Sunday, October 18, 2015

Alaska, Marijuana and Parkinson's

Yesterday we had a potentially controversial topic as a meeting subject: Marijuana as treatment for PD.  This post is based on comments I made to frame the issue and ease in the speaker.

We people with Parkinson's Disease are fond of noting that every person's case of Parkinson's is unique. What works for one person may result in dramatic and unwanted side effects in the next. Each case demands an individual approach.

The case of marijuana as a medical intervention, too, is almost unique. There is not much in the way of studies on marijuana and Parkinson's because it has been declared illegal to research this substance in the customary settings, at least in the United States. This is loopy and counter-productive. If we can tolerate morphine in medical practice, surely marijuana can be investigated for medicinal value as well.

The ban on studying the medical potential of pot is not absolute. If a researcher jumps though enough hoops, they may do science with cannabis. An example: a study on Pubmed, a free resource from the National Center for Biotechnology Information (NCBI) at the National Library of Medicine®, which says in its abstract "The use of cannabis as a therapeutic agent for various medical conditions has been well documented. However, clinical trials in patients with Parkinson disease (PD) have yielded conflicting results. The aim of the present open-label observational study was to assess the clinical effect of cannabis on motor and non-motor symptoms of PD.
Twenty-two patients with PD attending the motor disorder clinic of a tertiary medical center in 2011 to 2012 were evaluated at baseline and 30 minutes after smoking cannabis using the following battery: Unified Parkinson Disease Rating Scale, visual analog scale, present pain intensity scale, Short-Form McGill Pain Questionnaire, as well as Medical Cannabis Survey National Drug and Alcohol Research Center Questionnaire.
Mean (SD) total score on the motor Unified Parkinson Disease Rating Scale score improved significantly from 33.1 (13.8) at baseline to 23.2 (10.5) after cannabis consumption (t = 5.9; P < 0.001). Analysis of specific motor symptoms revealed significant improvement after treatment in tremor (P < 0.001), rigidity (P = 0.004), and bradykinesia (P < 0.001).”

 Researchers found in their conclusions:

There was also significant improvement of sleep and pain scores. No significant adverse effects of the drug were observed. The study suggests that cannabis might have a place in the therapeutic armamentarium of PD. Larger, controlled studies are needed to verify the results."

So there seems to be some scientific weight behind the idea that what we called "dope" in high school harbors significant value in dealing with the symptoms of PD. Unfortunately, this potential value has been underexplored as it became entangled with our feelings and laws concerning what substances society will tolerate as legal when it comes to getting high.  

Alaska has long been the exception to the general legal treatment of marijuana. It has been lawful, as a matter of privacy under state law, for an individual to possess a small amount for personal use since the Alaska Supreme Court's Ravin Decision in 1975. Further, Alaskans subsequently voted to legalize marijuana for medicinal use, with the law signed in 1998. Covered conditions for use of medical marijuana include Cachexia, Cancer, Chronic Pain, Glaucoma, HIV or AIDS, Multiple Sclerosis, Nausea, and Seizures.

The voters of Alaska went another step in 2014, legalizing Marijuana for personal recreational use. The state is still formulating regulations that will govern the fine points of the use of marijuana, but the law clearly says "Adults are allowed to possess up to one ounce of marijuana and to grow up to six marijuana plants, three of which may be flowering, in their households. They may also possess all of the marijuana grown from their plants at the location where the cannabis was grown. Individuals 21 and older may gift up to an ounce of marijuana and up to six immature plants to other individuals 21 and older. They cannot be compensated for these transactions. Adults 21 and older will also be allowed to purchase up to an ounce of marijuana from properly registered businesses."

So  where does this leave us? We have some scientific evidence from the U.S. and elsewhere, that marijuana is useful for PD symptoms, among them tremor, rigidity and bradykinesia, as well as Parkinson's-associated pain, and sleep trouble. Marijuana, with restrictions, is legal for personal use under state law and, for all practical purposes this appears to be tolerated by federal policy. In the present climate we can now test for ourselves as best we may how cannabis affects our symptoms.

I would prefer if the substance had been through the scientific mill years ago, but there is enough promising evidence that it may alleviate some Parkinson’s symptoms that it would be cruel to force sick people to wait for what has already been delayed too long by misguided politics. Perhaps, like our past fear of marijuana, our present hope for the plant’s power to alleviate PD-related suffering is overblown. The only way to find out is to try it. We can thank the humane laws of our state for the opportunity.

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