I never had any fascination or a particular interest in marijuana. But in the past few years, my patients have been coming to me with questions and I made the decision to find answers. Could medicinal cannabis help their movement disorders? If so, how?
Many of my patients live with Parkinson’s disease. Others have Tourette syndrome, essential tremor, Huntington’s disease and other life-altering conditions. The medical interventions available vary from robust to nonexistent. And when there is little to offer, people may grasp at whatever is available.
Of all the conditions I treat, Parkinson’s disease has excellent medical and surgical interventions. But even with these established treatments, relief is still lacking. Many patients ask me about new options, such as cannabis. There’s no worse feeling than having a wonderful visit with a patient — and then they ask you a question you can’t answer. I felt an obligation to keep an open mind and learn everything I could about medicinal cannabis.
I have heard some professionals insist that cannabis should not even be considered as a medicine, and I remember thinking, “Well, why not?” There’s a history of kismet in pharmacology with medication and plants, as well as recreational drugs that turned out to have medicinal value.
I realized I must research any and all avenues that might relieve the suffering of my patients. I am thankful I participated as The Parkinson Alliance, a patient advocacy group, brought together Parkinson’s patients, movement disorder specialists, psychiatrists, researchers, and others exploring cannabis and treatment strategies.
As physicians and scientists, we all want the gold standard of randomized, controlled clinical trials. But the federal classification of cannabis as a Schedule I drug — meaning there is no accepted medical use and a high potential for abuse — hinders the research we need. Medicinal cannabis, meanwhile, is legal in many states, including New Jersey and Pennsylvania and patients are taking it for the conditions I treat.
I understand why a physician might decline to work with patients taking cannabis until the research is clear, but I would rather support the patients of mine who are interested in cannabis and keep them under my care. For me, cannabis is just one more tool in my toolbox. I have frank conversations with patients and I do not suggest cannabis right out of the gate. I tell my patients to first try the established medical strategies I can provide. If those strategies are not helpful or not well tolerated, we consider adding cannabis.
Mostly, I find cannabis helps patients with the non-motor symptoms common in people with movement disorders, such as insomnia, anxiety and pain. There is some research showing the benefits of cannabis in these areas so I feel comfortable there. And the drugs Parkinson’s patients are often prescribed — benzodiazepines such as Klonopin and Xanax for anxiety and opioids such as Percocet for pain — have their own side effects, especially among the elderly. One patient found her pain declined so much she rarely needed the opioids she had been taking.
There is anecdotal evidence about marijuana and tremor. Patients often tell me about videos on the internet of people who took a bite of a marijuana brownie and suddenly their tremors disappeared. I tell my patients to take those examples with a grain of salt, and I would never suggest marijuana over established interventions. But I never belittle any patient’s decision to try marijuana or dampen their hope. I want them to be open with me and share their experiences.
I’m sharing my own experiences now because I think too many doctors shut the door on marijuana unnecessarily. In New Jersey, in July 2019, just 1,000 of the state’s more than 30,000 doctors were participating in the state’s Medicinal Marijuana Program. People with muscular dystrophy, multiple sclerosis and other disorders are eligible for medicinal cannabis. I don’t want these patients to seek out physicians who focus most of their practice on prescribing marijuana. Instead, I urge doctors already treating these conditions to consider incorporating medicinal marijuana into their practice and to become more knowledgeable. Just about 15% of my patients have tried medicinal marijuana and about 10% take it regularly.
Yes, we absolutely need more research. That’s why I joined the advisory board of the Cannabis Education and Research Institute (CERI), which works to advance unbiased medical research and credible information about medicinal cannabis. And I believe the federal government must change the classification of marijuana and open the door to quality research.
In the meantime, we have patients who are suffering right now and who may benefit from medicinal cannabis. As physicians, we need to be there for them.