Today the UK have announced that they plan to legalise cannabis for medical use and so join the Republic of Ireland, Germany, The Netherlands and Israel.
Therefore, a new treatment option for symptom control and probably progressive MS (yes a neuroprotective) may be coming your way.
Twenty years ago, we (MD1 & MD2) provided the first scientific evidence that the endocannabinoid system controls spasticity. We demonstrated that THC within Cannabis and the CB1 cannabinoid receptor, were the major mechanisms of activity by looking at mice with spasticity.
We (MD1, MD2 and ProfG) also showed that by blocking the over-excitation of nerves that control symptoms, it saved nerves and so could potentially affect the disease course. Therefore ,I believe that cannabis has neuroprotective potential to control progressive MS. However, I have no definative proof that this occurs in humans.
I thought we may never get to the bottom of this, but todays news may change this.
Our researcher colleagues also suggested that cannabis was a immune regulator to control relapsing disease. Personally we think this is a load of old tosh, which we have not seen unless the animals are so unrealistically "out of it". It has not being demonstrated by the clinical reality. But as our lone-decenting voice of reason that it does not do everything has been lost in all the hype. Cannabis is viewed as the "Aspirin of the twenty first Centuary".
However, sadly neuros did their best to ensure that our seminal data on symptom control and neuroprotection was ignored as their clinical trials, failed, failed and failed.
However, GW pharma, who got a licence to grow medical cannabis in the UK in 1998 kept on going and eventually they got a trial design that could show something positive. The approval for a cannabis extract to be used to treat spasticity and neuropathic pain occurred in 2010.
Therefore our ideas translated into human benefit.
This medicine is an alchoholic spray. However, it can be unpleasant becuase the alcohol can "burn" (fix) the skin in the mouth. Much of the spray under the tongue is swallowed and gets metabolised before it goes round the body. Importantly the dose is limited so you avoid getting high. However, if you avoid this, you are getting a suboptimal dose.
Some people may favour a smoke. This heats the cannabis converting the THC acids into THC, it gets in the lungs and into the brain pretty quickly allowing dose control.
However, the big problem for the pharmaceutical variant of cannabis, is the cost. They charged too much!
NICE said that the medical pharmaceutical variant was not cost-effective, so NHS England has not allowed it to be used.
In North America the FDA has been holding out until efficacy is shown on the Ashworth scale, which most anti-spastic drugs have shown no effect in trials.
Pharmaceutical development of cannabis has been hampered because in the USA they have medical cannabis and true competition, so the price of medicinal cannabis has plummetted as growers spring up left right and centre. Why pay ten times or more for a pharmaceutical medicinal cannabis extract when you can buy your standardised Ganja for a fraction of the price?
Now the UK is set to legalise Medical Cannabis. This should mean that people with MS will get access to a treatment they are being denied. Who is going to grow it and at what cost? Will NICE approve it?
So is this further impact from our research?
In addition to THC, the cannabis plant produces hundreds of other cannabinoids and the major non-psychoactive compound was cannabidiol.
We showed that this is a potent ion channel modulator but is well tolerated and neuroprotective. Therefore, it is interesting that it was found that cannabidiol in cannabis can inhibit epilepsy in children. A medical pharmaceutical variant has been made approved in the USA.
As epilepsy is a problem of nerve excitation often associated with ion channel mutations, maybe it makes sense that it can affect epilepsy. The pot growers have made variants of cannabis with high amounts of cannabidiol and who needs to do trials when you can simply say it works, as the pot growers do
The law in the UK is problably being changed because of people power, where the actions of a few people with epilepic children have made the Home Office change there tune, leading them to grant licences for the possession of medical cannabis and Government to legalised this.
Our idea that cannabis could save nerves has been, at least temporaility, on hold as the neuros have done their best to sink the idea. The trial (CUPID) was seen to have failed, although if you looked at the subgroup of people who where getting worse it showed benefit. However, there was no desire to go back and do the study with the hindsight of the failure.
We had virtually given up on cannabis research as no-one would fund it and the Home Office Licence to do this cost £5,000 a year. Maybe this will change and people will get interest in cannabis and the endocannabinoid system.
How does cannabidiol work...I have a fair idea but that's for another day.