Through a recent questionnaire in MJFF’s Fox Insight online study , nearly 1,900 people with Parkinson’s shared their experiences with cannabis. In general, most people reported benefits on sleep, anxiety and pain. But some also had side effects and nearly one-third reported not discussing use with their physician. Full results are expected later in 2021.
Try to be open, honest and willing to hear what your doctor says. Tell them you are looking at all treatment options and want to learn if and how cannabis might help. And if you are considering or taking specific products, share which. (Bring printed information or a picture of the label.)
Is cannabis safe? Effective?
Clinical trials have generally had mixed or conflicting results (some positive, some negative). On questionnaires, people often report benefit on pain, sleep, mood, or motor symptoms such as tremor or stiffness. But many also report side effects. This leaves patients, doctors and researchers with insufficient evidence to guide use.
There are many anecdotal reports of benefit. But controlled trials — on motor and non-motor symptoms as well as dyskinesia (involuntary, uncontrolled movement) — have not yet proven the safety or benefits of cannabis in Parkinson’s.
The amount of THC, CBD, other cannabinoids and other (sometimes unknown) substances varies across products. Sometimes, the levels of these contents may not be known. And even if the product does have a label, studies have shown the label may not fully or accurately represent what’s inside. (There are no federal regulations governing standards of purity or label accuracy. Most states have their own regulations, but these vary.)
Several factors limit the ability to perform research and interpret results:
(Of note, the acronym for CBD is confusing in the context of PD, since the acronym is also used to refer to cortico-basal degeneration, a neurodegenerative disease that shares some clinical properties with PD. In this article, CBD refers to cannabidiol).
It is not just the Parkinson’s disease community that has taken an interest in CBD. There are countless health claims that CBD is helpful for a whole host of conditions. Clinical trial evidence to support the use of CBD however, is minimal. The only FDA-approved indication for CBD is to reduce seizure frequency in certain rare and severe forms of childhood epilepsy. A purified form of CBD, sold under the brand name Epidiolex® was tested in a well-designed clinical trial in order to gain this approval. (Three other cannabis related drug products that are not CBD, but rather synthetic THC, also have FDA approval and are used to treat loss of appetite and weight loss in patients with HIV, and severe nausea and vomiting due to chemotherapy).
Pre-clinical evidence that CBD has anti-inflammatory and antioxidant properties
APDA Vice President and Chief Scientific Officer
There is a lot of confusion around this question, related to the fact that the law distinguishes between CBD extracted from hemp and CBD extracted from marijuana. In reality, hemp and marijuana are two different names for the cannabis plant, with hemp defined as cannabis containing less than 0.3% THC. CBD products derived from hemp are federally legal. On the other hand, CBD derived from a cannabis plant containing more than 0.3% THC is federally illegal – even if the CBD is purified and the product itself contains less than 0.3% THC. To add to the confusion, is the fact that each state has its own laws that govern the use of CBD products which often contradict federal law.
People with PD are already using CBD in various forms for all sorts of symptoms of PD including insomnia, anxiety, tremor, dystonia and pain.
The medication most people with Parkinson’s end up taking at some point is levodopa, which is the gold standard for treating Parkinson’s. It was developed in the late 60s. It is sometimes used for diagnostic purposes.
I decided to continue using levodopa since it was providing me with much-needed relief from my symptoms. Over time, I’ve tried other medications either in combination with or in place of levodopa like Azilect, Stalevo, entacapone, and amantadine. Due to the side effects or the drug’s ineffectiveness, I stopped taking all of these except the amantadine. I continue taking levodopa but have switched to Rytary which is the extended-release version of levodopa. I have also had deep brain stimulation (DBS) surgery due to the dyskinesia I experienced with levodopa.
Taking levodopa to treat Parkinson’s
With more states legalizing it, there will continue to be a large demand for medical marijuana. Hopefully, well designed, large scale research is forthcoming.
After my diagnosis, the next challenge was deciding how to treat my disease? I found out very quickly that there didn’t seem to be a consensus on when one should start levodopa as opposed to other medications, like Azilect. The concern was that starting levodopa treatment early in one’s treatment would increase the risk of dyskinesia.
While illegal at the federal level, medical marijuana is legal in 33 states and the District of Columbia for certain conditions. In some states, Parkinson’s disease is one of these conditions. However, state laws vary in the conditions the medical marijuana can be used for, the formulations allowed and whether physician certification is required. By federal law, physicians cannot prescribe marijuana or cannabinoids. In states that require certification from a qualified physician, it can be challenging to find a qualified doctor since many physicians elect not to apply for certification.