The pharmacological effects of inhaled cannabis on pain in patients with multiple sclerosis: risks versus rewards

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Inflammation Research

COMMENTARY

The pharmacological effects of inhaled cannabis on pain in patients with multiple sclerosis: risks versus rewards Zaid H. Maayah1 · Jason R. B. Dyck1,2  Received: 22 May 2020 / Revised: 27 July 2020 / Accepted: 13 August 2020 © Springer Nature Switzerland AG 2020

Abstract Purpose  Despite the fact that the risk versus benefit of smoking cannabis has not been extensively studied, many individuals with multiple sclerosis are smoking cannabis to reduce their pain intensity and spasticity. The lack of information about inhaled cannabis might be attributed to the fact that most trials focus on orally administered cannabis. Given the fact that the administration of cannabis via inhalation is known to rapidly deliver cannabinoids with a higher total bioavailability than what can be achieved through oral or buccal routes, it is important to understand the clinical trials conducted using smoked cannabis on patients with multiple sclerosis. Methods  We sought to discuss the relevant literature about the safety and efficacy of smoked cannabis in multiple sclerosis patients in order to further understand the risks and benefits of this potential therapy for this patient population. Results  The current knowledge about the potential effects of smoked cannabis on treating neuropathic pain associated with multiple sclerosis is reviewed. In addition, we discuss the possible adverse effects associated with smoking cannabis and we suggest safer as well as new effective inhaled cannabis formulations for the treatment of neuropathic pain associated with multiple sclerosis. Keywords  Inhaled cannabis · Neuropathic pain · Multiple sclerosis Given the shifting global landscape and the questions surrounding cannabis use for the treatment of various conditions including multiple sclerosis (MS), there is a need to determine the effectiveness and safety of different cannabis formulations. In addition, the different routes of administration contribute to this effectiveness and safety. Thus, the means by which the formulations are delivered to the patients must also be considered to provide a more fulsome understanding of cannabis-based medicines. To this end, we have recently reviewed the efficacy and safety of oral formulated full-spectrum cannabis extract in the treatment of neuropathic pain and inflammation associated with MS Responsible Editor: John Di Battista. * Jason R. B. Dyck [email protected] 1



Cardiovascular Research Centre, Department of Pediatrics, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada



458 Heritage Medical Research Centre, University of Alberta, Edmonton, AB T6G 2S2, Canada

2

[1]. However, given the fact that the administration of cannabis via inhalation is known to rapidly deliver cannabinoids with a higher total bioavailability than what can be achieved through oral or buccal routes [2, 3], it is important to also discuss the clinical trials conducted using smoked cannabis on patients with MS. This is crucial as many MS patients are smoki

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