IMHO, there isn’t a real "starting" dose for MS pts as pts differ in height/ weight, age, other medications being administered (i.e. is the pt being given a muscle relaxant like baclofen to ease strictures, MSK pain ?) The presumptive goal in using cannabis for MS symptoms is to ease strictures, improve pain mgmt, etc. If that is the case, I advise pts use cann. intake methods with decreased time to onset (i.e. vape/ inhalation, sublingual tinctures) and slowly/ carefully redose until end-results are achieved. With patients, I express the concept of "minimal effective dose/ concentration" when it comes to cannabis and using the least amount of redoses/ puffs/ droppers to achieve the desired results (decreased pain/ increased analgesia/ decreased muscle stricture). With cannabis and MS, I also like to warn against cannabis being used too soon relative to muscle relaxants like baclofen & tizanidine as this may increase risk of fall / accident (in general, pts should be careful of the amount of cann. consumed given general weakness/ increased risk of fall of MS in general). I hope this answer clarifies this issue
drpark
I agree with Dr. Park’s answer. The effects of cannabis in MS are often more global than just relief of spasm, and my MS patients who used medicinal cannabis also valued its ability to moderate their mood and assist with sleep. Dr. Park’s suggestion regarding cautiously advancing the dose/redose schedule to discover the optimal amount is a good one. Cannabis is similar to many medications whose effects can change with changes in dose, sometimes significantly and not always in a desired way. In my opinion, the "minimal effective dose" concept is particularly relevant with cannabis. I also like to point out that effects occur quickly after inhalation, and this makes titrating the dose a lot easier. One other point worth mentioning is that patients with neurological illnesses are often interested in the laboratory science findings that indicate a possible "neuroprotective" activity of some cannabinoids. That word obviously sounds good, but the actual science refers to lab rather than clinical observations, and in medicine it can be a very long way from one to the other. Nevertheless, the lack of apparent toxicity of CBD has led some patients to try it as a treatment for a variety of neurologic conditions. Other than some intriguing studies in seizure disorders, I am not aware of any published science to guide this use at all. My experience as a physician with cannabis in MS has been that it provides ancillary benefits, but whether it affects the course requires study.
drelkind
