The influence of THC:CBD oromucosal spray on driving ability in patients with multiple sclerosis‐related spasticity. Issue 5 (6th April 2018)

• Record Type: Journal Article
• Authors: Celius, Elisabeth G.; Vila, Carlos
• Is Part Of: Brain and behavior. Volume 8:Issue 5(2018)
• Page Start: n/a
• Page End: n/a
• Publication Date: 2018-04-06
• Subjects: driving ability -- multiple sclerosis -- oromucosal -- Sativex -- spasticity -- tetrahydrocannabinol/cannabidiol; Neurology -- Periodicals; Neurosciences -- Periodicals; Psychology -- Periodicals; Psychiatry -- Periodicals; 616.8005
• DOI: 10.1002/brb3.962
• Languages: English
• ISSNs: 2162-3279

Abstract

Abstract: Background: Driving 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, Δ 9 ‐tetrahydrocannabinol:cannabidiol (THC:CBD) oromucosal spray (Sativex ® ), and its potential impact on driving performance. Methods: Articles 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. Results: The 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. Abstract : Multiple sclerosis (MS) is a chronic neurological disease associated with a multitude of symptoms that may cause physical and cognitive disability and reduce well‐being and quality of life (QoL). Driving ability is a key function which the majority of patients want to retain to maintain family/friend, social, and work‐related interactions. Spasticity is a common symptom associated with MS, and it may affect driving performance either directly or via the medications used to treat it. Δ9‐tetrahydrocannabinol:cannabidiol (THC:CBD) oromucosal spray (Sativex®) is approved across the EU for the management of moderate‐to‐severe MS‐related spasticity in adult patients resistant to other antispasticity therapies. Cannabinoid‐based medicines require special consideration due to the legal complexities surrounding THC. The 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.