Last updated 16 August 2026 · Originally published 2 August 2021
Multiple sclerosis is one of the few conditions where a cannabis medicine is actually licensed. That’s worth knowing before anything else — and so is the fact that the licensed medicine isn’t CBD alone.
It’s a 1:1 mix of CBD and THC.
The approved medicine
Nabiximols, sold as Sativex, is an oromucosal spray containing roughly equal parts THC and CBD. It’s approved in around 30 countries as an add-on treatment for moderate-to-severe MS spasticity in people who haven’t responded adequately to standard anti-spasticity drugs.
It isn’t approved in the United States. A US Phase 3 programme began in 2020, but a 68-person trial failed to improve clinician-rated muscle tone, and nabiximols remains unapproved there.[2]
The approval came from proper trials, and the way it’s prescribed reflects something interesting: patients start with a trial period, and treatment continues only if they show a clear response. Not everyone does.
What the evidence actually shows
A systematic review published in August 2026 pulled together 27 randomised controlled trials covering more than 3,000 participants.[1]
Its central finding is the one this article is about. Preparations containing both THC and CBD — mainly nabiximols — showed modest but consistent benefit. They were the only cannabis-based products to significantly reduce patients’ own ratings of spasticity compared with placebo.
There’s a catch, and it’s the interesting part: those improvements weren’t consistently reflected in objective clinical assessments. Patients felt better. The measuring instruments largely didn’t agree.
The reviewers rated the overall certainty of the evidence as low, and recommended cannabinoids be considered cautiously, as an adjunct, with safety monitoring.
What about CBD on its own?
Much less, and this is where the distinction matters most.
CBD alone hasn’t demonstrated the spasticity benefit that the combination has. The review found THC-CBD preparations were the only ones producing a significant effect on patient-rated spasticity — which by implication means CBD-only products didn’t.
There is a plausible case for CBD in MS beyond spasticity. It has immunomodulatory effects in laboratory work — regulating T cell activity and inflammatory signalling — and MS is an immune-mediated disease.[3] Animal models have been encouraging. CBD has also been studied for anxiety in other populations — but that doesn’t establish a benefit for anxiety or sleep in people with MS.
But those are mechanisms and adjacent findings, not demonstrated benefit for MS itself. And nobody has established a dose for CBD in MS. That’s why clinical guidance can recommend nabiximols for selected patients without extending that recommendation to CBD oil.
What patients report
Real-world use tells a warmer story than the trial statistics, and it’s worth taking seriously.
A 2024 German open-label study followed 51 patients, 49 of them classified as nabiximols responders. After 12 weeks, 65% considered their spasticity much improved and 62% of their chosen treatment goals had been achieved as expected or better. The overall goal-attainment score rose 46%, and mean gait speed improved 23%.[4]
Meaningful results — though largely in a group of known responders. That tells us what improvement looks like among people who respond, not what proportion of everyone starting treatment will benefit.
A case series of 12 patients found spasticity reduced in 11, with eight reaching a clinically meaningful improvement; pain fell in 11, and sleep problems resolved entirely in three.[5]
These are open-label and uncontrolled, so expectation is doing some unknown share of the work. But they’re consistent, they come from ordinary clinical practice rather than trial conditions, and they describe the sort of improvement people actually care about — walking further, sleeping through, hurting less.
One possible explanation for the gap in the trial data is that the clinical scales measure a different and possibly less relevant part of the experience. The commonly used Ashworth scale captures resistance during passive movement at a single moment; patients experience spasms, pain, disrupted sleep and difficulty walking across a whole day.
That may not be the whole story. Open-label studies are vulnerable to expectation, and THC’s noticeable effects make blinding difficult even in placebo-controlled trials. The evidence can’t tell us how much of the gap comes from insensitive scales and how much from expectation-influenced self-reporting.
If you’re considering it
Ask your neurologist about nabiximols first if spasticity is the problem. In much of the world it’s a licensed medicine your MS team can prescribe, with dosing they know and monitoring built in. That’s a better starting point than a shop-bought oil.
Understand it’s an add-on. It’s licensed for people whose spasticity hasn’t responded adequately to standard treatment, not as a first option.
Expect a trial period. Response varies, and the licensing reflects that — treatment is meant to continue only if you clearly improve. That’s a sensible model for any cannabinoid, prescribed or not.
If CBD alone is what’s available to you, be clear about what you’re getting. Evidence from nabiximols can’t be transferred to CBD oil, and no effective CBD dose has been established for MS symptoms.
Expect possible side effects. Adverse events are common with nabiximols, though usually not serious. Dizziness, sleepiness and problems with attention or balance matter particularly for anyone already having mobility difficulties — and because it contains THC, it may impair driving.
Tell your MS team either way. CBD affects how the body processes a number of drugs — see our guide to CBD and drug interactions.
Where this leaves it
MS spasticity is one of the strongest cases for cannabis as medicine, and one of the weakest for CBD in isolation.
A 1:1 THC-CBD spray has been licensed for over a decade, works modestly but consistently on what patients report, and is used in clinical practice in the countries where it’s available. Take the THC out and that evidence doesn’t come with you.
The honest summary is that the evidence here belongs to a standardised THC-CBD medicine, not to CBD alone. Worth saying plainly at a time when the two are so often discussed as though one is medicinal and the other merely a problem.
None of this is medical advice. MS needs specialist care, and nothing here substitutes for it.
For more, see our guides to CBD for pain and what the research actually shows, or browse Health Conditions.
References
- Hamm-Buiar L, Gorski D, Kagueiama MH, Wiens A. Efficacy and safety of cannabinoids in the treatment of spasticity in multiple sclerosis: a systematic review of randomized clinical trials. British Journal of Clinical Pharmacology. 2026. doi:10.1002/bcp.70719
- Bethoux FA, Farrell R, Checketts D, et al. A randomized, double-blind, placebo-controlled trial to evaluate the effect of nabiximols oromucosal spray on clinical measures of spasticity in patients with multiple sclerosis. Multiple Sclerosis and Related Disorders. 2024;89:105740. doi:10.1016/j.msard.2024.105740
- Furgiuele A, Cosentino M, Ferrari M, Marino F. Immunomodulatory potential of cannabidiol in multiple sclerosis: a systematic review. Journal of Neuroimmune Pharmacology. 2021;16(2):251–269. doi:10.1007/s11481-021-09982-7
- Haupts MR, et al. Patient-reported benefits from nabiximols treatment in multiple sclerosis-related spasticity exceed conventional measures. Neurodegenerative Disease Management. 2024;14(1):11–20. doi:10.2217/nmt-2023-0040
- Garde N, Heibel M. Effect of nabiximols oromucosal spray (Sativex) on symptoms associated with multiple sclerosis-related spasticity: a case series. Drugs in Context. 2024;13:2023-10-1. doi:10.7573/dic.2023-10-1
About this article
Substantially rewritten in August 2026. This update reflects that a THC-CBD medicine is licensed for MS spasticity in around 30 countries, adds the systematic review published since, and separates the evidence for the combination from that for CBD alone. With earlier reporting by Sabine Downer.
