Illegal cannabis use is common among Danes with multiple sclerosis

      Highlights

      • Illegal cannabis use is common among Danes with multiple sclerosis.
      • Cannabis was used within the past year (current user) by 21%.
      • 21% of current users received prescribed cannabis-based medicine.
      • Current cannabis users reported high efficacy in relieving pain and spasticity.
      • Mild to moderate severity of adverse effects were reported by current users.

      Abstract

      Background

      Use of cannabis to alleviate multiple sclerosis (MS)-related symptoms is increasing. Due to strict regulations, only a minority of MS patients receive cannabis-based prescription drugs. The extent of recreational and medical cannabis use among Danes with MS is unknown. Our aim was to evaluate the prevalence of illegal and legal use of cannabis in MS patients, as well as reasons for use and perceived adverse effects.

      Methods

      An anonymous questionnaire was sent to all 3606 patients at the Danish Multiple Sclerosis Center, Rigshospitalet, University of Copenhagen. The questionnaire included questions about sociodemographic factors, clinical characteristics and medical or recreational cannabis use.

      Results

      Questionnaires were completed by 2244/3606 (62%), of which 2009 questionnaires from patients with MS or clinical isolated syndrome (CIS) were valid for analysis. Forty-nine percent (980/2009) had used cannabis at least once. Cannabis was used within the past year (current user) by 21%, and only 21% of those received prescribed cannabis-based medicine. Recreational use was reported by 17%. The primary reasons for use were to alleviate pain (61%), spasticity (52%) and sleep disturbances (46%). The most common adverse effects were drowsiness (30%), feeling quiet/subdued (23%) and dizziness (13%). Almost half (44%) of the non-cannabis users would consider use of cannabis to alleviate MS symptoms if the drug was legalized.

      Conclusion

      This study shows that illegal cannabis use is common among Danes with MS as only 21% of the current cannabis users received prescribed cannabis-based medicine. Current cannabis users reported high efficacy in relieving pain, spasticity and sleep disturbances. In addition, only mild to moderate severity of adverse effects were reported. To the best of our knowledge, this is the most comprehensive survey of cannabis use among MS patients.

      Keywords

      To read this article in full you will need to make a payment

      References

        • Andre C.M.
        • Hausman J.-F.
        • Guerriero G.
        Cannabis sativa: the plant of the thousand and one molecules.
        Front. Plant Sci. 2016; 7: 1-17
        • Andresen S.R.
        • Biering-Sørensen F.
        • Hagen E.M.
        • Nielsen J.F.
        • Bach F.W.
        • Finnerup N.B.
        Cannabis use in persons with traumatic spinal cord injury in Denmark.
        J. Rehabil. Med. 2017; 49: 152-160
        • Bramness J.G.
        • Dom G.
        • Gual A.
        • Mann K.
        • Wurst F.M.
        A survey on the medical use of cannabis in Europe: a position paper.
        Eur. Addict. Res. 2018; 24: 201-205
        • Chong M.S.
        • Wolff K.
        • Wise K.
        • Tanton C.
        • Winstock A.
        • Silber E.
        Cannabis use in patients with multiple sclerosis.
        Mult. Scler. J. 2006; 12: 646-651
        • Clark A.J.
        • Ware M.A.
        • Yazer E.
        • Lynch M.E.
        • Murray J.
        Patterns of cannabis use for multiple sclerosis.
        in: 2003 TIAFT Meet, Melbourne2003 (Aust. 2098–2100)
        • Hohol M.J.
        • Orav E.J.
        • Weiner H.L.
        Disease steps in multiple sclerosis: a simple approach to evaluate disease progression.
        Neurology. 1995;
        • Kindred J.H.
        • Li K.
        • Ketelhut N.B.
        • Proessl F.
        • Fling B.W.
        • Honce J.M.
        • Shaffer W.R.
        • Rudroff T.
        Cannabis use in people with Parkinson's disease and multiple sclerosis: a web-based investigation.
        Complement. Ther. Med. 2017; 33: 99-104
        • Koch-Henriksen N.
        • Magyari M.
        • Laursen B.
        Registers of multiple sclerosis in Denmark.
        Acta Neurol. Scand. 2015; 132: 4-10
        • Krupp L.B.
        • Larocca N.G.
        • Muir Nash J.
        • Steinberg A.D.
        The fatigue severity scale: application to patients with multiple sclerosis and systemic lupus erythematosus.
        Arch. Neurol. 1989;
        • Kurtzke J.F.
        Rating neurologic impairment in multiple sclerosis: an expanded disability status scale (EDSS).
        Neurology. 1983;
        • Weinkle L.J.
        • Shelton I.
        • Sillau S.H.
        • Domen C.
        • Nair K.V.
        • Alvarez E.
        Exploring cannabis use by patients with multiple sclerosis in a state where cannabis is legal.
        Neurology. 2018; 90: 383-390
        • Learmonth Y.C.
        • Motl R.W.
        • Sandroff B.M.
        • Pula J.H.
        • Cadavid D.
        Validation of patient determined disease steps (PDDS) scale scores in persons with multiple sclerosis.
        BMC Neurol. 2013; : 13
        • Lintzeris N.
        • Driels J.
        • Elias N.
        • Arnold J.C.
        • McGregor I.S.
        • Allsop D.J.
        Medicinal cannabis in Australia, 2016: the cannabis as medicine survey (CAMS-16).
        Med. J. Aust. 2018; 209: 211-216
        • Martínez-Rodríguez J.E.
        • Munteis E.
        • Carreño M.
        • Blanco Y.
        • Roquer J.
        • Abanades S.
        • Graus F.
        • Saiz A.
        Cannabis use in Spanish patients with multiple sclerosis: fulfilment of patients’ expectations?.
        J. Neurol. Sci. 2008; 273: 103-107
        • Page S.A.
        • Verhoef M.J.
        • Stebbins R.A.
        • Metz L.M.
        • Levy J.C.
        Cannabis use as described by people with multiple sclerosis.
        Can. J. Neurol. Sci. 2003; 30: 201-205
        • Russo E.B.
        Taming THC: potential cannabis synergy and phytocannabinoid-terpenoid entourage effects.
        Br. J. Pharmacol. 2011; 163: 1344-1364
        • Sexton M.
        • Cuttler C.
        • Finnell J.S.
        • Mischley L.K.
        A cross-sectional survey of medical cannabis users: patterns of use and perceived efficacy.
        Cannabis Cannabinoid Res. 2016; 1: 131-138
      1. The Danish Health and Medicine Authority - The drug situation in Denmark2018, https://www.sst.dk/da/udgivelser/2018/∼/media/C10D68C52DCE48ABA7E517D29FEE792A.ashx[WWW Document], n.d.

      2. The Danish Health Authority - https://www.sst.dk/en/health-and-lifestyle/alcohol[WWW Document], n.d.

        • Torres-Moreno M.C.
        • Papaseit E.
        • Torrens M.
        • Farré M.
        Assessment of efficacy and tolerability of medicinal cannabinoids in patients with multiple sclerosis.
        JAMA Netw. Open. 2018; 1e183485
        • Ullrich O.
        • Merker K.
        • Timm J.
        • Tauber S.
        Immune control by endocannabinoids - new mechanisms of neuroprotection?.
        J. Neuroimmunol. 2007; 184: 127-135
        • Ware M.A.
        • Adams H.
        • Guy G.W.
        The medicinal use of cannabis in the UK: results of a nationwide survey.
        Int. J. Clin. Pract. 2005; 59: 291-295