About 1 in 6 Italian MS patients used unprescribed cannabis, mostly for medical reasons, often without telling their doctor

Current unprescribed cannabis use prevalence was 15.5% (higher than the 10.2% Italian general population rate). Only 36.4% of users disclosed their use to their physician. Current users more frequently reported medical motivations compared to former users. Medical users had higher disability, more spasticity and pain, reduced quality of life, and more neurological/psychiatric medication use. 41.1% of non-users would try cannabis if legal.

Multicenter cross-sectional study across MS centers in Lombardy, Italy. 5,620 MS patients invited; 2,024 (36%) completed anonymous online survey from March 2022-February 2023.

The gap between cannabis use and physician disclosure (only 36% tell their doctor) creates a blind spot in MS care. Patients may be self-medicating with unprescribed cannabis while simultaneously receiving medications that could interact with cannabinoids.

The finding that MS patients use cannabis at higher rates than the general population, primarily for symptom management, while rarely telling their doctors, highlights a systemic gap between patient behavior and clinical awareness in neurological care.

Anonymous survey with 36% response rate; respondents may differ from non-respondents. Lombardy region may not represent all of Italy. Self-reported use. Cannot verify medical vs recreational motivations. Cross-sectional design.