Literature Review
INDIANAPOLIS—In August 2014, approximately 16% of patients with multiple sclerosis (MS) reported currently using marijuana to treat their disease, according to survey results presented at the 2015 CMSC Annual Meeting. People with moderate disability and those with high spasticity are more likely to use marijuana than other patients.
Approximately 82% of respondents reported that they would consider using marijuana if it became legal where they live, said Stacey Cofield, PhD, Associate Professor of Biostatistics at the University of Alabama at Birmingham. More than one-third of respondents already had spoken to their physician about using marijuana, regardless of whether they were current marijuana users.
Survey Not Linked With NARCOMS Data
In 2014, the North American Research Committee on MS (NARCOMS) created a brief online survey to characterize marijuana use among people with MS, determine whether participants had spoken to their doctors about marijuana use, and investigate the disease status of marijuana users and nonusers. The survey did not distinguish between various forms (eg, smoked, ingested, or sprayed) of marijuana. To ensure that participants’ personal health information was not associated with their marijuana status, NARCOMS initiated the survey outside of the organization’s website and kept all responses anonymous. One of the survey’s limitations is that the responses are not linked with the NARCOMS longitudinal data, said Dr. Cofield.
In August 2014, more than 12,000 active participants in the NARCOMS database received invitations to participate in the survey, and more than 5,600 people responded. About 50% of participants live in a place where marijuana is legal in some form, and this result is consistent with the characteristics of the general US population. Also, 1.1% of respondents live in a place outside of the US where marijuana is legal.
Approximately 10% of participants described their disease as progressive MS with no history of relapses, and about 90% of participants had a history of relapses. Respondents with progressive MS were older at diagnosis, older at the time of the survey, and less likely to be female, compared with respondents with relapsing-remitting MS. These results are consistent with the characteristics of the larger population of Americans with MS, said Dr. Cofield.
Respondents’ median score on the Patient Determined Disease Steps (PDDS), a self-reported measure of disability, was 3, which represents early gait disability. People with stable relapsing-remitting MS (ie, with no relapse in the previous two years) had moderate disability, and patients with active relapsing-remitting MS had a higher level of disability. People with progressive MS had the highest levels of disability.
Respondents’ median score on the spasticity performance scale was 2, which represents mild spasticity. People with active MS had slightly more spasticity than respondents with stable MS. Patients with progressive MS and relapses had more spasticity than patients with primary progressive MS.
Active Disease Increased Likelihood of Use
The lowest prevalence of marijuana use (12.2%) was among respondents with stable relapsing-remitting MS. Approximately 19.9% of respondents with active relapsing-remitting MS and 19.2% of respondents with progressive MS and a history of relapses reported marijuana use. About 15.0% of respondents with primary progressive MS currently used marijuana. Between 60% and 70% of people reported using marijuana at least once in the past, and about 50% of people had considered using marijuana for their MS since their diagnosis.
Respondents with a moderate level of disability, as measured by PDDS, reported the highest percentage of current marijuana use, compared with those with mild disability and those with severe disability. The low level of marijuana use among NARCOMS participants with severe disability (ie, bedridden status) may result from the small sample size or the limited mobility among these patients who completed the survey, said Dr. Cofield. Marijuana use increased with increasing spasticity. The proportion of respondents who had never used marijuana was highest among people reporting no spasticity.
People with progressive MS and relapses, progressive MS without relapses, and active relapsing-remitting MS were more likely to be current marijuana users than respondents with stable relapsing-remitting MS. In addition, people with more severe disability, as measured by PDDS score, were more likely to be current marijuana users than respondents with no disability. “This holds true for every level higher than normal [ie, no disability],” said Dr. Cofield. Among respondents with moderate disability, people with higher PDDS scores were more likely to be current marijuana users than people with lower PDDS scores.
Survey May Inform Clinical Trials
Among the goals of the survey were to see which patients with MS were talking about using marijuana “and to bring the participants into the discussion,” said Dr. Cofield. “It’s clear from … the responses that we’ve gotten that patients are willing to talk about it—even the patients who aren’t taking it.”
