Psychoactive substances and adverse side effects for patients with multiple sclerosis

Using psychoactive substances for recreation, socialization or symptom self-management is common for many people living with multiple sclerosis.

When used to self-manage symptoms, some psychoactive substances may provide immediate relief along with unexpected adverse symptoms.

Anna Kratz, Ph.D., a Professor of Physical Medicine and Rehabilitation at University of Michigan Health and head of the Kratz Lab, and a team of researchers were able to examine both positive effects and adverse symptoms people with multiple sclerosis might experience using different commonly consumed psychoactive substances.

Using an ecological momentary assessment approach, people with multiple sclerosis were asked to report in real-time their symptom severity and use of psychoactive substances four times a day for 14 days.

Participants reported levels of fatigue, pain, stress, and depressive symptoms, along with whether they had used alcohol, caffeine, nicotine, cannabis, or opioids prior to their symptom ratings.

Taking the momentary symptom ratings together with information on the substance used, the research team began noticing patterns between psychoactive substance use and both positive and negative effects on symptoms.

Published in the Archive of Physical Medicine and Rehabilitation, the study mixed positive and negative effects for several substances. The findings included the following correlations.

• Alcohol use showed a decrease in stress, but increased fatigue.

• Caffeine use showed a decrease in fatigue, but increased stress.

• Cannabis use showed benefits in pain management but was related to increased fatigue.

• No positive effects were seen for nicotine, which was only related to increased fatigue. 

"Just as many people look to a cup of coffee in the afternoon for a pick me up, people with multiple sclerosis may seek caffeine to help with fatigue or alcohol to manage pain,” said Kratz.

“Insights from studies like this could prompt a person with multiple sclerosis to reflect on what they are putting into their bodies and how it is impacting their symptoms.”

Kratz not only encourages patients to talk with their provider about what outside psychoactive substances they are using habitually or for recreation or symptom management, but for providers to be attentive listeners as well.

SEE ALSO: Different pain types in multiple sclerosis can cause difficulty staying active

“Having a better understanding of how these substances impact patients with multiple sclerosis will be beneficial for providers,” she said.

“Patients using psychoactive substances is not going to go away. Being able to understand the role these substances play and the pros and cons of each will allow providers to better advise their patients when it comes to use of these products.”

Additional authors: Jeeyeon Kim, from the Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, MI. Dawn M. Ehde, from the Department of Rehabilitation, University of Washington, Seattle, WA. Kevin N. Alschuler, from the Department of Rehabilitation Medicine University of Washington, Seattle, WA and the Department of Neurology, University of Washington, Seattle, WA. Nora E. Fritz, from the Department of Health Care Sciences, Wayne State University, Detroit, MI and the Department of Neurology, Wayne State University, Detroit, MI.

Paper Cited: “Daily Temporal Associations Between Use of Psychoactive Substances and Fatigue, Pain, Stress, and Depressive Symptoms in People With Multiple Sclerosis,” Archive of Physical Medicine and Rehabilitation. DOI: 10.1016/j.apmr.2026.01.014

Sign up for Health Lab newsletters today. Get medical tips from top experts and learn about new scientific discoveries every week

Sign up for the Health Lab Podcast. Add us wherever you listen to your favorite shows