What Is Sativex? The THC and CBD Spray for Multiple Sclerosis, Explained

Sativex (nabiximols) is a prescription mouth spray that delivers controlled doses of THC and CBD, and it's mainly used to relieve muscle spasticity in multiple sclerosis. Medical cannabis flower, on the other hand, brings a much wider mix of cannabinoids and terpenes, with doses that are harder to pin down.

Both are used for multiple sclerosis and nerve pain, and patients report relief from each, but they work quite differently. So what actually sets them apart? Here's the rundown.

What is Sativex and what is it used for?

Sativex, also known by its generic name nabiximols, is a medication made with two cannabinoids and designed to relieve symptoms tied to several medical conditions. It comes as an oral spray, and each 10 ml vial contains a precise mix of 270 mg of THC and 250 mg of CBD.

The drug was developed in the UK and has since been authorized for use under specific circumstances in several other countries, including Spain, Germany and Switzerland.

Even so, it's not easy to get. Prescriptions are generally limited to pain and neurology specialists, and only a handful of conditions qualify.

Who makes Sativex?

Sativex comes from the British biotech company GW Pharmaceuticals, founded in 1998. GW holds a research license that lets it legally grow, possess and supply cannabis.

The plant material comes from British Sugar, one of the UK's biggest legal cannabis growers, which runs huge greenhouses in Norfolk.

Even though cannabis is a Class B drug in the UK, the country is a world leader in exporting cannabis-based medicines. Besides Sativex, GW Pharmaceuticals developed Epidiolex, an oral CBD solution used to treat certain types of childhood epilepsy.

The UK marketing rights for Sativex were picked up by pharma giant Bayer, which also had the option to expand sales into Europe and Canada.

How does Sativex work?

Sativex works by getting cannabinoids into the bloodstream quickly through an oral spray. Sprayed onto the lining of the mouth, the cannabinoids are absorbed fast, while some of the dose gets swallowed and reaches the digestive tract, which stretches out and boosts the effects.

Its active compounds mainly interact with the endocannabinoid system (ECS), a network of receptors that runs throughout the body, including the central and peripheral nervous systems. THC binds to the ECS's CB1 receptors, which appears to change how the body perceives pain.

CBD, on the other hand, has a low affinity for CB1 and CB2 receptors, but it works on the ECS by blocking the enzymes that break down anandamide, one of the body's own endocannabinoids.

Like THC, anandamide binds to the CB1 receptor and may help fight pain. CBD also activates the TRPV1 receptor, which plays a role in pain and inflammation.

What conditions is Sativex prescribed for?

In the UK, parts of Europe and Canada, specialist doctors can prescribe Sativex to ease the symptoms of multiple sclerosis and, in some countries, for severe neuropathic pain linked to cancer.

Multiple sclerosis is an autoimmune disease that attacks the nervous system, causing fatigue, vision problems, and cognitive and muscle issues. Sativex appears to ease the spasms and pain that come with it.

Studies have reported significant improvements in sleep quality for patients with a range of painful conditions, such as multiple sclerosis, arthritis and peripheral neuropathic pain.

Some patients do experience cognitive side effects, but observational data suggest Sativex helps many people, with a high share of patients benefiting enough to stick with the treatment despite possible side effects.