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Wednesday, October 28, 2015

Medical Marijuana and RLS

Medical Marijuana and RLS

By Jacquelyn Bainbridge, PharmD, and Mark Buchfuhrer, MD, FRCP(C), FCCP, FAASM

The medical and recreational use of marijuana is increasing in the U.S. The drug remains illegal under federal law (even though it is legal in 23 states and the District of Columbia), but a federal spending bill passed in December 2014 prohibits the Justice Department from using federal funds to enforce this ban in states with medical marijuana laws.

Medical marijuana is recognized as a legitimate medical application for many disease states. Restless legs syndrome (RLS) is one disease for which patients are looking to experiment with medical marijuana to relieve symptoms when more conventional treatments are unsuccessful, too expensive or cause unwanted side effects.

Current treatment for RLS
Current treatment for RLS includes dopaminergic agents, an alpha-2-delta ligand subunit drug, and other medications that are not approved by the U.S. Food and Drug Administration (FDA) for treating RLS. The FDA-approved drugs demonstrate effectiveness by enhancing dopamine activity in the brain (Requip, Mirapex, Neupro Patch) or by modifying calcium channels on nerves (Horizant), which changes the excitability of nerves that carry RLS sensations or pain.

Medical marijuana in RLS
There are no current studies or clinical trials on the use of medical marijuana in RLS. Though marijuana is not FDA approved for medical indications in the disease, anecdotal evidence from some patients’ experiences with the drug have shown improvement in some of the symptoms commonly associated with RLS.

Marijuana works mainly by acting on multiple cannabinoid receptors in the brain to provide variable psychoactive effects (that is, affecting mental processes) on areas including motor activity, coordination and pain relief by inhibiting prostaglandin biosynthesis and thus blocking pain receptor pathways.

Although there are no studies examining the use of marijuana for treating RLS, there is some clinical experience available based on its anecdotal use by many patients. Typically, ingested marijuana (through brownies or cookies, for example) does not seem to benefit RLS very much, while inhaled marijuana (through a marijuana cigarette or vaporizer) works very quickly and effectively. Most RLS sufferers report that after only a few puffs of a marijuana cigarette or a few inhalations of vaporized medical marijuana, even very severe symptoms are relieved within minutes. The relief does not last very long, wearing off after one or two hours. Therefore, inhaled marijuana works best for RLS symptoms that occur mainly at bedtime. Patients have reported that a one month supply of medical marijuana may last three to four months when used to treat bedtime RLS symptoms.

Marijuana is a structurally diverse chemical. Very little is known about the 489 constituents of the marijuana plant, Cannabis sativa. It is known that 70 of these constituents are cannabinoids, and the remainder are potentially unwanted neuroactive substances that cross the blood-brain barrier. An important distinction regarding cannabis products is that tetrahydrocannabinol (THC) is the major psychoactive ingredient (that is, it affects mental processes), and cannabidiol (CBD) is the major non-psychoactive component. It is believed that products that are high in CBD and low in THC will produce wanted effects in the brain with little or no side effects on mental processes.

Some of the cannabinoids widely consumed are:

Restless Legs Syndrome Foundation Blog Pages Wednesday, October 28, 2015 Medical Marijuana and RLS Medical Marijuana and RLS By Jacquelyn Bainbridge, PharmD, and Mark Buchfuhrer,

More evidence of cannabis efficacy in restless legs syndrome

Affiliations

  • 1 Département de Neurophysiologie Clinique, Pôle Neurosciences Cliniques, CHU de Bordeaux, F-33076, Bordeaux, France. [email protected]
  • 2 Université de Bordeaux, Institut de Neurosciences Cognitives et Intégratives d’Aquitaine, UMR 5287, F-33076, Bordeaux, France. [email protected]
  • 3 Centre National de la Recherche Scientifique, Institut de Neurosciences Cognitives et Intégratives d’Aquitaine, UMR 5287, F-33076, Bordeaux, France. [email protected]
  • PMID: 31820197
  • DOI: 10.1007/s11325-019-01978-1

More evidence of cannabis efficacy in restless legs syndrome

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Author

Affiliations

  • 1 Département de Neurophysiologie Clinique, Pôle Neurosciences Cliniques, CHU de Bordeaux, F-33076, Bordeaux, France. [email protected]
  • 2 Université de Bordeaux, Institut de Neurosciences Cognitives et Intégratives d’Aquitaine, UMR 5287, F-33076, Bordeaux, France. [email protected]
  • 3 Centre National de la Recherche Scientifique, Institut de Neurosciences Cognitives et Intégratives d’Aquitaine, UMR 5287, F-33076, Bordeaux, France. [email protected]
  • PMID: 31820197
  • DOI: 10.1007/s11325-019-01978-1

Abstract

Restless legs syndrome (RLS) is one of the most disabling and sometimes painful sensorimotor ailment of the nervous system that has only in recent years become more widely accepted as a clinical disorder with its own distinct features. Usually, symptoms respond well to dopamine agonists, anticonvulsants, or opiates, but still a subset of patients remains refractory to medical therapy and/or reports serious side effects. Recently, patients’ statement of a remarkable and total remission of RLS symptoms following cannabis use has been reported. Here, we confirm and extend these findings to more patients with RLS. The antinociceptive effect of marijuana has been documented in many painful neurological conditions, and the potential benefit of cannabis use in patients with refractory RLS should therefore be questioned by robust clinical trials.

Keywords: Cannabis; Restless legs syndrome; To the Editor; Treatment.

Restless legs syndrome (RLS) is one of the most disabling and sometimes painful sensorimotor ailment of the nervous system that has only in recent years become more widely accepted as a clinical disorder with its own distinct features. Usually, symptoms respond well to dopamine agonists, anticonvuls …