Decoding Cannabis: THC, CBD, and the search for better MS symptom control with medical cannabis

At its core, multiple sclerosis is a disorder of internal miscommunication. The immune system turns on the nervous system, stripping away protective layers around nerves and leaving behind confusion in movement, memory, mood, and sometimes extreme pain. 

The result is a physical disability and a complex web of symptoms that can (and often do) shift day to day, making it tricky to find effective long-term treatment solutions.

Conventional treatment approaches do what they can, aiming to slow the underlying damage. Symptom-specific medications are usually stacked one on top of another: opioids for pain, muscle relaxants for spasticity, and benzodiazepines for sleep or anxiety. 

But for some, this patchwork approach can bring more problems than it solves, with all three of the above-mentioned pharmaceutical groups coming with concerning potential side effects, and both opioids and benzodiazepines being highly addictive with extremely unpleasant withdrawal symptoms.

Welcome back to Decoding Cannabis, our blog series where we break down the latest research on medical cannabis into an easier read without missing any of the important findings and results.

This edition has a closer look at a recent US study on how medical cannabis for multiple sclerosis was tracked in a clinical setting. We’ll unpack what symptoms improved, how it affected other medications, and what it could mean for people living with MS today.

Learn more about medical cannabis for neurological conditions by heading to our recent blog Decoding Cannabis: How medical cannabis (THC and CBD) helps manage neurological conditions

What kind of study are we looking at?

While it lacks the controlled conditions of a placebo trial, this was still a robust piece of research grounded in real data. In science speak, it was a retrospective observational study, which simply means the researchers reviewed existing clinical records to track how medical cannabis was prescribed and what happened next.

The study included 141 patients diagnosed with MS. Each had at least four follow-up appointments after beginning cannabis treatment. At each visit, clinicians recorded symptom scores, side effects, and any changes to other medications, such as opioids or muscle relaxants.

Because there was no control group or placebo, this type of study can’t establish cause and effect - but what it does offer insight into is: 

• How medical cannabis was used by real MS patients 
• How these patients responded to medical cannabis treatment over time
• What formulations are chosen 
• And how their broader treatment plans shift as a result. 

It reflects real clinical care, not just laboratory models. In other words, real-world results from real MS patients who were being treated by a real medical cannabis clinic (over time) - exactly what we offer and how we operate here at Releaf.

Why are patients with MS turning to medical cannabis?

MS is one of those disorders where patients (and their clinical team) have real struggles with predicting how the symptoms will appear from one day to the next. Monday may start with chronic pain, followed by a few days of muscle tightness and poor sleep, which leads to heavy fatigue and the inevitable cognitive and emotional dips that follow. 

And these symptoms rarely come alone. This is why people with MS are usually prescribed a heavy cocktail of pharmaceuticals to try and reduce their daily struggles. 

That’s where medical cannabis has been shown to offer such value. 

Unlike most pharmaceuticals, which are designed to work through one specific therapeutic pathway, medical cannabis offers a multi-symptom approach, with the potential to ease pain, improve sleep, reduce spasticity, and support emotional well-being, all through a single, adaptable treatment.

What types of medical cannabis were administered in the study?

Most patients began treatment with a balanced 1:1 ratio of THC to CBD, which accounted for around 65% of prescriptions at baseline (the actual percentages or milligram levels of THC and CBD aren't cited in the study). As treatment progressed, many shifted toward higher-THC options (a 20:1 ratio) to help manage symptoms like pain and spasticity.

Sublingually administered medical cannabis oil options (or tinctures) were the most common format, used daily for steady relief. Vaporised cannabis was added occasionally, usually as needed during flare-ups or for breakthrough symptoms that required faster action.

This flexible approach reflects a core principle of medical cannabis prescribing: there is no one-size-fits-all, cookie-cutter approach. What works for one patient (dosing levels, cannabinoid ratios, and delivery methods) may not offer the same level of symptomatic control for the next, which is why clinical oversight and guidance are so crucial, especially in the first year or so. 

What symptoms improved most with medical cannabis?

Somewhat unsurprisingly (as medical cannabis for chronic pain is the most common reason for a Releaf prescription), the best scores came from: 

• Pain relief, with 72% of patients in this study experiencing some improvement. MS pain can be caused by nerve irritation, muscle cramping, or both. Medical cannabis has been shown to offer relief through several pathways. It may dampen nerve signalling, reduce local inflammation, and ease muscle tension via its interaction with the endocannabinoid system

Learn more: What is the endocannabinoid system? 

• Next up, muscle spasticity (again, no huge shock here - MS-related muscle spasticity is one of the three conditions that the NHS will consider medical cannabis prescriptions for, but rarely actually issue prescriptions for ) - almost half of all patients in the study (48%) reported improvements. 

These sudden, usually quite drawn-out muscle contractions are horrible to go through. They can be extremely debilitating, and reducing their frequency or intensity has a huge impact on movement, sleep, and general quality of life.

• Sleep improved in just over 40% of cases. While that number is a little lower than we expected, improving sleep architecture in MS can lead to better energy regulation, mood, and cognitive function the next day.

A smaller but notable number of patients reported:

• Better gait
• Lower overall anxiety
• An obvious uptick in general mood
• Fewer headaches
• Higher quality of life scores
  
  

It’s important we emphasise medical cannabis is not a magic cure for MS - unfortunately nothing is - but it can help many patients manage the symptoms that cause havoc in their day-to-day lives. 

Can medical cannabis help reduce the need for pharmaceutical interventions?

Now, this is a touchy area. We are not saying that pharmaceutical options should be ruled out if a patient begins to use medical cannabis. That said, the data in this study showed a clear drop in opioid use among patients prescribed medical cannabis.

Here’s what the study found in this area:

• Average daily opioid use fell from 51 mg to 40 mg morphine milligram equivalents (MME)
• 22% of patients discontinued opioids entirely
• 32% reduced their opioid dose
• There were also downward trends in benzodiazepine and muscle relaxant use, though these did not reach statistical significance

This supports the emerging data that a medical cannabis prescription can often help reduce the need for certain high-risk medications, a concept referred to as the “opioid-sparing” effect. It doesn’t mean cannabis-based treatment options replace others completely, but it may allow for a gentler, more strategic approach to medication planning for MS.

Was medical cannabis a good option for every study participant?

No. 48% discontinued their medical cannabis treatment before the fourth follow-up. This comes down to a few reported factors.11% found that it simply wasn’t in their budget, while a small number (6%) found that it didn’t offer the sustained symptom relief they needed. 

This is in line with what we already know - that is, that medical cannabis treatment doesn't work for every single patient.

Only 3% of the participants reported that they stopped due to side effects, with fatigue being the only statistically significant adverse effect reported.  

What do Releaf patients say about UK medical cannabis for MS?

Behind every Releaf account is a patient in need, and behind every prescription is a story.

In the 18 months since Releaf opened our doors, we’ve had the privilege of supporting dozens of people living with MS. Patients who arrived exhausted, in pain, and (in many cases) still searching for a treatment that might finally make the difference they so sorely need. Not another prescription to layer on top of the rest, but something with a broader reach. Something that worked with their body and mind, not against it.

Jean’s story

Take Jean, who was diagnosed in her early 40s and has spent the last few decades looking for a treatment option that actually helps. Now in her late 70s, she still lives independently, with Releaf medical cannabis helping her stay just that little bit more in control.

“I’ve been very grateful to Releaf because it was getting to the point where I couldn’t sleep because of a lot of pain in my legs. Now, at around half past 9 or 10 o’clock at night, I take my 0.3 milligrams of medical cannabis oil, and I sleep like a log all night until about 7 o’clock the next morning. It’s brilliant. Good sleep makes such a difference, and I didn’t realise how much I’d been missing it.

I’ve even started vaping the flower. I’ve never done that sort of thing before because I don’t smoke. I’m still deciding about it -  have only tried that a handful of times so far, but I think I will carry on with it, as it’s been very supportive.

Using medical cannabis has also helped me stay somewhat independent. Life’s been hectic lately, and there’s been talk of continuing care or going into a home, which I don’t want to do. Medical cannabis has made it possible for me to manage my health issues better and keep living in my own space, which is very important to me.”

Deb’s story

A career army nurse and now a practising psychotherapist, Deb approached her MS diagnosis with every tool she could find: prescription meds, strength training, diet, and determination - and now, a UK medical cannabis prescription through Releaf.

“My dosing routine was designed in consultation with different doctors at Releaf. I've had follow-up consultations virtually every month, and received a lot of advice from the doctors, but the final decisions about the treatment plan were up to me. 

I started with medical cannabis oil, only a tiny bit, twice a day, and even a small dose made a big difference in my pain symptoms after only a few days. 

I take my cannabis oil in the morning at about 8 a.m., and then nothing else until bedtime, and that gets me through the night. Falling asleep is not a problem for me because I have MS fatigue, but it helps with the pain. I’m aware that it’s more common to take medical cannabis for insomnia, but it also seems to help a lot with chronic fatigue. I used to feel as though I was wading through mud, day after day, but I very rarely experience that feeling now.”

Could a UK medical cannabis prescription be part of your MS care plan?

As we’ve stated time and time again, cannabis-based treatments aren’t right for everyone. That said, for some people living with MS, medical cannabis can offer meaningful relief from the pain, spasticity, sleep, and mood symptoms that go hand in hand with an MS diagnosis. 

At Releaf, we offer personalised prescriptions and ongoing clinical support tailored to each patient’s symptoms and lifestyle. For those needing regular care, our Releaf+ membership includes unlimited specialist consultations each month, free prescription repeats and delivery, and member-only medical cannabis pricing for just £39.99/month - ideal for managing long-term conditions like MS.

If you would like to learn more, feel free to head over to our medical cannabis eligibility checker. It takes just 20 seconds to complete, costs nothing, and could be the first step in understanding whether medical cannabis is a suitable option for your MS care plan. You’ll get a clear answer based on your condition and treatment history.

No obligation, no pressure. Just honest guidance to help you make an informed decision in your own time. 

Releaf - Let’s Rethink Healthcare.