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

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, Δ9-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.

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  • Authors+Show Affiliations

    ,

    Department of Neurology Oslo University Hospital, and Institute of Health and Society University of Oslo Oslo Norway.

    Almirall Neurology Global Medical Affairs Barcelona Spain.

    Source

    Brain and behavior 8:5 2018 05 pg e00962

    MeSH

    Automobile Driving
    Cannabidiol
    Cognition
    Dronabinol
    Drug Combinations
    Humans
    Multiple Sclerosis
    Muscle Spasticity
    Neuromuscular Agents

    Pub Type(s)

    Journal Article
    Review

    Language

    eng

    PubMed ID

    29761015

    Citation

    Celius, Elisabeth G., and Carlos Vila. "The Influence of THC:CBD Oromucosal Spray On Driving Ability in Patients With Multiple Sclerosis-related Spasticity." Brain and Behavior, vol. 8, no. 5, 2018, pp. e00962.
    Celius EG, Vila C. The influence of THC:CBD oromucosal spray on driving ability in patients with multiple sclerosis-related spasticity. Brain Behav. 2018;8(5):e00962.
    Celius, E. G., & Vila, C. (2018). The influence of THC:CBD oromucosal spray on driving ability in patients with multiple sclerosis-related spasticity. Brain and Behavior, 8(5), pp. e00962. doi:10.1002/brb3.962.
    Celius EG, Vila C. The Influence of THC:CBD Oromucosal Spray On Driving Ability in Patients With Multiple Sclerosis-related Spasticity. Brain Behav. 2018;8(5):e00962. PubMed PMID: 29761015.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - The influence of THC:CBD oromucosal spray on driving ability in patients with multiple sclerosis-related spasticity. AU - Celius,Elisabeth G, AU - Vila,Carlos, Y1 - 2018/04/06/ PY - 2017/12/05/received PY - 2018/02/09/revised PY - 2018/02/18/accepted PY - 2018/5/16/entrez PY - 2018/5/16/pubmed PY - 2019/3/7/medline KW - Sativex KW - driving ability KW - multiple sclerosis KW - oromucosal KW - spasticity KW - tetrahydrocannabinol/cannabidiol SP - e00962 EP - e00962 JF - Brain and behavior JO - Brain Behav VL - 8 IS - 5 N2 - 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, Δ9-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. SN - 2162-3279 UR - https://www.unboundmedicine.com/medline/citation/29761015/The_influence_of_THC:CBD_oromucosal_spray_on_driving_ability_in_patients_with_multiple_sclerosis_related_spasticity_ L2 - https://doi.org/10.1002/brb3.962 DB - PRIME DP - Unbound Medicine ER -