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Effects Of Cannabis In Parkinsons Disease: A Systematic Review And Meta

Cannabis and Parkinson’s Disease

Article type: Systematic Review

Authors: Urbi, Berzenna b | Corbett, Joelc | Hughes, Iana | Owusu, Maame Ammaa | Thorning, Saraha | Broadley, Simon A.b c | Sabet, Armanb c | Heshmat, Samanb d *

Affiliations: Office for Research Governance and Development, Gold Coast Hospital and Health Service, QLD, Australia | School of Medicine, Griffith University, QLD, Australia | Department of Neurology, Gold Coast Hospital and Health Service, QLD, Australia | UQCCR, Centre for Clinical Research, University of Queensland, QLD Australia

Correspondence: Correspondence to: Dr. Saman Heshmat, Department of Neurology, Gold Coast University Hospital, 1 Hospital Blvd., Southport, QLD 4215, Australia. E-mail: .

Keywords: Cannabis, Parkinsons disease, efficacy of cannabis, tremor, UPDRS

DOI: 10.3233/JPD-212923

Journal: Journal of Parkinson’s Disease, vol. 12, no. 2, pp. 495-508, 2022

Does Medical Marijuana Have A Role In Parkinson’s Disease Care

At a conference hosted two years ago by the Parkinson’s Foundation, many neurologists had a pressing issue on their minds: pot.

“Doctors were saying that the number one question from their patients was, “Can I use medical cannabis for my Parkinson’s disease?'” recalled James Beck, the foundation’s senior vice president and chief scientific officer.

The answer isn’t a simple one, according to a summary of pot use recommendations that was prompted by that question and published recently by the Parkinson’s Foundation.

Researchers have studied the use of cannabis in patients with Parkinson’s disease for more than 20 years, but there are precious few randomized, controlled clinical trials, partly because the drug is still illegal under federal law, explained Susan Fox, director of neurology at Mount Sinai Health System in New York City.

But the growing legalization of has spurred interest. “When people hear that something is legalized, they think it’s safe to use,” Fox said. She added that her patients ask her if they should try using marijuana “a lot.”

That high level of interest prompted Parkinson’s Foundation experts to analyze all of the existing research related to marijuana and Parkinson’s disease.

The end result was a mixed bag.

Despite the risks and limited research, experts believe that marijuana might ease symptoms like muscle and joint pain, anxiety and insomnia.

The foundation’s statement covers not only the side effects, but also the lack of effects.

Citation

Is Medical Marijuana An Option For Me

What’s next for a person with PD who wants to know if medical marijuana is an option? “Marijuana should never be thought of as a replacement for dopaminergic and other approved therapies for PD,” said Dr. Michael S. Okun, the Parkinson’s Foundation National Medical Advisor.

Research is still needed to determine how medical marijuana should be administered and how its long-term use can affect symptoms of PD. To keep people safe, states that legalize medical marijuana will eventually need to develop training programs for doctors and medical teams that prescribe medical marijuana. Consult your doctor to see if medical marijuana is an option for you.

The Parkinsons Foundation Consensus Statement on the Use of Medical Cannabis for Parkinsons Disease is designed to help guide the PD community in making informed decisions about using cannabis for Parkinsons. The statement is based on the input from 46 experts who attended the Foundations first-ever medical marijuana convening. Read it now.

Page reviewed by Dr. Chauncey Spears, Clinical Assistant Professor and Dr. Sydney M. Spagna, Clinical Fellow at the University of Michigan.

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Benefits And Risks Of Using Medical Marijuana

The decision to use medical marijuana comes down to an individual choice based on weighing the pros and cons.

The Parkinsons Foundation reports that some research has found cannabis to be neuroprotective, offering potential guard against damaging neurons. The cannabinoids may protect brain cells through antioxidant and anti-inflammatory properties, notes the Michael J. Fox Foundation.

In addition to possible sleep, anxiety, and tremor benefits, patients may find that it relaxes muscles and makes movement easier. One of the symptoms of Parkinsons is rigidity from a tightening of the muscles. It may also help with loss of appetite.

Because dosing can be difficult, potency of the cannabis can pose risks. Parkinsons patients can have trouble with cognition, and strong marijuana can cause problems with learning, memory, and thinking. If a person gets too high, he or she can feel overanxious and paranoid, and have difficulty functioning at all. If the product is too strong, the user may experience hallucinations or delusions, according to Dr. Beck.

Dr. Duarte advises that you dont want to give a THC component to anyone who is at risk of psychosis.

Sustained marijuana use may raise blood pressure, according to a study published in August 2017 in the Journal of Hypertension, and Beck cautions that the product may also cause blood pressure to drop dangerously low.

Parkinsons Disease: What Is It

How Marijuana Helps with Treatment of Parkinsons Disease

Parkinsons disease is a progressive nervous system disorder that affects movement and motor control. Symptoms are gradual and often begin with little more than a slight tremor in one hand .

In more advanced stages of the disease, victims may experience cognitive impairment, difficulty walking, masked facial expressions, and trembling of upper and lower extremities.

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Parkinsons Disease And Pain

Those suffering from PD, multiple sclerosis and many other such diseases often endure painful muscle cramps. Constant aches and stiffness are common for those with PD. Tetrahydrocannabinol can be used to manage pain, as well as target the same CB1 receptors that anandamide targets, thereby helping regulate the bodys movements.

While many cannabis consumers may feel better in terms of pain and muscle control, others may experience side effects. PD patients may suffer from confusion, impaired posture and a loss of balance after using cannabis. For some, the side effects of using cannabis for PD may outweigh the benefits. However, experiences are highly individual, and prescription medications come with their own side effects.

Our Position On The Use Of Medical Marijuana And Medicinal Cannabis In Parkinsons

There are many endorsements of cannabinoids for Parkinsons symptoms in the social media. However, the science tells a different story.

Statement of Position

Further research into the efficacy and safety of medicinal cannabis in the treatment of symptoms in Parkinsons disease is necessary before Fight Parkinsons will advocate its use for people with Parkinsons disease.

Medicinal Use of Cannabis

The two main active ingredients used for medical care are tetrahydrocannabinoids or THC and cannabidiol or CBD. Both are referred to as cannabinoids. THC is the part that produces the high favoured by recreational users of cannabis and may have benefits in reducing nausea. CBD produces no highand may be used to treat pain inflammatory conditions and seizures. Generally, the use of either form of medicinal cannabis is for symptom relief and is not a cure.

The Evidence Base for Medicinal Cannabis

Many people with a range of serious conditions such as cancer have reported symptom benefits from cannabis or medical marijuana. A review of current scientific research suggested there was reasonable evidence that cannabinoids can help symptoms of chronic pain and spasticity including that experienced in Multiple Sclerosis. In other conditions, such as in nausea and vomiting due to chemotherapy, weight gain in HIV infection, sleep disorders, and Tourette syndrome use of cannabinoids remains unproven.

Changing Legal Framework

Prescribing of Medicinal Cannabis

References

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Cbd Side Effects And Risks

Cannabis Research in Parkinson’s

In most studies, CBD is tolerated well. It rarely causes side effects, and the ones that do happen tend to be mild. They include tiredness, changes in appetite, and diarrhea or nausea.

However, CBD can interact with prescription and over-the-counter medications. Talk to your doctor before taking CBD, especially if youre on medications that contain a grapefruit warning. CBD and grapefruit have a similar effect on certain enzymes related to drug metabolism.

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Parkinsons Foundation Centers Of Excellence And Medicinal Marijuana

The Parkinsons Foundation, in partnership with Northwestern University researchers, studied attitudes about cannabis at 40 Centers of Excellence members of our Global Care Network. To the best of our knowledge, this is the first study to provide data on the practices, beliefs and attitudes of expert PD physicians concerning cannabis use.

The results were interesting: most experts said they knew what cannabis did but disagreed on the details. While there is no general agreement on what the benefits might be for people with PD, the survey confirmed that cannabis is a popular subject within Parkinsons Foundation centers, as 95 percent of neurologists reported people have asked them to prescribe it.

These cannabis study results also included:

  • Only 23% of physicians had any formal education on the subject of cannabis , thus 93% of physicians want cannabis taught in medical school.
  • Physicians reported that 80% of their people with PD have used cannabis.
  • Only 10% of physicians have recommended the use of cannabis to people with PD.
  • In terms of memory: 75% of physicians felt that cannabis would have negative effects on short-term memory and 55% felt that cannabis could have negative effects on long-term memory.
  • Only 11% of physicians have recommended use of cannabis in the last year.

What Are The Side Effects

Respondents who had used cannabis-derived products in the past said they didn’t experience side effects, and that the products didn’t interact with their Parkinson’s medication. This was backed up by professionals.

However, people who hadn’t used them said they were worried about potential side effects and interactions with Parkinson’s medication.

It works better for me than conventional drugs. Person with Parkinson’s currently using a cannabis-derived product

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European Journal Of Internal Medicine

Another study, driven by Agnelli, and published in the European Journal of Internal Medicine in 2018, asserted that marijuana was a safe and effective method of treating symptoms of PD in older patients. The study stated that marijuana patients experienced a significant decrease in pain. After six months of use, 18% of patients diminished or discontinued opioids as painkillers.

Cannabinoids Effect On Movement Disorders

What beneficial effect does marijuana give to people with Parkinson

This study on clinical observations and trials of cannabinoid-based therapies suggests a possible benefit to tics and probably no advantage for tremors in dyskinesias or PD motor symptoms. Further pre-clinical and clinical research may characterize better the pharmacological, physiological, and therapeutic effects of this class of drugs in developmental disorders.

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How Does Medical Marijuana Affect The Body

Marijuana affects the body through neurotransmitters, which are the chemical messengers of the nervous system.

Various factors can stimulate neurotransmitter activity, initiating a set of physiological responses. In cannabis, it is mainly THC or CBD binding to endocannabinoid receptors that produce new physiological reactions in the body.

The endocannabinoid system is one of the most important neurotransmitter systems in the body. It utilizes cannabinoid receptors located throughout the central nervous system and peripheral nervous system . Cannabis works to turn on endocannabinoid neurotransmitters through activity at these receptors.

Medical Marijuana As A Treatment For Parkinsons Symptoms

Parkinsons disease is a disorder of the central nervous system that causes tremors, slow movement, stiffness, and loss of balance. Because marijuana directly affects the central and peripheral nervous systems, scientists have studied the effect of marijuana as a treatment for Parkinsons symptoms.

A 2020 review of 14 different studies acknowledged evidence that medical marijuana provides a reduction in anxiety, tremors, and involuntary or erratic movements. However, the researchers concluded that there is insufficient evidence to recommend medical marijuana use as part of Parkinson’s treatment.

A 2017 study with patients who used medical marijuana over three months to manage Parkinson’s symptoms found that the treatment improved their symptoms and did not cause major adverse effects.

Other research has shown that medical marijuana may be able to help with some Parkinsons disease symptoms, including:

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Watch: Marijuana Controls Parkinsons Tremor

Meet Ian Frizell, a 55-year-old man who uses medical cannabis to help control the symptoms of Parkinsons Disease . The following video demonstrates the transformative potential of cannabis medicine on Parkinsons-related tremors.

We see Ians tremors lessen and then stop by the end of the time-lapse video. He claims he does not use any prescription medication but rather vaporizes cannabis for tremor relief, which lasts up to four hours.

In fact, cannabis may be a viable treatment for PD and other neurodegenerative diseases because of the plants potential to decrease or even stop tremors. Why does cannabis have this powerful effect on Ian? Theres no definitive evidence yet to prove that cannabis helps Parkinsons Disease, but the testimonials of many people like Ian make it difficult to discount the phenomenon as anecdotal or chance.

For more information on obtaining a medical marijuana card, reach out and speak to one of our qualified physicians online.

Colorado Company To Research Cannabis As A Treatment For Parkinsons Disease

77-Year-Old Coloradan With Parkinson’s Does An About Face On Marijuana

Colorado-based Day Three Labs announced this week that the worlds first government-sponsored cannabis technology incubator will fund the companys research into using cannabis as a treatment for Parkinsons disease.

Day Three Labs is a cannabinoid consumer products ingredient manufacturer specializing in the development and commercialization of novel cannabis products with its headquarters in Denver and a research facility in Israel, where regulations make studying cannabis far easier than in the United States. The firm is the only company to have passed the first phase of the CanNegev program, a cannabis technology incubator that receives funding from the Israeli government.

Colorado-based Day Three Labs announced this week that it has received funding from Israeli cannabis … technology incubator CanNegev to study cannabis as a treatment for the symptoms of Parkinson’s disease.

getty

Research shows that cannabis has the ability to ease Parkinsons symptoms in patients, but to date, no one has been able to decipher the exact combination of cannabinoids and terpenes for a consistent, reliable, and repeatable remedy, Dr. Shimon Lecht, chief innovation officer at Day Three Labs, said in a statement from the company on Monday.

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The Challenge Of Regulating Cbd Products

Practically, CBD products can be obtained relatively easily at health food stores and online. They are not considered drugs , and therefore are not regulated by the Food and Drug Administration . This can be very problematic because without FDA oversight:

  • There is no assurance that what is stated on the package is what is being sold. For example, even if the bottle says it is pure CBD, the product may contain other chemicals from the cannabis plant, or a higher amount of THC than advertised
  • The manufacturing process, which is also not regulated, may introduce contaminants
  • There is no assurance that the dosage written on the bottle is correct
  • Medication interactions between CBD products and other drugs are not clear to consumers

The FDA is aware of the health claims that are made by manufacturers about various products and issues warnings to companies who market CBD products with unsubstantiated health claims.

Best Marijuana Strains For Parkinsons Disease

July 1, 2019

Parkinsons Disease is the second most common neurodegenerative disorder related to age, just after Alzheimers Disease.

Between 7 and 10 million people around the world lives with this disease and every year about 6,600 Canadians are diagnosed with it.

PD is a degenerative disease and theres still little known about its exact cause.

However, it seems that cannabinoids could be a new, helpful treatment for the disease.

Recent studies have found that:

Cannabis is useful in relieving Parkinsons symptoms because cannabinoids modulate CB receptors and protect dopaminergic neurons .

But thats just the tip of the iceberg. Lets try to get the whole picture.

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The Science Behind Marijuana

What is the science and pharmacology behind marijuana, and can it be used to treat Parkinson’s symptoms?

The endocannabinoid system is located in the brain and made up of the endocannabinoids and cannabinoid receptors on neurons . The endocannabinoid system helps regulate many functions, including memory, pleasure, concentration, movement, appetite, and pain.

Researchers began to show enthusiasm to study cannabis in relation to PD after people with PD gave anecdotal reports and posted on social media as to how cannabis allegedly reduced their tremors. Some researchers think that cannabis might be neuroprotective , though there have not yet been studies in humans that demonstrate this effect.

Cannabinoids have also been studied for use in treating other symptoms, like bradykinesia and dyskinesia . Despite some promising preclinical findings, researchers have not found any meaningful or conclusive benefits of cannabis for people with PD.

Indica Vs Sativa For Parkinsons Disease

How Marijuana Helps with Treatment of Parkinsons Disease

Cannabis sativa is one of several subspecies of cannabis. Sativa strains are usually recommended for daytime use because of their energizing properties, but they also have strong cerebral effects.

On the other hand, Cannabis indica usually produces sedative effects which makes it favorite among people with sleeping problems.

Indica strains are usually more potent than sativas, making people feel relaxed, sleepy and very hungry. Indica strains are usually recommended for nighttime use, due to higher concentrations of terpenes that cause the high to be felt more in the body than in the head.

But, when it comes to Parkinsons Disease, the first recommendation would be to use indica strains, because of their relaxing and painkilling properties, and since indica is most likely to help with sleep.

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