Expert review finds nabiximols effective for MS spasticity when first-line drugs fail | Research

The takeaway

An expert review of over 7,500 patients across 33 studies found nabiximols (THC/CBD spray) is safe and effective for treating MS-related spasticity that does not respond to first-line oral medications, while finding no scientific evidence for smoked marijuana in MS.

MS patients, neurologists, and policy makers involved in medical cannabis access.

33 studies, 7,500+ patients support nabiximols for MS spasticity

What the researchers found

Evidence-based data from 33 studies with over 7,500 patients supports nabiximols for MS-related spasticity, pain, and urinary symptoms. However, the review found no scientific evidence supporting smoked marijuana for MS patients.

Why it matters

The review distinguishes between evidence-based cannabis medicine (nabiximols) and unregulated marijuana smoking, providing clinicians with clear guidance on what cannabis-related treatments have actual support.

The numbers in context

33 studies reviewed, over 7,500 patients. 12 studies from the UK, 11 from Italy. Nabiximols treats spasticity, pain, and urinary symptoms.

How the study worked

Expert review examining published clinical evidence on cannabis-derived treatments for MS, including 33 studies (12 from the UK, 11 from Italy) involving nabiximols.

What this study cannot tell us

Expert review rather than systematic review or meta-analysis. Legislation, cost, and prescribing restrictions limit real-world access and experience with nabiximols in many countries.

How to read the evidence

Strong: large evidence base across 33 studies and multiple countries, though presented as an expert review rather than systematic review.

When this study was published

Published in 2020 in Expert Review of Neurotherapeutics.

The bigger picture

Despite growing interest in medical marijuana for MS, the evidence specifically supports pharmaceutical-grade nabiximols rather than smoked cannabis, highlighting the gap between patient expectations and scientific evidence.

Questions still open

Why has smoked marijuana bypassed traditional clinical trials for MS? Would broader access to nabiximols reduce use of unregulated cannabis products among MS patients?

Common questions

What is nabiximols?

Nabiximols (brand name Sativex) is a pharmaceutical spray containing a standardized ratio of THC and CBD extracted from cannabis plants. It is sprayed under the tongue and is approved in some countries for MS-related spasticity.

Can smoking marijuana help MS?

According to this expert review, there is no scientific evidence that smoking marijuana provides benefits for MS patients. The evidence specifically supports nabiximols, a pharmaceutical-grade product, not smoked cannabis.

Read the original research

Cannabis and multiple sclerosis.

Expert review of neurotherapeutics, 20(8), 849-854

View on PubMed ↗Publisher’s paper ↗

Citation

Fragoso, Yara Dadalti; Carra, Adriana; Macias, Miguel Angel. (2020). Cannabis and multiple sclerosis.. Expert review of neurotherapeutics, 20(8), 849-854. https://doi.org/10.1080/14737175.2020.1776610