Sativex is a cannabis-derived medicine which is indicated in the treatment of spasticity caused by multiple sclerosis (MS). It contains the cannabinoids ∆-9-tetrahydrocannabinol (THC) and cannabidiol (CBD) and may be of benefit to patients who live in regions where marijuana is not yet legal or available.
Let’s take a closer look at cannabis-derived Sativex and how it works.
What is Cannabis-Derived Sativex?
Sativex is a medicine developed by GW Pharmaceuticals, a company with a penchant for cannabis-based medicines (they also developed Epidiolex, a CBD product designed to treat seizures due to rare childhood epilepsies such as Lennox-Gastaut syndrome and Dravet syndrome).
The drug is licensed to treat MS-related spasticity, although it has also been investigated for other conditions including cancer-related pain. It comes as an oromucosal spray, which is applied to the inside of the mouth and contains a cannabis extract known as Nabiximols. Nabiximols is made up of cannabinoids equivalent to 27mg THC and 25mg CBD per milliliter. The spray also contains ethanol, propylene glycol, and peppermint oil.
When using Sativex for the first time, the dose is gradually increased over the course of two weeks. One spray is used on Day 1, and by Day 14 the dosage can be increased to a maximum of 12 sprays each day, although patients are advised to use the minimum dosage required to obtain relief. A minimum of 15 minutes should be left between sprays.
Each 100µL spray contains 2.7mg THC and 2.5mg CBD, almost a 1:1 ratio of these two cannabinoids.
Sativex Cautions and Contraindications
The manufacturers advise that Sativex be used with caution in the following groups of patients:
- Pregnant women
- Under 18s
- Those suffering from epilepsy or seizure disorders
- Patients with kidney or liver problems
- Patients with heart problems, including angina, heart attacks, uncontrolled high blood pressure, and irregular heartbeat
- The elderly
- Those with a history of substance abuse
Furthermore, Sativex should not be used by patients who are:
- Hypersensitive to any of the medicine’s ingredients
- Suffering from or have a history/family history of psychiatric illness other than MS-related depression
Sativex can also interact with other drugs, and anybody taking other prescribed or over-the-counter medications should inform their physician before using Sativex for the first time.
Sativex Side Effects
Like all medicines, Sativex comes with a long list of potential side effects, although these will not necessarily affect everyone who uses it. Sativex may cause any of the following side effects which are listed from most to least common:
- Poor memory or concentration
- Blurred vision
- Difficulty speaking
- Increased or decreased appetite
- Altered taste or dry mouth
- Constipation or diarrhea
- Nausea or vomiting
- Burning, pain, or ulcers in the mouth
- Lack of energy
- Increased risk of falls
- Changes in pulse rate or blood pressure
- Throat irritation
- Abdominal pain
- Changes in the color of mouth or teeth
- Irritation in areas where Sativex is sprayed
- Red, swollen, or peeling of the mouth
The risk of adverse effects such as mouth irritation can be reduced by spraying Sativex on a different area each time.
Research on Sativex
Sativex was being researched for MS symptoms as far back as 2005. One study of 368 patients found that the spray significantly reduced symptoms such as neuropathy, spasticity, muscle spasm, and sleep disturbances. The most commonly reported adverse effects included dizziness, drowsiness, fatigue, intoxication, and a bad taste in the mouth.
The drug has also been investigated for its effects on cancer-related pain, although the results are somewhat inconclusive. In February 2019, the charity Alzheimer’s Research UK announced that it would be dedicating £300,000 to researching whether Sativex could benefit patients with Alzheimer’s disease and dementia.
Why Does Cannabis-Derived Sativex Work?
Sativex works for MS-related spasticity as it contains cannabinoids, compounds which can influence the body’s endocannabinoid system (ECS). The ECS is a group of chemicals called endocannabinoids and the cell receptors to which they bind. These receptors are called CB1 and CB2 receptors, and they are found throughout the central nervous system as well as in peripheral cells.
The ECS is presumed to play a role in the development of conditions like MS. The exact cause of MS is unknown, but it is believed to be a combination of genetic and environmental factors. What we do know about MS is that it is an autoimmune disorder, meaning that the immune system fails to recognize and subsequently attacks the body’s own cells.
In the case of MS, the immune system attacks nerve cells, specifically those of the central nervous system, which are covered by a substance known as the myelin sheath. Myelin sheath is a membrane which wraps around the long tail (axon) of a nerve cell. It acts as a kind of electrical insulation, allowing nerve impulses to ‘jump’ between gaps in the myelin sheath and speeding up the rate at which they are transmitted.
When the immune system attacks the myelin sheath as it does in MS, the membrane is damaged to form areas of inflammation known as ‘plaques.’ These plaques prevent nerve signals from being transmitted as they should, and this is what causes many of the symptoms of MS.
This inflammation of the nervous system is thought to activate the ECS. Endocannabinoids are released, and these reduce inflammation and have a protective influence over nerve cells. Endocannabinoids are also believed to have an immunosuppressant effect, meaning that they could help to modulate some of the damage caused by autoimmune disorders.
Another function of endocannabinoids in the body is the regulation of neurotransmitters and how nerve impulses are conveyed from one cell to the next. This means that they play an essential role in the management of pain and other sensory changes.
So, Sativex works by mimicking the body’s natural ECS. It contains cannabis-derived cannabinoids which have a similar molecular structure to endocannabinoids and can, therefore, produce many of the same effects.
What you may be wondering, is whether Sativex has any distinct advantages over regular marijuana. Let’s take a look.
Sativex vs. Medical Marijuana
The most apparent advantage of Sativex over medical marijuana is legality. In the UK, for example, Sativex has been legal for several years, whereas medical marijuana was only approved in late 2018. Apart from the fact that cannabis is still highly stigmatized in the UK, it is extremely difficult to get hold of legally, and the situation does not seem as if it is about to change.
Another advantage of Sativex is that it may be easier to control your dosage than when you use marijuana flower. Even when you purchase medical marijuana legally and know precisely how much THC and CBD it contains; it can be challenging to take an accurate dose each time. This issue is avoided when you use Sativex as you get a fixed dose of cannabinoids with every spray.
Finally, Sativex contains a 1:1 ratio of THC and CBD. This is something which is more difficult to achieve when using marijuana as most strains are bred to be high in either THC or CBD. However, there are some strains which claim a 1:1 ratio including Pennywise and Cannatonic.
Although Sativex has several advantages over medical cannabis, using the herb in its natural form may have some additional benefits too. There is far more to marijuana than just THC and CBD. It also contains other cannabinoids, terpenes, and flavonoids, all of which have their own unique effects on human health.
There is even the widely-held belief that all of these active compounds work more effectively when used together than in isolation, a phenomenon known as the ‘entourage effect.’ The entourage effect may also minimize side effects when using cannabis as opposed to Sativex, although, of course, they can still be a problem for some people.
Also, there are many different ways to use medical marijuana: smoking, vaping, tinctures, edibles, concentrates, and more. This increased versatility means that it is easy to find an administration method that suits you, whereas Sativex is only available as a spray.
In the end, whether you choose Sativex or marijuana is a matter of personal choice as both have distinct advantages and disadvantages. However, if you are unlucky enough to live in a region where cannabis is not yet legal medicinally or is not readily available, Sativex may be your only choice.
What is Cannabis-Derived Sativex and Why Does It Work? Final Thoughts
Whenever an herb is found to have beneficial properties, you can be sure that it will not be long before a pharmaceutical company decides to take advantage. GW Pharmaceuticals has done just that with Sativex, taking one of nature’s oldest medicines and making it their own.
While some may consider the commercialization of herbal remedies to be a bad thing, it is essential to keep an open mind. For MS patients who do not have access to medical marijuana, Sativex could provide a much-needed lifeline when it comes to managing symptoms such as spasticity, without breaking the law.