Research Proposal: Medical Cannabis / Multiple Sclerosis

Research Proposal - Introduction:

Cannabis is a flowering plant genus with three varieties: Sativa, Indica, and Ruderalis all originally grown in South and Central Asia. Medical cannabis (or medical marijuana) refers to the use of cannabis and its constituent cannabinoids, such as tetrahydocannabinol (THC) and cannabidiol (CBD), as medical therapy to treat disease or alleviate symptoms. The cannabis plant has a history of medical use dating back thousands of years across many cultures.

As a group, we researched medical cannabis and its effects on diseases including cancer, epilepsy, and multiple sclerosis (MS). Active cannabis studies relating to these diseases are currently happening right now both across Canada, and around the globe.

When dealing with the disease of cancer in relation to cannabis there can be various types of studies.

Patients taking cannabis with high levels of THC are tested while receiving chemotherapy to measure the reduction of nausea and vomiting. Other studies may include patients who take it in hopes to limit inflammation, cell proliferation, and cell survival.

The main arguments find this topic should receive much more attention and be further studied.

The study also suggests that cannabis shows promise for treating cancer.

One interesting fact about the herbal treatment of medical cannabis in relation to epilepsy is that current research studies are just as prominent in pets (dogs and cats) as they are in humans. There have been countless trials which all conclude that the cannabis extract known as CBD decreases seizures among patients (both animal and human) by an approximate 99 percent. Not only that, we had learned there is a multi-million, if not billion dollar international market for CBD infused pet foods. Any pet, with the right veterinary prescription, can simply purchase these products by going online.

After reading, and gathering knowledge about these various medical studies we concurred to lay our focus on the connection between cannabidiol (CBD) extract and the disease of multiple sclerosis.

Literature Review:

Perception of Cannabis Use: Unfortunately, most of the studies that have been done on MS patient cannabis use were purely scientific in nature, meaning there is little information on how public perception of cannabis use may affect an MS patient’s decision to use medicinal cannabis. We attempted to find all the studies that may have discussed this matter, but the Page study was the only study we could find that made an attempt to determine how the perception of cannabis may affect an MS patient using medicinal cannabis.

The Page study also states that the authors believe their study to be the only study that focuses on this aspect. Of the patients surveyed in the Page study, one participant voiced concerns about being referred to as a cannabis user on a government list. A few patients experienced disapproval from friends and family regarding the decision to use medicinal cannabis. This disapproval was allegedly based on legal concerns, supposed addiction and supposed negative effects. Some patients also reported that they had refrained from informing doctors about cannabis use due to anticipation of a negative reaction.

Negative Side Effects: Out of more than 495 Multiple Sclerosis patients included in the 5 studies that were reviewed, none reported any serious or severe negative side effects. The Iskedjian study did not record side effects officially, but within the report it is stated that the only noteworthy side effect found was dizziness, which was experienced by “some” patients. It should be mentioned that dizziness was also reported by the placebo groups in the Iskedjian study. Difficulty in concentration/drowsiness and general forgetfulness was reported in all 5 studies. Patients in the Zajicek and Clark studies reported dry mouth. Both the Zajicek and Clark studies report side effects unique to their studies (side effects that were not reported by any of the other studies). Three patients in the Clark study reported palpitations, anxiety, and paranoia; none of these effects were noted in the other studies. Diarrhea and possible constipation were reported by a small number of patients in the Zajicek study, effects that were not found in any of the other studies.

Study Methodology:

The Clark and Page studies sent surveys to self identified Multiple Sclerosis patients; in the Page study, 780 surveys were mailed to MS patient addresses taken from a Calgary MS clinic’s database and the 14 most eligible respondents were further interviewed over a period of weeks. The Page study’s aim was to describe medical marijuana use from the perspectives of patients with multiple sclerosis, mainly in qualitative terms. In the Clark study, 220 questionnaires were mailed to self-identified MS patients in Halifax, Nova Scotia; 205 questionnaires were completed and no further questions were asked. The questionnaires in the Clark study were designed to “estimate the patterns and prevalence” of cannabis use in these patients. The Zajicek and Corey-Bloom study participants were also selected through MS/neurology clinics and specialists. In the Zajicek study, 417 MS patients took 2 pill form cannabinoids daily for 14 weeks and responded to interviews with the aim of testing the notion that cannabinoids have a beneficial effect on spasticity and other symptoms related to multiple sclerosis. In the Corey-Bloom study, 30 MS patients smoked 1 medicinal cannabis joint every day for 3 days, with the intent of determining the short-term effect of smoked cannabis on patient spasticity. The Iskedjian study analyzed seven placebo-controlled studies of cannabis-based medicine on MS-related or neuropathic pain in patients. Each study focused individually on Sativex, cannabidiol, or dronabinol, which are all cannabis-based medicines. These 7 studies were then combined to produce a master set of results. The intent was to summarize the efficacy and safety data of cannabinoid-based drugs for neuropathic and MS related pain.

Benefits of Cannabis Use: All of the studies we reviewed concluded that medicinal cannabis use is beneficial in alleviating MS patient pain. Excluding the Iskedjian study (which was unclear on the subject), all of the reviewed studies suggested that cannabis use relieves spasticity, which is important for the treatment of MS. Stress, sleeping issues and irritability all decreased in the Clark and Page studies. The Zajicek study also notes improved sleep quality, and mentions increased patient mobility. The Page study also lists improvements in nausea, numbness, bladder and bowel problems, fatigue, sexual dysfunction, writing ability, and even reduced need for conventional medicine.

Research Questions:

Was your decision to use medicinal cannabis influenced by your friends and family’s perception of cannabis use? If so, how did this influence your decision?

Do you feel like your identity as a medicinal cannabis user is a part of a larger political struggle over cannabis legality? Do you think the perception of your own medicinal cannabis use is affected by what politicians say about cannabis?

Do you think more Multiple Sclerosis patients would use medicinal cannabis if there wasn’t a negative stigma attached to cannabis use? Do you think it possible that the negative stigma surrounding cannabis use is having a negative impact on patients who may benefit from cannabis based medicine?

Do you think politicians have a responsibility to speak intelligently about cannabis, considering that their words may influence other people’s attitudes towards medicinal cannabis use?

Methodology:

The setting selected for our research is St. Michael’s Multiple Scoliosis Clinic. The clinic does treatment, education, and research. It offers a multidisciplinary approach to treating MS, offering physiotherapy, occupational therapy as well as medical treatment. This clinic was selected because it meets the criteria for time, geography, and finance; the interviews to be conducted and the recruitment process will not take long, the hospital is in Toronto, and the only cost is getting to and from the hospital. It was also chosen because of the high number of people that could be potentially interacting with. The clinic boasts to boasts to help thousands of people from across the GTA. The most important part that stood out, however, was their stated interest in exploring new therapies, and thus, would presumably have an interest in why or why not some of their patients may be using cannabis.

To gain access to the setting we will have to go through the Office of Research Administration, which coordinates and manages research operations at St. Michaels. The gatekeeper is one Dina Coronios; she is listed as the contact person for the Office of Research Administration. To gain approval from this gatekeeper, we will make first contact with a phone call making a formal request for an informational meeting were we would explain our research goal and also make sure to explain our methods for ensuring no harm would come to their patients, as well as ensure that we would not interfere with the day-to-day operations, or “get in the way.” We would also offer to share our research considering they are, in part, a research institution.

If our access is denied we will ask if we could place a sheet on the hospital’s bulletin seeking multiple sclerosis patients who use cannabis to help manage their illness. The sheet would have an email account and we would arrange an interview at a location that is convenient to them. As medical use of cannabis is a controversial issue, people who have an opinion about it would most likely want to express it to people who are actually gathering research on the subject.

The research methods for exploring the controversy of medical cannabis and its relation to multiple sclerosis are qualitative interviews, specifically one-on-one, and media analysis.

Qualitative interviews are interviews that have a predetermined set of specific questions. These are unlike journalistic interviews which may go in different directions and break from the script depending on the answers of the interviewee. We have chosen it because we want to find out about what people who have multiple sclerosis and who use cannabis to medicate have to say about the controversy surround medical cannabis, and there is no better way to find that out than by asking them.

Media analysis is studying media, and breaking them down into themes and then discussing them. We would specifically analyze political advertisements and relevant parts of speeches and interviews regarding cannabis with the purpose of gathering information on what the political perception is, and how it is shaping the opinions of voters.

Both of these techniques and the results they yield will be useful on understanding if public perception of cannabis use is having any effect on people with multiple sclerosis using it. We will gain the public perception from the media analysis, and we will get our answers from the interviews.

Analysis:

Since our methodology is essentially designed to catalog the attitudes of Multiple Sclerosis patients towards medicinal cannabis, our analysis work would be begin with finding commonalities between patient attitudes. All interview responses would be compared with one another, using key themes in responses to create categories for patient attitudes towards cannabis use, such as patients who believe the negative stigma attached to cannabis use is limiting the number of medicinal cannabis-using MS patients. These categories may also be separated into smaller categories based on key themes if necessary. For example, if a respondent is asked “Do you think the perception of your own medicinal cannabis use is affected by what politicians say about cannabis?” and the respondent answers affirmatively, his or her response will be further categorized based on why the respondent believes that politicians statements affect his or her perception of medicinal cannabis use. All interview responses would be broken down into categories in this manner, with the goal of essentially converting all of the information gathered from patients into “Yes” or “No” answers to specific questions. This would give us a set of binary values for qualitative statements (For example, we would be able to determine what percentage of our interview respondents believe that politicians have a responsibility to speak intelligently about cannabis). All interview responses would be reviewed, and any useful information that couldn’t be converted into a “Yes” or “No” answer would be noted and included separately in our study from the previously mentioned set of binary values. The analysis of a large scale study performed in this manner should paint an accurate picture of the “demographics” of Multiple Sclerosis patients’ attitudes towards medicinal cannabis use. All interview responses would also be closely examined for outliers and viewpoints that seem unusual or out of place, and the validity of the response and respondent participation would be questioned with the purpose of determining a source of action. Individual responses considered invalid would be removed from the study, and similarly all responses made by an individual suspected of answering questions dishonestly would also be removed from the study.

Conclusion:

The related symptoms of cannabis in the study are positive, though varied. Also, it proves that the use of cannabis should be pushed in the palliative treatment of oncology patients.

CBD's have neuro-protective and anti inflammatory effects, also, it appears to be well tolerated in both humans and animals.

The current Liberal Party of Canada is in support of both cannabis/marijuana legislation and regulation. The current leader of the Liberal Party Justin Trudeau has recently defended cannabis/marijuana alongside supporting activists Marc and Jodie Emery.

Marc is a marijuana activist and supporter of the liberal party and wife Jodie, also an activist recently ran in the Vancouver-West end riding. These Canadians are the ones who are leading the fight against the current government in support of all aspects of medical cannabis regulation, legislation, and full legalization.