June 28, 2023

Should Cannabis be Considered an RLS Treatment?

By Adrianna Colucci, RLS Foundation Administrative Assistant

Research examining the potential role that medical cannabis can play in treating medical conditions and sleep disorders is increasing within the United States. Cannabis is a plant containing active ingredients that is classified as a psychoactive drug when ingested, inhaled, or applied.1 Under federal legislation, cannabis is illegal and defined as a Schedule I drug: however, states have individual laws regarding its recreational and medical use. While medical marijuana is not among the approved treatments for RLS, there are individuals who have anecdotally had success in managing symptoms using the drug with or without the supervision of their healthcare providers.

WHAT IS CANNABIS?

Over 450 chemical compounds have been identified in cannabis. The two most commonly referred to compounds, or cannabinoids, are delta-9-tetrahydrocannabinol (THC) and cannabidiol (CBD). The human body produces endocannabinoids naturally as an important part of regulating the circadian sleep cycle and maintaining homeostasis, a state of balance among biological systems in the body.2 These endocannabinoids bind to cannabinoid receptors in the body, primarily CB1 and CB2 receptors. These are found predominantly in the central and peripheral nervous systems and in immune tissues.1 When THC or CBD are introduced to the body, these cannabinoids interact with the endocannabinoid receptors differently, producing distinct reactions.

DIFFERENCES IN CLASSIFICATIONS OF CANNABIS

THC is the main psychoactive component in marijuana and interacts primarily with the brain’s CB1 receptors, eliciting a euphoric or “high” sensation. THC can be used medicinally to prevent nausea that occurs in chemotherapy patients, promote appetite and can help treat certain medical conditions. Some of the adverse effects include short-term memory loss, increased heart rate, loss of coordination, and hallucinations. Longer term, there is a risk of addiction, along with impaired cognition and brain development.

CBD does not produce the same euphoric feeling as THC. How CBD interacts with cannabinoid receptors is not well understood, but studies suggest it can provide relief from anxiety or pain. There are no significant neurological effects associated with CBD, and it can help increase sedation to help insomnia. Some of the adverse effects include decreased appetite, fatigue, drowsiness and an increased risk of infection.2

CANNABIS AND SLEEP

A study conducted in 2017 looked at the effectiveness of medical cannabis as a substitution for pharmaceutical options for pain, anxiety and sleep.3 Of the 1,513 participants who took part in the survey, 76.7% indicated the ability to reduce their regularly prescribed opioids after incorporating medical cannabis into their management plan. Furthermore, 65.2% reduced their sleep medications. Other studies show that administration of THC is beneficial on a short-term basis, but developing tolerance and withdrawal can eventually cause sleep disturbances.

Although drowsiness is a side effect of CBD, findings vary on its effectiveness for treating sleep disorders. CBD was used in a large case study that observed its efficacy in a group of 72 adults presenting with anxiety, of which 25 suffered from inadequate sleep.4 Most patients were prescribed 25 milligrams, although those with severe cases were prescribed 50-75 milligrams. For those with anxiety, the capsule was administered early in the day, and for those with sleep concerns, it was given in the evening. Sleep quality was documented according to the Pittsburgh Sleep Quality Index. In the first month, the quality of sleep improved in 66.7% of participants, while 25% experienced worsening sleep issues. These numbers fluctuated in the following month when only 56.1% reported an improvement in sleep and 26.8% reported worsening problems. Though sleep scores demonstrated a mild improvement, CBD showed a more consistent benefit for anxiety than with sleep issues.

CANNABIS AND RLS

There are very few academic studies that investigate the correlation between RLS and the effects of medical cannabis directly. Observational data published in 2020 by Dr. Imad Ghorayeb examined twelve predominantly male RLS patients, ages 31 to 69.5 Eleven of the twelve participants reported an improvement in RLS symptoms after smoking cannabis or using CBD oil in addition to their current treatment medications. These improvements ranged from 60% to 100%, with the last participant noting no improvement. Due to concern about psychoactive effects and the potential risk for abuse, three of the individuals switched to CBD oil, noting the increased effectiveness of smoking cannabis versus a topical treatment. This data shows the need for further clinical trials and research on the efficacy of cannabis and CBD.

The observations of one of the RLS experts based in California, where marijuana has been legal and widely used for many years, is that inhaled marijuana most often relieves RLS symptoms after only 1-3 inhalations. This effect typically onsets within less than 5 minutes but only lasts 1-2 hours. Edible marijuana, even in high doses is rarely effective in relieving RLS symptoms. CBD may sometimes promote sleep but does not improve RLS symptoms.

CONCLUSION

Cannabis has been cultivated by numerous cultures, spanning centuries for its medicinal properties. Based on a lack of clinical data, further research is required before cannabis can be recommended for routine use for RLS. If you are thinking of integrating cannabis into your treatment, be sure to consult your doctor, as it can interact with other drugs. There are various forms of cannabis available including vapor, smoke, edibles, plant resin and oil extracts. Consult with your physician to determine which method and dosage may be right for you.

SOURCES:

1 Kaul M, Zee PC, Sahni AS. “Effects of Cannabinoids on Sleep and their Therapeutic Potential for Sleep Disorders.” Neurotherapeutics. 2021 Jan;18(1):217-227. Doi: 10.1007/s13311-021-01013-w. Epub 2021 Feb 12.

2 Bainbridge, Jacqueline Pharm D. FCCP, MSCS, FAES. “Medical Marijuana/ Cannabis: The Proof is in the Pudding” Webinar. 2022.

3 Piper BJ, DeKeuster RM, Beals ML, Cobb CM, Burchman CA, Perkinson L, Lynn ST, Nichols SD, Abess AT. “Substitution of medical cannabis for pharmaceutical agents for pain, anxiety, and sleep.” J Psychopharmacol. 2017 May;31(5):569-575. doi: 10.1177/0269881117699616. Epub 2017 Apr 1 PMID: 28372506.

4 Shannon S, Lewis N, Lee H, Hughes S. “Cannabidiol in Anxiety and Sleep: A Large Case Series.” Perm J. 2019;23:18-041. doi: 10.7812/TPP/18-041. PMID: 30624194; PMCID: PMC6326553.

5 Ghorayeb I. “More evidence of cannabis efficacy in restless legs syndrome.” Sleep Breath. 2020 Mar;24(1):277-279. doi: 10.1007/s11325-019-01978-1. Epub 2019 Dec 9. PMID: 31820197.