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Cannabinoids: These are group of compounds that are present in cannabis plants and have properties and actions like marijuana. The two main natural cannabinoids are tetrahydrocannabinol (THC) and cannabidiol (CBD).
Marijuana: It is also known as cannabis; marijuana is a preparation of the cannabis plant intended for use as psychoactive drug.
Medical Marijuana: It refers to marijuana that is prescribed by healthcare practitioner with the authority and scope of practice to do so. Medical marijuana is used in management of medical conditions and/or for the alleviation of the symptoms of medical conditions. Various forms of marijuana can be authorized for medical use, including dried or fresh marijuana and cannabis oil.
Wearing-off phenomenon: Reduced effectiveness of levodopa prior to the scheduled time for the next dose, resulting in decreased poor performance. If symptoms return before next dose medication, it means “wearing-off” state.
Paralysis agitans: The Latin form of the older, popular term "shaking palsy," which was used to designate early Parkinson's diagnosis. A person with Shy-Drager syndrome has symptoms of Parkinson's (Parkinsonism), extremely low blood pressure that worsens upon standing, bladder problems, severe constipation, and decreased sweating.
Myoclonus: Jerking, involuntary movement of arms and legs, usually occurring during sleep.
Where did it come from?
In the report, author Barney Warf describes how cannabis use originated thousands of years ago in Asia, and has since found its way to many regions of the world, eventually spreading to the Americas and the United States.
"It likely flourished in the nutrient-rich dump sites of prehistoric hunters and gatherers," Warf wrote in his study.
This map shows how marijuana spread throughout the world, from its origins on the steppes of Central Asia. (Image credit: Barney Warf, University of Kansas )
Both hemp and psychoactive marijuana were used widely in ancient China, Warf wrote. The first record of the drug's medicinal use dates to 4000 B.C. The herb was used, for instance, as an anesthetic during surgery, and stories say it was even used by the Chinese Emperor Shen Nung in 2737 B.C. (However, whether Shen Nung was a real or a mythical figure has been debated, as the first emperor of a unified China was born much later than the supposed Shen Nung.)
From China, coastal farmers brought pot to Korea about 2000 B.C. or earlier, according to the book "The Archeology of Korea" (Cambridge University Press, 1993). Cannabis came to the South Asian subcontinent between 2000 B.C. and 1000 B.C., when the region was invaded by the Aryans — a group that spoke an archaic Indo-European language. The drug became widely used in India, where it was celebrated as one of "five kingdoms of herbs ... which release us from anxiety" in one of the ancient Sanskrit Vedic poems whose name translate into "Science of Charms."
In the 1830s, Sir William Brooke O’Shaughnessy, an Irish doctor studying in India, found that cannabis extracts could help lessen stomach pain and vomiting in people suffering from cholera.
By the late 1800s, cannabis extracts were sold in pharmacies and doctors’ offices throughout Europe and the United States to treat stomach problems and other ailments.
Scientists later discovered that THC was the source of marijuana’s medicinal properties. As the psychoactive compound responsible for marijuana’s mind-altering effects, THC also interacts with areas of the brain that are able to lessen nausea and promote hunger.
In fact, the U.S. Food and Drug Administration has approved two drugs with THC that are prescribed in pill form, Marinol and Syndros, to treat nausea caused by cancer chemotherapy and loss of appetite in AIDs patients.
What is the science and pharmacology behind marijuana, and can it be used to treat Parkinson's symptoms?
The endocannabinoid system is located in the brain and made up of cannabinoid receptors (a receptor is molecular switch on the outside of a cell that makes something happen inside a cell when activated) that are linked to neurons (brain cells) that regulate thinking and some body functions.
Researchers began to show enthusiasm to study cannabis in relation to PD after people with PD gave anecdotal reports and posted on social media as to how cannabis allegedly reduced their tremors. Some researchers think that cannabis might be neuroprotective— saving neurons from damage caused by PD.
Cannabinoids (the drug molecules in marijuana) have also been studied for use in treating other symptoms, like bradykinesia (slowness caused by PD) and dyskinesia (excess movement caused by levodopa). Despite some promising preclinical findings, researchers have not found any meaningful or conclusive benefits of cannabis for people with PD.
The Parkinson’s Foundation, in partnership with Northwestern University researchers, studied attitudes about cannabis at 40 Centers of Excellence. To the best of our knowledge, this is the first study to provide data on the practices, beliefs and attitudes of expert PD physicians concerning cannabis use.
The results were interesting: most experts said they knew what cannabis did, but disagreed on the details. While there is no general agreement on what the benefits might be for people with PD, the survey confirmed that cannabis is a popular subject within Parkinson’s Foundation centers as 95 percent of neurologists reported patients have asked them to prescribe it.
This graph shows how physicians expect cannabis would improve, worsen, or show no effect to PD-related symptoms given their expertise and observations of patients with PD.
The Cannabis act (C-45) of June, 2018, paved the way to legalization of Canada on October 17, 2018.
The cannabis act creates a strict legal framework for controlling the production, distribution, sale and possession of cannabis. The Act aims to accomplish 3 goals:
• Keep cannabis out of the hands of youth.
• Keep profits out of the pockets of criminal
• Protect public health and safety by allowing adults access to legal cannabis
• Possess up to 30 grams of legal cannabis, dried or equivalent in non-dried form in public.
• Share up to 30 grams of legal cannabis with other adults.
• Buy dried or fresh cannabis and cannabis oil from a provincially licensed retailer.
• Grow, from licensed seed or seedlings, up to 4 cannabis plants per residence for personal use.
• Make cannabis products, such as food and drinks at home as long as organic solvents are not used to create concentrated products.
The current regime for medical cannabis will continue to allow access to cannabis for people who have the authorization of their health care provider.
Cannabis offenses target those acting outside of the legal framework. Penalties are set in proportion to seriousness of offense. No person may sell or provide the cannabis to any person under age of 18.
1. Loss of smell
2. Trouble sleeping
3. Constipation
4. Masked Face
5. Mood disorders
6. Dizziness and fainting
7. Small handwriting
8. Tremors and Shaking
10. Poor Posture
11. Voice changes
12. Stiff muscles
1. Tremors or shaking
2. Slowed movement
3. Rigid muscles
4. Changes in writing
5. Impaired posture and balance
6. Speech and voice changes
Parkinson's disease has five stages. With each stage, patients may experience a progression of symptoms, ranging mild tremors movement problems in the initial stage to being incapacitated and needing nursing care in the final stage. However, the progression of Pakinson's disease symptoms can vary in patients and some may never experience symtoms associated with the final stage.
Parkinson's Disease Foundation
Conventional Medications:
1. Carbidopa- Levodopa: Levodopa, the most effective Parkinson's disease medication, is a natural chemical that passes into brain and is converted to dopamine.
2.• Dopamine agonists: Unlike levodopa, dopamine agonists don't change into dopamine. Instead, they mimic dopamine effects in brain.
3. MAO B inhibitors: These medications include selegiline, rasagiline and safinamide. They help prevent the breakdown of brain dopamine by inhibiting the brain enzyme monoamine oxidase B (MAO B). This enzyme metabolizes brain dopamine.
4. • Catechol O-methyltransferase (COMT) inhibitors:This medication mildly prolongs the effect of levodopa therapy by blocking an enzyme that breaks down dopamine.
5. Anticholinergics: These medications were used for many years to help control the tremor associated with Parkinson's disease.
6. • Amantadine: Doctors may prescribe amantadine alone to provide short-term relief of symptoms of mild, early-stage Parkinson's disease
Marijuana, also known as cannabis is the preparation of the cannabis plant intended for use as an psychoactive drug
• Marijuana or cannabis is used as a treatment for many illness and diseases including neurological conditions, with Parkinson’s Disease
• Cannabis or marijuana have two components: THC (Tetrahydrocanabinol) and CBD (Cannabinoids)
• The endocannabinoid system is located in brain and made up of cannabinoid receptors
• Marijuana contains more than 100 neuroactive chemicals that work with two type of cannabinoid receptors, type 1(CB1) located in brain and type 2 (CB2) located in brain and peripheral immune system
• People with Parkinson’s disease have less CB1 receptors as compared to people who do not have Parkinson’s disease
• A boost to CB1 receptors like marijuana through an agonist, like marijuana, can improve tremors and may alleviate dyskinesia
• Relieves Pain: A small study of 22 individuals with Parkinson’s found that using cannabis helped improve pain. However, this study was conducted with medical marijuana, which contains both CBD and THC
• Tremors: Some of the most common treatments for Parkinson’s disease can cause medicine-related tremors or uncontrolled muscle movements. Treatment with the medicine won’t make it better — and it could make it worse.
• Psychosis: Psychosis is a possible complication of Parkinson’s disease. It can cause hallucinations, delirium, and delusions, and it’s more common in people in the later stages of the disease.
One small 2009 study in individuals with Parkinson’s disease and psychotic symptoms found that the compound did reduce the severity of symptoms. It also didn’t cause any adverse effects.
• Sleep: Sleep disruption and a lack of quality sleep is a serious concern for people with Parkinson’s disease. Vivid dreams or nightmares, as well as movement during sleep, is common. Studies have found that both cannabis and CBD alone may help with sleep disturbances
Comparison of Cannabinoids Products
• Central Nervous System: euphoria, anxiety, panic, psychosis, sedation, dizziness, ataxia, visual or hearing effects or cognitive effects
• Cardiovascular: Tachycardia, postural hypotension, palpitations, Increased risk of myocardial infarction within one hour after use of smoking
• Respiratory (if smoked): Bronchitis, COPD or lung infections
• Others: Dry mouth, headache, abdominal pain, diarrhea, decreased appetite
• Ensure that physician and pharmacy are aware that a patient wishes to use their medical marijuana and document this fact in medical record
• Ask the patient evidence for proving he/she is authorized to use medical marijuana and ensure such evidence is copied and filed in progress notes of medical record
• Report any loss of or theft of medical marijuana, inform physician and document evidence and complete a safety report