is cbd oil good for parkinson’sDecember 15, 2021
Diana Apetauerova, MD, is board-certified in neurology with a subspecialty in movement disorders. She is an associate clinical professor of neurology at Tufts University.
Those dealing with Parkinson’s disease may also have trouble sleeping due to REM sleep behavior disorder (RBD), a condition in which patients ‘act out’ their dreams while asleep. A study published in the Journal of Clinical Pharmacy and Therapeutics found that four patients with Parkinson’s disease who also suffered from RBD had a decrease of RBD symptoms during sleep with the use of CBD.
In connection with Parkinson’s disease as well as other movement-related disorders, CBD may help improve motor skills. In one study published in Frontiers in Pharmacology CBD was shown to have a more preventative role in delaying abnormal movement symptoms in animal models of Parkinson's.
The benefits and research around CBD are still emerging.
More research out of Brazil suggests CBD can improve the overall quality of life of those with Parkinson’s disease. In a sample of 21 patients, those who were treated with 75 mg to 300 mg of CBD per day reported a significant increase in quality of life, though no significant differences were noted in motor and general symptoms or neuroprotective effects. This goes to show how much results can vary when it comes to the effects of CBD, requiring larger studies to be done in order to get more definitive answers to this treatment option.
Parkinson’s disease can impact cognitive function and memory, particularly in those whose symptoms progress to Parkinson’s disease dementia. Because of this, medical marijuana with both THC and CBD may not be recommended, as it can impair thinking and brain function even more so. CBD by itself may be a safer route.
What can cause side effects is if a patient decides to mix medical marijuana with their treatment plan that consists of certain prescription medications. If you plan to use medical marijuana as opposed to CBD by itself, it’s smart to consult a healthcare provider or your pharmacist before you start mixing it in with other medications to make sure it's safe for you.
Since Parkinson’s disease can take some time to properly diagnose when the symptoms are already prevalent, using CBD once diagnosed may not offer much benefit. With early detection combined with the use of CBD together the possibility of reducing movement-related symptoms increases.
While the research on CBD to treat Parkinson’s disease symptoms is largely inconclusive, its mild effect on patients as a whole makes it enticing to try in addition to an existing traditional treatment plan. Parkinson’s disease has no cure. But with prescription medication, therapy, and now perhaps the use of nontraditional options like CBD, patients may be able to experience less frequency and severity of symptoms that affect their motor skills.
In some cases, people suffering from Parkinson’s disease may also have symptoms of psychosis, ranging in hallucinations to vivid dreams and illusions. Research has found that CBD may be able to help. In research out of University of São Paulo in Brazil, patients were given a dose of CBD starting out at 150 milligrams (mg) per day in addition to their current treatment plan of therapy for four weeks. The use of CBD showed no adverse effects, no impact on worsening motor function, and a decrease in their reported psychosis symptoms, meaning that not only can it help with the physical setbacks of Parkinson’s disease, it can also play a part in the cognitive challenges as well. This was however an older study and current clinical trial evidence to support the use of CBD is minimal.
The body of research on using CBD for Parkinson’s disease symptoms is rapidly growing, as Parkinson’s disease affects 1% of the population over 60 years old. Parkinson’s disease is a neurological condition, affecting the nervous system. Parts of the brain that produce dopamine, which is responsible for sending messages to the body in order to direct movement, become damaged or die. This results in tremors, muscle stiffness, the inability to use facial expressions, and trouble balancing.
CBD has been discovered as an effective way to help treat Parkinson’s disease symptoms because it interacts with two cannabinoid receptors in the body found on certain cells called CB1 and CB2. By interacting with one or both of these receptors, CBD may delay tremor development as well as have protective neurological benefits. But as seen with the above studies, there is no uniform approach or conclusion on this treatment method. This means that patients may react differently to using CBD, some having tremendous success while others seeing little difference. But regardless of whether or not CBD is an effective treatment option for you, you always need to consult your treating physician to make sure this treatment will not cause side effects.
With the legalization of medical marijuana, many states are approving the use of it in a non-traditional way to treat the symptoms of certain conditions, including Parkinson’s disease. Marijuana has two major components to it—tetrahydrocannabinol (THC) and cannabidiol (CBD). Both may help with nausea and muscle pain or spasms, but unlike THC, CBD doesn’t give you the “high” feeling marijuana is most commonly known for. This makes it an enticing, natural way for many to help treat their Parkinson’s disease symptoms. What’s more, is that because CBD is a natural compound from the Cannabis sativa plant, using it may also leave you side effect-free, unlike many prescription medications.
If you’re interested in trying CBD for Parkinson’s disease, talk to your healthcare provider about it. They will be able to point you to the latest research and provide recommendations on how much you should take. They will also be able to monitor your progress with the rest of your care team in order to come to a conclusion if this is the right treatment plan for you.
Uses and Safety.
What research is ongoing?
Under federal law, doctors cannot prescribe cannabis. But qualified doctors (those who have completed additional training and registration) can issue “certifications” that permit patients to get a license for medical cannabis. Many doctors choose not to pursue qualification and therefore are not able to issue certifications. (Some states maintain registries of qualified doctors that you can search online.)
How can I access cannabis?
If you are thinking about cannabis, you may want to ask your doctor:
Still, it’s important to read labels, ask questions, and have a general idea of the amount of THC or CBD in the product. For those who choose to try cannabis, use caution — start with a low dose and increase slowly (if at all). Much of this is trial and error because solid studies on dosing and formulation are lacking. (See below.)
In states that have legalized recreational cannabis, you don’t need a license for purchase. However, having a license may decrease costs and provide access to dispensaries that may be more familiar with your condition.
The main cannabinoid is tetrahydrocannabinol (THC). This can cause the feeling of being “high”—described as happiness, amusement or contentment — that is commonly associated with marijuana. THC may help nausea, pain or muscle spasms, but it also can have negative effects on mood, behavior and thinking. The second most common cannabinoid, cannabidiol (CBD), seems to have less effect on thinking, memory or mood.
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.
Several factors limit the ability to perform research and interpret results:
Many doctors and researchers believe the marketing and hype of cannabis products is ahead of the science and evidence. Be wary. Many have watched videos of people with PD using marijuana and seeing all their symptoms disappear within seconds. There also are many internet stories about marijuana as an “all-natural” cure for Parkinson’s (as well as cancer and other conditions). In general, when social media provides a level of endorsement significantly out of proportion to what you hear from your doctor, it is probably too good to be true.
If you are considering or taking cannabis, let your doctor know. They may be able to help you weigh the pros and cons, and they’ll have a complete picture of all your treatments (prescription or otherwise) in case there is a change in symptoms or possible drug interaction. They also can direct you to ongoing research studies, if of interest.
Cannabis also could interact with other medications you are taking. While interactions are largely unknown, adding cannabis to a complex regimen of Parkinson’s and other prescription medications could present a risk. It’s important to tell your Parkinson’s doctor what you are taking, so that they can alert you to possible interactions.
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.
Researchers continue to work on defining safety for cannabis in Parkinson’s. And several studies are looking at possible benefits on specific symptoms. For the most up-to-date clinical trial information, visit Fox Trial Finder .
Marijuana comes from the Cannabis plant, which contains hundreds of different components, including cannabinoids. Cannabinoids bind to receptors throughout the brain and body to influence movement, mood, inflammation and other activities. Many of these receptors are in areas of the brain impacted by Parkinson’s disease (the basal ganglia).
What else should I know?
One of the most common questions people with Parkinson’s ask is, “What about medical marijuana?” Many are curious if and how it might work for different symptoms, and what the research says.
The Michael J. Fox Foundation also recently convened a workshop on this topic with field leaders and other Parkinson’s organizations. Participants examined opportunities and challenges, agreeing that much work remains to understand how patients and doctors are using and talking about these products; to build education and communication around cannabis and Parkinson’s; and to evaluate safety, potential benefits, side effects and drug interactions, as well as the optimal dosing and formulations.
Why is cannabis research difficult?
Regulations may deter investigators and participants. The federal government classifies marijuana as Schedule I, which includes drugs that have no current acceptable medical use and a high potential for abuse. The Michael J. Fox Foundation supported legislation that eliminated barriers to conducting medical cannabis research. Funding restrictions also may limit research. Studies often have limitations. Size, design, and lack of standardized formulations or dosing make it difficult to compare studies and draw conclusions. Many studies include small numbers of participants, so it’s unlikely the group represents the broad Parkinson’s population or that results apply to the majority. Few studies include a placebo group, which makes it difficult to determine how much benefit may truly be from cannabis and how much might be placebo effect. And studies that include questionnaires rely on individual report, which may involve bias or inaccuracies.
With a license, you can visit a dispensary, which sells cannabis products. Licenses typically don’t specify dosing or product information, so you work with the dispensary for recommendations on what may work for you. (This often is a trial-and-error process.) As the same product may vary significantly from location to location, it’s best to stick with one dispensary.
Cannabis comes in several forms and can be taken different ways: smoking or vaping dried leaves, swallowing pills or eating or drinking foods (edibles) that contain cannabinoids, putting liquid or drops under the tongue, or applying creams or ointments to your skin (on painful areas, for example). Two U.S. Food and Drug Administration (FDA)-approved prescription cannabis medications also are available for specific conditions, such as epilepsy or cancer- or AIDS-related symptoms.
How can I talk to my doctor about cannabis?
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.
As an increasing number of states authorize medical (and even recreational) marijuana, a significant number of people with Parkinson’s disease (PD) report using these products. Some describe benefit on sleep, tremor or other symptoms. Others report side effects. And many say they are unsure how to discuss with their physician.
As of April 2021, 36 states and the District of Columbia allow the use of medical cannabis. The authorized medical conditions, formulations, and patient and physician requirements are different in each state. Note that even if Parkinson’s is a condition for authorized use, there may be additional requirements, such as also having another diagnosed condition (severe pain, nausea or malnutrition, for example).
Here, we offer general information about cannabis and Parkinson’s, tips for talking with your doctor, and more.
Cannabis refers to products from the Cannabis plant, including marijuana.
What is medical marijuana?
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.)
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.
Unfortunately, there has not been much research on how effective marijuana is in treating PD symptoms. The few trials that have been conducted have shown that medical marijuana may treat problems with both motor and non-motor symptoms, but more research needs to be done.
With more states legalizing it, there will continue to be a large demand for medical marijuana. Hopefully, well designed, large scale research is forthcoming.
Trying different medications.
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.
CBD can be expensive and isn’t covered by insurance. The FDA has not approved medical marijuana and classifies it as a Schedule 1 drug which is a drug that has been found to have no acceptable medical use and a high potential for abuse.
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.
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 have also used dietary supplements like CoQ10 but did not find it to make any difference. I’ve also considered alternative medications like medical marijuana which recently became legal in my state.
These cannabinoids come in various forms from dried leaves that can be smoked, oil that is sprayed under the tongue, and pills that can be swallowed. There are even CBD gummy bears.
What are cannabinoids?
I decided to use CBD oil to find out what, if any, benefit it provides. I was hesitant at first due to the high cost and lack of evidence beyond some anecdotal evidence that it does help relieve a few motor (tremor, slowness, stiffness) and non-motor symptoms (sleep, pain, anxiety.
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.
One of the most difficult decisions a person with Parkinson’s disease (PD) will face is deciding what medications to use to treat the disease.
Marijuana contains many compounds called cannabinoids. The main cannabinoid is THC (tetrahydrocannabinol) which causes the “high” the user experiences with marijuana. Another cannabinoid is CBD or cannabidiol which doesn’t cause the “high” that THC does.
CBD for my symptoms.
I was prescribed levodopa and was told that if it provided relief from my initial symptoms, that there was a good chance I had PD. Otherwise, there was a good chance that I didn’t have PD but, possibly something worse.
This is one of the reasons why more research has not been done and why organizations like the MJF Foundation have called for a reclassification of marijuana.
After only a few days, it wasn’t evident that it was providing any benefit. I was hoping it would relieve pain due to stiffness. Perhaps it takes more than a few days and/or a dosage change. I plan to finish the bottle I have before deciding whether to continue using it.
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.
According to Rachel Dolhun, MD Vice President, Medical Communications at the Michael J Fox Foundation, “The work to date on marijuana and cannabinoids has given promising but conflicting signals on potential benefit for motor and non-motor symptoms as well as levodopa-induced dyskinesia. This therapy may represent a future treatment option for PD, but the correct dose and formulation are not clear, full side effects and drug interactions are unknown, and benefits have not been rigorously determined.” 1.