Pubdate: Thu, 06 Nov 2003 Source: Toronto Star (CN ON) Copyright: 2003 The Toronto Star Contact: http://www.thestar.com/ Details: http://www.mapinc.org/media/456 Bookmark: http://www.mapinc.org/mjcn.htm (Cannabis - Canada) FIRST LARGE STUDY OF POT FOR MS FINDS BENEFIT The first large clinical trial looking at whether marijuana actually has a medicinal effect for people with multiple sclerosis has found that there is probably a clinical benefit from taking the drug. The British trial was designed to see if doses of cannabinoids, the active compounds in cannabis, reduce spasticity in people who have MS. While it made no discernible difference on that front, people who received the drug had less pain, slept better and had better mobility than people who received a placebo. "It's fair to say that in the study, we did not see an effect on that pure muscle stiffness," said Dr. Alan Thompson of the U.K. MS research group, which conducted the trial. "But when we went on to look at . . . the impact of that stiffness on people and on their lives and on their mobility, we did see a fairly consistent pattern suggesting there was some benefit in those taking the cannabis preparations." The study, which will be published Saturday in the British medical journal The Lancet, is expected to be keenly scrutinized by both sides in the heated debate over whether marijuana belongs in the medicine cabinet. Anecdotal evidence suggests the drug is helpful for managing the symptoms of a range of ailments but those opposed to its use argue there is precious little scientific proof to back up the claims. "The eyes of the world are on this study because each country has been wondering what they should do about this," Thompson, from the National Hospital for Neurology and Neurosurgery, said in an interview from London. "What we now have is data that people can look at. And they have to decide on the basis of the data how they wish to proceed." A Canadian MS researcher praised the study, saying she hopes it leads to legal changes. "Aside from the research and moving ahead that way, I hope that this study will also stimulate some better, more rational laws regarding cannabis for medical purposes," said Dr. Luanne Metz, a neurologist and a professor of clinical neurosciences at the University of Calgary. Currently MS patients can get a waiver allowing them to possess and grow marijuana ? so long as they get a doctor to attest to the fact they have MS and specify the dose they should use. Because so little research has been done on cannabis and because the strength of marijuana from plants can vary greatly, that puts doctors in an ethical bind. "How do you do that? And how do you prescribe smoked cannabis when you know that it puts three to four times the tar in the lungs as a cigarette does?" asked Metz, who co-wrote a commentary on the study for the journal with research associate Stacey Page. "It puts physicians in a bad spot and patients in an impossible spot." The research team followed 611 people with multiple sclerosis from across Britain. Participants were randomly assigned to receive oral cannabis extract, a synthetic version of a cannabinoid known as tetrahydrocannabinol or THC or a placebo. Neither patients nor their doctors were told who was receiving which treatment, though the authors conceded that many of the people getting cannabis guessed they were on the drug. The researchers tested muscle stiffness using an accepted tool known as the Ashworth scale. A physician attempted to move the limbs of a reclining patient, assessing on a scale of zero to four how hard it was to do so. They found no real difference between the groups, but conceded the scale might be too insensitive to register "small but clinically significant effects on spasticity." Metz agreed. "I think it's a lousy way to measure it. I've used the scale and I'm unimpressed that it has much sensitivity to it," she said. Benefits were noted in other tests, including a timed 10-metre walk and self-assessments filled in by the patients. There was a significant placebo effect noted in the findings, but in all measures other than spasticity those receiving cannabis or THC scored significantly higher than those on placebo. Still, it was not a clear home run. Thompson himself called the findings "a mixed picture"; the study suggests more research is necessary. "One always hopes for clarity," Thompson admitted. "The trouble with science, I think it's fair to say, is that it often gives you grey rather than black and white. And you don't get clarity. And we are forced to make judgments based on the evidence . . . as to how we intend to proceed."