In this installment of our “Voices from the Experts” series, Parkinson’s News Today Drs. Michelle Sexton to answer some of your questions about cannabis.
Sexton is a naturopathic physician who completed pre-doctoral and post-doctoral fellowships at the University of Washington, where he studied the endocannabinoid system and its role in neuroinflammation and neurodegeneration. His National Institutes of Health-funded doctoral and postdoctoral research on cannabinoids and their role in neuroinflammation and neurodegeneration examined cannabis use and its effects on inflammatory markers. He continued to research the health effects of cannabis as an adjunct assistant professor in the Department of Anesthesiology at the University of California San Diego (UCSD). He is on the medical staff of the Center for Integrative Medicine at UCSD, the first cannabis clinic in a major medical center.
Sexton’s clinical practice, research and teaching focus is on the endocannabinoid system and its role in integrative medicine for the treatment of conditions across the lifespan. Sexton has presented his research internationally and has published numerous articles in peer-reviewed journals. He began his career in the healthcare industry as a herbalist and midwife. He opened the first cannabis analysis laboratory in Washington State and served as an editor for the botanical monographs of the Herbal Pharmacopoeia of America. He is a member of the International Society for Cannabinoid Research, the International Association of Cannabinoid Medicines, the California Association of Naturopathic Physicians, and the American Association of Naturopathic Physicians. He is in private medical practice in San Diego.
What misconceptions about the use of cannabis in Parkinson’s would you like to dispel?
Cannabis cannot cure any disease, including neurological diseases. This is not a one-size-fits-all solution to helping people with Parkinson’s disease (PPD). As with any potential therapy, some people respond well and see relief of symptoms, while others do not. If you decide to use cannabis, you need to weigh the various positive benefits against the negative side effects and determine whether using cannabis for your situation will benefit you and your unique symptom profile and/or quality of life. Adverse effects may include effects on cognitive function, perception of space and time, dizziness, nausea, and more.
Is there any advice regarding the medical use of cannabis for people with Parkinson’s disease?
In a perfect world, you would be able to discuss the use of medical cannabis with your doctor. However, due to the unique nature of cannabis, which is widely used medicinally, medical professionals may not feel ready to advise on such use.
It’s important to be open with your doctor if you decide to use cannabis, but they can help monitor any side effects or potential for drug interactions. There are many “experts” offering advice on the use of cannabis. Some are health professionals, some are not. Be careful who you take advice from. The best advice on how to use and dose cannabis comes from someone with extensive experience with PPD and a strong background in cannabis science.
Be careful what you read online, as it can be difficult to separate fact from marketing claims about what to expect from cannabis use. There is very little research on cannabis in PPD.
Any words of caution?
Marijuana, especially inhaled cannabis, can affect the brain, the part of the brain that helps maintain balance and make precise movements. The brain is rich in CB1 receptors, the THC-binding protein in cannabis. So caution should be exercised in people with PD who have balance issues, dizziness, or gait disturbances.
Furthermore, CB1 receptors are also found on smooth muscle tissue and endothelial cells, and when THC acts on the receptor there, it causes blood vessels to dilate. When this occurs, it causes a hypotensive effect, or a drop in blood pressure. Because PPD may already be postural or orthostatic hypotension, this should also be cautious. Especially if you have a risk of falling, starting to use cannabis suggests that you should always use a walker. Staying well hydrated, consuming electrolytes, and ascending slowly are all ways to minimize these effects. Instead of inhaling cannabis, taking it orally may cause less dizziness, balance, and hypotension, but the dose does matter!
In what ways might medical cannabis be particularly suitable for people with Parkinson’s?
The most striking observation from clinical practice is the beneficial effect on sleep. Other ways include reducing anxiety, reducing tremors, and improving quality of life (pain relief).
Do you think patients’ symptoms will respond positively to a THC heavy or CBD heavy strain?
It’s really impossible to answer this question because the effects are individual. In general, for therapeutic purposes (medicinal use), low doses of THC can be beneficial. A plant type (chemotype or strain; the term used in microbiology) that is high in CBD has a much lower THC content and may therefore be more suitable for medical use. Chemotypes are more important when using inhaled cannabis than when using oral cannabis. This is due to the essential oil of the plant, which leads to effects when inhaled. Since the essential oil component of cannabis is metabolized by the liver when taken orally, the biological effects of these compounds are almost invisible.
What positive effects have you seen in the medical use of cannabis?
As mentioned above, the most impressive effect is on sleep, and in general, cannabis can be considered as a medicine for the quality of life. Mild mood-enhancing, anxiety-relieving, sleep-promoting, calming, relaxing, and euphoric effects can be achieved with low doses of THC, reducing the potential for cognitive or physical impairment.
Do you recommend a specific way to deliver cannabis?
Inhalation is for those who need a quick effect, while taking a cannabis product orally will have long-lasting effects. Administration and dosage are highly variable and dependent on many factors, including consideration of drug interactions and current balance issues, hypotension, dizziness, and cognitive function. The best advice comes from a healthcare provider experienced in the use of medical cannabis. Be wary of information coming from dispensaries, as they may be biased or ill-informed about medical cannabis.
Is there ongoing or recent research on cannabis that excites you?
It’s fun to watch everything Current cannabis research, as previous funding was only for research on the harms of cannabis. It seems like it’s time for more understanding and evidence for the use of cannabis, along with other botanical remedies, to treat chronic conditions that are generally difficult to treat and improve quality of life!
Expert Voices is a monthly series featuring a Q&A with an expert in the Parkinson’s space on a specific topic. These topics and questions are based on a survey we asked readers about what they wanted to know more about from experts. Click here if you would like to submit topics or questions for consideration in a future part of the series here to take a survey.
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