Medical Marijuana for Parkinson's Treatment

Cannabis Treatments for Parkinson’s Disease

 

Since the discovery of the endocannabinoid receptor system, research has focused on what effects are influenced by this abundant receptor system. Regulation of motor control is due, in part, to the participation of CB1-related mechanisms in the brain, thus opening the door for cannabinoid therapy that affects motor control in Parkinson’s patients.

 

Emotional disturbances, pain, and depression have also been linked to the functions of the endocannabinoid system. This allows cannabis to be used to treat multiple symptoms simultaneously in order to improve the overall happiness of the patient. An observational study of almost four hundred patients with Parkinson’s disease in Colorado revealed that of the 25% of patients with symptoms who had consumed cannabis, almost half reported it to be beneficial.

 

Research like this can be conducted in states where cannabis has been legalized.  Cannabis was legalized for medical use in Colorado in 2000 and recreational use in 2014.   This created an optimal research environment to discover the benefits of cannabis therapies. Between November 2012 and August 2013, a self-administered study was given to  Parkinson’s patients to provide information on the effectiveness of complementary and alternative therapy for the disease. The survey revealed that many patients used alternative therapies for their movement disorders, but out of the 207 patients who completed the survey only 4.3% reported using cannabis as a therapeutic alternative. This low percentage could be due to lack of education and awareness about cannabis in addition to the stigma that still surrounds the use of marijuana.  It is worth noting that while fewer respondents reported using cannabis, it was rated as the most successful of all alternative therapies. Of the nine patients who reported using cannabis for their symptoms, five noted “great improvement” in their symptoms, specifically with improvement in their mood and sleep. Two patients reported improvement in their motor symptoms and quality of life. No one reported worsening of symptoms or side effects.

 

There is a video on YouTube, demonstrating the profound effects of medical cannabis on the movement symptoms of Parkinson’s disease.  Ex-cop Larry Smith is show displaying dyskinesias (abnormal movements) associated with the disease and its pharmaceutical treatments.  The video shows how these tremors and erratic movements stop after a 5 minutes of administering a few drops of cannabis oil under his tongue.  Patients with Parkinson’s disease in Texas qualify for this treatment under the T.CUP (Compassionate Use Act) in the state.

 

CBD for Sleep Disturbances

 

One of the most destructive symptoms of severe Parkinson’s disease is a sleep disturbance called REM Behavior Disorder (RBD).  REM sleep is the stage of sleep when we dream, so the brain normally inhibits movement during this stage to keep people from acting out (walking, hitting, eating) their dreams.  REM behavioral disorder is characterized by a lack of muscle relaxation during REM sleep and is associated with nightmares and active behaviors during dreaming.  Patients can experience hallucinations while sleeping that lead to thrashing, shouting, and sometimes screaming in the middle of the night. Movements can be so severe that sleep partners have been injured when patients became violent.  Patients can experience episodes of REM behavioral disorder before doctors have even made a diagnosis of Parkinson’s. In addition to the symptoms mentioned above, episodes can include behaviors such as laughing and singing; and patients may not remember their dreams the next morning

 

A 2014 parallel, double-blind, placebo-controlled exploratory trial of CBD observed a significant reduction in REM behavior disorder symptoms and in psychosis with doses of 75mg and 300mg of CBD per day. Patients experienced no reported side effects and when CBD was discontinued, symptoms returned. This is encouraging news for patients looking for help with sleep disorders and psychosis associated with Parkinson’s disease. When treating sleep disorders with CBD, patients should medicate with cannabis throughout the day in order to balance the endocannabinoid system and take a larger dose of CBD at bedtime. If using oral products, start with 10-20mg CBD every 8 hours with a bedtime dose of 25–50mg CBD consumed 1 hour before bedtime. Increase the bedtime dose by 10mg every night until you’re satisfied with the effects or, if treating multiple conditions such as pain, increase the daytime CBD dose as well.

 

Another symptom that can occur as Parkinson’s disease progresses is called “Freeze”.  This happens when patients with more advanced disease experience medication “off” periods in which levodopa levels drop.  Symptoms can accelerate quickly during these times, which are fairly predictable in timing.  Although some patients have unpredictable symptoms in these cases, and they can suddenly lose the ability to move,  leaving them helpless until more levodopa can be administered to the brain.

 

A prescription inhaled levodopa product was recently approved by the FDA for this exact purpose. As we have discussed, too much levodopa will cause excessive movements and can lead to hallucinations, so patients are caught between a rock and a hard place when deciding on how much levodopa to use. Cannabis may be able to help patients relax both the mind and body and improve their motor function in times of freeze. When levodopa levels drop suddenly, patients can inhale a few puffs from a vape or place a few drops of cannabis oil under the tongue to loosen muscles and initiate movement. Products for freeze should include high amounts of both THC and CBD, although strains dominant in THC may be equally as effective.

 

 

Cannabis vs Opioids for Parkinson’s Pain Control

 

Cannabis is effective for both muscle relaxation and nerve pain. Opioids can exacerbate confusion, hallucinations and constipation in patients with Parkison’s and are, therefore, considered a bad choice when looking for options to treat pain in patients with neurodegenerative disease. Cannabis with THC helps loosen muscle tone and decreases inflammation, which naturally leads to decreased pain. Patients can use small-inhaled doses throughout the day for mild to moderate pain or scheduled edible doses for the treatment of more severe pain or for overnight relief. (Oral doses last 6 to 12 hours.) Orally consumed indica products for overnight relief should include CBD if patients are also experiencing other sleep issues such as REM behavioral disorder. CBN may offer benefits like relaxation as well, but there are no studies on the effects of CBN (cannabinol) for the treatment of Parkinson’s disease. Feel free to experiment with CBN if available in your area.

 

 

Marijuana for Emotional Issues

 

Cannabis can help with the emotional disturbances that intensify as the disease progresses. Dopamine is linked to emotional responses, schizophrenia, and ADHD, but its exact function is not fully understood. Currently prescribed treatments for depression, specifically the drug bupropion (Wellbutrin), increase levels of dopamine in the brain since a lack of dopamine can lead to increased anxiety and depressive symptoms. In patients with Parkinson’s disease, the CB1 receptor of the endocannabinoid system has been shown to decrease expression in the substantia nigra. This effects motor, as well as emotional responses.  Therefore, when cannabis is used properly, it can effectively treat motor and non-motor symptoms simultaneously through activation of the CB1 receptor. In this disease, anxiety and depression are a direct result of dopamine depletion from damaged neurons and a side effect of Parkinson’s medications. Each additional pill can lead to more emotional side effects creating a never-ending cycle of pill after pill after pill with minimal effectiveness. Cannabis for emotional issues should be tailored to the patient. THC offers substantial benefits for both mood and motor symptoms, so patients with mild symptoms may need a 5:1 CBD:THC ratio, while patients with more advanced emotional disorders may require a 2:1 or 1:1 CBD:THC product. THC-dominant strains can offer substantial benefits on their own. Inhalation, sublingual administration, and edibles can all be of value when treating Parkinson’s symptoms. Oral dosing can be administered every 6 to 12 hours for preventative care, while patients with milder symptoms have the freedom to inhale from their vaporizer whenever they feel they need it. If patients experience excessive drowsiness, decrease the THC dosage by 25% or extend the dosing frequency. A CBD-rich sativa strain that has moderate to high levels of THC will help relax patients during the day without causing excess sedation or anxiety. Indica strains can be used for relaxation at night or to help calm an aggressive patient.

 

Pharmacology designed to treat Parkinson’s disease targets symptoms only, so choose how and when you medicate wisely. The most effective treatment for most symptoms of Parkinson’s disease, carbidopa/levodopa, has a short window of success (around 2 years) before problems begin to arise. If patients can hold off on starting pharmaceutical medications, it will not only affect the progression of the disease but can leave more tools in the toolbox for when the disease has advanced and symptoms have become more severe. Exercise is the only option available today that has been shown to modify disease progression.  Fortunately, as cannabis is decriminalized and research moves forward, we continue to discover the benefits for both treatment of underlying neurological inflammation and symptom relief. For both caregivers and the people who suffer from this disease, cannabis can offer comfort when added to the treatment toolbox.

Author
Dr. Allison Kendrick

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