March 23, 2021
4 min read
Patients self-reported varying opinions on cannabis use and its efficacy in alleviating the symptoms of Parkinson’s disease, according to a study published in NPJ Parkinson’s Disease that characterized patterns of use among the population.
“In the U.S., cannabis has become more widely available for medical and recreational use. However, little is known about the attitudes toward, and experiences with, cannabis use among those living with PD,” James Beck, PhD, senior vice president and chief scientific officer of the Parkinson’s Foundation, told Healio Neurology. “We believe that this topic should be better understood and have committed to doing so with a medical marijuana convening and its published guidelines, and most recently, conducting this survey to better understand cannabis use among the PD community.”
Beck and colleagues distributed an anonymous survey to “constituents” of the Parkinson’s Foundation with PD; they reported a 17.6% response rate. The 1,064 patients (mean age, 71.2 years; mean disease duration, 7.4 years) who provided complete responses and were included in the final analysis came from 49 U.S. states, according to the study results. The researchers examined patients’ attitudes toward and knowledge of cannabis, routines using cannabis and self-reported perception of its efficacy in reducing PD symptoms.
Knowledge of, attitudes toward cannabis
Approximately three-quarters (75.5%) of respondents reported that they had not used cannabis in the previous 6 months, according to the study results. Beck told Healio Neurology that this was “primarily because there was a lack of scientific evidence supporting any benefits,” which was cited by 59.9% of respondents as the reason for non-use. Other reasons included state or federal legality, side effects, no need for cannabis and disinterest, according to the study.
Among 261 patients (24.5%) with PD who reported using cannabis in the previous 6 months, 63.6% reported using cannabis primarily for medical reasons related to PD, 9.2% for other medical reasons, 4.6% for non-medical or recreational purposes and 21.5% for both medical and non-medical or recreational purposes and 1.1% indicated that they did not know.
Of those who used it for medical or for both medical and non-medical reasons, most did not get information about cannabis or recommendations for using cannabis from PD physician. Instead, these patients most commonly reported receiving information from the internet or news sources (30.5%) as well as from friends or peers with PD (26%), according to the researchers. Of these patients, 64.4% reported that they did not receive a recommendation to use cannabis from a licensed provider.
Beck said the results “demonstrate that there is a knowledge gap among people living with PD, which may be impacting decisions about cannabis use, as a large portion of consumers reported not knowing the type, brand or dosage of cannabis they primarily use.”
Patients who received information about how to use cannabis most commonly reported learning from a non-PD doctor (25%), dispensary staff (22.2%) and friends or peers with PD (22.2%). However, 56.1% of medical or medical and recreational users reported that they did not receive recommendations on using cannabis and 22.2% of all users reported that they did not know information such as strain name or CBD and THC concentrations.
Patterns of use, perceptions of efficacy
More patients who used cannabis for any reason reported that they used it on an “as needed” basis (64.4%) vs. using cannabis regularly (35.6%), according to the researchers. They also found that the most common times of day that patients used cannabis was in the evening (25.3%) or before going to bed (26.4%).
The most common consumption methods reported were sublingual drops mechanisms (29.1%), smoking (27.2%) and eating or swallowing (19.2%), according to the study results. The most common methods of acquiring cannabis were through a medical dispensary (38.7%) or a friend or family member (24.5%).
The most frequently reported non-motor symptoms that patients reported trying to treat with cannabis included anxiety (45.5%), pain (44%) and sleep disorders (44%). Motor symptoms included stiffness (43%) and tremor (42%), according to the researchers.
“We found that among some consumers, reported cannabis use may have been beneficial, particularly for non-motor PD symptoms such as anxiety, pain, sleep disorders, stiffness and tremor,” Beck said, which he added was “consistent with other research studies.”
Most patients reported “a moderate or considerable improvement” in the severity of anxiety (78%), pain (71.6%), sleep disorders (76.1%), stiffness (64%) and tremor (63.1%). There were also improvements to symptom frequency: Patients reported moderate or considerable improvements in anxiety (67%), pain (63.6%), sleep disorders (61.4%), stiffness (58.1%) and tremor (56%).
“Interestingly, 23% of consumers stated they stopped cannabis use in the previous six months, primarily due to a lack of symptom improvement,” Beck said.
Most patients “recognize that cannabis is no substitute for PD medications,” he continued.
“I think it’s most important to note that, while some survey participants reported benefits of cannabis use, cannabis consumers see the limited effectiveness of cannabis for symptom management overall,” Beck said.
Patients who used cannabis believed prescription PD medication had greater efficacy in controlling motor symptoms (P < .001) and non-motor symptoms (P = .03) and 84.7% reported that cannabis did not change prescription medication usage, according to the researchers. Additionally, 89% of patients who used cannabis for medical as well as medical and recreational purposes “had not thought that cannabis would be a replacement” for prescription medications.
“Most consumers can weed through the haze and recognize that cannabis is no substitute for PD medications,” Beck added.
Overall, 12.6% of patients who used cannabis reported negative side effects, which were 7.43 times more likely to occur in users of high THC forms of cannabis vs. high or pure CBD (95% CI, 1.38-59.76). The most common side effects reported by users and non-users who reported prior negative experiences with cannabis included anxiety (30%), impaired coordination (20%), dizziness (20%) and other reasons (38%), including sleepiness, confusion and worsening orthostatic hypotension.
“We know from our previous research that clinicians are not getting the education they may need to advise patients about cannabis and its use. Nevertheless, clinicians can know that patients, though they may be interested in cannabis, will often understand the lack of evidence for cannabis and PD and follow medical advice around that,” Beck said. “Also, if patients are going to experiment with cannabis, clinicians can help educate them to be aware of any potential drug interactions, that different forms of cannabis are processed differently, and that people should always go slow to minimize any negative side effects.”