Q&A: Medical Marijuana for Multiple Sclerosis

Allen Bowling, MD, PhD, explains the benefits and roadblocks of alternative medicine for MS.

Allen Bowling, MD, PhD, has spent 3 decades researching the pharmacological scope of alternative medicine for multiple sclerosis (MS). The physician associate at the Colorado Neurological Institute (CNI), clinical professor of beurology at the University of Colorado, and founder of NeurologyCare.net, has authored 5 books on MS during his time in the field.

But some of Bowling most pressing subjects are still ahead of him. Unconventional treatment for MS, such as medical marijuana, is well-documented in trials, but without a tangible path to mainstream use.

In this interview with MD Magazine, Bowling explained the benefits of MS alternative medicine, its prevalence in clinical trials, and the challenges medical marijuana faces in becoming a common treatment for MS' effects.

How has alternative medicine come into play in MS treatment?

Allen Bowling, MD, PhD, Physician Associate, Colorado Neurological Institute: In terms of alternative medicine in MS, for many, many years people with MS haven’t had an interest in alternative or unconventional medicine. Most people with MS have an interest in mixing that with their conventional medicine, but even now, many healthcare professionals are not trained in unconventional medicine.

There’s lots of education that still needs to be done with health professionals and with people with MS on just what are the facts — what’s the transparent approach to risks and benefits of different unconventional therapies. And if you look at the facts, some of these unconventional therapies should be avoided, some are potentially very dangerous, and others are promising or should actually be a part of the standard of care for people with MS.

It’s this very broad spectrum, so that’s sort of the mission behind the writing and speaking that I do. Also, in taking the conventional medicine and blending that with the unconventional medicine, the third area is people’s lifestyle. How people live their lives has an impact on their MS — it certainly has an impact on the health of the nervous system. The broad umbrella approach is integrative medicine.

Are there any successes in marijuana treatment trials for MS?

Bowling: I think many MS health professionals don’t even know this tidbit of fact, which is that of all the very formal, clinical, randomized trials of marijuana products, MS is second only to chemotherapy-induced nausea and vomiting for the number of trials.

There are actually 19 different randomized controlled trials of marijuana products in MS, showing benefit for pain, people’s sense of muscle stiffness. It may help as well with sleep, especially sleep interrupted by pain and muscle stiffness. The challenge is that those studies have been done with research-grade preparations that are free of contaminance, and those products are not available in US dispensaries. There’s a lack of fidelity — you can’t take the clinical trial results with these particular products and tell a patient to go to a dispensary buy these products because those products are just not available.

Added into that is the very, very complex pharmacology of cannabis, where you have than 100 potentially pharmacologically active compounds. Each of those compounds may have 5-10 different pharmacological effects. Some of the compounds might actually antagonize each other’s effects. It’s kind of overwhelming to theorize what the potential therapeutic effects might be, or the side effects.

That’s a real challenge with many plant-based products, or herbs. I think that comes up frequently with cannabis, and I think that’s an element of this whole treatment approach that’s not often appreciated by health professionals and people with MS — the complexities of trying to understand a product in a dispensary and the effects it might have on someone.

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