MS Patient With Tics, Dystonia, and Marijuana Dependence Improved on Prescription THC | Research

The takeaway

A 52-year-old woman with MS, vocal tics, dystonia, and marijuana dependence reported dramatic improvement on prescription dronabinol, including reduced craving and elimination of the "high" she experienced from marijuana.

Read this if you have MS and currently use marijuana, and want to understand how prescription THC might compare.

MS patient reported dramatic improvement on dronabinol with no "high" and reduced marijuana craving

What the researchers found

The authors presented a case of a 52-year-old woman with multiple sclerosis complicated by paroxysmal dystonia (sudden abnormal muscle contractions), complex vocal tics, and marijuana dependence.

When started on dronabinol (synthetic THC capsules normally prescribed for chemotherapy nausea), she reported multiple improvements: dramatic reduction in craving for marijuana and illicit use, improved sleep quality with fewer nighttime awakenings, decreased vocal tics and associated tension, reduced anxiety, and fewer episodes of dystonia.

Notably, she reported not experiencing the "high" from the prescribed dronabinol that she experienced from smoked marijuana. This may reflect the different pharmacokinetics of oral versus smoked delivery, or the controlled dosing versus self-titrated smoking.

The case was presented alongside a review of current evidence for cannabis-based MS treatments.

Why it matters

This case illustrated several important points: prescription THC can potentially replace illicit marijuana use in MS patients, oral delivery may produce therapeutic effects without the euphoric "high," and cannabinoids may address multiple MS symptoms simultaneously including unusual ones like tics and dystonia.

The numbers in context

One 52-year-old female patient with MS. Multiple symptom improvements on dronabinol. Reduced craving and illicit marijuana use. Improved sleep, reduced tics, reduced dystonia, reduced anxiety. No reported "high" from prescription THC.

How the study worked

Single case report with clinical observations. The patient was started on an empirical trial of dronabinol (oral synthetic THC) and outcomes were documented. A literature review of cannabis in MS accompanied the case.

What this study cannot tell us

Single case reports cannot establish efficacy or generalizability. Placebo effects may account for some improvements. The patient's self-report of reduced craving and no "high" is subjective and unverified.

How to read the evidence

This is a single case report, the weakest form of clinical evidence. While illustrative, it cannot establish that dronabinol would produce similar results in other patients.

When this study was published

Published in 2008. Prescription cannabinoids for MS symptoms have since become more widely available, though their use as substitution therapy for marijuana dependence remains understudied.

The bigger picture

This case raised the possibility that prescription cannabinoids could serve as substitution therapy for MS patients who self-medicate with marijuana, similar to how methadone substitutes for heroin. It also added to evidence that cannabinoids may help with movement disorders beyond spasticity.

Questions still open

Could dronabinol serve as formal substitution therapy for MS patients dependent on marijuana? Why did prescription THC not produce a "high" when smoked marijuana did?

Common questions

What is dronabinol?

Dronabinol is a prescription medication containing synthetic THC in capsule form. It's FDA-approved for chemotherapy-related nausea and AIDS-related appetite loss. Its oral delivery produces different effects than smoked marijuana.

Why didn't the prescription THC get her high?

Oral THC is absorbed more slowly and produces a different metabolite profile than smoked marijuana. The controlled, consistent dose may also lack the rapid spike in blood THC levels that produces the euphoric rush from smoking.

Read the original research

Current status of cannabis treatment of multiple sclerosis with an illustrative case presentation of a patient with MS, complex vocal tics, paroxysmal dystonia, and marijuana dependence treated with dronabinol.

CNS spectrums, 13(5), 393-403

View on PubMed ↗

Citation

Deutsch, Stephen I; Rosse, Richard B; Connor, Julie M; Burket, Jessica A; Murphy, Mary E; Fox, Fiona J. (2008). Current status of cannabis treatment of multiple sclerosis with an illustrative case presentation of a patient with MS, complex vocal tics, paroxysmal dystonia, and marijuana dependence treated with dronabinol.. CNS spectrums, 13(5), 393-403.