cbd oil benefits for parkinson’s

Complementary therapies

Many people with Parkinson’s are interested in complementary therapies such as acupuncture, aromatherapy and herbal medicine. These non-conventional treatments are often based on centuries-old techniques.

Although there is little scientific evidence about their use as a form of Parkinson’s therapy, many people with the condition seem to find complementary therapy techniques helpful, especially for relaxation and to reduce stress and depression. This section provides a guide to complementary therapies in general as well as specific techniques that people with Parkinson’s have tried.

Always consult your doctor before trying any form of complementary therapy. Depending on how Parkinson’s affects you, some techniques may not be suitable, and some herbal medicines could react badly with medicines used to treat Parkinson’s.

Cannabis (marijuana) and Parkinson’s

In recent years, there has been increased interest in the medical use of cannabis but to date, there is very limited evidence into its benefits in Parkinson’s.

What is cannabis?

Cannabis, also known as marijuana, comes from the Cannabis sativa plant which is thought to contain around 100 different compounds known as cannabinoids. Its main cannabinoid is tetrahydrocannabinol (THC) which is known to be a psychoactive drug, that is a substance that affects brain function. THC may help with pain, nausea and muscle spasms but it also alters mental processes, behaviour, mood, consciousness and perception.

The second most common cannabinoid is cannabidiol (CBD) which does not have psychoactive properties but many believe it may be beneficial in treating a wide range of conditions such as multiple sclerosis, chronic pain, depression and Parkinson’s. In 2018 a major study 1 found cannabis to be beneficial in treating some cancer-related symptoms (pain, sleep problems and nausea) but evidence for its benefits for other symptoms and conditions remains elusive.

Cannabis can be taken in different forms and ways, for example, smoking dried leaves, as a spray under the tongue or as tablets. THC and CBD are thought to be largely responsible for the effects of cannabis although their mechanisms of action are not fully understood.

The concentrations of THC, CBD and other cannabinoids vary from one form to another, and also from one plant to another. This variability is one of a number of challenges encountered in clinically evaluating the effects of cannabis, both alone and in combination with other medications.

  1. Prospective analysis of safety and efficacy of medical cannabis in large unselected population of patients with cancer. European Journal of Internal Medicine 2018 Mar. Vol. 49; 37-43 – view article

The role of cannabinoid receptors

Our bodies naturally make cannabinoids that control various processes, such as mood, sleep and appetite, by binding to cannabinoid receptors throughout the brain and body. We have two main types of cannabinoid receptor, which are like switches outside cells that trigger a biological reaction within a cell once the receptor is activated: CB1 receptors are located in the brain and respond to THC which results in the ‘highs’ associated with cannabis use; CB2 receptors are found mainly on cells relating to the immune system and on brain cells believed to be responsible for pain relief.

There are concentrations of cannabinoid receptors in the basal ganglia area of the brain, where dopamine-producing neurons are located and which is known to be involved in the movement symptoms of Parkinson’s. Researchers have therefore speculated that a substance such as cannabis, which binds with cannabinoid receptors in an area of the brain so closely involved in Parkinson’s, may positively affect the symptoms of the condition. Extensive research into this is underway.

Cannabis and Parkinson’s

Although cannabis has been used since ancient times for relieving pain, improving sleep and for many other purposes, there is still very little evidence regarding its efficacy and safety.

Studies have suggested that cannabis may have antioxidant, anti-inflammatory and neuroprotective properties but much more research is needed to understand this. Neuroprotection is of particular interest in Parkinson’s due to the loss of dopamine-producing neurons.

Anecdotal evidence and some clinical studies have suggested that cannabis may help with symptoms in a wide range of conditions, including Parkinson’s. But despite some promising suggestions, using animal models, that cannabis may help with movement symptoms such as tremor, slowness and levodopa-induced dyskinesia, there have been mixed and often confusing results. In non-motor symptoms such as pain, sleep problems, anxiety, depression, memory problems and hallucinations, research is also ongoing with some encouraging results but side-effects are common and we need to understand more before any conclusions are drawn.

Unfortunately, many clinical studies into cannabis as a Parkinson’s treatment have been hampered by regulatory restrictions or have had various shortcomings. For example, some have not been conducted using the gold standard double-blind, placebo-controlled trial design, many include only a small number of participants, and variable concentrations of CBD and THC (depending on how cannabis is consumed) make it difficult to compare outcomes. As a result, many study results are not widely acknowledged because minimum research standards have not been met.

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There is, therefore, a renewed focus on conducting more rigorous studies in large cohorts of patients before any conclusions regarding the potential benefits in treating Parkinson’s symptoms can be reached. These studies will need to establish which symptoms can be alleviated, in whom, appropriate dosages and how cannabis can be safely administered, particularly in the long-term, so as to eliminate associated risks such as addiction and increased risk of heart or lung problems, and side-effects such as nausea, dizziness, hallucinations, physical weakness and cognitive changes.

The potential risks of taking cannabis

Until unambiguous trial results are available, cannabis should be used with great caution in Parkinson’s because of its associated risks, including addiction. Cannabis affects thinking and executive function, which are already frequently impaired in those with the condition. It should not be taken as a substitute for dopaminergic and other approved Parkinson’s treatments. You should always seek medical advice before taking cannabis in any form.

In many countries, taking cannabis is illegal and may result in imprisonment if you are caught with the drug. It can also impair judgement which presents a real danger when driving or carrying out other hazardous activities.

What does the future hold?

Cannabis may be a future Parkinson’s treatment but for now, we need conclusive evidence of the benefits and to better understand appropriate formulations and dosages, the side-effects and interactions with other medications, and any long-term risks. A lot more research is required both in the lab and in clinical trials, including into specific molecules isolated from the plant, in order to achieve these goals.

Content last reviewed: August 2018

Acknowledgement

We would like to thank Prof Peter Jenner (King’s College, London, UK) for his help in reviewing this information.

Can Cannabis Help Parkinson’s Disease?

Thanks to the discovery of the endocannabinoid system, today’s researchers have a significantly better understanding of how chemicals in the brain interact and communicate. They also have a better understanding of what happens when the body does not produce enough neurotransmitters to interact with their corresponding receptors.

Many researchers today credit the endocannabinoid system with maintaining the functions of homeostasis, the internal balance that living organisms need to survive. It’s the process of homeostasis that keep internal processes such as fluid balance, blood sugar levels, and temperature within an established range.

The messengers of the endocannabinoid system are called cannabinoids. The two main endocannabinoids that are produced in the body, anandamide and 2-AG (2-arachidonoylglycerol) are referred to as endocannabinoids because endo means within. The corresponding endocannabinoid receptors located throughout the body are simply named CB1 and CB2. CB1 receptors are found in their highest concentration within the brain and spinal cord. CB2 receptors are most often found within the peripheral nervous system and the immune system. Just a few of the many functions regulated by the endocannabinoid system include:

  • Neuroprotection
  • Muscle movement
  • Energy and metabolism
  • Pain perception and inflammation
  • Cardiovascular function
  • Digestive processes
  • Immune system function
  • Moods and emotions
  • Sleep and sleep cycles

The endocannabinoid system messengers interact with the endocannabinoid receptors to initiate a response from the brain. The nature of the response is determined by the chemical composition of the message received.

The Endocannabinoid System

Ideally, the body would produce all the cannabinoids necessary to keep this essential regulatory system functioning efficiently, but under the influence of illness, injury, or stress, the demand for endocannabinoids can exceed the supply, creating an endocannabinoid deficiency.

Many researchers today believe endocannabinoid deficiencies are to blame for many difficult-to-treat conditions including migraine, fibromyalgia, irritable bowel syndrome, and several neurodegenerative disorders, raising questions about the therapeutic potential of plant-based cannabinoids for Parkinson’s disease.

The receptors of the endocannabinoid system also respond to the plant-based cannabinoids in cannabis. The phytocannabinoids in cannabis mimic the effects of cannabinoids produced in the body, potentially alleviating the effects of endocannabinoids deficiencies. It didn’t take researchers long to discover that the phytocannabinoids in cannabis plants, particularly CBD (cannabidiol), also influence several non-endocannabinoid receptors, including:

  • Dopamine ReceptorsDopamine is a neurotransmitter released by neurons to send signals to other nerve cells when a CB1 receptor is stimulated. The brain has several dopamine pathways that regulate muscle movement, behavior, cognition, and the perception of pleasure and pain. CBD is shown to increase the production of dopamine by activating the G-coupled protein receptor GPR6.
  • GABA ReceptorsGamma-aminobutyric acid (GABA) is a neurotransmitter that blocks the impulses between nerve cells. When GABA receptors are activated by the neurotransmitter, the excitability between overactive nerve impulses is substantially reduced. It’s the effect on GABA receptors that may explain the interest in medical marijuana products for their potential to minimize the tremors associated with Parkinson’s disease.
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CBD is also shown to be a potent antioxidant that researchers believe contribute to the neuroprotective properties of cannabis. Antioxidants could be particularly beneficial for those living with neurodegenerative disorders, including Parkinson’s disease. While preliminary reports are encouraging, it’s important to note that there is still a significant amount of research that needs to be done to assess the full risks, benefits, and clinical applications of medical marijuana use.

Parkinson’s & Cannabis

The many plant-based cannabinoids in cannabis, particularly the non-psychoactive cannabinoid CBD, are showing remarkable potential for influencing nervous system function. By interacting with key receptors throughout the body, CBD is shown to have analgesic, antiemetic, antispasmodic, anti-inflammatory, and neuroprotective properties. The mechanisms are not yet fully understood because of the multiple targets affected, but many experts believe the antioxidant and neuroprotective properties beneficial to those living with neurodegenerative movement disorders. While the therapeutic potential of medical marijuana is encouraging, initial investigations are showing mixed results. Consider the following examples:

  • An open-label study of CBD was conducted on six Parkinson’s patients experiencing symptoms of parkinsonian psychosis. All six patients found psychotic symptoms improved, confirming the antipsychotic properties of CBD. The same results were reported in Parkinson’s patients experiencing REM behavior sleep disorders. At higher doses, CBD shows a trend to delay the progression of dystonia, involuntary muscle contraction. : a control group, a group treated with 75 mg of CBD per day, and a third group taking 300 mg per day. Participants were assessed one week before beginning the trial for motor symptoms, general symptoms, and perceived well being and quality of life. While the trial concluded with no significant differences in general symptoms, perceived well-being scores significantly improved for those taking CBD. While the study suggests that CBD may have the potential to improve quality of life for those living with Parkinson’s disease, investigators cautioned that additional studies with a larger sample would be necessary before any determination could be made.
  • Over a 31-day trial period, patients received an incrementally increasing daily dose of CBD, with the highest dose on the 17th day of the trial. Of the subjects who completed the trial, clinical rating scores decreased from 45.9 to 36.4, motor scores decreased from the initial 27.3 to 20.3, and mean rigidity scores decreased from 9.14 to 6.29. Data also suggested that CBD reduced irritability and minimized pain.

When viewing research and reports on the therapeutic potential of medical marijuana, it’s important to keep in mind that there are two distinctly different sources of CBD, marijuana and hemp. The plants are classified by their THC content. While THC (tetrahydrocannabinol) causes a psychotropic effect, it is also shown to work similarly to CBD for alleviating muscle spasms and pain. Many find the combined effects of THC and CBD superior to the effects of CBD alone.

In a survey of 84 Parkinson’s patients using cannabis, more than 46 percent experienced mild to substantial improvement of their symptoms. The Parkinson’s Foundation notes that most medical marijuana trials provide test subjects with capsules, tinctures, or nasal sprays containing either a combination of CBD and THC or CBD isolate.

ECS Function and Movement Disorders

During their investigations, researchers have found functions of the endocannabinoid system altered in those living with several movement disorders, including Parkinson’s disease. Since cannabinoid receptors are found in particularly high numbers in areas of the brain controlling movement, researchers are focusing on the ability of plant-based cannabinoids to bind basal ganglia (and other) receptors to potentially modify the progression or ease the symptoms of the disease.

A significant number of studies have explored the role of cannabinoids, particularly the effects of CBD, which is shown to mimic the effects of the endocannabinoids produced in the body and initiate a response from the endocannabinoid receptors. It’s the interaction with the endocannabinoid receptors and several non-endocannabinoid receptors that explain the anti-inflammatory, analgesic, antiemetic, anxiolytic, antispasmodic, and neuroprotective properties of cannabis.

Research also suggests the effects of CBD are potentially enhanced by the additional cannabinoids found naturally in cannabis, including THC. The amplification of the combined effects of these additional, lesser known, cannabinoids is called the entourage effect.

While preliminary investigations suggest modulating cannabinoid signaling could significantly improve symptoms,13 trials have yielded mixed results. But patient surveys and anecdotal evidence still suggest that cannabis has the potential to benefit the motor and non-motor symptoms of Parkinson’s disease. Since cannabis products can interact with several medications, it’s important to consult a healthcare provider before using cannabis or hemp-derived products.

Over Half of Cannabis Users with Parkinson’s Disease Report Clinical Benefits

Amsterdam, NL – With medicinal cannabis now legalized in many parts of the world, there is growing interest in its use to alleviate symptoms of many illnesses including Parkinson’s disease (PD). According to results of a survey of PD patients in Germany in the Journal of Parkinson’s Disease, over 8% of patients with PD reported using cannabis products and more than half of those users (54%) reported a beneficial clinical effect.

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Cannabis products containing THC (tetrahydrocannabinol, the main psychoactive compound of cannabis) can be prescribed in Germany when previous therapies are unsuccessful or not tolerated, and where cannabis can be expected with not a very unlikely chance to relieve disabling symptoms. CBD (pure cannabidiol, derived directly from the hemp plant, a cousin of the marijuana plant) is available without a prescription from pharmacies and on the internet.

“Medical cannabis was legally approved in Germany in 2017 when approval was given for therapy-resistant symptoms in severely affected patients independent of diagnosis and without clinical evidence-based data,” explained lead investigator Prof. Dr. med. Carsten Buhmann, Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany. “PD patients fulfilling these criteria are entitled to be prescribed medical cannabis, but there are few data about which type of cannabinoid and which route of administration might be promising for which PD patient and which symptoms. We also lack information about the extent to which the PD community is informed about medicinal cannabis and whether they have tried cannabis and, if so, with what result.”

Investigators aimed to assess patient perceptions of medicinal cannabis as well as evaluate the experiences of patients already using cannabis products. They performed a nationwide, cross-sectional, questionnaire-based survey among members of the German Parkinson Association (Deutsche Parkinson Vereinigung e.V.), which is the largest consortium of PD patients in German-speaking countries with nearly 21,000 members. Questionnaires were sent out in April 2019 with the association’s membership journal and were also distributed in the investigators’ clinic.

Over 1,300 questionnaires were analyzed; results showed that interest in the PD community in medical cannabis was high, but knowledge about different types of products was limited. Fifty-one percent of respondents were aware of the legality of medicinal cannabis, and 28% were aware of the various routes of administration (inhaling versus oral administration), but only 9% were aware of the difference between THC and CBD.

More than 8% of patients were already using cannabinoids and more than half of these users (54%) reported that it had a beneficial clinical effect. The overall tolerability was good. Over 40% of users reported that it helped manage pain and muscle cramps, and more than 20% of users reported a reduction of stiffness (akinesia), freezing, tremor, depression, anxiety, and restless legs. Patients reported that inhaled cannabis products containing THC were more efficient in treating stiffness than oral products containing CBD but were slightly less well tolerated.

Patients using cannabis tended to be younger, living in large cities, and more aware of the legal and clinical aspects of medicinal cannabis. Sixty-five percent of non-users were interested in using medicinal cannabis, but lack of knowledge and fear of side effects were reported as main reasons for not trying it.

“Our data confirm that PD patients have a high interest in treatment with medicinal cannabis but lacked knowledge about how to take it and especially the differences between the two main cannabinoids, THC and CBD,” noted Prof. Dr. med. Buhmann. “Physicians should consider these aspects when advising their patients about treatment with medicinal cannabis. The data reported here may help physicians decide which patients could benefit, which symptoms could be addressed, and which type of cannabinoid and route of administration might be suitable.”

“Cannabis intake might be related to a placebo effect because of high patient expectations and conditioning, but even that can be considered as a therapeutic effect. It has to be stressed, though, that our findings are based on subjective patient reports and that clinically appropriate studies are urgently needed,” he concluded.

Bastiaan R. Bloem, MD, PhD, Director, Radboudumc Center of Expertise for Parkinson & Movement Disorders, Nijmegen, The Netherlands, and Co-Editor-in Chief of the Journal of Parkinson’s Disease, added: “These findings are interesting in that they confirm a widespread interest among patients in the use of cannabis as a potential treatment for people living with PD. It is important to emphasize that more research is needed before cannabis can be prescribed as a treatment, and that guidelines currently recommend against the use of cannabis, even as self-medication, because the efficacy is not well established, and because there are safety concerns (adverse effects include among others sedation and hallucinations). As such, the present paper mainly serves to emphasize the need for carefully controlled clinical trials to further establish both the efficacy and safety of cannabis treatment.”