Richard E. Musty, PhD

The Second National Clinical Conference on Cannabis Therapeutics

Analgesia and Other Indications

Sponsors: Patients Out of Time; Oregon Department of Human Services, Health Services; Oregon Nurses Association; Mothers Against Misuse and Abuse (MAMA); Portland Community College; The Institute for Health Professionals

May 2, 3, 4, 2002 - Portland, Oregon

Session: The Effect of Cannabis and Cannabinoids on Spasticity and Pain

Presenter: Richard Musty, PhD, Department of Psychology, University of Vermont, Burlington

Cannabinoid Effects in Patients With Multiple Sclerosis and Spinal Cord Injury: A Review

MS studies:

Researchers Petro et al., in 1981 ran a double blind, placebo controlled study on 9 patients using 5 and 10 mg Oral THC, finding the reduction in spasticity significant.

Researcher Clifford, ran a 9 patient study in 1983 using 5-15 mg doses of Oral THC, and found 5 improved subjective symptoms.

Researchers Ungerleider et al., in 1987 tested 9 patients in a double blind, placebo controlled study using Oral THC doses of 2.5 mg 1-2/day, finding significant improvement at 7.5 mg.

Researchers Meinck et al., ran an open trial in 1989 on 1 patient with Smoked Cannabis, finding improvement in tremor, spasticity, and ataxia.

Researchers Greenberg et al., in 1995 had a double blind, placebo controlled study of 10 MS/ 10 normal patients, using Smoked Cannabis, and found impaired posture and balance.

Researchers Grinspoon et al., in 1993, Researchers Davies and Doyle in 1992, Researchers Ferriman, Handscome, Hodges, and James in 1993 ran studies involving MS Case Reports of 10 patients using either Smoked or Oral Cannabis, and found improved walking, balance, and appetite.

Researchers Martyn et al., in 1995, ran a double blind, placebo controlled study on 1 patient using Oral Nabilone, and found improvement in spasticity, and noturia.

Researchers Consroe et al., in 1997, surveyed 108 patients that used Smoked Cannabis, and found that it improved spasticity and balance.

Researcher Vaney, in 2001, ran a double blind crossover, placebo controlled study using Oral Plant extract in capsule, and found reduced spasms.

MS Conclusions

• From the studies reviewed above, it is clear that cannabis and related cannabinoids reduce symptoms of MS.
• Further double blind, placebo-controlled studies are warranted.

Spinal cord Injury and Movement Disorders:

Researchers Dunn et al., ran a study in 1974 of 10 patients using Smoked Cannabis, and found 5/8 reduced spasticity, and 4/8 reduced phantom pain.

Researcher Petro, in 1980, ran a study on 1 MS patient, and 1 Spinal Cord patient using Smoked Cannabis, and found reduced spasms and pain.

Researchers Malec et al., in 1980, surveyed 25 patients using Smoked Cannabis, and found 21/24 reported reduced spasticity.

Researchers Consroe et al., in 1986, studied 5 patients with mixed dystonias using Oral CBD of 100-600 mg for 6 weeks, and found 25-50% reduction of dystonias, and increase of tremor for 2 patients.

Researchers Maurer et al., in 1990, in a double blind, placebo controlled study of 1 patient using Oral THC of 5 mg or codeine 50 mg, and found THC equals codeine for pain, and that the THC is better for spasticity.

Researchers Grinspoon et al., in 1997, studied 2 patients with paraplegia, and 1 with dystonia using Smoked Cannabis, and found a reduction of spasms, dytonic symptoms, and pain.

Researchers Consroe et al., surveyed 108 patients with spinal cord injury using Smoked Cannabis, and found a reduction of spasms and pain.

Researcher Imler, in 1998, studied several patients with quadriplegia using Smoked Cannabis and found a reduction in spasms and pain.

Researchers Sandyk et al., in 1988, studied 3 patients with Tourette Syndrome using Smoked Cannabis, and found a reduction of motor tics.

Researchers Muller-Vahl, et al., in 2001, ran a retrospective survey of 17 patients using Smoked Cannabis, and found 82% reported a reduction to remission of motor and vocal tics.

Researchers Muller-Vahl, et al., in 2001, ran a double blind crossover, placebo controlled study of 13 Tourette Syndrome patients using Oral THC titrated to 10 mg, and found significant decrease in tics compared to placebo.

Urinary/Bladder Problems:

Researchers Grinspoon et al, in 1990, studied 4 MS patients with bladder control problems using Smoked Cannabis, and found improved bladder control.

Researchers Consroe et al., in 1999, surveyed 108 MS patients using Smoked Cannabis, and found improved bladder control.

Researchers Consroe et al., in 1998 surveyed 106 spinal cord injury patients using smoked cannabis, and found improved bladder control.

Researcher Hagenbach, in 2001, studied 2 separate groups of 6 patients with spinal cord injury using Oral Marinol and THC-H suppository, and found Marinol increased Bladder Compliance (CPL) 65%, and THC-H increased CPL 53%.

Mechanisms of Action in Dystonias

• Consroe, Musty et al., (1986) tested mutant rats with Dystonias and Torticollus.
• CBD reduced dystonic behaviors and torticollus in a dose dependant manner.
• These data show that CBD has a true pharmacological action on movement disorders.
• Cannabidiol behaves as an antagonist acting in the micromolar range (Petitet et al., 1998).

Mechanism of Action of THC and CB1 agonists in MS

• Baker et al. (2000) tested spasticity and tremor in the MS model Biozzi ABH mice.
• CB1 receptor agonists, JWH 133, WIN 55,212,^9-THC and methanadamide blocked spasticity and tremor.
• The specific CB1 inverse agonist, SR141716, reversed the effects of these agonists. Given alone SR, exacerbated these symptoms.
• These data confirm:
  • Cannabinoid agonists reduce clinical signs of MS and Spinal Cord Injury and an antagonist reduces dystonic symptoms.
  • These data support both surveys of cannabis users and clinical studies, in humans, reported here.

Acknowledgements

• The Open Society Institute for an Individual Project Fellowship.
• Colleagues and Students:
  • Paul Consroe, Ph.D. University of Arizona
  • Richard Deyo, Ph.D. Winona State University
  • Rita Rossi, M.A. University of Vermont

Endnote

• References and forthcoming publications are available from author.
• Please e-mail Richard.Musty@uvm.edu
• Or write to Richard E. Musty, Department of Psychology, University of Vermont, Burlington, VT 05405.