ALS and the Potential of Cannabis-Based Therapies: Insights from Dr. Ethan Russo

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On February 20, 2025, CReDo Science presented, “Update on ALS: Amyotrophic Lateral Sclerosis, Cannabis, and Hope for the Future,” an hour-long webinar in which Ethan Russo, MD, neurologist and medical researcher discussed ALS symptoms, conventional treatments, and studies on treatments using cannabis components. ALS, he explained, is a terminal degenerative disease affecting upper and lower motor neurons, causing weakness, paralysis, and affecting speech, and swallowing. Even after decades of research, there have been no breakthrough conventional treatments yet.

Dr. Russo began the webinar with a literature review of clinical studies involving cannabis for ALS, noting one study that listed many symptoms that commonly affect patients that cannabis could help, including pain, fatigue, and spasticity. Additionally, one mouse model study showed that THC has antiexcitotoxic properties and increased life by several days, and also suggested that CBD could have neuroprotective properties. In another study, one researcher noted that the pathology of ALS likely required a cocktail of treatments, which cannabis components are able to address. No randomized control trials (RCT) have been done for pain and none for spasticity before 2017. One single case report suggested CBD co-medicating temporarily improved motor symptoms and slowed delayed degeneration. A couple studies identified new potential targets for the disease, specifically within the endocannabinoid system. Another study examined a combination of CBD and CBG and found various benefits, including a nerve protective effect.

Next, he discussed randomized clinical control trials and observational studies. In 2019 the first RCT examined a THC and CBD oral muscosal spray and found statistically significant effects on spasticity and pain without a decrease in strength. Another similar study found improved spasticity using a lower dose of THC and CBD. A 2021 study compared endocannabinoid levels in ALS patients and found that concentrations of certain cannabinoids were predictors for the presence of ALS, again supporting the idea of the ECS as a biomarker source for ALS assessment.

Dr. Russo then explained conventional treatment for ALS. Currently, there is no FDA-approved drug to treat the symptoms, though one FDA-approved drug, riluzole, can extend life for 2-3 months. Additionally, the medications to treat ALS symptoms can cause adverse effects. Tricyclic antidepressants and anticonvulsant drugs for pain can be minimally effective. Sialorrhea treatments of botulinum toxin and anticholinergics can cause sedation and memory impairment. Anxiety, spasticity, and sleep disturbances are usually treated with benzodiazepines, which can cause sedation.

In comparison, cannabinoids and terpenes can be used to treat the side effects, as discussed in the recently published review article, “Amyotrophic Lateral Sclerosis, the Endocannabinoid System, and Exogenous Cannabinoids: Current State and Clinical Implications,” which Dr. Russo co-authored. For example, THC can work on spasms, provide pain relief, stimulate appetite, and the common side effect of dry mouth can be helpful for ALS. Additionally, CBG has muscle relaxant properties and is an anti-anxiety agent. THCA works through tumor necrosis factor alpha (TNF-α) and PPAR-γ. The terpenoid D-Limonene has anti-anxiety and anti-depressant effects. Additionally, cannflavins – flavonoids in cannabis – also have anti-inflammatory properties. They can potentially extend life, as demonstrated in studies involving nematodes.

Ultimately, cannabis-based treatments for ALS could be an attainable goal. “A properly constituted multi-component cannabis-based preparation may address longevity, symptoms, and quality of life, and might produce conventional drug sparing and reduce care costs,” Dr. Russo summarized. “It could treat ALS better, faster and less expensively, and might also be applicable to other neurodegenerative diseases.” CReDo Science is currently partnering with Canurta Inc. to create a whole plant cannabis drug for ALS.