MEDICINAL MARIJUANA MAY HELP WITH MS

LONDON -- A marijuana pill appeared to relieve some of the symptoms of
multiple sclerosis in the first scientifically rigorous study of the
strongly debated drug.

The research, published this week in The Lancet medical journal, found
that even though improvements could not be detected by doctors' tests,
a greater proportion of patients taking the drug reported reduced pain
and muscle stiffness than those taking fake capsules.

Experts said the mixed results make them tricky to interpret. Some
said they were encouraged any improvement was noted, while others said
if there had been a major effect, it would have shown up in the
doctors' tests.

One study leader, Dr. John Zajicek of the University of Plymouth in
England, said the research raises questions about what's more
important: a doctor's measurements or the patient's
perspective.

"I think if there's a conflict, it's what the patient feels which is
important, so I think it's quite encouraging," said Roger Pertwee, a
professor of neuropharmacology at University of Aberdeen, who was not
connected with the study.

Multiple sclerosis, a common nervous system disease, causes a range of
chronic symptoms, including muscle stiffness and spasms, pain, tremor,
fatigue, depression and bladder problems.

It is difficult to study because the disease is unpredictable and its
symptoms hard to measure.

Orthodox treatments often provide inadequate relief, so many MS
sufferers experiment with alternatives, including cannabis and its
major active components -- cannabinoids.

There have been anecdotal reports of the success of cannabis -- the
Latin word for marijuana -- in treating MS symptoms, particularly
muscle stiffness. However, there has been little scientific evidence.

The study was set up to test the theory that cannabis and cannabinoids
reduce muscle stiffness and may help alleviate other MS-related symptoms.

It involved 630 multiple sclerosis patients from around Britain.
One-third received a capsule containing whole cannabis oil; another
third took one containing a synthetic version of a cannabinoid known
as tetrahydrocannabinol, or THC. The rest got a fake capsule. Results
were reported after 15 weeks of treatment.

"The stiffness as you move the limb on the bed and measure it
carefully does not pick up a difference," said one researcher, Dr.
Alan Thompson. "But when you look at the impact that (muscle
stiffness) has on everyday life -- on what the patient feels -- then
there is a difference."

Fifty-seven percent of the patients taking the whole cannabis extract
said their pain had eased, compared with 50 percent on THC and 37
percent on dummy capsules.

For muscle stiffness, 61 percent on cannabis extract and 60 percent on
THC reported an improvement, compared with 46 percent on fake treatment.

Patients reported improved sleep and fewer or less intense muscle
spasms. Those who could walk showed improved walking ability.

However, when an objective test of muscle stiffness was used, no
difference was detected.

One explanation for the mixed results could be the muscle test, called
the Ashworth scale, is not sensitive enough to detect changes that are
meaningful to patients.

"It is very far removed from everyday life. Moving someone's leg up
and down when they are lying flat on a table doesn't necessarily
translate very well into what happens when they get up and try to walk
around or do the housework or whatever," Thompson said.

In addition, the way the drug was given could have been a factor,
Pertwee said.

"Oral capsules in vegetable oil ... are notoriously problematic in
terms of absorption," said Pertwee, an expert in the pharmacology of
cannabis. "What tends to happen is the cannabinoids are so fat soluble
that they just sit in the vegetable oil and it's difficult to persuade
the drug to go into the (blood)."

Pertwee said smoking is not considered a therapeutic option because
marijuana smoke causes cancer and other forms of cannabis extract are
possible, such as a mouth spray.

In addition, a high percentage of those on fake pills -- 46 percent --
reported improvements and about 77 percent of those on cannabis and 50
percent of those on dummy medication guessed what they were on because
of the easily recognized side effects of marijuana, such as dry mouth
and a lightheaded high.

"It makes their perception suspect in that there could have been, in
effect, an enhanced placebo effect," said Dr. Andrew Goodman, director
of the MS center at the University of Rochester in New York and deputy
medical officer of the U.S. National MS Society, who was not involved
in the study. "You know you're getting it, so therefore it feels like
it works even better, perhaps. That's why the results are tricky to
interpret."

However, Pertwee said the unusually high placebo effect may reflect
natural cannabinoid activity in the body. Research indicates the body
makes its own cannabinoids and levels are elevated in MS. It could be
the body tries to self-medicate in response to the disease, he said.