The following is an interview with Lisa Ducharme, a Nurse Practitioner working with Canada House. Lisa is a primary healthcare nurse practitioner (PHC- NP) and has been working with Canada House clinics since 2018. She has over 23 years of clinical nursing experience and leadership in both acute care and primary care. Lisa has been a practicing NP since 2014.
What is Parkinson’s disease?
Parkinson’s disease (PD) is a chronic, progressive and degenerative neurological disease that primarily affects the motor system due to a loss of dopamine-producing nerve cells in a part of the brain called the substantia nigra. The hallmark symptoms of PD typically manifest after 80% or more of these nerve cells are lost and include involuntary movements (tremors), stiffness of the limbs (rigidity), slow movement (bradykinesia) and impaired balance and coordination.
What is the typical treatment for Parkinson’s disease?
PD medication is primarily aimed at reducing symptoms and improving movement but they do not stop or slow the progression of the disease.
The gold standard treatment for Parkinson’s is a medication called Levodopa-Carbidopa (e.g. Levocarb, Sesemet). Levodopa crosses the blood-brain barrier and is converted into dopamine. Cardopa is added to prevent Levodopa from being metabolized before it reaches the brain. There are other medications that may be added or used as an alternative to Levodopa-Cardopa if its side effects become intolerable. The side effects of Levodopa may include nausea, vomiting, dry mouth and dizziness and in some clients may even cause confusion, hallucinations or psychosis, however, the latter symptoms are less common.
How effective is the pharmaceutical therapy for treating PD?
Pharmaceutical medications such as Levidopa-Carbidopa are very effective at treating the motor symptoms of PD by reducing tremors and improving walking & movement. However, a holistic and individualized treatment plan should be implemented to address both the motor and non-motor symptoms of PD including depression, difficulty swallowing, sexual problems and cognitive deficits. A PD care plan may also include physio, occupational, and speech language therapy, deep brain stimulation and counseling in addition to pharmaceutical treatment.
Is there any scientific evidence that medical cannabis can help with Parkinson’s disease?
There is no real substantive evidence, to date, that demonstrates medical cannabis is an effective treatment for Parkinson’s symptoms. The research available is limited in scope and lacks proper controls for confounding variables which has resulted in poor validity and reliability of these studies. The quality of the research is just not there right now, however, since cannabis was legalized last year, we should start to see improvements in quality as restrictions are eased regarding the use of cannabis in human studies.
What risks, if any, are there with a patient using medical cannabis alongside their pharmaceutical treatment?
There is no evidence of any specific drug interactions between cannabis and PD drugs, however, there are various risks associated with the potential effects of THC and CBD in cannabis that may adversely affect pharmaceutical treatment, albeit indirectly.
For example, CBD has the potential to lower blood pressure as can several pharmaceutical drugs used to treat PD. So it’s not a contraindication to treatment, but certainly a consideration that requires close monitoring of their blood pressure.
With THC, you can understand that it’s psychoactive effects (as a central nervous system depressant), may potentially (in higher doses) worsen the cognitive and motor deficits associated with PD. So it’s very important to be careful with prescribing THC, ensuring the lowest doses indicated for only specific symptoms including neuropathic pain and sleep, while carefully weighing the risks and benefits of its use.
What evidence have you seen that medical cannabis can help with Parkinson’s disease?
Despite the lack of credible scientific data, the anecdotal evidence is quite remarkable. From a practitioner’s standpoint, you can’t ignore the improvements in motor function, nor the positive impact medical cannabis is having on quality of life for individuals living with Parkinson’s disease.
…what I’m seeing in these clients is “a reversal” (which may not be the correct term) but I’m definitely observing a significant improvement especially with regards to their mood and mobility.”
There are different stages of Parkinson’s and, for the most part, people usually present to us at stage 3 or 4 by the time their disease has manifested. But what I’m seeing in these clients is “a reversal” (which may not be the correct term) but I’m definitely observing a significant improvement especially with regards to their mood and mobility.
It’s hard to say what the mechanism of that is. There may be a relationship to improving or enhancing dopamine production in other ways. It could also be that medical cannabis is complimenting the Parkinson’s medications by reducing the side effects. For example, Levodopa-Carbidopa has a lot of side effects including nausea, vomiting, and dizziness but if cannabis is helping to relieve these symptoms then clients are more likely to tolerate the medication, especially if higher doses are required.
It could also be the result of CBD’s anti-inflammatory effect since limited mobility, muscle spasms and atrophy result in increased inflammation throughout the body. CBD has anti-anxiolytic properties as well and this may be helping to calm the central nervous system and, therefore, reducing the symptoms of PD.
But of course, it’s all conjecture at this stage, and only future research will be able to reveal the true therapeutic effects of medical cannabis treatment for individuals with PD.
Can you share any experiences you have had treating Parkinson’s disease with medical cannabis?
So there are two separate components to symptoms of PD, motor and non-motor symptoms. Apart from the motor symptoms we have already discussed, there are also cognitive and emotional symptoms associated with PD including severe depression and anxiety (especially around a new diagnosis). I have seen improvements in both with cannabis treatment.
One of my clients with PD required a walker and assistance with transitioning positions. He was previously a very active man so the restrictions to his mobility (and independence) greatly affected his mood. He was also very anxious about the PD diagnosis and his overall prognosis. He had essentially given up on everything. He was no longer social and didn’t even want to see family or friends; a man who was actively engaged with his family, friends and community prior to his diagnosis. He had, within a month’s period, completely isolated himself and was only communicating with his wife; he was growing more irritable and depressed as each day passed and his wife was very concerned about his mental health. She was also worried that he was in denial about the diagnosis and still holding out for “a cure”.
So it was great to see this person come alive, to actually meet the person that his wife knew him to be all along.”
We started him on medical cannabis treatment (primarily CBD and 1:1 oils) and his wife reported that she saw improvements within a week of him starting the oils. He was now walking with a cane and no longer required assistance with transfers. He had become more independent and that was helping to elevate his mood. As time went by, he was using the cane less and less, as well as walking and repositioning independently. He also wanted to socialize and visit family again, his mood was improving and he had come to terms with the diagnosis but felt more hopeful about his prognosis.
So it was great to see this person come alive, to actually meet the person that his wife knew him to be all along. It’s rewarding to see what a difference it had made in both their lives and not just his medical condition, but also his overall quality of life. And I see that again and again with PD clients, it’s very rewarding.
So although there is little scientific evidence to support medical cannabis use, the anecdotal evidence is simply incredible and you can’t deny the positive effects it is having on individuals with PD. Nevertheless, I also believe we need to learn more about the mechanisms by which it is having these effects and further standardize treatment in order to lend more credibility for it’s use as part of a holistic care plan for individuals living with Parkinson’s disease.
But that’s just one example of many clients I have seen with the same disorder- maybe not as drastic as this gentlemen, but definitely I am seeing remarkable improvements with most of my clients with PD.
Anything else you would like to share in relation to treating Parkinson’s disease with medical cannabis?
I don’t think that medical cannabis is a replacement for conventional treatment of PD, but it’s definitely a complementary treatment that appears to support first-line therapy and, therefore, should be considered as part of a holistic treatment plan for Parkinson’s disease.
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