Preliminary Evidence on Cannabis Effectiveness and Tolerability for Adults With Tourette Syndrome
Abstract
Methods
Results
Clinical Characteristics and Cannabis Use
ID | Age (Years)/Gender | Comorbidities | Current and Past Medications | How Participant Learned About Cannabis for Tics | Pharmaceutical Cannabinoid | Cannabis | |||
---|---|---|---|---|---|---|---|---|---|
Current Source | Dosing | Route | Duration of Single Dose Effect on Tics (Hours) | ||||||
1 | 19/M | OCD, ADHD, restless leg syndrome, nocturnal myoclonus | Past: clonidine, risperidone, sertraline, amphetamine/dextroamphetamine, atomoxetine, clonazepam, desmopressin | Mother found information online | None | Approved supplier | 0.5 g four times daily | Smoked | 2–3 |
2 | 40/F | OCD, depression | Current: citalopram, clonazepam; Past: clonidine, risperidone, pimozide, aripiprazole, quetiapine, tetrabenazine, paroxetine, fluoxetine | Family friend with TS | Past: nabiximols, nabilone | Approved supplier | 0.125–0.5 g in food every night; 0.5 g smoked/day | Smoked, ingested with food | 6 |
3 | 21/M | OCD, anxiety | Past: olanzapine, quetiapine, methylphenidate, atomoxetine, fluoxetine, bupropion | Personal experience | None | Unapproved supplier | 1 g three times daily | Vaporized, ingested with food | 3–4 |
4 | 32/M | ADHD, ASD, hypertension | Past: clonidine, risperidone, haloperidol, pimozide, fluoxetine | TS clinic | Past: nabiximols | Approved supplier | 0.5 g every night for 1 week, then discontinued for 3 weeks | Vaporized | 24 |
5 | 34/M | OCD, social phobia | Current: venlafaxine Past: clonidine, pimozide | Friend | Past: dronabinol | Compassion clinic | 0.25 g daily | Vaporized | Uncertain |
6 | 51/M | OCD | Current: clonazepam Past: clonidine, mirtazapine, amytriptyline, lorazepam, valerian | Read research by Muller-Vahl and colleagues online | none | compassion clinic | 3 g in food, twice weekly | ingested with food | 5 |
7 | 28/M | OCD, ADHD, platelet abnormality | Past: risperidone | Personal experience | None | Unapproved supplier | <3 g spread over entire day | Smoked | Uncertain |
8 | 27/M | HIV positive | Current: elvitegravir/cobicistat/emtricitabine/tenofovir, guanfacine, clonazepam Past: clonidine | Personal experience | None | Compassion clinic | 0.1 g three times daily | Smoked | 2–3 |
9 | 18/M | OCD, ADHD, panic disorder | Current: sertraline Past: clonidine, methlyphenidate | Online | None | Unapproved supplier | 0.3 g spread over entire day | Smoked | 1.5–2 |
10 | 22/M | ADHD | Past: clonidine, risperidone, pimozide, quetiapine, methylphenidate, atomoxetine, bupropion, fluoxetine, clonazepam | Online | Past: nabilone | Unapproved supplier | 1.5 g spread over entire day | Smoked, ingested with food | 2 |
11 | 27/M | OCD, ADHD | Past: clonidine, methlyphenidate, fluoxetine, clobazam, prindolol | Personal experience | None | Approved supplier | 1.5–2 g 4–5×/daily | Smoked, ingested with food | 1–2 |
12 | 64/M | OCD, ADHD, COPD, type 2 diabetes | Current: citalopram, acetylsalicylic acid, clopidogrel, metformin, bisoprolol, amlodipine, atorvastatin, hydrochlorothiazide, omeprazole; Past: clonidine, amytriptyline, bupropion | Personal experience | Past: nabiximols | Approved supplier | 10 g/day | Smoked, ingested with food | 1–2 |
13 | 24/M | OCD, ADHD, depression | Past: clonidine, risperidone, haloperidol, methlyphenidate, atomoxetine, valproate, topiramate, fluoxetine, fluvoxamine, bupropion, zopiclone, clonazepam, lorazepam, diphenhydramine | Magazine | Past: nabiximols, nabilone | Unapproved supplier | 1 g/day smoked, 2 g/day vaporized | Smoked, vaporized | 2–3 |
14 | 30/F | Anxiety | Current: ziprasidone, clonazepam, sertraline, pimozide Past: risperidone, lurasidone, quetiapine, tetrabenazine, pramipexole, clomipramine, trazodone, zoplicone, lorazepam, melatonin, tetracycline, isotretinoin | Personal experience | None | Approved supplier | 0.2–0.4 g 1–2 times/week | Smoked | 2–4 |
15 | 24/M | ADHD, anxiety, depression | Current: fluoxetine Past: haloperidol, risperidone, olanzapine, quetiapine, clonidine, topiramate, fluoxetine, fluvoxamine, citalopram, methylphenidate, dextroamphetamine, atomoxetine, clonazepam, diazepam | Friend | Past: nabiximols, nabilone | Unapproved supplier | 0.6 g 4–5 times/day | Vaporized | 3 |
16 | 42/F | OCD, ADHD, PTSD, hepatitis C | Current: clonidine, aripiprazole, lisdexamfetamine, paroxetine, trazodone, clonazepam Past: ziprasodone, topiramate, bupropion | Personal experience | Past: nabilone | Approved supplier | 0.25 g 4–6 times/day | Smoked | 2 |
17 | 25/M | OCD | Current: haloperidol, fluvoxamine, acetaminophen/dextromethorphan/doxylamine Past: aripiprazole, lorazepam | Personal experience | None | Unapproved supplier | 1 g three times daily | Smoked | 4–6 |
18 | 32/M | OCD, ADHD, specific phobia (needle) | Past: clomipramine, imipramine, methylphenidate, sertraline, fluoxetine, paroxetine | TV: news report | None | Approved supplier | 1 g/day total: small amount ingested every few hours, vaporizer in PM | Vaporized, ingested with food | 3 |
19 | 49/M | none | Current: sildenafil Past: clonidine, pimozide, tetrabenazine, clonazepam, notriptyline, gabapentin, naproxen | TS clinic | Past: dronabinol, nabiximols, nabilone | Approved supplier | 0.5 g twice daily | Vaporized | 8–12 |
Effect of Cannabis on Tics and Related Symptoms
ID | YGTSS Total Tic Score | YGTSS Impairment | Y-BOCS Total | ASRS Criteria for ADHD | CGI-S Score | CGI-I Score | Cannabis Impact on Comorbid Conditions | |||||
---|---|---|---|---|---|---|---|---|---|---|---|---|
Before Cannabis Use | During Cannabis Use | Before Cannabis Use | During Cannabis Use | Before Cannabis Use | During Cannabis Use | Before Cannabis Use | During Cannabis Use | Before Cannabis Use | During Cannabis Use | |||
1 | 26 | 0 | 40 | 0 | 17 | 0 | Yes | No | 5 | 1 | 1 | Decreased OCS, ADHD and rage |
2 | 46 | 20 | 50 | 40 | 27 | 16 | Yes | No | 7 | 4 | 2 | Decreased OCS and rage |
3 | 26 | 10 | 30 | 10 | 22 | 11 | Yes | No | 3 | 1 | 2 | Improved attention; decreased restlessness, impulsivity and rage |
4 | 44 | 18 | 50 | 0 | 12 | 12 | Yes | No | 4 | 2 | 1 | Improved attention and communication skills |
5 | 36 | 11 | 20 | 10 | 28 | 16 | Yes | Yes | 4 | 3 | 1 | Decreased OCD and anxiety; improved attention |
6 | 26 | 17 | 30 | 20 | 21 | 19 | Yes | No | 4 | 3 | 2 | Decreased OCD, anxiety, and rage; improved sleep |
7 | 21 | 8 | 20 | 0 | 0 | 0 | No | No | 4 | 2 | 2 | Reduced rage and irritability |
8 | 26 | 13 | 30 | 10 | 20 | 14 | Yes | No | 4 | 3 | 2 | Decreased ADHD and rage; improved sleep |
9 | 23 | 6 | 0 | 20 | 23 | 19 | No | No | 4 | 2 | 2 | Reduced rage |
10 | 30 | 18 | 30 | 10 | 0 | 0 | Yes | No | 5 | 3 | 2 | Reduced restlessness and anxiety; improved attention |
11 | 37 | 24 | 40 | 20 | 23 | 20 | No | No | 5 | 3 | 2 | Reduced OCD and ADHD; improved concentration and organization |
12 | 26 | 28 | 40 | 30 | 26 | 18 | No | No | 4 | 4 | 3 | Reduced OCD and restlessness; improved concentration and organization |
13 | 31 | 0 | 50 | 0 | 25 | 0 | Yes | No | 5 | 1 | 1 | Decreased OCD, ADHD and rage |
14 | 24 | 0 | 40 | 0 | 0 | 0 | Yes | No | 5 | 3 | 1 | Reduced rage |
15 | 35 | 0 | 50 | 0 | 35 | 0 | Yes | No | 6 | 1 | 1 | Decreased OCD, ADHD, and rage |
16 | 33 | 15 | 40 | 20 | 38 | 12 | Yes | No | 5 | 2 | 2 | Decreased symptoms of OCD and rage |
17 | 25 | 7 | 40 | 10 | 0 | 6 | No | No | 6 | 2 | 1 | Decreased anxiety and rage |
18 | 39 | 15 | 40 | 10 | 25 | 13 | Yes | No | 5 | 3 | 1 | Reduced anxiety and improved productivity |
19 | 26 | 21 | 30 | 10 | 14 | 3 | No | No | 4 | 3 | 1 | Decreased OCS |
Instrument and Symptoms | Baseline (Mean±SD) | During Cannabis Treatment (Mean±SD) | Percentage Reduction From Baseline (%) | p | |
---|---|---|---|---|---|
YGTSS | Motor tic severity | 16.7±3.3 | 7.3±5.2 | 56.3 | <0.001 |
Vocal tic severity | 13.8±4.4 | 4.8±4.4 | 65.2 | <0.001 | |
Impairment | 35.3±12.6 | 11.6±11.2 | 67.1 | <0.001 | |
Total tic severity | 30.5±7.2 | 12.2±8.6 | 60 | <0.001 | |
Total severity scale | 65.8±17.7 | 23.7±18.1 | 64 | <0.001 | |
Y-BOCS | Obsession subtotal | 9.5±6.0 | 5.0±4.5 | 47.4 | 0.001 |
Compulsion subtotal | 9.2±5.8 | 4.5±3.7 | 51.1 | 0.003 | |
Total | 18.7±11.7 | 9.4±7.8 | 49.7 | 0.001 | |
PUTS | 26.2±4.9 | 18.6±4.6 | 29 | <0.001 | |
Baseline (Number of Participants) | During Cannabis Treatment (Number of Participants) | Percentage Reduction From Baseline (%) | |||
ASRS: Symptoms highly consistent with ADHD | 13 | 1 | 92.3 | <0.001 | |
CGI-I: Much improved or very much improved | N/A | 18 | N/A | N/A | |
CGI-S: Moderately to extremely ill | 18 | 2 | 88.9 | <0.001 |
Cannabis Tolerability
ID | Marijuana Effect Expectancy Questionnaire | Adverse Effects Based on Open-Ended Questions | |||||
---|---|---|---|---|---|---|---|
Cognitive and Behavioral Impairment | Relaxation and Tension Reduction | Social and Sexual Facilitation | Perceptual and Cognitive Enhancement | Global Negative Effects | Craving and Physical Effects | ||
1 | 2.6 | 2.3 | 2.3 | 2.3 | 1.0 | 2.5 | None reported |
2 | 3.3 | 3.1 | 3.0 | 3.3 | 2.7 | 4.2 | Increased sleepiness and reduced concentration |
3 | 2.4 | 2.4 | 1.7 | 2.1 | 1.3 | 3.0 | None reported |
4 | 3.2 | 3.3 | 3.0 | 3.3 | 2.8 | 3.3 | Increased irritability and appetite |
5 | 2.6 | 3.8 | 2.8 | 3.3 | 2.3 | 3.3 | Dry mouth and eyes |
6 | 2.4 | 3.3 | 2.4 | 2.4 | 1.4 | 2.7 | None reported |
7 | 1.7 | 3.1 | 2.0 | 2.8 | 1.1 | 2.5 | Less motivated, reduced short-term memory |
8 | 3.3 | 3.0 | 2.9 | 2.9 | 2.1 | 3.7 | Higher doses cause increased social anxiety and appetite |
9 | 3.3 | 2.9 | 1.9 | 2.8 | 1.3 | 3.0 | Decreased concentration and worsening of symptoms at higher doses |
10 | 3.8 | 3.9 | 2.2 | 2.8 | 1.4 | 3.0 | May impair attention, short-term memory, information processing |
11 | 1.9 | 2.9 | 1.9 | 1.8 | 1.1 | 2.3 | None reported |
12 | 2.7 | 3.1 | 2.1 | 2.9 | 1.7 | 3.2 | None reported |
13 | 1.7 | 1.4 | 1.9 | 2.0 | 1.3 | 2.0 | None reported |
14 | 3.5 | 3.4 | 2.2 | 3.4 | 1.4 | 3.5 | Increased anxiety if around others |
15 | 2.7 | 2.3 | 1.7 | 2.0 | 1.1 | 2.5 | None reported |
16 | 2.2 | 3.0 | 1.7 | 1.5 | 1.0 | 2.3 | None reported |
17 | 3.0 | 3.0 | 2.0 | 2.5 | 1.2 | 2.8 | Higher doses cause wheezing and the sensation of being “high” |
18 | 3.2 | 3.4 | 2.1 | 2.0 | 1.1 | 3.5 | Higher doses cause sleep problems, confusion, and “high” sensation |
19 | 2.6 | 2.6 | 2.3 | 2.4 | 1.3 | 2.8 | Feels “high” sometimes |
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