Cannabis and Cognition in Multiple Sclerosis

After 15 years, up to 50% of MS patients develop some cognitive decline despite good physical functioning. Cannabis use is increasing in MS patients to treat spasticity, pain, sleep, mood, incontinence, headaches, loss of appetite. Evidence is better for spasticity than the other symptoms. In fact, we are part of a new trial seeking FDA approval for spasticity of Sativex, an oral mucosal cannabis spray approved in Canada. Cannabis contains CBD and THC and there are no good studies supporting the use of CBD alone.

Cognitive impairment is the main risk of cannabis use. Is it reversible? A new study by Dr Anthony Feinstein, published in Brain 2019, concluded that it is. Researchers looked at 40 Canadian MS patients who were heavy users of cannabis, even for many years. None used it prior and most started it 2–3 years after their MS diagnosis. They had been using it to treat MS symptoms 4–5 times a day or more for an average of 7 years.

It’s known that cognitive impairment in healthy long-term users, provided they started as adults, is fully reversed after 28 days of abstinence. The same result was seen in the group of MS patients. Perhaps not unexpectedly, some patients, even recognizing that their cognitive function improved, commented that they would rather be using cannabis to feel better than to have their memory intact.

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