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Parkinson’s disease, also known as PD, is the second most common neurodegenerative disorder. The disease is characterized by a loss of dopamine-producing neurons in the substantia nigra, which is an area of the brain responsible for movement. Cannabis, specifically CBD, has shown promise in treating some of the symptoms of PD. In this video we will define Parkinson’s disease and cannabis, explain how cannabis can help with PD, and physician perspectives on prescribing cannabis. This video was created by Demystifying Medicine students Simran Matharu, Mahek Minhas and Micaela McNulty in collaboration with the McMaster Demystifying Medicine Program Copyright McMaster University 2021 For more information visit: https://www150.statcan.gc.ca/n1/pub/82-003-x/2014011/article/14112-eng.htm Time Stamps: Introduction/What is Parkinson’s Disease? → 00:00 - 01:23 What is Cannabis? → 01:24 - 02:34 How Can Cannabis Help With Parkinson’s? → 02:35 - 05:09 Physician Perspectives → 05:10 - 07:19 Conclusion → 07:20 - 07:52 References: Bega, D., Simuni, T., Okun, M. S., Chen, X., & Schmidt, P. (2016). Medicinal cannabis for Parkinson's disease: Practices, beliefs, and attitudes among providers at national Parkinson Foundation centers of excellence. Movement Disorders Clinical Practice, 4(1), 90-95. Benner, E. J., Banerjee, R., Reynolds, A. D., Sherman, S., Pisarev, V. M., Tsiperson, V., Nemachek, C., Ciborowski, P., Przedborski, S., Mosley, R. L., & Gendelman, H. E. (2008). Nitrated alpha-synuclein immunity accelerates degeneration of nigral dopaminergic neurons. PloS one, 3(1), e1376. Clapper, J. R., Mangieri, R. A., & Piomelli, D. (2009). The endocannabinoid system as a target for the treatment of cannabis dependence. Neuropharmacology, 56, 235–243. de Lau, L. M., & Breteler, M. M. (2006). Epidemiology of Parkinson’s disease. The Lancet Neurology, 5(6), 525–535. Edelstein, O. E., Wacht, O., Isralowitz, R., Reznik, A., & Bachner, Y. G. (2020). Beliefs and attitudes of graduate gerontology students about medical marijuana use for Alzheimer’s and Parkinson’s disease. Complementary Therapies in Medicine, 52, 102418. Gardiner, K. M., Singleton, J. A., Sheridan, J., Kyle, G. J., & Nissen, L. M. (2019). Health professional beliefs, knowledge, and concerns surrounding medicinal cannabis – A systematic review. PLOS ONE, 14(5), e0216556. Hauser, R. A., Rascol, O., Korczyn, A. D., Jon Stoessl, A., Watts, R. L., Poewe, W., De Deyn, P. P., & Lang, A. E. (2007). Ten-year follow-up of Parkinson's disease patients randomized to initial therapy with ropinirole or levodopa. Movement disorders: official journal of the Movement Disorder Society, 22(16), 2409–2417. Jankovic, J. (2008). Parkinson’s disease: Clinical features and diagnosis. Journal of Neurology, Neurosurgery & Psychiatry, 79(4), 368–376. Klein, C., Karanges, E., Spiro, A., Wong, A., Spencer, J., Huynh, T., Gunasekaran, N., Karl, T., Long, L. E., Huang, X.-F., Liu, K., Arnold, J. C., & McGregor, I. S. (2011). Cannabidiol potentiates Δ9-tetrahydrocannabinol (THC) behavioural effects and alters THC pharmacokinetics during acute and chronic treatment in adolescent rats. Psychopharmacology, 218(2), 443–457. Lang, A. E., & Lozano, A. M. (1998). Parkinson’s Disease. New England Journal of Medicine, 339(16), 1130–1143. Laun, A. S., & Song, Z. H. (2017). GPR3 and GPR6, novel molecular targets for cannabidiol. Biochemical and biophysical research communications, 490(1), 17–21. Marras, C., Beck, J. C., Bower, J. H., Roberts, E., Ritz, B., Ross, G. W., Abbott, R. D., Savica, R., Van Den Eeden, S. K., Willis, A. W., & Tanner, C. (2018). Prevalence of Parkinson’s disease across North America. Npj Parkinson’s Disease, 4(1), 21. Nutt J. G. (2000). Response to L-dopa in PD: the long and the short of it. Neurology, 54(10), 1884–1885. https://doi.org/10.1212/wnl.54.10.1884 Oeckl, P., Hengerer, B., & Ferger, B. (2014). G-protein coupled receptor 6 deficiency alters striatal dopamine and cAMP concentrations and reduces dyskinesia in a mouse model of Parkinson's disease. Experimental neurology, 257, 1–9. https://doi.org/10.1016/j.expneurol.2014.04.010 Severe Spasticity. (2020). https://lioresal.com/severe-spasticity/. Venderová, K., Růzicka, E., Vorísek, V., & Visnovský, P. (2004). Survey on cannabis use in Parkinson's disease: subjective improvement of motor symptoms. Movement disorders: official journal of the Movement Disorder Society, 19(9), 1102–1106. https://doi.org/10.1002/mds.20111 Wang, M., Wang, Y.-H., Avula, B., Radwan, M. M., Wanas, A. S., Mehmedic, Z., van Antwerp, J., ElSohly, M. A., & Khan, I. A. (2017). Quantitative Determination of Cannabinoids in Cannabis and Cannabis Products Using Ultra-High-Performance Supercritical Fluid Chromatography and Diode Array/Mass Spectrometric Detection. Journal of Forensic Sciences, 62(3), 602–611. https://doi.org/10.1111/1556-4029.13341

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In the US, the CBD industry is consistently regarded as the Wild West – a reference to the western US frontier period of roughness and lawlessness according to a new column in New Food Magazine that interviewed Jaclyn Bowen, from The Clean Label Project about what research is being done surrounding CBD health claims. CBD is not yet FDA approved for any conditions (with the notable exception of the EpidiolexTM as an anti-seizure medication) many of the National Institute of Health’s (NIH) –  and other international studies – have shown promising results for a variety of conditions. The recent passing of the Farm Bill serves to help accelerate this research. Pelin Thorogood, President and Co-Founder of the Wholistic Research and Education Foundation, says there simply has not been sufficient research to date, from either NIH or other sources, primarily due to the Schedule 1 status of CBD and cannabis since 1970. This has led to a scarcity of evidence-based data on the short, and long-term health effects of cannabis, as was stated in a recent report on the Health Effects of Cannabis and Cannabionoids from the National Academies of Science, Engineering and Medicine (NASEM). Researchers typically say CBD, and cannabis in general, ‘may or may not be’ beneficial because they simply do not have enough data to conclusively prove its effects across a diverse set of conditions. There are two projects Thorogood’s Foundation have embarked on that truly go above and beyond a traditional clinical approach and may be a significant factor in the adoption and sales of CBD products: The University of Utah investigation, “Brain Effects of Cannabinoids”, uses advanced imaging (PET, fMRI) to visualise the personalised effects of various cannabinoids (including CBD isolate, THC isolate and full-spectrum cannabis) in the brains of healthy adults.  And the UC San Diego research project “Investigating Cannabinoids in Autism Spectrum Disorders” which is truly a first of its kind, multi-disciplinary study that explores whether CBD can reduce behavioral abnormalities in children with Autism, and if so, how.  Thorogood says the findings would provide the FDA with the evidence-based data necessary to approve CBD use for certain indications or for certain populations.

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