The Experience of Doctors

Denis Petro, M.D

As a practicing neurologist, I saw many patients for whom uncontrollable spasticity was a major problem. Unfortunately, there are very few drugs specifically designed to treat spasticity. Moreover, these drugs often cause very serious side effects. …Dantrium or dantrolene sodium carries a boxed warning in the Physician's Desk Reference because of its very high toxicity. …The adverse effects associated with Lioresal Baclofen are somewhat less severe, but include possibly lethal consequences, even when the drug is properly prescribed and taken as directed….Unfortunately, neither Dantrium or Lioresal are very effective spasm control drugs. Their marignal medical utility, high toxicity, and potential for serious adverse effects, make these drugs difficult to use in spasticity therapy.

As a result, many physicians routinely prescribe tranquilizers, muscle relaxants, mood elevators, and sedatives to patients experiencing spasticity. While these drugs do not directly reduce spasticity, they may weaken the patient's muscle tone, thus making the spasms less noticeable. Alternatively, they may induce sleep or so tranquilize the patient that normal mental and physical functions are impossible.

[Dr. Petro then related his experience with a twenty-seven year-old MS patient who reported he was smoking marijuana for his symptoms. Dr. Petro and colleagues examined the patient and then asked him to refrain from smoking for six weeks. He continues:]

After six weeks he returned for another examination. At this time, he reported an increase in his symptoms to the point where he had leg pains, increased clonic activity, and uncontrolled leg spasms every night. More disturbing to him was urinary incontinence, which occurred on two occasions during leg spasms.

On objective examination….in layman's terms, this patient's spasticity had increased dramatically in six weeks. This spasticity made his legs extremely rigid, he was finding it increasingly difficult to walk or sleep, and he was losing bladder control. Following our examination, and at the patient's request, he left the clinic then returned one hour later to be examined for a second time.

This second examination was remarkable. The earlier findings of moderate to severe spasticity could not be elicited. Deep tendon reflexes were brisk, but without spread, ankle clonus was absent, and the plantar response was flexor on the left and equivocal on the right.

In short, this patient had undergone a stunning transformation. Moreover, this unmistakable improvement had occurred in an incredibly brief period of time-- less than an hour separated the two examinations. On questioning, the patient informed us he had smoked part of one marijuana cigarette in the interval between examinations.

Denis Petro, M.D., Former FDA Review Officer and principal investigator on spasticity and cannabis studies, in testimony submitted before DEA In the Matter of Marijuana Rescheduling, October 18, 1987.

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