Evidence Note: Evidence strength varies by condition. Chronic pain and epilepsy have the strongest clinical evidence base. Other conditions are treated based on specialist clinical judgement and emerging research. All prescriptions require specialist assessment.
Spasticity — the involuntary stiffening and spasming of muscles — affects hundreds of thousands of people in the UK as a consequence of multiple sclerosis, spinal cord injury, stroke, cerebral palsy, and other neurological conditions. It causes significant pain, limits mobility, and severely impacts quality of life. Despite a range of antispasticity medications (baclofen, tizanidine, dantrolene), many patients achieve inadequate relief or experience dose-limiting side effects.
Cannabis and Spasticity: The Strongest Evidence Base
Of all the conditions for which cannabis-based medicines are prescribed in the UK, spasticity — particularly MS-related spasticity — has the most robust clinical evidence. Sativex (nabiximols; 1:1 THC:CBD oromucosal spray) is a licensed UK medicine specifically approved for MS spasticity that has not responded adequately to other treatments. This represents the highest level of regulatory validation for any cannabis-based medicine in the UK.
Who May Benefit from Cannabis for Spasticity
Multiple sclerosis — the primary licensed indication; Sativex available on NHS in some regions
Spinal cord injury — unlicensed cannabis prescribing by specialist neurologists
Stroke-related spasticity — emerging evidence
Cerebral palsy — paediatric and adult use, specialist supervision required
Spinal cord compression — secondary spasticity
How Medical Cannabis Reduces Spasticity
THC acts on CB1 receptors in the spinal cord and brain to reduce neuronal excitability, decreasing the hyperactive reflex arcs that underpin spasticity. CBD complements this through its anti-inflammatory and muscle-relaxant properties. The combination — as in Sativex — appears more effective than either cannabinoid alone for spasticity management.
Frequently Asked Questions
Is medical cannabis for spasticity available on the NHS?
Sativex (nabiximols) is available on NHS prescription for MS-related spasticity that has not responded to other treatments, subject to local formulary approval. In practice, NHS access varies by region and remains limited. Private prescribing via a specialist cannabis clinic provides the broadest access for spasticity from any cause.
What is Sativex and how does it work for spasticity?
Sativex is a licensed UK medicine containing a 1:1 ratio of THC and CBD, delivered as an oromucosal spray. It is the only cannabis-based medicine with a UK marketing authorisation for a specific indication (MS spasticity). THC acts on CB1 receptors in the spinal cord to reduce pathological muscle tone; CBD provides complementary anti-inflammatory and neuromodulatory effects.
Can medical cannabis help spasticity from spinal cord injury?
Yes, though this is an unlicensed use. GMC-registered neurologists and specialist cannabis clinicians can prescribe cannabis-based medicines for spinal cord injury-related spasticity where standard antispasticity treatments have not provided adequate relief. Evidence from small trials and observational studies supports clinically meaningful reductions in spasm frequency and severity.
How quickly does cannabis reduce spasticity?
Inhaled or vaporised cannabis can reduce acute spasm within minutes. Oil-based preparations typically take 1-2 hours to reach peak effect. Sativex is typically titrated over two weeks to achieve the optimal dose. Most patients notice meaningful improvement in spasm frequency and severity within the first month of treatment.
Ready to Explore Your Options?
Our GMC-registered specialists assess each patient individually. Book a consultation to discuss whether medical cannabis is appropriate for your condition.
