Monday, 6 June 2011

Street cannabis; what to do?

In response to an email query:

"My MS has slowly got worse re: pain, incontinence, sleep pattern and spasticity, and I find that the only way to control it to a certain extent is through smoking cannabis. I have tried various drugs that were kindly prescribed for me and I have been offered botox injections in my bladder to stem the flow. The drugs didn't work in the main, and I have had terrible headaches and nausea with some of them. As regards the botox injections, I am very apprehensive as I will have to learn how to catheterise myself, and these won't help with the bowel. It's got to the point where I am frightened to go out not knowing if I will be able to locate a toilet in time. Not only do I spend all of my spare cash on cannabis, but I can never be certain of the quality of the plant that I am buying from these very shady characters. You were kind enough to invite me a few years ago to a lecture that you gave on this subject, and in desperation I am asking if you can recommend a course of action. Is it possible to obtain cannabis legally, or can I grow a small amount in my home?" Anonymous

A response from a colleague with experience in the field: "I usually offer Nabilone to patients who anecdotally find cannabinoids helpful but quite properly want to stay legal and not be involved with criminals. An unlicensed indication of course, and the full 1mg (one capsule) oral dose is a bit strong for some, can be got around by pulling the capsule open and taking only a portion of the powder inside, once daily in evening but can increase to as much as 6mg daily. Advise extreme caution driving. Obtaining cannabis from countries were it is legal (The Netherlands) and home growing is not advised!"

"We can't recommend street cannabis. This is one of the reasons why the government would like a legal form available. Having Sativex licensed in the UK for spasticity has not helped as it is difficult to get the PCTs to cover the cost as it has not been reviewed by NICE. In my opinion the chances of it getting through NICE are non-existent without cost-effectiveness data, which at present does not exist. Do you think NICE would buy into the argument of preventing PwMS from taking chances by buying street cannabis with all the associated risks? Anybody else prepared to offer some advise; it would be much appreciated? Thanks."

1 comment:

  1. I've got SPMS, my first MS problem was in 1979 I was diagnosed about 15 years ago and it is still progressing gently. I read your comments with great interest. I have been doing ISC (Internittant Self Catheterisation) for a few years. When the behaviour of my bladder became an issue I shared your fears but was persuaded to try ISC and now I can go out and not be worried. I also take Tolterodene Tartrate to help control the bladder. Both of these treatments also help me to get a good night's sleep. The fear of not being able to get to the toilet used to cause me and my wife considerable anguish, now mainly a thing of the past. I also have spasticity plus all sorts of aches and pains in my muscles and joints of my left leg, I find that Gabapentin and Baclofen do a pretty good job at keeping these to an absolute minimum.

    Personally I'm not convinced that cannabis makes a big difference, might be because I am always worried about the potency plus it is not at all easy to get the dose consistent and correct. A few years ago I managed to get gold of some Sativex the little bit I had did not make me a convert.

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