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

The takeaway

In a multicenter Italian survey of 2,024 MS patients, 15.5% currently used unprescribed cannabis, often for medical purposes, but only 36% disclosed this to their physician, with 41% of non-users saying they would use it if legal.

Neurologists treating MS patients; medical cannabis program designers in European contexts.

15.5% of MS patients used unprescribed cannabis; only 36% told their doctor

What the researchers found

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.

Why it matters

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 numbers in context

2,024 MS patients (mean age 45.2, 64.5% female). 77.3% relapsing-remitting. Current users: 15.5%. Former users: 15.0%. Never users: 69.5%. Disclosure rate: 36.4%. Would use if legal: 41.1% of non-users.

How the study worked

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.

What this study cannot tell us

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.

How to read the evidence

Multicenter survey with reasonable sample size, though low response rate and anonymous format introduce potential bias.

When this study was published

2024 study

The bigger picture

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.

Questions still open

What prevents patients from disclosing cannabis use? Would formal integration of cannabis into MS treatment plans improve outcomes and safety?

Common questions

Why do MS patients use cannabis?

Medical users reported higher disability, spasticity, and pain. While nabiximols (Sativex) is approved for MS spasticity in Italy, some patients prefer unprescribed cannabis for broader symptom management or because of access barriers to approved products.

Why do most patients not tell their doctors?

The study did not investigate specific reasons, but likely factors include stigma, fear of judgment, concern about legal consequences, and uncertainty about how physicians will respond.

Read the original research

Unprescribed cannabinoids and multiple sclerosis: a multicenter, cross-sectional, epidemiological study in Lombardy, Italy.

Journal of neurology, 271(11), 7186-7205

View on PubMed ↗Publisher’s paper ↗

Citation

Giossi, Riccardo; Mercenari, Martina; Filippi, Massimo; Zanetta, Chiara; Antozzi, Carlo Giuseppe; Brambilla, Laura; Confalonieri, Paolo; Crisafulli, Sebastiano Giuseppe; Tomas Roldan, Eugenia; Annovazzi, Pietro; Conti, Marta Zaffira; Barrilà, Caterina; Ronzoni, Marco; Grobberio, Monica; Negri, Attilio; Gustavsen, Stefan; Torri Clerici, Valentina. (2024). Unprescribed cannabinoids and multiple sclerosis: a multicenter, cross-sectional, epidemiological study in Lombardy, Italy.. Journal of neurology, 271(11), 7186-7205. https://doi.org/10.1007/s00415-024-12472-4