Use of Cannabidiol (CBD) for PD symptoms
People with PD are eager to find alternative methods to help their symptoms, leading many of these patients to look into whether other therapies, such as medical marijuana, also known as medical cannabis, can be useful. Previously, I wrote a blog on medical marijuana and PD which you may find interesting.
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.
(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).
What is CBD?
Cannabidiol, or CBD, is one of the two main components of medical marijuana. (The other one is tetrahydrocannabinol or THC.) Pure CBD does not cause a “high” and does not pose a risk of abuse or dependence. THC on the other hand, can cause these effects.
Pre-clinical evidence that CBD has anti-inflammatory and antioxidant properties
CBD has been studied extensively in the laboratory and has been shown to have anti-inflammatory and antioxidant properties. Inflammation in the nervous system has been linked to neurodegeneration and therefore it has been hypothesized that CBD might even be beneficial as a neuroprotective agent. Although this is interesting and potentially exciting information, there are numerous other chemicals that have been studied in the laboratory with these properties that did not result in clinical benefit when tried in humans. Therefore, clinical trials become essential to support any claims that CBD should be used for medical purposes. Bottom line, don’t get too excited until there is scientific data to back it up.
Is CBD legal?
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.
The increased interest in CBD products as supplemental treatment
There is also a very confusing array of CBD products that are available for purchase. These vary in:
- What the manufacturers state is in the product. That is, some formulations of CBD will state on their label that they also contain a small amount of THC or that they contain other cannabis-derived compounds, but not THC. Others state that they are pure CBD.
- The formulation. CBD is available in oils, creams, pills, inhalants and more.
It is not just the Parkinson’s disease community that has taken an interest in CBD. There are countless health claims that CBD is helpful for a whole host of conditions. Clinical trial evidence to support the use of CBD however, is minimal. The only FDA-approved indication for CBD is to reduce seizure frequency in certain rare and severe forms of childhood epilepsy. A purified form of CBD, sold under the brand name Epidiolex® was tested in a well-designed clinical trial in order to gain this approval. (Three other cannabis related drug products that are not CBD, but rather synthetic THC, also have FDA approval and are used to treat loss of appetite and weight loss in patients with HIV, and severe nausea and vomiting due to chemotherapy).
For all the other health claims, there is not enough clinical trial data to allow the FDA to state whether or not CBD is effective. And there definitely is not enough data to support the use of one type or formulation of CBD over another.
This has not dimmed the enthusiasm of millions of CBD users for a wide range of medical conditions.
The challenge of regulating CBD products
Practically, CBD products can be obtained relatively easily at health food stores and online. They are not considered drugs (except for Epidiolex®), and therefore are not regulated by the Food and Drug Administration (FDA). This can be very problematic because without FDA oversight:
- There is no assurance that what is stated on the package is what is being sold. For example, even if the bottle says it is pure CBD, the product may contain other chemicals from the cannabis plant, or a higher amount of THC than advertised
- The manufacturing process, which is also not regulated, may introduce contaminants
- There is no assurance that the dosage written on the bottle is correct
- Medication interactions between CBD products and other drugs are not clear to consumers
The FDA is aware of the health claims that are made by manufacturers about various products and issues warnings to companies who market CBD products with unsubstantiated health claims.
CBD and Parkinson’s Disease
What evidence is available for the use of CBD for PD?
The FDA is aware that patients are frustrated that our understanding of how best to use CBD remains minimal because of the lack of clinical trials. In 2015, the FDA changed some of their regulations to make it easier to study CBD in clinical trials.
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.
- In one, an open label study of CBD was conducted on six patients with psychosis. Psychotic symptoms decreased.
- In a second trial, an open-label study of CBD was conducted on four patients with REM behavior sleep disorder. Symptoms decreased.
- A third trial was conducted on 21 patients with PD and was double blinded, meaning neither patient nor doctor knew who received treatment and who received a placebo. Motor scores did not improve, but quality of life scores did.
Additionally, three more recent trials of CBD for PD were conducted.
of 13 patients studied the tolerability and efficacy of CBD on tremor in PD. The trial is completed but results have not yet been published.
- Epidiolex®, the CBD formulation approved by the FDA for certain intractable childhood epilepsies, was trialed in 10 people with PD in an open-label study. Results were published and showed improvements in motor scores, nighttime sleep and emotional dysregulation scores.
- Finally, a double blinded study for motor symptoms of PD is currently underway. This trial aims to enroll 60 people with 30 patients receiving CBD and 30 receiving placebo.
Using CBD for treating Parkinson’s disease symptoms
People with PD are already using CBD in various forms for all sorts of symptoms of PD including insomnia, anxiety, tremor, dystonia and pain.
Without clinical trial data however, we do not know whether CBD is safe and effective for a particular symptom, and if it is, what CBD formulation and dosage is best to be used for a particular symptom.
We also don’t know the side effect profile of CBD in people with PD. At baseline, people with PD may have various non-motor symptoms that may make them more prone to side effects from CBD, including fatigue and nausea.
If you would like to try CBD for one of your PD symptoms, have a conversation with your movement disorders specialist about it. Your doctor may be willing to oversee your trying it, or may feel that it is too risky for you without evidence that it will help. At the very least, he/she can make sure that there are no drug interactions between CBD and anything else that you take and discuss with you any potential side effects that you need to be aware of.
Tips and takeaways
- CBD is a component of medical marijuana that does not have abuse or addiction potential
- CBD products can be easily obtained in health food stores and online, but they are not regulated by the FDA
- There is minimal clinical trial data that support CBD-related health claims
- Despite this, various CBD products are used by people with PD (and by people with a multitude of other conditions) for symptoms such as pain, insomnia, and anxiety
- More clinical trials are necessary to understand whether and how to safely and effectively use CBD for the treatment of PD symptoms
- As with all medical decisions, if you would like to use a CBD product, first talk with your neurologist and other members of your health care team
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Dr. Rebecca Gilbert
APDA Chief Scientific Officer
Dr. Gilbert received her MD degree at Weill Medical College of Cornell University in New York and her PhD in Cell Biology and Genetics at the Weill Graduate School of Medical Sciences. She then pursued Neurology Residency training as well as Movement Disorders Fellowship training at Columbia Presbyterian Medical Center. Prior to coming to APDA, she was an Associate Professor of Neurology at NYU Langone Medical Center. In this role, she saw movement disorder patients, initiated and directed the NYU Movement Disorders Fellowship, participated in clinical trials and other research initiatives for PD and lectured widely on the disease.
DISCLAIMER: Any medical information disseminated via this blog is solely for the purpose of providing information to the audience, and is not intended as medical advice. Our healthcare professionals cannot recommend treatment or make diagnoses, but can respond to general questions. We encourage you to direct any specific questions to your personal healthcare providers.
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Using CBD to Treat Parkinson’s Disease Symptoms
The benefits and research around CBD are still emerging
Colleen Travers writes about health, fitness, travel, parenting, and women’s lifestyle for various publications and brands.
Verywell Health articles are reviewed by board-certified physicians and healthcare professionals. These medical reviewers confirm the content is thorough and accurate, reflecting the latest evidence-based research. Content is reviewed before publication and upon substantial updates. Learn more.
Diana Apetauerova, MD, is board-certified in neurology with a subspecialty in movement disorders. She is an associate clinical professor of neurology at Tufts School of Medicine.
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.
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.
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.
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.
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 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.
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.
Uses and Safety
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.
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.
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.
Should You Use It?
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.
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.