(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).
More recently, I have received many inquiries specifically about the use of cannabidiol or CBD, for symptoms of PD. So today I’ll take a more in-depth look at CBD to help you better understand what it is and its possible use for symptoms of PD.
Pre-clinical evidence that CBD has anti-inflammatory and antioxidant properties
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.
APDA Vice President and Chief Scientific Officer
There have been a few studies of CBD for various symptoms of PD which have generally involved a small number of patients. Many have been open-label trials, in which the doctor and patient are both aware that the patient is receiving treatment and there is no control group that received a placebo.
What is medical marijuana?
Here, we offer general information about cannabis and Parkinson’s, tips for talking with your doctor, and more.
What is cannabis?
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.
- 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.
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 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.
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
More information about medical marijuana & CBD
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.
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. I remember thinking “while I want relief from my symptoms, I don’t want a diagnosis of PD.” Unfortunately, I couldn’t have it both ways. If I found relief (which I did) there was an excellent chance that I had PD (which I do).
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.
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.