state. The card is valid for one year, and you’ll need to renew annually with a new physician certification and fee payment.
You can start the process at the Pennsylvania Department of Health’s registration page.
Dr. Shea said that you may need proof of your diagnosis, and after providing it, you’ll discuss medical marijuana with your physician to make sure it’s safe for you. “The doctor will then give the certification and approval of the card, [which] will come in the mail. That’s where the real work happens. The patient gets the card, they come into the dispensary, and they have a sitdown consultation with the pharmacist.”
Medical marijuana products that may help people with MS
Drs. Shea and Ottavio said that, in some cases, products containing cannabidiol (CBD) or cannabinol (CBN) may be preferred for MS symptom management. In other cases, Drs. Shea and Ottavio said that products rich in tetrahydrocannabinol (THC) may produce different and more potent relief.
When high-CBD (low-THC products) are best
Dr. Shea said that, more often than not, medical marijuana products higher in CBD than THC are best for patients with MS.
“I think a common misconception is [that] high-potency THC products are going to help, whereas [a] more individualized, nuanced low-and-slow approach is more advisable,” he said.
When THC-rich products are best
For some patients who struggle with sleep, THC-dominant products may be beneficial.
“If sleep is the patient’s primary concern, I often recommend a THC-rich product in the evening,” Dr. Ottavio said. “For daytime symptoms, I generally start with a balanced approach of THC and CBD, or a CBD-rich product [if appropriate], and then we adjust that to the patient’s response for efficacy, safety, and tolerance.”
Common product types for managing MS
A combination of inhalable, ingestible, and topical medical marijuana products is often recommended for MS patients.
- Inhalable products offer the fastest onset of effects, potentially making them especially well-suited for patients with debilitating symptoms.
- Ingestible products may be especially powerful for potential long-term or overnight relief since the duration of effects is extended compared to inhaled products.
- Topicals are applied directly on the skin at points of muscle and nerve pain, potentially lessening symptoms for four to six hours.
Specific product recommendations
For patients new to medical marijuana, Dr. Shea said, “I think the Wonder Relax troches are a good daytime option. They contain 5 milligrams of THC and 10 milligrams of CBD per ‘gummy.’ They are great because patients sensitive to THC could take a quarter of a troche and start as low as approximately 1 mg of THC per dose.”
Dr. Shea also recommended Wonder Sleep troches as “an option that contains an additional ingredient, CBN, which is linked to increased sedation. Or Good News Berry troches, which is a simple, THC-based product perfect for those wanting to narrow down effects to one ingredient at a time and slowly and methodically find favorable effects.”
Dr. Shea also recommended the Harlequin Cresco liquid live resin vape cart. He said that it is ideal for “patients who are looking for the potential for in-the-moment relief of spasticity, pain, anxiety, or other symptoms that require quick-acting effects rather than controlling symptoms.”
Tips for managing MS symptoms with medical marijuana
Drs. Shea and Ottavio suggested starting low and going slow, being consistent, and asking your pharmacist and doctor about potential medication interactions between medical marijuana and prescription drugs.
Starting low and going slow
Dr. Shea noted that, although patients often get excited and want to start with a high dose of THC, that’s usually not ideal.
“When starting out, it’s a good idea to get a handle on how you respond to the medication by increasing the doses little by little,” he said. “Some patients with MS who suffer with chronic spasticity and muscle tension may require immediate relief and be less inclined to take their time with dose escalation. The patients who move too quickly tend to have a rockier road, experiencing less relief and more side effects and unwanted psychoactivity. Going slowly can be frustrating, since it may take longer to find effective doses, but it helps to prevent side effects and make those dose changes easily trackable and more effective.”
Staying consistent
Establishing a regular consumption schedule is important when incorporating medical marijuana into your routine.
“Taking [medical marijuana] more consistently, like around-the-clock dosing, may help to more effectively control symptoms. This works a lot better than sporadically taking doses,” Dr. Shea said.
Checking for medication interactions and other medical concerns
Although medical marijuana may have interactions with some pharmaceutical medications, it’s rare for this to happen with medications prescribed for MS.
“It’s a case by case situation, but for the most part, the common medications, even the disease-modifying agents, don’t typically interact with [medical marijuana],” Dr. Ottavio said.
Dr. Shea said that even when medication interactions aren’t in the picture, it’s worth asking about other medical concerns.
“Some patients may be advised to avoid products that can cause impairment. This could be due to a history of weakness, imbalance, or another diagnosis entirely,” he said. “Other patients may want to avoid feeling ‘high’ or loopy due to personal beliefs or previous history. We try to meet the patients where they are coming from.”
A medical marijuana pharmacist can help you decide.
Get support for medical marijuana as an MS treatment
With a Pennsylvania medical marijuana card and support from licensed medical marijuana pharmacists, you may feel better on an everyday basis if MS is causing you daily challenges. In his time at Vytal Options, Dr. Shea has observed exactly this.
“I’ve seen my patients experience pain relief and sleep improvement, especially with attentiveness to their medication doses and the reactions they have to those medications,” he said.
Book a consultation with Vytal Options, and this could be you too.
