Tuesday, January 8, 2019

Cannabis and Parkinson's Disease




Cannabis and Parkinson’s Disease


Parkinson’s Disease (PD) is a progressive neurodegenerative disease caused by the loss of neurons that produce the neurotransmitter dopamine within a small region in the midbrain called the Substantia Nigra. Reduced levels of dopamine will interfere with coordination and motor function. The usual symptoms of PD are tremors, muscular rigidity, and slowness of movement.



History

Cannabis may have been used to treat diseases similar to PD, Indian medical Texts from 1000 B.C.E. show therapeutical uses for cannabis. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3234454/

 Parkinson’s Disease was first described by James Parkinson in 1817. In 1899, the 19th-century British Neurologist William Gowers used cannabis in combination with opium to treat PD and stated, “I have several times seen a very distinct improvement for a considerable time under their use.”

“William Gowers, working in London, contributed an important study of Parkinson's disease demographics in his “Manual of Diseases of the Nervous System,” describing his personal experience with 80 patients in the 1880s. He correctly identified the slight male predominance of the disorder and studied the joint deformities typical of the disease. Known for his descriptive prose, Gowers offered one of the most memorable similes regarding Parkinsonian tremor (Gowers 1888)”




Cannabinoids and the Endocrine System

The Endocannabinoid System regulates diverse functions such as memory, digestion, motor function, immune response and inflammation, appetite, pain, blood pressure, bone growth, and the protection of neural tissues, among others. The Endocannabinoid System take up cannabinoids and distributes them to receptors throughout your body.  The two primary subtypes of cannabinoid receptors in the endocannabinoid system are CB1 and CB2. These receptors are distributed throughout the central nervous system, immune system, and within many other tissues including the brain, gastrointestinal system, reproductive and urinary tract, spleen, endocrine system, heart, and circulatory system.

Cannabinoids can be found naturally in your body (endocannabinoids). Some people are deficient in natural cannabinoids. Recent research has shown that a possible "Endocannabinoid Deficiency" may be the reason for many diseases and other conditions. Plant cannabinoids found in Cannabis are called Phytocannabinoids, such as THC, CBD, CBG, CBC, CBN, and more. The two most popular and most researched cannabinoids are THC (known to cause some psychoactivity) and CBD (non-psychoactive). CBD (cannabidiol) can help ease distress, while THC is more effective for pain relief, for reducing the number of opioids needed to treat, and increasing the quality of sleep. Medicines with CBD and THC can lessen the psychoactivity feeling from THC.


It can be a disturbing experience for a cannabis-naive person to use a cannabis product with a high level of THC. Paranoia and anxiety are some side-effects that occur with high THC products. Products with combined ratio of THC and CBD are recommended. Cannabis products can interfere with specific prescription medications. A trusted physician can advise whether there are potential interactions between cannabis and current medications.

There is a great amount of observational data that supports the use of cannabis in Parkinson’s Disease.



Research and Evidence

The effectiveness of cannabinoids in treating PD is somewhat inconclusive, yet promising. In 2004, a survey at Prague Movement Disorder Center indicated that more than half of the PD patients who tried cannabis claimed subjective improvement. https://pdfs.semanticscholar.org/a569/1349d19c96cccace47d4db3efa5295069440.pdf

 One randomized, double-blind, placebo-controlled crossover trial in seven patients found a significant reduction in dyskinesias (uncontrolled movements) in response to the use of cannabinoid receptor agonist Nabilone*, a synthetic cannabinoid that works as a CB1 receptor agonist, like THC. http://n.neurology.org/content/57/11/2108.short

A group of Israeli researchers delivered cannabinoids via inhalation, the most common method of administration from PD patients. The patients’ conventional medications “had proved insufficient to combat severe PD-related pain and tremor.” The effects of cannabis on these patients’ PD symptoms were evaluated with the Unified Parkinson’s Disease Rating Scale (UPDRS). The Israeli researchers found that after using cannabis, patients experienced an overall 30% improvement in their average UPDRS score. Analysis of different motor symptoms also revealed significant improvement for tremors, rigidity, and slowness of movement. The researchers also found improvement in pain and sleep scores and observed no adverse effects from the inhaled cannabis. Cannabis smoking had no effect on the patients’ posture, however they reported drowsiness as the primary side effect. Researchers concluded that cannabis ameliorated both motor and non-motor symptoms in patients suffering from PD.


Recent evidence indicated that other cannabinoids may prove of even more value than THC in PD treatment. THCV, found in some southern African and Central Asian cannabis, has been shown to provide neuroprotection and symptom relief in animal models of PD.* With the additional neuroprotective characteristics associated with CBD, there is discussion of potential combination therapy of these two cannabinoids as a treatment to interfere with the progression of PD.





Endocannabinoid System and Parkinson’s Disease

The Endocannabinoid System changes observed in PD are currently thought to occur both in compensation to the disease and as part of its pathology. The endocannabinoids released in the early phases of PD, as compensation to maintain control of locomotion, may end up impairing locomotion in later phases of the disease. The use of cannabinoids in PD may require a better understanding of how cannabinoid medicines can boost the production of endocannabinoids in the early stages of PD; then how different cannabinoid medicines might curb the production of endocannabinoids in later stages of the disease.





Dosing

For pain/neuropathy, take 2.5 to 7.5 mg THC orally or inhaled, every 3-4 hours to manage pain. Taking cannabis orally requires some patience and planning to achieve even relief over time, since oral medications (swallowed) usually take 45 minutes – 1 hour to be felt. Inhaled forms of cannabis medicine can be felt almost immediately, and sublingual oils can take 20 minutes to be felt. Topical cannabis salves or lotions may help painful neuropathy.

The addition of CBD to a THC dose can reduce the intensity of THC psychoactivity while providing potential neuroprotection.

Taking Cannabis medicine orally is quite effective for increasing the quality of rest and sleep, and for providing analgesia for neuropathic pain in PD patients. Oral CBD and beta-caryophyllene (a terpene found in some cannabis) have significant neuroprotective, antioxidant, anti-inflammatory, and immune-modulator action, aspects that could be helpful in treating neurodegenerative diseases like Parkinson’s. 25-50 mg oral daily seems to be an effective dose for these effects.

Floraplex is a company that sells plant terpene extracts and you can find Beta-caryophyllene extract for as low as $20 https://www.buyterpenesonline.com/terpenes-for-sale/beta-caryophyllene/




Vaporized or inhaled THC is recommended for faster onset. Always use the lowest effective dose to avoid the development of tolerance. Patients new to cannabis should start with 2.5 mg of THC and wait about 15 minutes to feel the effects before adding more (only when necessary), this is equivalent to about 1-2 hits of cannabis flower.

High-CBD varieties, such as AC/DC, Suzy Q, Cannatonic, and Charlotte’s Web, may be useful for neuroprotection. Cultivars containing THC and CBD may provide broader symptom relief, especially if that cultivar is also high in Beta-Caryophyllene, like Cookies or Kryptonite.

www.leafly.com is a great source to find doctors and dispensaries near you. They also have information on specific strains, conditions to treat, products, news, health, politics, growing, and cannabis education.



Information about Cannabis and Parkinson’s Disease was taken from the amazing book Cannabis Pharmacy: The Practical Guide to Medical Marijuana by Michael Backes, Andrew Weil M.D., and Jack McCue M.D.  This book educates on all topics of cannabis and medical conditions. 




Talk to your doctor if you're thinking about medical marijuana. Your personal physician can help you review the latest research, the pros and cons, and how the therapy might fit into your regimen.



Videos for Cannabis and Parkinson’s Disease

Cannabis & Parkinson’s Disease: Growing Like a Weed – Maureen Leehey, MD


Cannabis Research in Parkinson’s


77-year-old Coloradan with Parkinson’s Does an About Face on Marijuana


16 New & Upcoming Treatments for Parkinson Disease


Medical Marijuana for Parkinson’s Disease – Dr. Rachna Patel


Man with Parkinson’s uses Marijuana for the First Time – and the Results are Amazing


Cannabis, Dads, and Parkinson’s Disease


An Israeli Research that may Answer the Prayers of Patients Suffering from Parkinson’s Disease


^^^ (Not cannabis related, but any natural medicine is worth looking into when the big pharma companies have failed us!)




More Information on Cannabis and Parkinson’s Disease


“The varying amounts of cannabinoid agonists and antagonists in different marijuana plants makes cannabis studies difficult to conduct. When researchers study the effects of a medication, dosages are controlled and often set to a specific number of milligrams. When testing medical marijuana, the dosage administered can vary dramatically depending on the plant and method of administration.”


“Scientifically it is not crazy to think that marijuana may play some positive role in the alleviation of Parkinson’s disease symptoms. There are cannabinoid (THC) receptors all over the brain, and these receptors seem to be concentrated in a region important to Parkinson’s disease, commonly referred to as the basal ganglia. In fact, the globus pallidus and the substantia nigra pars reticulata, which are structures within the basal ganglia, are some of the most densely packed cannabinoid (THC) receptor areas in the human body.”


“Our bodies make natural cannabinoids that control sleep, appetite, mood and other processes by binding to receptors throughout the body and brain. These receptors are found in particularly high numbers in the basal ganglia, a circuit of brain cells that controls movement and is affected in Parkinson's. Because the cannabinoids in marijuana bind to the receptors in our body and brain, researchers have looked at whether they could bind to basal ganglia and other receptors to modify the course of PD or help ease symptoms of disease.

Pre-clinical work, including several studies funded by MJFF, shows that cannabinoids may protect brain cells through antioxidant and anti-inflammatory mechanisms.

Clinical studies have evaluated whether marijuana can ease Parkinson's motor and non-motor symptoms as well as levodopa-induced dyskinesia, involuntary movements that may result with long-term use of levodopa and many years of living with PD. In general, trials show mixed results (some positive, some negative), which leaves patients, doctors and researchers with insufficient evidence that medical marijuana and cannabinoids are an effective treatment for Parkinson's.”


“One must also consider that just like any medication, medical marijuana can interact with other prescription medications such as those that cause sleepiness or thin the blood. In addition, medical marijuana can have side effects. And just like any medication, the side effects will vary depending on the person taking it. Elderly patients are typically more susceptible to side effects, for example. Some side effects that might occur include sleepiness, confusion, difficulty concentrating, apathy, mood changes and gait imbalance. Therefore, before even considering medical marijuana, especially in the elderly, patients need to discuss how marijuana interacts with their other medications and weigh all the risks and benefits with their doctor.”


“Making therapeutic medicines out of plants was the birth of pharmacology and has been done for millennia, yet harnessing what is truly therapeutic, removing what is not while keeping the compound effective is the very essence of the controversy. We are in the moment of finding out if this can be done for marijuana as it segues into the medical realm.

A recent increase in medical marijuana distribution centers across the US has reignited the conversation in the media and politics. Parkinson’s disease (PD) is one of the qualifying conditions for medical marijuana eligibility in many states.”


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