Multiple sclerosis: causes, symptoms & experience with medicinal cannabis

Multiple sclerosis (MS) is a chronic inflammatory disease of the nervous system that can lead to a variety of symptoms. More than 280,000 MS sufferers live in Germany. MS affects the central nervous system and can cause movement disorders, spasticity, pain and fatigue. While traditional medication is often used, many sufferers also rely on medicinal cannabis with THC to alleviate their symptoms. Back to overview: medical cannabis for diseases.

What multiple sclerosis is and what causes it

Multiple sclerosis is an autoimmune disease in which the immune system attacks the protective myelin sheaths of the nerves. This results in inflammatory processes that disrupt the transmission of signals between the brain and body. The exact cause is not fully understood, but genetic predispositions, environmental factors and possibly viral infections play a role. MS can be relapsing or chronic and often affects young adults.

• Muscle weakness and coordination problems
• Spasticity and uncontrolled muscle cramps
• Chronic tiredness and exhaustion
• Pain and numbness
• Visual impairment and cognitive impairment

What experiences have specialists had?

• Multiple sclerosis and cannabis: experiences

Further links:

• German Multiple Sclerosis Society – Information, advice & support
• Multiple Sclerosis Clinic – Specialized Clinic for Diagnostics & Therapy

How THC works in the body and why it can help

THC influences the endocannabinoid system, which plays an important role in muscle control, pain regulation and inflammatory processes. Studies show that cannabinoids modulate neuronal signaling and can thus alleviate spasticity, pain and sleep problems. In clinical studies, THC was able to significantly reduce muscle stiffness in MS patients(Zajicek et al., 2006).

• Can reduce spasticity and muscle stiffness
• Can relieve pain
• Can improve sleep problems

You can find out more about medicinal cannabis in our article on cannabis on prescription.

What studies on THC and MS show

The effectiveness of THC in MS has been comparatively well researched. A large randomized study with over 600 patients(CAMS study) showed that preparations containing THC were able to significantly reduce muscle stiffness(Zajicek et al., 2003). A follow-up study also showed that long-term users experienced a further improvement in symptoms(Zajicek et al., 2007). Meta-analyses also confirm the effectiveness, particularly for spasticity and chronic pain(Whiting et al., 2015).

• Significantly reduces muscle stiffness and spasticity
• Effectively relieves chronic pain
• Improves sleep quality and general well-being

Experiences: How THC can help in everyday life

Many MS patients report that THC helps them to cope better with everyday life. It is often used for relaxation, pain reduction and better mobility.

Katrin, 41:

“I had severe spasticity for years, which limited my mobility. THC helps me to move in a more relaxed way.”

Thomas, 52:

“My pain was often unbearable. Since I started taking medicinal cannabis, it has improved significantly.”

What THC products are available

THC can be taken in different forms. Some are fast-acting, others have a longer-lasting effect. The choice depends on symptoms, lifestyle and desired effect.

• Flowers for inhalation (quick effect)
• Oil for targeted dosing
• Capsules for a uniform effect
• Sprays for easy application

What advantages and disadvantages there are

• Reduces spasticity and pain
• Improves sleep
• Can cause fatigue in high doses
• Temporary memory problems possible

Other treatment methods for MS

• Physiotherapy for muscle relaxation
• Regular exercise to promote mobility
• Change in diet to support the immune system

Frequently asked questions about THC and MS

Does THC help immediately against MS symptoms?

THC can help to reduce spasticity and pain in the short term, but is no substitute for causal therapy.

Is THC addictive?

In controlled medical doses there is no high risk of dependence.

Can I get THC for MS without a prescription?

In Germany, medicinal cannabis is only available on prescription.

5 tips for dealing better with MS

1. Regular exercise to strengthen the muscles
2. Relaxation techniques for coping with stress
3. Healthy nutrition to support the immune system
4. Make sure you get enough sleep
5. Making use of psychological support

Medical cannabis as a treatment

Are you interested in the practical application of medicinal cannabis? Studies on cannabis show how THC is increasingly being used for neurological diseases such as MS. Click here to return to the overview:

• Medical cannabis for diseases

Medical Cannabis for MS in the UK: Clinical Guidance

Multiple sclerosis is one of the conditions most supported by evidence for cannabis-based medicinal products (CBMPs) in the UK. Nabiximols (Sativex), a mouth spray containing equal parts THC and CBD, is the only licensed cannabis-derived medicine specifically approved for MS-related spasticity in the United Kingdom.

Evidence Level: Moderate (spasticity) — Limited (other MS symptoms)

NICE Guideline NG144 (Cannabis-based medicinal products, November 2019) recommends considering nabiximols (Sativex) as an add-on treatment for adults with moderate-to-severe spasticity in MS, when other treatments have not provided adequate relief. This is one of the stronger NICE recommendations for any CBMP indication.

A 2012 Cochrane review of nabiximols for MS spasticity found a significant reduction in patient-reported spasticity scores compared to placebo (NRS improvement of approximately 1.3 points). The CAMS study demonstrated a 61% improvement in spasticity scores with cannabis extracts. For pain, neuroprotection, and other MS symptoms, evidence is more limited. NICE acknowledges that the evidence base for CBMPs beyond spasticity in MS is insufficient for routine recommending.

The MS Society UK supports patient access to Sativex and CBMPs where evidence exists, but notes that NHS commissioning remains inconsistent across England, Wales, Scotland, and Northern Ireland.

Contraindications

• Serious cardiovascular disease — THC causes tachycardia and blood pressure changes; nabiximols is contraindicated in patients with ischaemic heart disease, arrhythmias, or severe heart failure
• Personal or family history of psychosis or schizophrenia — THC component is an absolute contraindication; MS patients with psychiatric comorbidities require careful screening
• Pregnancy and breastfeeding — contraindicated; women of childbearing age should use effective contraception during treatment
• Under 18 years — Sativex is not licensed for paediatric MS
• Severe hepatic impairment — cannabinoids are extensively hepatically metabolised
• Hypersensitivity to cannabinoids, propylene glycol, or other excipients in Sativex
• Current substance use disorder — relative contraindication; specialist assessment required

Drug Interactions

MS patients frequently use multiple medications; key interactions with nabiximols and other CBMPs:

• CNS depressants (baclofen, tizanidine, benzodiazepines) — all used for spasticity; additive sedation and muscle relaxation with nabiximols; dose adjustment of existing spasticity medications often needed
• Disease-modifying therapies (interferon beta, natalizumab, ocrelizumab) — no direct pharmacokinetic interactions documented; however, monitor for combined immune effects with long-term use
• Amantadine and fampridine — limited interaction data; monitor for additive CNS effects
• SSRIs/SNRIs (often prescribed for MS-related depression) — CBD inhibits CYP2D6; sertraline levels may increase; monitor
• Warfarin — CBD inhibits CYP2C9; monitor INR; relevant in MS patients with cardiovascular comorbidities
• Opioids (for MS pain) — additive sedation and respiratory depression; titrate carefully if combining

Dosing Guidance (Sativex for MS Spasticity)

• Initiation: 1 spray at bedtime on day 1, increasing by 1 spray per day over 2 weeks
• Maximum: 12 sprays per day (each spray delivers 2.7 mg THC and 2.5 mg CBD)
• Titration assessment: formal clinical assessment at 4 weeks; continue only if at least 20% improvement in NRS spasticity score from baseline
• Administration: spray onto oral mucosa (gums, under tongue); rotate sites to avoid local irritation
• Response rate: approximately 50% of patients achieve meaningful benefit; discontinue in non-responders at 4 weeks

Side Effects

• Very common: dizziness, fatigue, somnolence, disorientation — particularly on initiation and at higher doses
• Common: nausea, mouth and throat irritation (from spray), fall risk (additive with existing MS gait instability — important safety concern), cognitive slowing, euphoria
• Psychiatric: mood changes, paranoia, dissociation — monitor for THC-related psychiatric effects, especially in patients with MS-related depression or cognitive impairment
• Dependence: cannabis use disorder can develop; withdrawal symptoms on cessation after prolonged use
• Fall risk: the combination of dizziness, spasticity reduction, and existing MS-related balance impairment significantly elevates fall risk, particularly in the early weeks of treatment; counsel patients and carers
• Driving: THC-containing products impair driving; patients must not drive during titration and should assess individual response before resuming

When Medical Cannabis Is NOT Appropriate for MS

• Spasticity has not been adequately trialled with first-line agents: baclofen (oral), tizanidine, and physiotherapy per NICE MS guideline (NG220)
• Personal or family history of psychosis or schizophrenia
• Significant cardiovascular disease
• Pregnancy or breastfeeding
• MS patient with significant cognitive impairment where medication complexity increases risk
• Seeking cannabis for primary disease modification of MS — there is no evidence that CBMPs alter MS disease progression

Note on NHS availability: Sativex is licensed in the UK for MS spasticity but NHS commissioning is inconsistent. In England, NHS England has not nationally commissioned Sativex, meaning most patients access it privately despite NHS licensing. Scotland, Wales, and Northern Ireland have separate commissioning decisions. Other cannabis products for MS are available only via private prescription.