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Affecting as many as one in 10 people in the U.S., restless legs syndrome is a disorder characterized by the uncontrollable urge to move the legs. Studies suggest that cannabis relieves the symptoms associated with the disorder and can improve sleep quality.
Overview of Restless Legs Syndrome
Characterized by an uncomfortable and irresistible urge to move the legs, restless legs syndrome is a sensorimotor disorder involving the nervous system. Restless legs syndrome, also called commonly referred to as RLS or Willis-Ekbom disease, typically worsens when lying or sitting. As a result, the syndrome is commonly accompanied with sleep problems, exhaustion, daytime sleepiness, and lower productivity.
RLS symptoms can vary in severity from day-to-day. The sensations often range from uncomfortable to irritating to painful. Moderately-severe cases involve symptoms occurring once or twice a week. Symptoms arise more than twice a week in severe cases.
The cause of RLS is still unknown, but medical experts believe that the condition does have a genetic component. Specific gene variants associated with the disorder can be found in families where the onset of symptoms is before the age of 40. Considerable evidence also suggests that RLS is related to a dysfunction in the basal ganglia, the part of the brain that uses the chemical dopamine to control movement. Low levels of iron in the brain have also been linked to RLS.
Treatment efforts for RLS are directed toward relieving symptoms. Moving the affected limbs often provides relief, but only temporarily. Iron supplements, hot baths, and leg massages are typically recommended. Additional medications, such as anti-seizure drugs and dopaminergic agents, are also commonly prescribed to manage RLS symptoms. While effective at first, the National Institute of Neurological Disorders and Stroke warn that long-term use of the drugs can lead to worsening of the symptoms for many people. Opioids are sometimes prescribed to treat those with more painful and severe forms of RLS.
Findings: Effects of Cannabis on Restless Legs Syndrome
Studies investigating the effects of cannabis on restless legs syndrome are severely lacking in volume, but findings in the limited research that has been done are promising. A 2017 case study found that cannabis completely relieved symptoms in six patients with RLS. Five of the patients reported total remission of symptoms after inhaling marijuana. One reported complete relief after consuming cannabidiol (CBD), a non-psychoactive compound found in cannabis. All six reported significant improvements in sleep quality with cannabis treatments4.
Numerous studies have supported the efficacy of dopamine agonist drugs for managing moderate-to-severe RLS2. Studies have yet to directly examine how the influence that cannabis has on dopamine release could impact RLS, but researchers do know that the cannabinoids found in cannabis interact with the endocannabinoid system’s cannabinoid receptors, CB1 and CB2, to modulate the release of dopamine8. These dopamine-regulatory effects of cannabis have shown to be beneficial at treating symptoms in other movement disorders, like Parkinson’s disease3.
Additionally, both of cannabis’ major cannabinoids — CBD and tetrahydrocannabinol (THC) — have demonstrated efficacy in many studies for managing pain and improving sleep7. These pain-relieving and sleep promoting properties have yet to be widely examined in patients with restless legs syndrome, but have shown to be applicable to multiple conditions9.
States That Have Approved Medical Marijuana for Restless Legs Syndrome
No states have specifically approved medical marijuana for the treatment of restless legs syndrome.
Some states will, however, consider other conditions and may approve medical marijuana for restless legs syndrome or sleep disorders. In California, “any debilitating disease where medical marijuana may be recommended by physician.” In Connecticut, “other medical conditions may be approved by the Department of Consumer Protection.” Massachusetts will approve “other conditions as determined in writing by physician.” The state of Washington allows medical marijuana for “any terminal or debilitating condition.” In Nevada, Oregon and Rhode Island, “other conditions subject to approval.” Additionally, Washington D.C. allows medical marijuana to be used for any debilitating condition as recommended by DC licensed doctor.
Recent Studies on Cannabis’ Effect on Restless Legs Syndrome
- Allen, R.P., Picchietti, D.L., Garcia-Borreguero, D. Ondo, W.G., Walters, A.S., Winkelman, J.W., Zucconi, M., Ferri, R., Trenkwalder, C., and Lee, H.B. (2014, August). Restless legs syndrome/Willis-Ekbom disease diagnostic criteria: updated International Restless Legs Syndrome Study Group (IRLSSG) consensus criteria─history, rationale, description, and significance. Sleep Medicine. 5, 860–873. Retrieved from http://www.sleep-journal.com/article/S1389-9457(14)00190-7/fulltext.
- Buchfuhrer, M.J. (2012, October). Strategies for the treatment of restless legs syndrome. Neurotherapeutics, 9(4), 776-790. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3480566/.
- Lotan, I., Treves, T.A., Roditi, Y., and Djaldetti, R. (2014, March-April). Cannabis (medical marijuana) treatment for motor and non-motor symptoms of Parkinson disease: an open-label observational study. Clinical Neuropharmacology, 37(2), 41-4. Retrieved from http://journals.lww.com/clinicalneuropharm/pages/articleviewer.aspx?year=2014&issue=03000&article=00001&type=abstract.
- Megelin, T., and Ghorayeb, I. (2017, August). Cannabis for restless legs syndrome: a report of six patients. Sleep Medicine, 36, 182-83. Retrieved from http://www.sleep-journal.com/article/S1389-9457(17)30222-8/fulltext.
- Restless legs syndrome. (2014, December 10). Mayo Clinic. Retrieved from http://www.mayoclinic.org/diseases-conditions/restless-legs-syndrome/basics/definition/con-20031101.
- Restless Legs Syndrome Fact Sheet. (2017, May). National Institute of Neurological Disorders and Stroke. Retrieved from https://www.ninds.nih.gov/Disorders/Patient-Caregiver-Education/Fact-Sheets/Restless-Legs-Syndrome-Fact-Sheet.
- Russo, E.B., Guy, G.W., and Robson, P.J. (2007, August). Cannabis, pain, and sleep: lessons from therapeutic clinical trials of Sativex, a cannabis-based medicine. Chemistry & Biodiversity, 4(8), 1729-43. Retrieved from http://onlinelibrary.wiley.com/doi/10.1002/cbdv.200790150/pdf.
- Stampanoni Bassi, M., Sancesario, A., Morace, R., Centonze, D., and Iezzi, E. (2017, February). Cannabinoids in Parkinson’s Disease. Cannabis and Cannabinoid Research, 2(1), 21-29. Retrieved from http://online.liebertpub.com/doi/full/10.1089/can.2017.0002.
- Ware, M.A., Wang, T., Shapiro, S., Robinson, A., Ducruet, T., Huynh, T., Gamsa, A., Bennett, G.J., and Collet, J.P. (2010). Smoked cannabis for chronic neuropathic pain: a randomized controlled trial. CMAJ : Canadian Medical Association Journal, 182(14), E694–E701. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2950205/.