Cannabidiol (CBD) is a non-psychoactive compound found in the cannabis plant often used by patients as an oil to manage the symptoms of chronic conditions.
In today’s podcast, Ben Thrower, M.D., the medical director of the Multiple Sclerosis Institute at Shepherd Center, will discuss the use of CBD products in managing the symptoms of MS.
Selected Podcast
The Role of CBD Products in Managing Multiple Sclerosis
Featured Speaker:
Dr. Thrower is a clinical instructor of neurology at Emory University and participates actively in clinical research. He serves on the board of directors of the Georgia Chapter of the National MS Society and has served on the board for the Consortium of Multiple Sclerosis Institutes.
Learn more about Ben Thrower, MD
Ben Thrower, MD
Ben Thrower, MD., is the medical director of the Multiple Sclerosis Institute at Shepherd Center. He previously served as the medical director of the Holy Family Multiple Sclerosis Institute in Spokane, Washington. In 2000, Dr. Thrower was awarded the Norm Cohn Hope Chest Award by the National MS Society, recognizing his work with the MS community. In 2005, he was the first physician inductee into the Georgia Chapter of the National MS Society Volunteer Hall of Fame.Dr. Thrower is a clinical instructor of neurology at Emory University and participates actively in clinical research. He serves on the board of directors of the Georgia Chapter of the National MS Society and has served on the board for the Consortium of Multiple Sclerosis Institutes.
Learn more about Ben Thrower, MD
Transcription:
The Role of CBD Products in Managing Multiple Sclerosis
Melanie Cole (Host): According to the National Multiple Sclerosis Society, more than two million people have MS worldwide. Cannabidiol is a non-psychoactive compound found in the cannabis plant often used by patients as an oil to manage the symptoms of some chronic conditions. Here to discuss the use of CBD products and managing the symptoms of MS is my guest, Dr. Ben Thrower. He's the medical director of the Multiple Sclerosis Institute at Shepherd Center. Welcome to the show. Give us a little background on MS and what are some of the more challenging symptoms that you see.
Dr. Ben Thrower (Guest): Thank you so much for having me on today. Multiple sclerosis is a varied condition from individual to the next. Some of the things that we do see that are more common would be sensory symptoms – numbness and tingling. Unfortunately, some of these sensory symptoms can be quite painful, so there's not just plain old numbness, but there could be a burning sensation. Some of the other things that are common with multiple sclerosis would be increased muscle tone or spasming that can leave people with very painful cramping throughout the day and night. We see cognitive issues with multiple sclerosis – trouble with memory or with processing speed. One of the things that is more obvious to the public might be mobility issues, so people that need a cane, a walker, a wheelchair or a power chair to help get around within that umbrella of multiple sclerosis that we see so many varied patterns from one person to the next.
Melanie: We hear about the many medications that patients with MS are on, sometimes even cocktail, but it’s getting much more advanced. Just generally, what are some of the typical medications or how many medications are they typically on to deal with some of these challenging symptoms?
Dr. Thrower: Science has advanced rapidly in our ability to manage multiple sclerosis. We don't have a cure yet, but we are getting closer. We now have 16 FDA approved treatment options in the United States for alternating the long-term course of multiple sclerosis. One of the goals with MS would be to stop the progression in its track, to not let things advance any further. There are two other buckets of treatment that we see out there, and that would be symptom management – managing some of those things that I mentioned earlier, like spasticity and the burning hypersensitivity. The third bucket would be treating acute attacks, so if someone woke up with a new neurological symptom, we can use things like steroid medications to hopefully shorten the duration of those symptoms. The average person with multiple sclerosis is on about six different medications just for their MS, and that’s not counting other health conditions. That can be both a blessing and a challenge in that we have to be cautious about using so many medications and then worrying about side effects of different drugs and drug interactions also.
Melanie: Tell us a little bit about Cannabidiol and this non-psychoactive compound found in the cannabis plant. How can it possibly help MS patients?
Dr. Thrower: There's been a lot of interest in recent years in the broad class of chemicals called cannabinoids. Cannabinoids are some of the chemical ingredients in the cannabis plant. There are over 400 cannabinoids. The two that have been most focused on are cannabidiol, or CBD, and then THC. THC would be the psychoactive part that people are more familiar with. Cannabidiol, as you mentioned, is the non-psychoactive part of the plant. There is a quite a body of literature out there looking at the use of cannabinoids to manage certain multiple sclerosis symptoms. Most commonly, we think of CBD as being something that we might use in the management of spasticity or in the management of these painful areas of hypersensitivity in people with multiple sclerosis. When we talked about those three buckets of MS treatment, managing relapses, managing symptoms and then changing long-term course, we could typically think of CBD to fit in that second bucket, or managing symptoms.
Melanie: How is it administered? What's its effect on the body and is this a controversial type of thing to use?
Dr. Thrower: The use of cannabinoids, the bigger class, can be a little bit controversial and also a little bit confusing. 43 states in the United States now have some sort of law in the book regarding the use of medical cannabis whether it's CBD or the whole plant material. Those laws vary from state to state, and many of those laws actually contradict what the federal law says. It leaves individuals very confused. It leaves healthcare providers very confused at times. CBA can be administered most commonly as an oil, which is taken by mouth. It would come in a small bottle and you would have something like a medicine dropper that looks like an eyedropper to put the medicine under the tongue. There are forms out there in a vaporizer so that you could put that into an inhaled form. There are edible forms as well, but most commonly, individuals with MS are used in an oil form through a medicine dropper.
Melanie: Is this something that now will go along with their medications or only used as needed for certain symptoms?
Dr. Thrower: We think of CBD as fitting in for symptom management like for the spasticity or pain, and it could be either used on an ass needed basis or as a maintenance medication. The challenge for us right now is finding reliable sources for people to obtain the oil and then hopefully being able to partner with whoever is providing that oil to help guide individual with MS. Personally, what I would like to do, if I have an individual with MS who’s already on some symptomatic medications, is add the oil to their existing regimen, see how they do with it and then hopefully be able to back off on some of their other prescription medications.
Melanie: I know this is based on upcoming studies, but do you see that it might have an effect on the long-term or is it simply palliative in nature?
Dr. Thrower: There is a lot of interest out there in cannabinoids for the long-term management of MS, in other words, fitting into that third bucket. Can we actually change the course of MS and do more than just symptom management? The background for that is that humans do have something called the endocannabinoid system. We have chemicals in our body made naturally that look like some of these cannabinoids and they seem to function primarily in the central nervous, but interestingly also in the immune system. There is quite a bit of interest out there in potentially using cannabinoids to tone down the over-activity of multiple sclerosis. On paper, it looks very promising. To date, no one’s been able to definitely show that, but it is certainly an area of quite a bit of interest.
Melanie: Does someone need a medical marijuana prescription to take CBD?
Dr. Thrower: This again is where things get a little bit confusing. There is a federal law that was passed in 2014 called the CBD Oil Act that allowed for the production of CBD oil from hemp. Hemp is a subspecies of cannabis that produces very little THC. At least one federal law says that CBD can be purchased legally in all 50 states. In spite of that, CBD is still listed as a schedule one compound where we put it with heroin and cocaine and things like that, so this is sometimes where the laws are very contradictory. That said, there are a number of sites out there where you can purchase pure CBD oil without THC in it. It is a case of buyer beware, so the FDA has sent out some warning letters to manufacturers who probably were not producing legitimate CBD oil or maybe what they said was in the bottle was not actually in the bottle. Ideally, you'd like to see a laboratory certificate from the manufacturer that says that this is a reliable source of CBD. When you get into compounds with THC in it, that’s where you're going to have to look at your state laws and see what the individual state says and how you would go about legally having access to that. For us here in Georgia, we have the low TBH CBD oil law saying that for 15 different health conditions, if you are registered with the state, you can possess CBD oil with up to 5% THC in it.
Melanie: Are there any side effects? Does it give a bit of a high as if you were using another one of the cannabinoids or is this something different?
Dr. Thrower: Pure CBD oil is non-psychoactive, so people cannot get high from it. We do hear people sometimes say they have a calming effect with it, but nothing that would impair your cognition or driving ability. Once you get into compounds or oils where there is THC, then you do have to start looking at that potential that someone could actually have a euphoric effect or actually get high from it. We typically think of some of these cannabinoids as having an anti-nausea effect. Many of the states where there is some sort of cannabis legislation, they have seen an increase in people reporting this paradoxical increase in nausea, and that’s usually a result of excessive THC use, so people ended up in the emergency room with cycles of nausea and vomiting because they're using too much of a THC compound. The treatment for that is simply getting them on less THC or taking it away altogether.
Melanie: Wrap it up for us with your best advice and information on CBD products in managing multiple sclerosis, what you want people to know and what questions you would like them to ask their physician if they're somebody with MS and they're dealing with some of these symptoms that they're having trouble and challenging managing these symptoms, what you want them to ask about CBD.
Dr. Thrower: I would advise people with multiple sclerosis to become knowledgeable about their individual state law, what is in the book, what are you allowed to have and then try to discuss that with their treating neurologist or healthcare team if you have symptoms of multiple sclerosis, like pain or spasticity, that might be amenable to treatment with a CBD product. Talk to your healthcare team, and at the same time, I would ask the patient with your healthcare team this whole area is evolving so rapidly, and for a lot of people, they didn’t receive training in medical school or nursing school or PA school on cannabinoids and where they might fit into the use in multiple sclerosis or other health conditions. I would say know your local laws, look at your resources that are out there, try to partner with your healthcare team, and then if you do end up using a CBD or CBD THC product, do your homework. Make sure that you're getting that from a reliable source. If possible, you want to see a laboratory certificate to show that this is what you think it is.
Melanie: Thank you so much. It’s really interesting information and so important for people to learn about these different advancements. This is Shepherd Center Radio. For more information, please visit shepherd.org. That’s shepherd.org. I'm Melanie Cole. Thanks so much for listening.
The Role of CBD Products in Managing Multiple Sclerosis
Melanie Cole (Host): According to the National Multiple Sclerosis Society, more than two million people have MS worldwide. Cannabidiol is a non-psychoactive compound found in the cannabis plant often used by patients as an oil to manage the symptoms of some chronic conditions. Here to discuss the use of CBD products and managing the symptoms of MS is my guest, Dr. Ben Thrower. He's the medical director of the Multiple Sclerosis Institute at Shepherd Center. Welcome to the show. Give us a little background on MS and what are some of the more challenging symptoms that you see.
Dr. Ben Thrower (Guest): Thank you so much for having me on today. Multiple sclerosis is a varied condition from individual to the next. Some of the things that we do see that are more common would be sensory symptoms – numbness and tingling. Unfortunately, some of these sensory symptoms can be quite painful, so there's not just plain old numbness, but there could be a burning sensation. Some of the other things that are common with multiple sclerosis would be increased muscle tone or spasming that can leave people with very painful cramping throughout the day and night. We see cognitive issues with multiple sclerosis – trouble with memory or with processing speed. One of the things that is more obvious to the public might be mobility issues, so people that need a cane, a walker, a wheelchair or a power chair to help get around within that umbrella of multiple sclerosis that we see so many varied patterns from one person to the next.
Melanie: We hear about the many medications that patients with MS are on, sometimes even cocktail, but it’s getting much more advanced. Just generally, what are some of the typical medications or how many medications are they typically on to deal with some of these challenging symptoms?
Dr. Thrower: Science has advanced rapidly in our ability to manage multiple sclerosis. We don't have a cure yet, but we are getting closer. We now have 16 FDA approved treatment options in the United States for alternating the long-term course of multiple sclerosis. One of the goals with MS would be to stop the progression in its track, to not let things advance any further. There are two other buckets of treatment that we see out there, and that would be symptom management – managing some of those things that I mentioned earlier, like spasticity and the burning hypersensitivity. The third bucket would be treating acute attacks, so if someone woke up with a new neurological symptom, we can use things like steroid medications to hopefully shorten the duration of those symptoms. The average person with multiple sclerosis is on about six different medications just for their MS, and that’s not counting other health conditions. That can be both a blessing and a challenge in that we have to be cautious about using so many medications and then worrying about side effects of different drugs and drug interactions also.
Melanie: Tell us a little bit about Cannabidiol and this non-psychoactive compound found in the cannabis plant. How can it possibly help MS patients?
Dr. Thrower: There's been a lot of interest in recent years in the broad class of chemicals called cannabinoids. Cannabinoids are some of the chemical ingredients in the cannabis plant. There are over 400 cannabinoids. The two that have been most focused on are cannabidiol, or CBD, and then THC. THC would be the psychoactive part that people are more familiar with. Cannabidiol, as you mentioned, is the non-psychoactive part of the plant. There is a quite a body of literature out there looking at the use of cannabinoids to manage certain multiple sclerosis symptoms. Most commonly, we think of CBD as being something that we might use in the management of spasticity or in the management of these painful areas of hypersensitivity in people with multiple sclerosis. When we talked about those three buckets of MS treatment, managing relapses, managing symptoms and then changing long-term course, we could typically think of CBD to fit in that second bucket, or managing symptoms.
Melanie: How is it administered? What's its effect on the body and is this a controversial type of thing to use?
Dr. Thrower: The use of cannabinoids, the bigger class, can be a little bit controversial and also a little bit confusing. 43 states in the United States now have some sort of law in the book regarding the use of medical cannabis whether it's CBD or the whole plant material. Those laws vary from state to state, and many of those laws actually contradict what the federal law says. It leaves individuals very confused. It leaves healthcare providers very confused at times. CBA can be administered most commonly as an oil, which is taken by mouth. It would come in a small bottle and you would have something like a medicine dropper that looks like an eyedropper to put the medicine under the tongue. There are forms out there in a vaporizer so that you could put that into an inhaled form. There are edible forms as well, but most commonly, individuals with MS are used in an oil form through a medicine dropper.
Melanie: Is this something that now will go along with their medications or only used as needed for certain symptoms?
Dr. Thrower: We think of CBD as fitting in for symptom management like for the spasticity or pain, and it could be either used on an ass needed basis or as a maintenance medication. The challenge for us right now is finding reliable sources for people to obtain the oil and then hopefully being able to partner with whoever is providing that oil to help guide individual with MS. Personally, what I would like to do, if I have an individual with MS who’s already on some symptomatic medications, is add the oil to their existing regimen, see how they do with it and then hopefully be able to back off on some of their other prescription medications.
Melanie: I know this is based on upcoming studies, but do you see that it might have an effect on the long-term or is it simply palliative in nature?
Dr. Thrower: There is a lot of interest out there in cannabinoids for the long-term management of MS, in other words, fitting into that third bucket. Can we actually change the course of MS and do more than just symptom management? The background for that is that humans do have something called the endocannabinoid system. We have chemicals in our body made naturally that look like some of these cannabinoids and they seem to function primarily in the central nervous, but interestingly also in the immune system. There is quite a bit of interest out there in potentially using cannabinoids to tone down the over-activity of multiple sclerosis. On paper, it looks very promising. To date, no one’s been able to definitely show that, but it is certainly an area of quite a bit of interest.
Melanie: Does someone need a medical marijuana prescription to take CBD?
Dr. Thrower: This again is where things get a little bit confusing. There is a federal law that was passed in 2014 called the CBD Oil Act that allowed for the production of CBD oil from hemp. Hemp is a subspecies of cannabis that produces very little THC. At least one federal law says that CBD can be purchased legally in all 50 states. In spite of that, CBD is still listed as a schedule one compound where we put it with heroin and cocaine and things like that, so this is sometimes where the laws are very contradictory. That said, there are a number of sites out there where you can purchase pure CBD oil without THC in it. It is a case of buyer beware, so the FDA has sent out some warning letters to manufacturers who probably were not producing legitimate CBD oil or maybe what they said was in the bottle was not actually in the bottle. Ideally, you'd like to see a laboratory certificate from the manufacturer that says that this is a reliable source of CBD. When you get into compounds with THC in it, that’s where you're going to have to look at your state laws and see what the individual state says and how you would go about legally having access to that. For us here in Georgia, we have the low TBH CBD oil law saying that for 15 different health conditions, if you are registered with the state, you can possess CBD oil with up to 5% THC in it.
Melanie: Are there any side effects? Does it give a bit of a high as if you were using another one of the cannabinoids or is this something different?
Dr. Thrower: Pure CBD oil is non-psychoactive, so people cannot get high from it. We do hear people sometimes say they have a calming effect with it, but nothing that would impair your cognition or driving ability. Once you get into compounds or oils where there is THC, then you do have to start looking at that potential that someone could actually have a euphoric effect or actually get high from it. We typically think of some of these cannabinoids as having an anti-nausea effect. Many of the states where there is some sort of cannabis legislation, they have seen an increase in people reporting this paradoxical increase in nausea, and that’s usually a result of excessive THC use, so people ended up in the emergency room with cycles of nausea and vomiting because they're using too much of a THC compound. The treatment for that is simply getting them on less THC or taking it away altogether.
Melanie: Wrap it up for us with your best advice and information on CBD products in managing multiple sclerosis, what you want people to know and what questions you would like them to ask their physician if they're somebody with MS and they're dealing with some of these symptoms that they're having trouble and challenging managing these symptoms, what you want them to ask about CBD.
Dr. Thrower: I would advise people with multiple sclerosis to become knowledgeable about their individual state law, what is in the book, what are you allowed to have and then try to discuss that with their treating neurologist or healthcare team if you have symptoms of multiple sclerosis, like pain or spasticity, that might be amenable to treatment with a CBD product. Talk to your healthcare team, and at the same time, I would ask the patient with your healthcare team this whole area is evolving so rapidly, and for a lot of people, they didn’t receive training in medical school or nursing school or PA school on cannabinoids and where they might fit into the use in multiple sclerosis or other health conditions. I would say know your local laws, look at your resources that are out there, try to partner with your healthcare team, and then if you do end up using a CBD or CBD THC product, do your homework. Make sure that you're getting that from a reliable source. If possible, you want to see a laboratory certificate to show that this is what you think it is.
Melanie: Thank you so much. It’s really interesting information and so important for people to learn about these different advancements. This is Shepherd Center Radio. For more information, please visit shepherd.org. That’s shepherd.org. I'm Melanie Cole. Thanks so much for listening.