In which situations is treatment with cannabis useful for ALS?

The cannabis plant contains several substances that have a pharmacological effect and are suitable for therapeutic use. In the human body, there are specific receptors in various organ systems (mainly in the nervous and immune systems as well as in connective tissue and bones), which are known as the endocannabinoid system. Chemical components of the cannabis plant (called cannabinoids) can act on the endocannabinoid system and have different effects.

Of the many components of the cannabis plant, tetrahydrocannabinol (THC) and cannabidiol (CBD) are the best characterized. Various pharmaceutical manufacturers have specialized in extracting THC and CBD (the targeted extraction through pharmaceutical processes). Other suppliers focus on the cultivation and processing of whole cannabis flowers, which contain all the components of the cannabis flower. In the treatment of selected symptoms of ALS, the extracts of THC and CBD are in the foreground. The use of THC medication (without CBD) and the use of cannabis flowers (with THC and all other components of the cannabis flower) are used less frequently.

A combination of THC:CBD has been approved in Germany for the treatment of spasticity in multiple sclerosis since 2011. There is therefore greater therapeutic experience with this drug combination. With the approval of THC:CBD in the treatment of spasticity (in multiple sclerosis), the use of this drug originally focused on spasticity therapy.

In 2018, a controlled study on CBD:THC therapy for ALS was completed, which demonstrated a positive effect of this combination drug on ALS-related spasticity . Other studies have shown that patients with a high severity of spasticity are highly satisfied with THC:CBD treatment. Medications containing cannabis can therefore be used to treat spasticity when conventional medications (e.g. baclofen or tizanidine) are not effective enough or have side effects.

During further development, it became apparent that other ALS-related symptoms such as muscle spasms (cramps) and unwanted muscle twitches (fasciculations) can also be alleviated with THC:CBD. However, the data on the treatment success of cramps and fasciculations is still limited. In these constellations, an individual treatment conceptmust be assumed.

A broad field of application for cannabis-containing medications is pain that cannot be alleviated by conventional pain medication or where adverse drug reactions limit pain therapy. In ALS, pain is rarely the focus of the symptoms, so that cannabis-containing medications are mainly useful in ALS for spasticity, muscle spasms and fasciculations and pain therapy is a rare field of application for THC:CBD in ALS.

The symptomatic and palliative treatment with cannabis-containing drugs is an intensive field of research, so that further research results on suitable drug combinations and dosages as well as fields of application can be expected in the future.