The influence of THC:CBD oromucosal spray on driving ability in patients with multiple sclerosis‐related spasticity

Abstract

BackgroundDriving ability is a key function for the majority of patients with multiple sclerosis (MS) to help maintain daily interactions. Both physical and cognitive disability, as well as treatments, may affect the ability to drive. Spasticity is a common symptom associated with MS, and it may affect driving performance either directly or via the medications used to treat it. In this article, we review the evidence relating the antispasticity medicine, Δ9‐tetrahydrocannabinol:cannabidiol (THC:CBD) oromucosal spray (Sativex®), and its potential impact on driving performance.MethodsArticles were identified by searching PubMed from 1/1/2000 to 30/6/2017 using a specified list of search terms. The articles identified using these search terms were augmented with relevant references from these papers and other articles known to the authors.ResultsThe results from THC:CBD oromucosal spray driving studies and real‐world registries did not show any evidence of an increase in motor vehicle accidents associated with THC:CBD oromucosal spray. The majority of patients reported an improvement in driving ability after starting THC:CBD oromucosal spray, and it was speculated that this may be related to reduced spasticity and/or better cognitive function. It should be noted that THC blood levels are significantly lower than the levels associated with recreational use of herbal cannabis.Conclusions THC:CBD oromucosal spray was shown not to impair driving performance. However, periodic assessment of patients with MS driving ability is recommended, especially after relapses and changes in treatment. Blood THC measurements might be above authorized thresholds for some countries following administration of THC:CBD oromucosal spray, thus specific knowledge of each country's driving regulations and a medical certificate are recommended.

Targeting Cannabinoid Receptors: Current Status and Prospects of Natural Products

“…After the optimization of preparation and delivery methods, another product, called Cannador ® , came to the market, delivering Δ9-THC:CBD within a narrow concentration range and at a two-to-one ratio, in the form of an orally administered capsule [ 45 ]. In relation to this, many of the recent studies on medical cannabis have focused on various forms of Δ9-THC + CBD administration [ 46 , 47 , 48 , 49 ] and co-administration of Δ9-THC with first-line neurotherapeutic drugs [ 50 ]. On the other hand, the synthesis of Δ9-THC analogs is another effective way to avoid or reduce its severe side effects.…”

Cannabis and Autoimmunity: Possible Mechanisms of Action

“…115 CB1 receptors may also be involved given their abundance in the central nervous system. 116 MC and cannabinoid-based medicines are currently being investigated and used to treat MS-associated spasticity, [117][118][119] but whether they can modify the neuroinflammation that causes progressive disability is still an open question: however, even if they cannot induce robust immunosuppression, they could still help by inhibiting the glial responses that facilitate neurodegeneration. 120…”

Barriers to the wider adoption of medicinalCannabis

“…79 A meta-analysis of studies using the orally administered CBD: THC mixture in nabiximols identified that there appeared to be an improvement in driving ability, probably due to reduced spasticity. 80 Guidance for police services and employers concerning the consumption of Cannabis and the effects of THC, in particular, tends to err towards a pragmatic approach of zero tolerance, although the practicalities of testing for relevant metabolites in biological samples are still being resolved.…”