How Much Do We Really Know About Marijuana, Alcohol, and Multiple Sclerosis?

Marijuana and alcohol — studies suggest that one of these substances helps patients with multiple sclerosis while the other can contribute to comorbidities. Allen Bowling, MD, PhD, a practicing multiple sclerosis specialist in Colorado, breaks down what we know about the two at the 2016 Annual Meeting of the Consortium of Multiple Sclerosis Center (CMSC) in National Harbor, Maryland.

With a steady number of states giving the go-ahead on medical marijuana, and even a number of them legalizing its recreational use, the amount of studies on the drug has climbed over the past two decades. Twenty-four states, and the District of Columbia (DC), have approved cannabis for medicinal purposes, including pain and spasticity and/or multiple sclerosis.

Unlike diet, there is “quite good evidence” supporting the use of cannabis for multiple sclerosis, according to Bowling. A meta-analysis published in The Journal of the American Medical Association (JAMA) in June 2015 assessed 79 trials with nearly 6,500 patients on the topic. Moderate-quality results emerged for spasticity. Further research in neurological clinical trials has found that marijuana is generally well-tolerated.

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The promising news doesn’t come without side effects, however. Bowling mentioned how magnetic resonance imaging (MRI) showed neurotoxicity from marijuana — a finding he described as “quite concerning.” Regular marijuana use results in structural changes, like in volume and gray matter density, in the brain, especially in the hippocampus. These neurologically relevant side effects can’t be ignored, especially in a population already battling a chronic illness.

Bowling presented the question: “Is ‘medical marijuana’ a misnomer?”

There’s a lack of safety and health information to communicate to medical professionals — which is one of the reasons that some people are so hot and cold on the drug.

Alcohol, on the other hand, comes with a different set of challenges in those with multiple sclerosis. One study found that 15% to 40% of people with multiple sclerosis use alcohol in excess, especially in the younger, male, and more educated population. It increases the risk for all-cause mortality (HR 7.6), but only one-quarter receive advice from health professionals. On the positive side, there’s been some evidence showing a decrease of alcohol intake after diagnosis.

There is “no definite effect course” between multiple sclerosis and alcohol, Bowling said. However, we do know that the drug promotes depression, anxiety, and suicidal ideation in these patients. In addition, alcohol contributes to fatigue, incoordination, gait difficulties, and increased reaction times.

• Related: Simple Behavioral Changes Predict Suicide Risk in Multiple Sclerosis

Comorbidities are quite common in people with multiple sclerosis. Alcohol has the power to impact the risk of developing more health issues, such as hypertension, cancer, and addiction. This understanding begs the questions — can multiple sclerosis be used as a motivator for treating addiction?

There isn’t a clear cut answer as to if those with multiple sclerosis should give up alcohol altogether, but it’s apparent that excessive use isn’t good for anyone.

As with various areas of multiple sclerosis, research focusing on marijuana and alcohol is ongoing. Therefore, it’s essential for physicians and patients to have open communication in order to make these important decisions.

Also on MD Magazine >>> More News from the CMSC 2016 Annual Meeting