Use of cannabis in patients with multiple sclerosis from Argentina

Highlights

• Cannabis use is frequent in PwMS from Argentina.

• Cannabis was used within the past year (current user) by 34.2%.

• Daily cannabis use was reported in 31.3% and 41.9% started their use after MS diagnosis.

• 54.3% of PwMS had never discussed about cannabis use with their neurologist.

• Younger age, chronic pain and current alcohol intake were predictors of current cannabis use.

Abstract

Background

The use of cannabis to treat some symptoms of neurological diseases, including multiple sclerosis (MS), has increased worldwide. We aimed to assess the use of cannabis in patients with MS (PwMS) from Argentina, its reasons and patients’ perceptions on the management of MS symptoms. Additionally, we assessed their association with socio-demographic and clinical aspects.

Methods

A cross-sectional online survey that included 281 PwMS from Argentina was conducted. Screening instruments: Demographics and clinical data, health-related QoL (MS Impact Scale-29), Fatigue Severity Scale, The Hospital Anxiety and Depression Scale, sleep disorders, physical disability (self-administrated Expanded Disability Status Scale) and medical or recreational cannabis use were evaluated. A logistic regression model was carried out.

Results

Current users (cannabis was used within the past year) was reported in 34.2% and former users (had tried cannabis but not used it within the past year) in 22.7%. Daily cannabis use was reported in 31.3% (current + former users) of the studied cohort, 41.9% started their use after MS diagnosis and 54.3% of them had never discussed about cannabis use with their neurologist. Recreational use was reported in 47.5%. Younger (age below 30 years) PwMS (OR = 2.39, p = 0.03), presence of chronic pain (OR = 2.42, p = 0.002) and current alcohol intake (OR = 3.33, p = 0.001) were predictors of current cannabis use in our multivariate model.

Conclusion

A high prevalence of use of cannabis in PwMS from Argentina was observed. Demographic, symptoms and lifestyle factors predict cannabis use. Identifying the presence and severity of these conditions would contribute to a better MS management and treatment.

Introduction

More than 100 cannabinoids contained in the cannabis plant have been reported, including cannabis sativa (Atakan, 2012). However, delta-9-tetrahydrocannabinol (THC) and cannabidiol (CBD) are the best-known. Cannabis and its component cannabinoids exert their effects mainly via the endogenous cannabinoid system. The cannabinoid receptors of the endogenous cannabinoid system are found across the body, particularly within the central nervous system (CNS) and immune system (Ullrich et al., 2007). The G-protein coupled receptors for THC are called cannabinoid receptors of type 1 (CB1) and 2 (CB2) and play critical functions in neurodegenerative and neuroinflammatory conditions. CB1 receptors are primarily located in the CNS (psychoactive effects are principally mediated by agonist effects at this receptor), whereas CB2 receptors are typically located in the periphery in immune cells, but also found in some neurons (Ullrich et al., 2007). Exogenous cannabinoids include compounds extracted from herbal cannabis (phytocannabinoids), such as THC and CBD as well as synthetic cannabinoids. Thus, THC has mainly a psychotropic effect (partial agonist at both CB1 and CB2 receptors), as opposed to CBD (non-psychotropic effect due to an allosteric negative modulator at both CB1 and CB2 receptors) (Andre et al., 2016). In this line, cannabis might be a natural treatment for managing inflammatory and degenerative disorders of the CNS because of the high density of cannabinoid receptors in that region (Ullrich et al., 2007).

Although recreational use of cannabis (marijuana) is illegal in Argentina, in November 2020 a law was passed legalizing cannabis in some forms for medicinal purposes (Boletín Oficial de la República, 2020). In the last decades, the use of cannabis to treat some symptoms of neurological diseases, including multiple sclerosis (MS), has increased worldwide. In this regard, there is an increasing body of evidence supporting the idea that cannabis may improve some symptoms, such as sleep disorders, neuropathic pain and spasticity (among others), which are common manifestations in patients with MS (PwMS) and all of which impact adversely on health-related quality of life (QoL) (Olsen, 2009; Yadav et al., 2014). PwMS are often looking for alternative treatment options for a better management of their symptoms, such as herbal supplements, complementary medicine and cannabis, among others (Olsen, 2009; Yadav et al., 2014).

The frequency and factors associated with the use of cannabis to treat symptoms of MS have not been extensively investigated in Latin America population, including Argentina. Therefore, we aimed to assess the use of cannabis in PwMS from Argentina, its reasons and patients’ perceptions on MS symptoms control. Additionally, we assessed their association with socio-demographic and clinical features in order to better understand the reasons for its use.