This presentation was part of the 2023 Holistic Health and Wellness Forum for MS held on May 17 in Southfield, Michigan.
Dr. Aaron Boster is an MS Specialist and President of the Boster Center for MS. Dr. Boster is a leading expert in the field of Cannabis for patients with MS. Cannabis may be beneficial for people with MS. Scientific evidence suggests that it can lessen pain, muscle problems, and bladder issues.
“It takes a village to live your best life with MS.” –Dr. Boster
Dr. Boster is a medical marijuana recommender in the state of Ohio. Marijuana is legal in Ohio for some conditions including multiple sclerosis. Dr. Boster was at first hesitant to recommend cannabis due to the lack of evidence in peer reviewed journals. However one week in his clinic, two different patients told him that cannabis helped with their MS symptoms including spasticity, chronic pain and sleep issues. He looked more deeply into the costs and benefits of trying medical marijuana and changed his stance.
The Endocannabinoid System
The endocannabinoid system is a series of receptors that modulate other body systems when stimulated like your appetite, metabolism, pain and inflammatory response. Endocannainoid molecule are made by the human body. Hundreds of phytocanabinoids are made in cannabis and can bind to the endocannabinoid system in the human body.
THC or tetrahydrocannabinol is the most prevalent phytocannabinoid in cannabis and is the psychoactive compound found in marijuana. It binds to the CB1 receptors in the body including in the brain. When you ingest cannabis this is the phytocannabinoid that causes you to be medicated or “high.”
CBD or cannabidiol is another phytocannabinoid that binds to CB2 receptors. CBD doesn’t bind in the brain the way THC does. It has no psychoactive affects. You could drive a car after ingesting it and not be affected. Benefits of using CBD include reduced pain, fatigue, inflammation, depression and spasticity.
Sativex
Sativex is a prescription. mouth spray that’s used in countries including Canada and the United Kingdom to hep with spasticity caused by MS. It is not currently approved for use in the US. It’s a vaporized THC extract that’s taken in an inhaler.
Areas where cannabis can help in MS
Cannabis can help with Insomnia
If you don’t get good sleep, your neurological symptoms can be exacerbated. Many people with MS are bad sleepers and experience pain, spasticity, or bladder issues while trying to sleep. People with MS often have trouble falling asleep and staying asleep. Behaviorally you can meditate, change your bedroom to make it colder or darker. Typical sleep aids are laden with side affects.
Using THC and CBD or just CBD by itself helps people with insomnia. Dr. Boster recommends that his patients take 1 to 4 THC gummies at bedtimes. Gummies range in strength between 5mg and 50mg and the recommendation is to always start with a low dosage. Patients who use cannabis to help with insomnia get restorative sleep and wake up without feeling impaired.
Cannabis can help with Anxiety
People with MS are twice as likely to experience anxiety than the general population. Anxiety can manifest as a chronic feeling in the gut or as acute anxiety as in a panic attack. People can take anti anxiety medicine but there are side effects and sometimes people can have breakthrough panic attacks despite being on anti-anxiety drugs. Side effects of these medications include feeling loopy, sleepy, indigestion and feeling agitated.
Dr. Boster recommends that his patients take a CBD tincture (a liquid applied under the tongue) or gummy to break the anxiety pattern.
Cannabis can help with Spasticity
Spasticity occurs when you muscles fight with one another. Because of damage to the spinal cord and brain, two opposing muscles play tug of war. Upwards of 70% of people with MS experience spasticity. Spasticity manifests as spasms or cramps like a charley horse or stiffness in the arms or legs that makes the limbs hard to bend. It can wake you from sleep.
Dr. Boster recommends that his patients try THC or CBD to help with different kinds of spasticity.
Cannabis can help with Neuropathic Pain
Neuropathic pain is defined as pain caused by a lesion or disease of the somatosensory nervous system. Dr. Boster recommends using CBD cream applied topically. It doesn’t work in all people but in well over half of patients have a robust response. THC or CBD gummies can also help with neuropathic pain.
Using cannabis before exercise often allows people with neuropathic pain to exercise longer without symptoms bothering them.
Routes of cannabis administration
Dr. Boster does not recommend lighting cannabis leaves on fire and sucking in the smoke. Smoke is pro inflammatory to your lungs, blood vessels and brain. In the same way that people with MS shouldn’t smoke tobacco, they shouldn’t smoke cannabis. Smoking cannabis in Ohio, where Dr. Boster practices is illegal, however medical ingestion in other ways is legal.
Cannabis Vape Pen for MS
If, for example you’re having a panic attack, you need treated right now. It wouldn’t be recommended to take an edible to deal with an acute symptom. A vape pen is a good method of administration. It looks like a pen and has a concentrate of liquid cannabis, HTC and CBD. It heats the cannabis to below the level of combustion. The onset of a vape pen is almost as fast as smoking a joint. It works in a couple of minutes. If you’re woken with neuropathic pain, use something fast like a vape pen.
Cannabis Edibles for MS
Some symptoms we want to deal with in a chronic fashion like difficulty sleeping or baseline anxiety throughout the day. You need to redose way too often for a vape pen. Chronic symptoms are better dealt with using edibles. The edibles Dr. Boster recommends have 10g on THC in each edible. The gummy takes about 45 minutes to kick in, peaks at 1 to 2 hours after consumptom and lasts for several hours. It’s a slow on and slow off method of administration
Cannabis Tinctures for MS
A tincture is an eyedropper full of liquid that you drop under your tongue where there are giant blood vessels. About 25% of the tincture is absorbed under the tongue and It kicks in within several minutes. The rest of the tincture (about 75%) goes into the stomach then kick in about 45 minutes after consumption like an edible. It’s a quick onset and slow decline method of administration.
Keep track of your cannabis experiences
Take notes of your experience with cannabis. Keep a notebook to keep track of what you do, how much you take and how you feel. Keep careful notes If you buy something from a dispensary. Only do one thing per day and record the effects. Avoid the trap of not waiting for it to kick in and taking more and then feeling horrible.
Risks and Side Effects of Cannabis
Cannabis is nowhere near as dangerous as Nancy Reagan made it out to be in her Just Say No to Drugs campaign. One potential side effect is an “I don’t care attitude’ and decreased energy. It’s not common, but it’s out there. Some patients develop a dependance to cannabis like they would to valium or other medicines.
Very rarely people will experience hyperemesis syndrome which is nausea then vomiting for a long time unless they’re in a hot shower. Dr. Boster has seen it twice with his patients. In both instances stopping the administration of cannabis for a few weeks solves this side effect.
Cannabis is a tool to help people live better lives. It’s not a cure for MS. The federal government has cannabis labeled as schedule 1 drug. You cannot cross state lines with cannabis. However state laws allow pure CBD to cross state lines as CBD is not controlled in the same way as THC.
CBD can increase calcium and can lead to an increased risk of kidney stones. Be honest with your doctor so you can talk about these things and be sure to hydrate.
Dr. Aaron Boster is a board-certified neurologist specializing in Multiple Sclerosis and related CNS inflammatory disorders. He decided to become an MS specialist at the age of 12, as he watched his Uncle Mark suffer from the disease in an era before treatment was available. Dr. Boster grew up in Columbus, Ohio and attended undergraduate at Oberlin college. He earned his MD at the University of Cincinnati College of Medicine and completed an internship in Internal Medicine and Residency in Neurology at the University of Michigan. He then completed a two-year fellowship in Clinical Neuroimmunology at Wayne State University. Since then, Dr. Boster has been intimately involved in the care of people impacted by multiple sclerosis. He has been a principal investigator in numerous clinical trials, trained multiple MS doctors and Nurse Practitioners and has been published extensively in medical journals. He lectures to both patients and providers worldwide and maintains an MS educational YouTube channel with over 36K subscribers. Dr. Boster’s mission is to EDUCATE, ENERGIZE and EMPOWER people impacted by MS. He lives in Columbus, Ohio with is son Max.