Marijuana for MS. Now What?

Medical marijuana got a big boost last week, perhaps the most significant ever. The American Academy of Neurology issued a new practice guideline that gave a qualified endorsement to certain cannabis-based products for controlling particular multiple sclerosis symptoms.

"Strong evidence" backs up a recommendation that physicians "might offer oral cannabis extract" to reduce subjective complaints about spasticity and non-neuropathic pain, the AAN said -- though it noted that cannabis products don't appear to reduce objective measures of spasticity, although the evidence against an effect is only modest.

The Sativex oral cannabinoid spray, which is not yet FDA-approved but is available in many other countries, also received the AAN's endorsement for treating spasticity and pain, as well as for reducing urination frequency (but not incontinence).

But with Sativex unavailable in the U.S., the practical impact of the new guideline remains uncertain, even in locations where medical cannabis is ostensibly legal.

In the Vanguard

As it happened, last week I was in Colorado, the only state where marijuana is now legally sold both for medical and recreational use. (Voters in Washington state approved similar legislation in 2012, but recreational sales were put on hold while regulations were developed; sales are supposed to begin by the end of June.)

Medical marijuana still exists in Colorado -- it's regulated separately and, more important, it's cheaper for buyers than recreational pot products because the latter are subject to a special 15% excise tax. Thus, individuals seeking marijuana for its medicinal properties have a strong incentive to stick with the medical marijuana system, which has been in place in its present form since 2011.

It requires patients to obtain an ID, known as a "red card," that entitles them to purchase cannabis products from licensed dispensaries. Not just anybody can get a red card -- a physician must declare that a patient has one or more of eight "qualifying conditions." These include cancer of any kind, glaucoma, or HIV infection, as well as those with the following 5 symptoms: cachexia, seizures, severe nausea, severe pain, or persistent muscle spasms. MS-related spasticity falls under this last category.

A physician must also supply a "recommendation" -- not a prescription per se, because that would be illegal in the absence of federal approval -- that the patient obtain medical marijuana for his or her specific condition.

One might wonder how the products themselves are regulated -- assuring users that the bag of flowers or the vial of extract that they are buying meets the most basic labeling and safety standards.

Since marijuana plants and extracts remain illegal at the federal level, there is no FDA or other national oversight, meaning it's up to the states. And Colorado is struggling with the responsibility.

Currently, regulation of growers and vendors rests with the state's Department of Revenue. Its primary focus is on ensuring that these businesses pay their required fees and taxes and they aren't run by known criminals -- not on product quality or safety.

Story Source: The above story is based on materials provided by (MEDPAGE TODAY) 

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