World Parkinson's Month: a review of medical cannabis and Parkinson’s disease

To celebrate Parkinson’s awareness month, we wanted to shed light on a new treatment option for patients with Parkinson’s who have been unresponsive to these traditional approaches in the UK, as an educational effort to improve health outcomes for those affected.

So, if you, or a loved one, have been wondering if medical cannabis is a suitable treatment option for Parkinson’s disease - you’ve come to the right place. This blog may give you the information, and the evidence, you need to make an informed decision about your health. 

But first, what is Parkinson’s disease?

Parkinson’s disease (PD) is a neurodegenerative disorder that affects an estimated 8.5 million people around the world. And, although it's globally well-recognised, unfortunately there is still a lot to learn about its true cause - and how it can be cured. 

At the moment, scientists are still unclear on exactly what causes Parkinson’s disease to develop in the first place - but they do know, its story begins in the basal ganglia - the brain’s ‘movement centre’. 

When nerve cells in the basal ganglia are damaged, motor control and dopamine regulation are disrupted. 

This can lead to the development of issues with motor symptoms, such as experiencing bradykinesia, slowness of movement, and tremors, as well as mental health concerns such as anxiety and/or depression. These symptoms typically get progressively worse, and cause a decline in quality of life for those with PD. 

And, when is Parkinson's Awareness month?

Every year, Parkinson's Awareness Month takes place in April, and an extra special effort is made on the 11th to mark Parkinson’s Awareness Day. 

This month-long awareness campaign seeks to educate people about Parkinson’s disease, and advocate for further research into treatments that may be able to benefit those living with this neurodegenerative disorder while there is still no cure. 

As a UK based medical cannabis clinic, we felt it was important to play our part in the awareness raising efforts, and so, in this blog, we’ll provide a quick overview of medical cannabis treatments for Parkinson’s disease.

The relationship between cannabis and Parkinson’s disease

While it's unclear exactly what causes nerve cells in the movement centre to become damaged in people with Parkinson’s, it is known that the impact of this results in a reduction in dopamine production, an increase in GABA production, and eventually an excessive build up of GABA. 

This can, in turn, block the basal ganglia’s messaging or signalling ability and reduce its control over movement, coordination, and rigidity, as well as its ability to produce dopamine, serotonin, and glutamate - all of which influence our emotions. 

However, research demonstrates that some cannabinoids (or therapeutic compounds) contained within cannabis may be able to help regulate GABA levels, and improve dopamine production levels - because of their interaction with the endocannabinoid system. 

The endocannabinoid system

When cannabinoids enter the body, they enter our endocannabinoid system. This system produces its own naturally occurring cannabinoids (called endocannabinoids) which send messages all around the brain and body to keep everything running smoothly and promote homeostasis. 

When cannabinoids derived from cannabis, like THC and CBD, enter the ECS, they can disguise themselves as endocannabinoids and boost or influence their natural functions and initiate different, or boosted, biological responses. 

These messages are received by cannabinoid receptors, which are located all over the body, and biological responses are triggered. Collectively, these receptors can regulate functions relating to learning and memory, pain control, immune responses, emotional processing, sleep, temperature regulation, and appetite. 

For this reason, as well as its ability to influence motor symptoms, medical cannabis also has the potential to improve sleep quality and mental health outcomes-which are common concerns for patients with Parkinson’s. 

Clinical investigations: Parkinson’s disease and medical cannabis 

Clinical investigations that explore the use of cannabis-based treatments on Parkinson’s disease symptoms are relatively limited, and further research in this area is required. 

However, just last month, the results of a long-term open label study using Nabilone (a licensed cannabis-based medicinal product currently prescribed to treat chemotherapy nausea and vomiting) found this treatment could also prove useful for patients with Parkinson’s.

This placebo-controlled, double-blind randomised controlled trial assessed the safety and efficacy of Nabilone in Parkinson’s symptom management for six months. Although the survey sample was small, results were positive. Nabilone was generally well-tolerated and patients self-reported improvements in sleep, pain, nighttime disturbances and non-motor symptom burden throughout the study. 

Medical cannabis and Parkinson’s symptoms

In 2020 a German survey of patients with Parkinson’s disease revealed their perceptions of, and experiences with, cannabis. This national survey found that only 8.4% of the 1123 patients that took part had tried cannabis-based treatments for Parkinson’s symptom management before - but 51% were aware these options were legally available in Germany.

Of those who had used cannabis therapeutically, over 40% reported a reduction in the muscle cramps and pain they experienced. 

The study also states 20% noted an improvement in their tremors, restless leg syndrome, akinesia, anxiety and depression, and, overall tolerability for the treatment type was deemed good. 

In 2019, Parkinson’s UK released a similar survey and revealed 16% of their survey cohort were actively using cannabis-derived products to control their Parkinson’s symptoms. A further 9% have used these options in the past, and 59% said they have never used these products for symptom management, but they would be open to the idea of doing so.

Medical cannabis and mental health 

Because a deterioration in mental health, or a development of anxiety and depression, is common amongst those with PD, the role medical cannabis can play in emotional regulation is also worth noting when discussing this plant’s potential for patients with Parkinson’s. 

For example, in 2021, the results of a large-scale US survey that investigated the effects medical cannabis can have on major depressive disorders and generalised anxiety disorder were released. Comparing their results against a control group who do not consume cannabis, this study found those consuming medical cannabis encountered significant reductions in anxiety and depression symptoms following treatment administration. 

Data from the UK’s largest medical cannabis observational survey strengthen these findings, and shows a gradual decline in severity of depression over three months of cannabis-based treatments, which is typically sustained at 6 months. For patients with diagnosed depression (as either a primary or a comorbid diagnosis) average severity scores on the PHQ-9 questionnaire halved within three months of medical cannabis, and stayed steady. 

Medical cannabis and sleep

The effects medical cannabis can have on sleep are well documented, and regardless of what patients are primarily treating with cannabinoid therapies, often one of the first areas people note improvement in after starting cannabis-based treatment is their improvement in sleep. 

For example, in a double-blind, randomised placebo-controlled crossover study, an 80% improvement was noted in insomnia patient’s sleep quality after medical cannabis oil administration. 

Another placebo controlled study worth noting has been described as ‘the most rigorous clinical trial ever undertaken to assess the therapeutic potential of medical cannabis to treat symptoms of chronic insomnia’. This study displays between a 26 and 36% reduction in insomnia severity index scores after medical cannabis treatments were administered, depending on the dosage given. 

Real-life evidence: Patient experiences with medical cannabis

As well as data generated from patient-response surveys, there is strong real-life evidence that supports the use of medical cannabis for Parkinson’s disease. One of the most notable stories includes Larry Smith’s, a former police captain who recorded his journey of using cannabis for Parkinson’s symptom management online. 

After gaining immense popularity on YouTube thanks to his candid accounts and visual demonstrations of how cannabis reduced his tremors and improved his mobility, Larry embarked upon a 300-mile cycling trip around South Dakota, 20 years after he was first diagnosed with Parkinson’s disease.

His incredible efforts were documented by a film crew, and the documentary called Ride With Larry was later released in 2013. Larry passed away seven years later, aged 71, but the story of how medical cannabis helped him get movement, independence, and motivation back when other options had failed, is still alive today. 

Can I get medical cannabis for Parkinson’s disease in the UK?

Providing you have tried at least two conventional treatments that have failed to treat your symptoms, or have caused unpleasant side effects, you may be eligible for a personalised, Parkinson’s medical cannabis treatment plan with Releaf. 

While cannabis based medicinal products have been legally available in the UK since 2018, they gave not yet been endorsed for Parkinson’s treatment by NICE, and so, they are not routinely prescribed by the NHS. 

At the moment, the NHS only (and rarely) prescribe CBMPS for the treatment of: 

• intractable nausea and vomiting
• Multiple sclerosis related spasticity
• severe treatment-resistant epilepsy.

FAQs

What is the finger test for Parkinson's?

The "finger test" for Parkinson's tests motor control, coordination, and tremors.

In the finger-tapping test, patients repeatedly tap their thumb and index finger to spot any slowed or reduced movement. The finger-to-nose test has them switch between touching their nose and a target to check for tremors and precision. Another version, the sequential finger movement test, involves tapping each finger to the thumb in order, highlighting any coordination issues or bradykinesia, a key Parkinson's symptom.

How close are we to a cure for Parkinson's?

That's impossible to say. Research is continuing, and there are promising new avenues being pursued. While there is currently no cure for Parkinson's, there are a variety of treatments and therapies available to manage symptoms and improve quality of life.

What causes a rapid decline in Parkinson's?

Parkinson’s symptoms can quickly worsen for a few reasons - the disease itself, problems with medication, or secondary health issues. Infections, dehydration, or malnutrition can also temporarily worsen symptoms. Cognitive issues, like Parkinson's-related dementia or severe depression, can further affect mental function.

Medical cannabis with Releaf

However, private medical cannabis clinics like Releaf can prescribe cannabis-based treatments, such as medical cannabis flower and prescribed cannabis oil, to patients they believe may benefit from these options, and oversee and monitor their treatment with follow-up care. 

At Releaf, these prescriptions are issued by GMC registered Specialist Consultants to patients who have exhausted the conventional treatment options used by the NHS, and treatments are dispensed from Releaf’s in-house pharmacy and delivered straight to the patient's front door. 

While medicines derived from cannabis are not an appropriate option for all, they can offer relief to some patients with Parkinson’s. To find out more about if these options may be suitable for you, fill out our free eligibility checker here.