b'long-term safety of cannabis products is largely and Medicine determined that there wasunknown. Use of medical marijuana could signicant evidence supporting the ecacy ofinteract with other prescription or non- cannabis treatment for improving MS spasticityprescription medications, and the use of any symptoms. cannabis-containing products should always In the U.S., there are three FDA-approvedbe discussed with a physician.cannabis-relateddrugproductsandoneUse in MS cannabis-derived product, none of which haveThere are currently no generally accepted an approved indication for use in MS. Epidiolexguidelines or FDA approved cannabis med- is the most recently approved medication, andications for use in MS, but there have been is a puried CBD substance used for seizures.several evidence-based reports of medical The other three approved medications includecannabisthatincludedoutcomesforMS dronabinolornabilone,syntheticTHCsymptoms, focusing on spasticity and pain. compounds, and are used for improvingSpasticity is one of the most common symptoms appetite in people with AIDS and for chemo-of MS, and is dened by a sudden stiening therapy-induced nausea and vomiting. Theof muscles, causing heaviness, involuntary complex legal status of cannabis in the U.S.movements, or temporary immobility. Evidence has signicantly limited its use in clinical trials.has not shown benefit in treating bladder- Though not currently approved for use inrelated symptoms or tremor in MS patients. the U.S., Sativex (nabiximols) is a combinationIn 2014, the American Academy of Neurology of THC and CBD medication that is manufacturedpublished a guideline for use of complementary in the form of a mouth spray. Sativex is approvedand alternative medicine options, which included in Canada, New Zealand, and a variety ofthe conclusion that oral cannabis extract and European countries for treatment of spasticitysynthetic THC compounds are probably eective caused by MS. There are currently severalfor reducing patient-reported symptoms of large ongoing studies at sites in Europe intospasticity and pain in MS. More recently, a 2017 the potential ecacy of dronabinol for MSreview of the therapeutic cannabis uses by the spasticity not controlled by rst-line treatmentNational Academies of Sciences, Engineering, options.FDA Approved Cannabis-Related ProductsEpidiolex Puried form of CBD * Treatment of seizures associated with Lennox-Gastaut(cannabidiol) or Dravet syndromeMarinol Synthetic THC * Anorexia associated with weight loss in AIDS patients(dronabinol) * Chemotherapy induced nausea/vomiting that did notSyndros respond to traditional antiemetics(dronabinol)Cesamet Synthetically-derived* Chemotherapy induced nausea/vomiting that did not(nabilone) component similar respond to traditional antiemeticto THCIn summary, there is evidence to support the use of medical marijuana in the treatment ofpain and spasticity in MS. Further research is needed into the use of medical marijuanaandhemp-derived cannabinoidsto establish ecacy, appropriate dosing, and contraindications.57 msfocusmagazine.org'