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Cannabis and Sativex
Cannabis is a flowering plant, native to South and Central America. This plant has long been used
for its fibrous stalks (hemp), its seeds, its medicinal properties, and for recreational use.
In the UK, cannabis is categorised as a class B drug, and it is illegal to possess, supply or
produce. However, in some countries, laws are being reformed to allow the possession of
cannabis for medical use.
In 1964, a chemist from Israel, Raphael Mechoulam, extracted over 60 different chemicals from
cannabis which were of potentially medicinal use.
One of the main constituents of cannabis is tetrahydrocannabinol (THC). This is the molecule
which produces a psychoactive effect when the plant’s leaves are smoked or consumed.
Another constituent of cannabis is cannabidiol (CBD). It is this molecule on which research has
focused as a potential treatment of spasticity in MS.
Research into cannabis-based medicines has shown mixed results, with some trials showing
beneficial effects for MS symptoms versus a placebo, and other trials not reporting positive results.
Many people with MS anecdotally report smoking or consuming cannabis alleviates their MS
symptoms, particularly spasticity, bladder and bowel problems, and pain.
One cannabis-based medication – Sativex – is licensed in the UK for the treatment of moderate to
severe spasticity for people where other medications (baclofen, tizanidine, gabapentin, pregabalin
and clonazepam) have been demonstrated as ineffective, or the adverse effects of these
medications have been found to be intolerable.
Moderate spasticity is categorised as stiffness in some limbs, may need help with dressing and
some help needed with personal care. Severe spasticity ranges from will need a lot of help with
personal care to complete immobility.
Sativex contains both THC and CBD, but THC is in much lower concentrations compared to the
native cannabis leaf or resin.
Sativex is delivered orally, as a spray, and absorbed across the wet tissues of the mouth. It can be
taken up to 12 times per day as required, although most people take it four times per day.
Sativex is generally well-tolerated with common symptoms being fatigue and dizziness. Long-term
studies demonstrated people taking Sativex do not demonstrate a dependency on the medication.
In people where other anti-spasticity drugs were demonstrated to be ineffective, Sativex was
shown to be effective in 48 per cent of people after four weeks.
As a result, the manufacturer, Bayer, offers a ‘Pay-For Responder’ scheme to neurologists where
the first pack of Sativex is offered free of charge to the NHS for the patient to try.
Even if a person finds Sativex does alleviate their spasticity, it can be difficult to extend the funding
for its use, paid for by the NHS. In October 2014, the National Institute for Health and Care
Excellence (NICE) in the UK, produced new guidelines for the treatment of MS. In these
guidelines, NICE stated: ‘Do not offer Sativex to treat spasticity in people with MS because it is not
a cost effective treatment’.
Sativex can be funded on the NHS, if the person and their neurologist are able to demonstrate the
need by completing an Individual Funding Request. It would then be the decision of the regional
Clinical Commissioning Group (CCG) whether NHS funding is granted.
The other route to Sativex in the UK is paying for the medication through private prescription.
Costs can vary per pharmacy but are approximately £500 per month.
Sativex is a class B drug, but can lawfully be possessed by someone with a prescription from a
qualified medical professional. A person using Sativex should not pass their medication onto
someone else, as this would be unlawful.
If travelling abroad, be aware that Sativex’s legal status varies between countries, so it is advisable
to check with the relevant Embassy before travelling to the country.
For more information about Sativex, please speak to your MS Nurse or neurologist. You can also
call MS-UK on 0800 783 0518 and talk to an MS Advisor.
Updated December 2014