Cannabinoids: Promising ALS Treatment Option For Patients

Cannabis derived compounds otherwise known as Cannabinoids have to be found to be an effective ALS treatment option for Amyotrophic Lateral Sclerosis (ALS). ALS is a neurodegenerative disease that causes the damage and death of the neurons that control motor activity; it progresses rapidly and leads to death in three to five years from its onset. However, studies have shown that cannabis and Cannabinoids slow down the progression of the disease and subsequently enable the patient manage the associated symptoms.

What is Amyotrophic Lateral Sclerosis?

Amyotrophic Lateral Sclerosis is also referred to as Lou Gehrig’s disease is one of the most common motor neuron degenerative diseases. It is rapidly progressive and affects the neural pathways between the brain and spinal cord, and the motor cortex that sends messages that control voluntary muscle movement.

What happens is that, the condition inhibits the appropriate nourishment of the motor neurons which leads to their eventual death. When the neurons are no longer able to initiate and control muscle movement, voluntary movement is ultimately lost. ALS patients eventually lose their ability to move, speak, feed themselves, and breath leading to death.

The cause of ALS is yet to be established but genetic makeup plays a significant role albeit a small one. Of all the reported cases of ALS only five to ten percent are inherited. There is no known cure for ALS yet but there are treatment options available that slow disease progression. All the current ALS drugs cannot reverse the motor neuron damage and are only able to extend life for a few months.

By prescribing these medications, doctors aim at alleviating the disease symptoms. Symptoms such as: pain, constipation, depression, insomnia, fatigue, muscle spasms, and excessive saliva and phlegm. The drugs attempt to improve the patients’ quality of life; some work effectively others not so much. Therefore scientists are continuously studying more effective treatment options in the long term.

The Effects of Cannabinoids on ALS

Over the recent years, there has been growing interest in Cannabinoids for their anti-inflammatory, antioxidant and anti-excitotoxic properties. Cannabinoids are bioactive compounds derived from the cannabis sativa plant. The plant contains approximately 70 of these compounds. Research on the therapeutic effects of cannabis has been centred on the following Cannabinoids: tetrahydrocannabinol (THC), cannabinol (CBD), tetrahydrocannabivarin (THCV) and cannabidivarin (CBDV). THC has been identified as a psychoactive (have a profound effect on mental processes) Cannabinoid while the rest are non-psychoactive.

So, how exactly does Cannabinoids (CB) work?

They exert their activities binding their receptors CB1 and CB2. After binding and signalling they inhibit the release of glutamate from the nerve endings preventing calcium influx and excitotoxicity in the motor neurons. It also promotes anti-inflammatory response by inhibiting microglia activation. CB prevents disease progression by inhibiting damage of cells and neurons by free radicals and subsequent death.

The most studied Cannabinoids are THC and CBN. THC has an affinity to CB2 receptors and CBN to CB1 receptors. There is both scientific and observational evidence that prove that Cannabinoids (especially THC) treatment slowed the worsening of the disease and prolonged life.

Scientific Evidence

In a recent study that supports that Cannabinoids are beneficial in the treatment of ALS, scientists studied mice that had similar gene expressions as humans with ALS. They mice were genetically engineered to express the human superoxide dismutase (hSOD) gene associated with the disease.

When the ALS hSOD mice were treated with THC either before or after onset of symptoms, the following was observed:

• Improved voluntary muscle response
• Five percent increase in survival rate
• THC reduced the imbalance between free radicals and the body’s ability to counteract their detrimental effects using antioxidants
• Reduced elevated levels of glutamate by protecting against excitotoxicity produced

Treatment with cannabinol (CBN) will effectively delay onset of disease in ALS hSOD mice. However, survival rates were not in any way affected.

The efficacy of Cannabinoids in extending life expectancy and slowing progression could be dependent on CB2 receptor suppression of microglia/macrophage activation of symptomatic mice. This is achieved by up-regulating spinal cords as a compensatory and protective measure. That is, drugs that activate CB2 receptors expressing predominantly in immune cells and non-neural tissues successfully improve symptoms associated with inflammatory diseases.

However, there is a need for further and conclusive studies on the neuroprotective effects of the Cannabinoids that target CB2 receptors.

Is There Potential Therapeutic Effects of Using in Human ALS?

The possibility of using Cannabinoids therapeutically to serve as an ALS treatment option continues to be studied by researchers. However due to the small number of ALS patients who have reported using Cannabis and the even smaller number of human study subjects, all inferences made are subjective. Since no proper and conclusive studies have been conducted to determine the therapeutic potential of Cannabinoids in ALS patients, it would be in order to consider observational evidence.

The progression and development of ALS has been related to the Cannabinoid system. The central nervous system of ALS patients shows an increase in CB2 positive microglia. Studies analyzing activated microglia in the spinal cords of ALS patients show how altering CB2 instigated processes could ultimately be beneficial to the patients. Some of the benefits include completely altering the pace at which the disease progresses and reducing excitotoxicity, neuro-inflammation, and oxidative cell damage.

In a single observational study, of all the ALS patients participating, only ten percent admitted to consuming marijuana. They also reported moderate relief from pain, depression, loss of appetite, and drooling. In addition, the patients noticed improved spasticity after consuming cannabis.
A randomized, double-bind crossover study to determine ALS patients’ tolerance of THC found that oral administration of THC was well tolerated. However, the intensity and frequency of muscle cramps did not change remarkably. Same results were found in other studies which prove that the use of cannabis is safe without great possibility of an overdose.

These studies provide a challenge to scientists for future research on the disease-altering potential of Cannabinoids. For now, we can only consider anecdotal evidence that cannabis has therapeutic properties.
Radio broadcaster Mark Bushey was diagnosed with ALS in 2013. The Maine-based man went through conventional treatment which turned out unsuccessful. When the usual treatment protocol was found to be ineffective, he was put on medical cannabis to treat his symptoms. When interviewed he said that the use of cannabis had improved on pain, breathing, appetite, and sleep.

Cathy Jordan from Florida was diagnosed with ALS in the mid 1980s. She was given not more than five years to live after her diagnosis. Several months into her treatment, she started using medical cannabis which significantly improved on her symptoms. He r doctors, however, refused to acknowledge the improvement because she was self-medicating on an illegal substance. As fate would have it, she lived for more than 25 years after diagnosis; outliving some of her doctors and her support groups.

These illustrations show that cannabis offers a broad therapeutic value in the treatment of ALS symptoms. Therefore future studies have the opportunity to be multi-centred, randomized, placebo-controlled, and double-blinded in order to conclusively illustrate the therapeutic potential of Cannabinoids in ALS patients.

Symptomatic Treatment Benefits in Humans

A team of researchers from Spain observed that phytocannbinoids are able to offer neuroprotective benefits for a number of diseases and conditions including neurological disorders such as ALS.

THC is the most elementary psychoactive component of cannabis that is used to reduce inflammation and pain. CBD is used to mitigate the negative effects of THC such as rapid heartbeat and unwanted psycho-activity. CBD is a more powerful antioxidant than vitamins C or E. CBN is an anti-convulsant; THCv an anti-inflammatory; cannabicycol (CBL) is a pain killer; and cannabichormene (CBC) is anti-inflammatory, a pain killer and promotes brain growth.

The therapeutic effects of the phytocannabinoids THC, CBD, CBN, CBC and THCv include:

1. THC, CBC and THCv have analgesic and anti-inflammatory properties that are crucial in the treatment of neuroinflammation, muscle pain, and in promoting brain cell survival.
2. CBD is a powerful antioxidant that controls the oxidative stress and inflammation of ALS brain cells.
3. CBN’s muscle relaxant property is also known to reduce muscle spasticity that affects ALS patients.
4. Cannabis possesses appetite stimulating properties that allow the patients to get the nourishment they require to avoid their muscles wasting away.
5. It’s known to give a sense of euphoria that lifts the spirits of those who take it thus reducing depression.
6. Cannabis promotes dilation of the respiratory system preventing laboured breathing and respiratory failure which often leads to the death of ALS patients.

In order to reap the full benefits of Cannabinoids, it is advisable to use whole-plant cannabis instead of either CBD or THC. The whole plant is loaded with several beneficial Cannabinoids which work together to better treat the neurological disorder symptoms. In short, the therapeutic effects of Cannabinoids target several neurotoxic pathways ensuring the efficacy of the treatment.

Terpenes found in cannabis alongside Cannabinoids provide the synergistic effect of the Cannabinoids. That is, much of the therapeutic effect and the feeling of being high are instigated by terpenes. Terpenes are the most widely occurring active chemical components found in nature.

Methods of Administering Cannabis

As a precaution, before taking cannabis for ALS talk to your doctor to determine its potential interactions with conventional drugs you are on. A physician who understands cannabis will be best suited to offer the desired consultation.

If you decide to take cannabis, here are some of the methods of administration that you will be considering:

1. Inhalation. Inhaled cannabis is most commonly administered through a cannabis cigarette also known as a joint. The plant material is directly combusted to create smoke and tar which could irritate the lungs. Alternatively, a vaporizer can be used. It heats the plant material to activate the chemical compounds and release them into a clean vapour that is inhaled without the risk of irritation. One of the major benefits of inhaled cannabis is the immediate relief patients get from their symptoms.
2. Edibles. Cannabis edibles give a stronger effect and sustained relief that is why they are preferred. However, when ingested cannabis has to be metabolised in the liver which could take up to three hours. The time taken depends on its potency, the patient’s body chemistry, and the amount of food in their system. The relief could last six to nine hours. It is advisable to start with small doses and wait three hours before consuming more.
3. Tinctures. These could be taken through feeding tubes or swallowed. Either way, the tincture is metabolised and processed in the same way as edibles. It could be taken under the tongue acting just as fast as inhaled cannabis. Symptomatic relief lasts 45 minutes to three hours.
4. Topical. Topical applications have been known to relieve joint pain.
5. Oil. Highly concentrated cannabis oil helps fight cancer, Multiple Sclerosis and other neurodegenerative disorders.

Precautions to Take Before and When Using Cannabis for ALS Treatment

Cannabis is safe and low in toxicity; however, it can cause side effects such as heart palpitations and dizziness. Often this is the result of overconsumption or using a plant sample that is not tolerated by the body. The side effects in case of overconsumption or low tolerance subside in 45 minutes for inhalation and six to nine hours for ingestion.

Each human is different and so before taking any form of cannabis always ensure that it is well tested for safety and that its chemical composition with percentages of Cannabinoids and terpenes is provided. This helps in determining the most appropriate plant material, chemical ratios and administration method to use.

Conclusion

While there has been no large scale human study on the efficacy of cannabis in the treatment of ALS, there is widespread evidence that mediation of the endocannabinoid system prevents the progression and even onset of ALS. The use of medical cannabis has maintained a favourable safety profile in the treatment of other neurodegenerative disorders. A similar profile is foreseeable in treating ALS.

The antioxidant, anti-inflammatory, analgesic, and neuroprotective properties of cannabis and Cannabinoids have made it use safer and more effective in the symptomatic treatment of ALS. It effectiveness is considered in comparison with other conventional ALS therapeutic drugs.