New York State Practitioner Education - Medical Use of Marijuana Course
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The Medical Use of Marijuana in Spasticity

Observations of the effects of cannabis on muscular tightness or spasticity have been documented for over 1000 years (Russo, 2007, al-Kindi and Levey, 1966), and its preparations were the first effective treatment for tetanus in the 19th century (Russo, 2014, O'Shaughnessy, 1838-1840).


Basic science studies have elucidated the rationale for cannabinoid treatment of spasticity (Russo, 2007): Muscle tone is under tonic control by the endocannabinoid system (ECS). CB1 agonists diminish spasticity, while antagonists such as SR141716A (Rimonabant) increase it (Baker et al. 2000). CB1 receptors are represented densely in cortical and basal ganglia areas sub-serving motor control function and in their corresponding cerebellar projections (Glass et al. 1997). Endocannabinoids are also integral in spinal interneurons affecting muscle tone (Farquhar-Smith et al 2000) and neocortex (Bacci et al. 2004) that pertain to pathophysiological bases of spasticity.


This report summarizes the high-quality evidence derived from case reports, clinical trials and prospective observational research studies that have investigated the impact of cannabis use on various health outcomes among people with spasticity.

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