Amyotrophic Lateral Sclerosis (ALS) and Medical Cannabis
Short answer · 1 minute read
Amyotrophic lateral sclerosis (ALS), also known as Lou Gehrig’s disease, slowly takes away the nerve cells that move the muscles. Medical cannabis is studied for the pain, stiffness, broken sleep and weight loss that come with it, not for the disease itself. Here is where the research actually stands.
- Not shownThat cannabis slows ALS or extends life in people. Those claims come from mice.
- Being studiedPain, spasticity, sleep and appetite, in small studies with limited answers so far.
- No differenceMuscle cramps: THC at 10 mg a day did no better than a placebo in a Cochrane review [1].
This guide draws on 15 published studies, and each one is labeled: study in people, review, or work in mice and cells. The full review starts at what studies in people found.
When ALS takes more than strength: pain, stiffness and sleepless nights
People expect the weakness. Fewer are warned about the rest: a calf that locks in the middle of the night, shoulders that ache because the muscles holding them have thinned, legs that turn stiff and heavy, meals that take an hour and still leave the scale lower each week. Sleep breaks up. Worry moves in, and it settles on the partner and the children as much as on the person with the diagnosis.
Then come the headlines. Search for CBD and ALS and you find bold promises that a family with appointments every week has no time to check. This page does that checking, symptom by symptom.
Cramps
Sudden, painful knots in a calf, foot or hand, often at night and often early in the disease. They come from nerve fibers firing on their own as they fail.
Stiffness
Spasticity, a constant tightness in the legs or arms, makes walking slow and stiff. It comes from damage to the upper motor neurons in the brain.
Pain
Aching joints, sore shoulders, cramp pain and pressure from sitting still. ALS itself does not hurt the nerves that feel pain, so the pain comes from what weakness does to the body.
Sleep
Cramps, trouble turning over, saliva and shallow breathing can all wake a person at night. Daytime tiredness then makes every task heavier.
Weight and eating
Chewing tires, swallowing turns risky and appetite fades, while the body burns more energy than before. Steady weight loss is a sign that the nutrition plan needs to change.
Worry
Anxiety and low mood are common after the diagnosis, for the patient and for the family. They deserve care of their own, not just a brave face.
Checked by licensed physicians, seen from home
- Every research figure carries a source you can open in the reference list.
- Each study is labeled: study in people, review, or work in mice and cells.
- Studies that found no benefit stay on the page and say so.
- Reviewed by physicians licensed in the states where we work, who also see patients from their own homes, with no trip to a clinic. Meet them.
Newly diagnosed, further along, or reading for someone: where to start
Pick the one closest to you and the guide points you to the parts that answer it.
You were diagnosed recently
Start with what ALS is and how it usually moves, then read what the research shows in people, kept apart from the mouse studies.
Cramps or stiffness are the hardest part
Cramps and spasticity are different problems with different evidence. The symptom table shows what was tested for each.
ALS is advanced, or hospice is involved
Comfort, sleep and calm become the goals. Breathing and sedation matter most here, and hospice programs have their own rules.
You are reading for a partner or parent
The patient takes part in the appointment and agrees to any plan. You can sit beside them, help with speech and keep the medicine list ready.
When speaking or typing is hard · Preparing for the appointment
You already have a card
Renewal means a fresh evaluation, and moving or traveling changes which rules apply.
What is amyotrophic lateral sclerosis (ALS)? Definition, meaning and pronunciation
Amyotrophic lateral sclerosis (ALS) is a progressive disease of the nervous system that destroys motor neurons, the nerve cells in the brain and spinal cord that carry the signal to move. As they die, the muscles they serve weaken and waste away, first in one limb or in speech, then spreading. In the United States it is also called Lou Gehrig’s disease, after the baseball player; in the UK the wider term motor neuron disease (MND) is used [3][4].
How to say it: am-ee-oh-TROH-fik LAT-er-ul skluh-ROH-sis.
A-myo-trophic
What it means
No muscle nourishment: muscles that lose their nerve supply shrink.
Lateral
What it means
The side columns of the spinal cord, where the affected nerve fibers run.
Sclerosis
What it means
Hardening: the scarring left in those columns once the fibers are gone.
Upper motor neurons
Where they are
In the brain, sending orders down the spinal cord.
What goes wrong
Stiffness, brisk reflexes, slow and clumsy movement.
Lower motor neurons
Where they are
In the brainstem and spinal cord, wired straight to the muscles.
What goes wrong
Weakness, twitching, cramps and muscle wasting.
Quick answers
How many people get ALS?
ALS is rare. A 2022 review puts it at about 1.75 to 3 people in every 100,000 [5]. It is most often diagnosed in people in their late fifties and sixties.
Is ALS chronic?
Yes. It is a chronic, progressive disease: it does not go away and it moves forward over months and years, at a speed that differs a great deal from one person to the next.
Does ALS affect thinking?
Most people keep a clear mind. Some develop changes in planning, language or behavior, and a smaller group has frontotemporal dementia (FTD) as well. That matters for cannabis, because THC can add to confusion.
Is ALS the same as motor neuron disease?
Motor neuron disease is the family name, and ALS is its most common form. In the UK the two terms are often used for the same illness [4].
ALS symptoms and stages: early signs to advanced disease
ALS rarely announces itself all at once. It starts in one place, often a hand, a foot or the voice, and the first signs are easy to blame on age or a sprain. Where it starts shapes the early months.
Limb onset, the more common start
- A weak grip: buttons, keys and jars get hard.
- Tripping, a foot that slaps the floor, trouble on stairs.
- Twitching under the skin (fasciculations) and cramps.
- Thinning of the muscles in the hand or shoulder.
Bulbar onset, in the muscles of the mouth and throat
- Slurred or nasal speech, a voice that tires.
- Coughing or choking on drinks and food.
- Extra saliva in the mouth, or drooling.
- Sudden laughing or crying that does not match the mood.
How ALS progresses
Doctors track the course with a questionnaire called the ALSFRS-R, which scores speech, swallowing, writing, walking and breathing. Families tend to think in three broad stages.
Early
Weakness in one area. Most daily tasks still go on, more slowly. This is the time to meet the ALS clinic team, plan ahead and talk about every symptom that bothers you, cramps included.
Middle
Weakness spreads. A cane, a wheelchair, a speech device or help with dressing come into the picture. Stiffness, pain and fatigue usually grow, and eating takes longer.
Advanced
Most muscles are very weak. Breathing needs support, often a mask at night (non-invasive ventilation), nutrition may go through a feeding tube, and communication relies on devices or eye-gaze boards. Comfort and hospice care move to the center.
Choose a stage to read what changes.
Pain, cramps, stiffness, sleep, appetite and drooling are the symptoms that come up most often when cannabis is discussed. What was tested for each.
What causes ALS? Is it genetic, and how do you get it?
For most people nobody can say. ALS is not contagious and is not caused by anything the person did. Doctors split it into two forms by whether it runs in the family.
Sporadic ALS
How common
Most cases, with no clear family history.
Typical age at onset
58 to 63 years [5].
Familial ALS
How common
About 5 to 10% of cases [5].
Typical age at onset
47 to 52 years, earlier than the sporadic form [5].
Genes named in ALS research
Choose a gene to see what it does, in plain words.
SOD1. Makes an enzyme that clears harmful oxygen by-products. Faulty versions clump inside motor neurons. Most ALS mouse models carry a human SOD1 mutation, and tofersen is a medicine aimed at this gene.
C9orf72. The most common genetic cause in families of European descent. A short stretch of DNA is repeated hundreds of times, and it can cause ALS, frontotemporal dementia or both in the same family.
TARDBP (TDP-43). Codes for a protein that handles genetic messages. Clumps of TDP-43 show up in the motor neurons of nearly everyone with ALS, even without a mutation, which is why TDP-43 mice are a second common model.
FUS. Another message-handling protein. Mutations are rare and often linked to an earlier, faster form of the disease.
What happens inside the nerve cells
- Too much glutamate, a signaling chemical, overexcites motor neurons until they wear out. hypothesis
- The brain’s immune cells (microglia) and support cells (astrocytes) turn from protective to inflamed. hypothesis
- Misfolded proteins such as TDP-43 and SOD1 stick together and choke the cell. hypothesis
Each idea has support, none explains every case, and the real answer is probably a mix. Inflammation and overexcitement are the two points where the body’s cannabinoid system comes in.
Can ALS be prevented? No proven method exists. Researchers are looking at genes, the environment and military service, but no habit, diet or supplement has been shown to stop ALS from starting, and cannabis has not been shown to prevent it either.
How is ALS diagnosed? Tests and the ICD-10 code G12.21
There is no single test for ALS. A neurologist builds the diagnosis step by step and rules out the conditions that look like it, several of which are treatable. That can take months, and the wait is one of the hardest parts.
-
History and exam
Where the weakness started, how it spread, reflexes, muscle tone and twitching.
-
EMG and nerve conduction
Small needles and electrical pulses show whether muscles have lost their nerve supply.
-
MRI and blood tests
To rule out a pinched spinal cord, thyroid problems, vitamin shortages and other look-alikes.
-
Criteria
Neurologists check the findings against agreed criteria, known as El Escorial and Gold Coast.
ALS has the ICD-10 code G12.21, within G12.2, motor neuron disease [6]. The F12 codes describe cannabis use and are a separate category with no connection to an ALS diagnosis. The code on a visit note helps a physician confirm the diagnosis at a medical card evaluation.
Could medical cannabis be worth raising for your ALS symptoms?
Fifteen short questions about the diagnosis, the symptom that bothers you most, breathing and the medicines you take. You get a plain summary of how that fits the research and what to take to a physician.
15 questions · about a minute · your answers stay in this browser
ALS vs multiple sclerosis: different diseases, different cannabis evidence
Both names end in “sclerosis”, both cause weakness and stiffness, and searches mix them up all the time. They are different diseases. Multiple sclerosis (MS) is an immune attack on the insulation around nerve fibers; ALS is the loss of the motor neurons themselves. The difference decides which research applies to you.
What is damaged
ALS
Motor neurons in the brain and spinal cord.
Multiple sclerosis
Myelin, the coating of nerve fibers, in patches.
Course
ALS
Steadily progressive.
Multiple sclerosis
Often relapses and recoveries, sometimes slow progression.
Senses and vision
ALS
Usually spared.
Multiple sclerosis
Numbness, tingling and vision problems are common.
How it is diagnosed
ALS
Exam and EMG; MRI mainly to rule other things out.
Multiple sclerosis
MRI lesions and spinal fluid tests.
Cannabinoid research
ALS
Few studies in people; cramps showed no difference [1].
Multiple sclerosis
A larger body of spasticity research of its own.
Multiple sclerosis and medical cannabis · Medicinal cannabis and MS
ALS life expectancy and prognosis: what the numbers mean
This is the question many people search for first and dread reading. The honest answer has two parts: a typical range, and a wide spread around it.
Some people live much longer. The physicist Stephen Hawking lived for decades with a slowly progressing motor neuron disease, which is rare, but it shows how far apart two courses can be. What tends to shape the outlook:
- Where it starts: bulbar onset often moves faster than limb onset.
- Breathing strength, and whether breathing support is used.
- Weight: steady weight loss is linked to a faster course, which is why nutrition is planned early.
- Age at onset and how fast the first symptoms spread.
Palliative care is not only for the last weeks. It can start at diagnosis, alongside every other treatment, to keep symptoms and worries under control. Comfort care and hospice.
How is ALS treated today? Riluzole, edaravone, tofersen and symptom care
No treatment cures ALS. A few medicines aim at the disease and a larger toolkit eases what it does. Cannabis, if it is used at all, sits next to this care and never replaces it.
Medicines aimed at the disease
Care for symptoms
- Baclofen or tizanidine for spasticity.
- Medicines and stretching for cramps.
- Drugs that dry up excess saliva.
- Pain medicines, from simple ones to opioids late in the disease.
Breathing, nutrition and communication
- Non-invasive ventilation (NIV), a mask that supports weak breathing muscles.
- A feeding tube (gastrostomy) before weight loss gets severe.
- Speech therapy and communication devices, set up early.
- A multidisciplinary ALS clinic that brings these together.
Is medical cannabis worth raising with your ALS team?
For some symptoms, yes, as a question. Expect a conversation about comfort: easing pain, stiffness, sleep or appetite for some people. Do not expect it to slow the disease, and do not expect a quick fix for cramps, where the one placebo-controlled THC trial found no difference.
Worth raising if
- Pain, stiffness, sleep or weight still trouble you with the usual care.
- You can show the physician your whole medicine list.
- Someone can help keep track of doses and effects.
- Your state’s program covers ALS or a related condition.
Not the right step if
- The hope is to slow or stop the disease.
- Breathing has changed and nobody has checked it yet.
- There is a past history of psychosis.
- It would replace treatment you already have.
Why cannabis comes up in ALS: the endocannabinoid system and motor neurons
Because the body runs its own cannabinoid system, and ALS changes it. That is the scientific reason researchers keep testing these compounds, mostly in mice so far.
-
What the system does
The endocannabinoid system is a set of signaling molecules made by the body, such as anandamide, and the receptors they bind to. CB1 receptors sit mostly on nerve cells; CB2 receptors sit on immune cells, including microglia, the brain’s own immune cells.
-
What changes in ALS
In the leg muscles of ALS model mice, CB1 receptors rose by 93% and anandamide by 37.3% compared with healthy mice, before the nerve decline was obvious [11]. in mice
-
Why researchers test cannabinoids
Calming inflamed microglia through CB2, or keeping more anandamide by blocking FAAH, the enzyme that breaks it down, might protect motor neurons. hypothesis
Which cannabinoids appear in ALS research
Three groups turn up in the studies, and they are not the same thing. THC produces a high; CBD does not, but it changes how the liver handles other drugs. Prescription capsules are medicines with an exact dose. Research compounds exist only in the lab.
| Substance | What was studied in ALS | Type of study |
|---|---|---|
| Dispensary products, with a medical card where state law allows | ||
| THC | Muscle cramps, 10 mg a day against placebo; no difference [1]. | Trial within a Cochrane review |
| CBD | A high-CBD, low-THC extract to slow progression; the trial plan was published, not its results [12]. CBD with cannabigerol protected motor neuron cells in a dish [13]. | Trial protocol; cell study |
| THC with CBD (oromucosal spray) | Spasticity in patients at one ALS center [14]. | Real-world cohort, no placebo group |
| Prescription medicines, filled at a pharmacy, not bought with a card | ||
| Dronabinol (Marinol, Syndros) | No ALS trial cited here. FDA-approved for weight loss in AIDS and for chemotherapy nausea, not for ALS [15]. | None cited |
| Nabilone (Cesamet) | No ALS study cited here. Approved for chemotherapy nausea. | None cited |
| Cannabidiol (Epidiolex) | No ALS study cited here. Approved for rare forms of epilepsy [16]. | None cited |
| Research compounds, lab only | ||
| CB2 agonists (AM-1241 and others) | Survival and motor neurons in SOD1 and TDP-43 mice [17][18]. | Animal studies |
| FAAH inhibitors (PF-04457845, URB937) | Survival and muscle changes in SOD1 mice [19][11]. | Animal studies |
Nothing matches this filter.
What studies in people found · How the endocannabinoid system works
What studies in people found, from strongest to weakest
In short: studies of cannabinoids in people with ALS are few and small. The one placebo-controlled THC result, for cramps, found no difference, and every report of longer survival comes from mice.
A randomized trial, where people are assigned by chance to a treatment or a placebo, can tell whether something helps. A study that only follows patients can show a link or describe experience. A mouse experiment can show a mechanism. The table puts what exists for ALS on each rung.
| Level | What exists for ALS | What it can and cannot tell you |
|---|---|---|
| Trials and reviews in people | A Cochrane review of cramp treatments that includes one THC trial [1]; a 2025 systematic review of cramp pain [2]; the plan of a CBD-extract trial [12]. | Can show an effect on one symptom; so far too small to show a benefit. |
| Studies that follow patients | Real-world use of a THC:CBD mouth spray for spasticity at one center [14]. | Describes experience; with no placebo group it cannot prove an effect. |
| Animal and lab work | CB2 and FAAH studies in SOD1 and TDP-43 mice; CBD in motor neuron cells [18][19][13]. | Explains why scientists are interested. Says nothing yet about patients. |
Cramps: the one result in people with a number
The same review shows how hard cramps are to treat in ALS at all. Nothing it looked at gave a clear benefit, cannabis or not.
What else was tried for ALS cramps in the same review Background, not cannabis
| Treatment against placebo | What was measured | Result (95% range) |
|---|---|---|
| THC 10 mg a day | Cramp intensity | 0.24 points (-0.31 to 0.79), no clear difference [1] |
| L-threonine 2 g a day | Cramp intensity | -12.61 points (-26.94 to 1.72), no clear difference [1] |
| Vitamin E 1 g a day | Cramp intensity | 3.7 points (-2.01 to 9.41), no clear difference [1] |
| Memantine 20 mg a day | Cramps | Risk ratio 0.86 (0.33 to 2.24), no clear difference [1] |
| Creatine 5 g a day | Cramps as a side effect | Risk ratio 0.55 (0.24 to 1.27), no clear difference [1] |
| Indinavir 800 mg a day | Cramps as a side effect | Risk ratio 2 (0.19 to 20.55), no clear difference [1] |
Each line used its own scale, so the numbers are not comparable with each other; what they share is that every range crosses “no difference”.
Pain, spasticity and a trial still to report
The 2025 systematic review of cramp pain found 9 studies with 233 participants and judged the evidence weak, with mixed results across very different treatments [2]. One ALS center described how its patients used a THC:CBD mouth spray for spasticity; patients reported benefit, but nobody was given a placebo for comparison, and some needed a relative’s help to use the spray because of weak hands or difficulty opening the mouth [14]. The EMERALD trial was designed to test whether a high-CBD, low-THC extract slows ALS against placebo; the published paper is its plan, so its answer is still open [12].
What kinds of studies is this evidence built on?
How to read it: one row per type of published study on cannabinoids and ALS; a longer bar means more studies of that type. The strongest designs are listed first. Gray bars, marked background, are reviews, animal work and lab work: useful for ideas, unable to show whether patients benefit.
Show as a table
| Design | Studies |
|---|---|
| Meta-analyses | 2 |
| Systematic reviews | 2 |
| Randomized trials | 2 |
| Crossover randomized trials | 1 |
| Other clinical trials | 3 |
| Cohort studies | 4 |
| Case-control studies | 3 |
| Cross-sectional studies | 1 |
| Surveys | 3 |
| Case reports | 1 |
| Narrative reviews (background) | 16 |
| Animal studies (background) | 24 |
| Cell and lab studies (background) | 9 |
| Who was studied | Studies |
|---|---|
| People given a treatment | 9 |
| People observed, not treated | 30 |
| Whole populations | 2 |
| Animals | 6 |
| Cells and molecules | 9 |
| Research methods | 1 |
| Not classified | 14 |
Browse the studies yourself
Each card is one of the papers this guide cites, in a sentence or two. Papers that found nothing, or that are mostly about something other than cannabis, stay in the list and carry a label.
Treatments for cramps in ALS
THC 10 mg a day did not ease cramps more than placebo, and no other treatment gave a clear benefit either [1].
Managing cramp pain in ALS
Pain affects about 70% of people with ALS; the treatment studies were small and at high risk of bias [2].
The EMERALD trial plan
Designed to test a high-CBD, low-THC extract against placebo for slowing ALS; asks patients to stop driving and keeps out people with serious kidney, heart or liver disease [12].
THC:CBD spray for spasticity
Patients described their experience with the mouth spray; there was no placebo group, and weak hands could make the spray hard to use alone [14].
Cell receptors as ALS targets
Reviews receptor targets, cannabinoid ones included, and reports survival, onset and riluzole figures used on this page [5].
Could cannabinoids help in ALS?
Summarizes the antioxidant and anti-inflammatory ideas from lab work and the thin clinical data, with mixed conclusions [20].
Muscle changes before nerve decline
Leg muscles of ALS mice showed more CB1 receptors and more anandamide early in the disease; blocking FAAH outside the brain did not improve survival or movement [11].
Blocking FAAH in ALS mice
The inhibitor PF-04457845 lengthened median survival from 129.5 to 138 days; blood samples from 26 and 55 patients were analyzed alongside [19].
CB2 activation outside the brain
CB2 agonists preserved motor neurons and calmed glial cells in SOD1 and TDP-43 mice, even one that does not enter the brain [18].
Losing CB2 speeds the decline
TDP-43 mice without CB2 receptors lived a median 113 days against 176 days with them [21].
A stress protein and ALS
Lower levels of the protein BiP made ALS mice decline faster; CB1 signaling was part of the picture [22].
Inflammation that helps, then harms
Support-cell signaling protected nerves early and turned harmful later, so timing matters for any anti-inflammatory approach [23].
Receptor shifts before symptoms
Before symptoms, spinal motor neurons of ALS mice carried 84.5% more CB1 receptors than normal [24].
A CB2 agonist started at symptom onset
AM-1241 lengthened the survival interval of ALS mice by a factor of 1.56 [17].
CBD with cannabigerol in motor neuron cells
Pre-treatment lowered inflammation, oxidative stress and cell death in a dish [13].
No studies of this type are cited here.
Cramps, spasticity, pain, sleep, appetite: symptom by symptom
Two words get mixed up most. A cramp is a sudden painful knot that lasts seconds to minutes and comes from failing lower motor neurons. Spasticity is a constant stiffness that comes from damaged upper motor neurons. They need different treatments and have different evidence. Pick a symptom to see what was tested.
| Symptom | What was tested | Type of study | What came out | How strong |
|---|---|---|---|---|
| Cramps | THC 10 mg a day against placebo | Trial in a Cochrane review | No difference in cramp intensity [1] | One small trial; very low certainty |
| Spasticity | THC:CBD mouth spray in everyday use | Real-world cohort, one center | Patients reported benefit; no comparison group [14] | Low |
| Pain | Drug and non-drug treatments for cramp pain | Systematic review, 9 studies [2] | Pain in about 70%; mixed results; no cannabis trial for pain itself [2] | Low |
| Sleep | No study in people cited here | None | Unknown in ALS | No data |
| Appetite and weight | No study in people cited here; muscle wasting studied in mice [11] | Animal only | Unknown in people | No data in people |
| Drooling | No study in people cited here | None | Unknown in ALS | No data |
Nothing matches this filter.
“No study” is an answer too: it means the physician has no ALS data to lean on for that symptom and will weigh general experience against your medicines and breathing. Feeling sleepy is also not the same as sleeping better; see cannabis and sleep.
What labs see: animal and cell studies, not data about people
A CB2 agonist at symptom onset
AM-1241 lengthened the survival interval of SOD1 mice 1.56-fold [17]; a later review describes this as a 56% gain [5].
Without CB2, decline came sooner
TDP-43 mice lacking CB2 lived a median 113 days, against 176 days, and lost balance by 7 weeks instead of 11 [21].
CB2 activation outside the brain
Agonists that stay outside the brain still preserved motor neurons and reduced glial reactivity in SOD1 and TDP-43 mice [18].
An FAAH inhibitor and survival
PF-04457845 raised the body’s own cannabinoid-like molecules and lengthened median survival by 8.5 days, 138 against 129.5 [19].
Muscle remodeling
A fast leg muscle lost 76.5% of its weight against 14.4% for a slow one, with CB1 up 93%; blocking FAAH outside the brain changed neither survival nor movement [11].
CBD with cannabigerol
In motor neuron-like cells, the two together reduced inflammation, oxidative stress and cell death [13].
Nothing matches this filter.
Why mouse results don’t transfer
Most ALS mice carry a single human mutation and get sick on a fixed schedule; most people have sporadic ALS with no known cause. Several of these studies used only male or only female mice, and treatment often started at a precise age that a patient cannot match. Gains of a few days in a mouse that lives about four and a half months do not translate into months for a person. That is why the trials in people matter, and why they still need to be done.
What science doesn’t know yet
The gaps are larger than the findings, and it is fairer to say so plainly.
- Whether any cannabinoid eases pain, spasticity, sleep or appetite in ALS: the studies in people are few, small and mostly without a placebo group [2].
- Whether cannabis changes the course of ALS or survival in people: no study shows it.
- How cannabinoids mix with riluzole, edaravone or tofersen: none of the studies cited here tested it.
- Long-term use, and which forms work when swallowing is impaired or nutrition goes through a feeding tube.
- How cramps behave over time without treatment, which makes any cramp result harder to judge [1].
- Whether mouse results hold for both sexes: several studies tested only one [11][18].
How to read a headline about cannabis and ALS
- Was it people, mice or cells?
- Was there a placebo group?
- How many patients, and for how long?
- Which product and dose, and can you actually get it?
Forms of cannabis when swallowing and breathing are affected
Cannabis is not only smoked. Medical products are also eaten, swallowed as capsules, dropped under the tongue, sprayed into the mouth, rubbed on the skin or worn as a patch. In ALS, weak breathing muscles, risky swallowing and weak hands change how each form looks. Some risks belong to one form; others come with every form. None of this recommends a form: that choice is made with a physician.
Which form are you asking about?
The card that applies to every form stays in view; choosing a form adds what is specific to it.
Applies to every form
THC acts on the brain however it enters the body: drowsiness, dizziness, slower reactions and, in some people, anxiety or confusion. CBD and THC both pass through the liver and can change other medicines. No driving after any form.
Smoking or vaping
What it avoids
Swallowing; it acts within minutes.
What remains
Smoke and hot vapor reach airways that weak breathing muscles already struggle to clear, and they do not mix with a breathing mask.
Edibles and capsules
What it avoids
The lungs.
What remains
Effects start late and last long; a second dose “because nothing happened” is a common cause of taking too much. Solid food and capsules need safe swallowing, and everything passes the liver first.
Under the tongue or mouth spray
What it avoids
The lungs, and most of the swallowing.
What remains
Part is still swallowed. With weak hands or a jaw that opens poorly, a relative may need to help with the spray [14].
Skin and patches
What it avoids
Lungs and swallowing.
What remains
Creams act mostly where they are applied. Transdermal patches carry cannabinoids into the blood, so their effects reach the whole body.
Suppositories
What it avoids
Lungs and swallowing.
What remains
Rarely used and little studied; whole-body effects still apply.
Prescription cannabinoids
What it avoids
Guesswork about the dose: dronabinol, nabilone and Epidiolex have an exact dose.
What remains
They are prescribed and filled at a pharmacy, not bought with a card, and none is approved for ALS [15][16].
With a feeding tube, nothing should go down the tube unless the physician and the team who placed it agree: oils can stick to the tube and doses change.
Show as a table
| Form | What it avoids | What remains |
|---|---|---|
| Smoking or vaping | Swallowing | Smoke or vapor on weak airways; not with a breathing mask |
| Edibles and capsules | Lungs | Late, long effect; risk of repeat dosing; safe swallowing needed; liver |
| Under the tongue or spray | Lungs, most swallowing | Part swallowed; may need help with weak hands |
| Skin and patches | Lungs, swallowing | Patches act on the whole body |
| Suppositories | Lungs, swallowing | Little studied; whole-body effects |
| Prescription cannabinoids | Uncertain dose | Pharmacy only; not approved for ALS |
Is cannabis safe with ALS? Side effects, falls and who should not use it
The side effects of THC are the same in ALS as in anyone. What changes is how much they cost: a little unsteadiness matters more on weak legs, and a little sedation matters more when breathing muscles are tired.
Drowsiness
THC and many ALS medicines make people sleepy. Together they can turn a calm evening into a groggy day.
Dizziness
Light-headedness, especially on standing up, is one of the most common complaints with THC and can come before a fall.
Falls with weak legs
Weakness and stiffness already raise the risk of falling. Any added unsteadiness, from any medicine, raises it further.
Breathing and sedation
Sedating substances can make breathing shallower, which matters once breathing muscles are weak or a mask is used at night.
Thinking changes
Where ALS comes with frontotemporal changes, THC can add confusion, poor judgment or anxiety. Tell the physician about any change in behavior.
Driving
Stop driving and operating machinery when taking cannabis; the EMERALD trial plan asked the same of its patients [12].
When to call a doctor right away
- Breathlessness at rest, morning headaches or confusion on waking, which can mean breathing is failing at night.
- Choking followed by a fever or cough, which can be a chest infection.
- A fall with a blow to the head, or a fall while on sedating medicines.
- Fainting, chest pain, a racing heartbeat, or sudden confusion after any new product.
Who should not use cannabis for ALS symptoms
Some people face risks that outweigh a possible benefit. The trial planned for ALS kept several of these groups out on purpose [12].
- Anyone with a past psychosis, schizophrenia or bipolar disorder.
- People with serious heart disease, including a weak heart pump (an ejection fraction below 35% was an exclusion in the trial) [12].
- People with severe kidney disease (eGFR below 30) or a badly inflamed liver (liver enzymes over five times normal) [12].
- Anyone who is pregnant or breastfeeding.
- Anyone who would use it in place of breathing support, nutrition or prescribed medicines.
Drug interactions: opioids, sleep aids, baclofen and riluzole
For someone with ALS, the medicine list often matters more than the diagnosis. Below is what the studies recorded, labeled by the kind of evidence behind it. It is not a full list, and the physician checks each medicine by name.
What is on your medicine list?
Tap everything you take; the matching entries open below.
Opioids, alcohol and sleeping pills clinical data
The EMERALD trial plan tells patients to avoid opiates, alcohol and sleep medicines because their effects add up with cannabis [12]. Together they deepen sleepiness, slow reactions and can make breathing shallower. Read more on mixing cannabis and Xanax.
Benzodiazepines such as lorazepam no study cited
Often used for anxiety, breathlessness or sleep late in ALS. No ALS study cited here tested them with cannabis, but both are sedating, so the physician will expect the combination to add up.
Baclofen and tizanidine no study cited
Both treat spasticity and both cause drowsiness and weakness on their own. Added sedation, a softer grip and wobbly legs are the things to watch; no study cited here measured the combination.
Several sedating medicines with weak breathing no study cited
Each sedating drug on its own may be fine. Stacked together, at night, with weak breathing muscles, they can lower breathing. Bring the breathing test results and any mask settings to the appointment.
Riluzole no study cited
Riluzole is cleared by the liver and needs liver blood tests. CBD and THC are processed by liver enzymes too. No study cited here tested them together, which is exactly why the prescribing neurologist should know before anything is added.
Edaravone and tofersen no study cited
There are no data on combining them with cannabinoids. Tell the team that runs the infusions or injections about any product you start.
No entries match this filter.
Questions to ask about the medicine list
- Which of my medicines already cause drowsiness, and would anything new add to it?
- Does anything on the list affect breathing at night?
- Which liver tests am I due, and should they be checked after a change?
- Who needs to know if a cannabinoid is started: the neurologist, the ALS clinic, the pharmacist?
Advanced ALS, palliative care and hospice: where cannabis fits
As ALS advances, the goals of care shift toward comfort: easing pain and stiffness, protecting sleep, calming anxiety and breathlessness. Palliative and hospice teams are expert at exactly this, and cannabis, where it is used, is one more thing to discuss with them, never a replacement for their plan. Where the person lives changes the rules.
Care at home
Home is where state law and the medical card apply most simply. Keep products locked away from children and visitors, write down each dose and the time, and share the log with the palliative team.
A hospice program
Hospice nurses and doctors manage pain, breathlessness and anxiety with their own medicines. Programs differ on cannabis: some will note it and watch for interactions, some will not be involved. Ask the team directly, so that sedation from two sources is not missed.
A nursing home or care facility
- Ask for the facility’s cannabis policy in writing before bringing anything in.
- Ask where products would be stored and who would give them.
- Give the nurses the full medicine list so they can watch for sleepiness and breathing changes.
When speaking or typing is hard
The evaluation is of the patient, who takes part and agrees to any plan, even when speech is slow or relies on a device. A family member can sit beside them, help with dates and the medicine list, and type if hands are weak. Tell the physician at the start about speech or breathing limits so the appointment goes at the patient’s pace.
What this means if you are considering it
Set expectations first. Cannabis might take the edge off one or two symptoms for some people. It will not rebuild strength or change the course of ALS, and everything already prescribed stays in place. A useful evaluation focuses on one or two symptoms, the full medicine list, breathing and swallowing, and a clear picture of what better would look like.
Keep a short symptom diary
- Cramps: how many a day or night, and how long they last.
- Stiffness: when it is worst and what it stops you doing.
- Pain: where, and a score from 0 to 10.
- Sleep: how often you wake and why.
- Weight, once a week.
What to bring to the appointment
Tap each item once it is ready. Nothing is saved.
Questions for your neurologist
- Which of my symptoms might a cannabinoid reasonably be tried for, and which not?
- THC, CBD or a mix, and why that choice for me?
- How would we know within a few weeks that it helps, or that it does not?
- Which signs mean stop at once?
This guide summarizes published research for education and does not replace your neurologist or ALS team. Cannabis has not been shown to slow ALS in people.
Is ALS a qualifying condition for a medical marijuana card?
In many states, yes: ALS is one of the conditions named most often on medical cannabis lists. Each program writes its own list, though, and the physician must match the diagnosis in your records to that wording. Lists change, so the version in force on the day of the evaluation is the one that counts.
Listed by name
Your state names ALS
The plainest case. A clinic note recording the diagnosis is what the physician needs.
Broader wording
Covered another way
Some lists say “debilitating condition”, “chronic pain” or “severe muscle spasms” instead. They still need a diagnosis on record.
Not on the list
Neither appears
Your state may not offer a card for this. Some allow physician discretion; others accept petitions to add conditions.
What else has a doctor diagnosed?
Programs list diagnoses, not symptoms. Choose anything already in your medical records.
Chronic pain. Listed in many states. See chronic pain and medical cannabis.
Muscle spasms. Severe or persistent spasms appear on several lists. See muscle spasm and medical cannabis.
Insomnia. Some programs list it. See insomnia and medical cannabis.
Anxiety or depression. A few lists include them or broader wording that covers them. See anxiety and depression.
None. Then everything turns on how your state words its list. Start with your state’s rules.
All qualifying conditions are listed in one place.
Medical cannabis rules by state: legal status, possession limits, taxes, home cultivation
Four things change most between states: whether only medical use is legal or adult use too, how much a patient may buy and keep, whether patients skip part of the cannabis tax, and whether patients may grow plants at home. Where adult-use sales are legal, adults can buy without a card, but a card still changes a few things.
Taxes
With a medical card
Often lower; some states drop part of the cannabis tax for patients.
Buying recreationally
The full state and local cannabis tax.
How much you can buy and keep
With a medical card
Often more, by state rule.
Buying recreationally
The adult-use limit.
Who can buy
With a medical card
Patients at medical dispensaries, in medical-only states too.
Buying recreationally
Only in adult-use states, above the age limit.
Home cultivation
With a medical card
Allowed for patients in some states, with a plant limit.
Buying recreationally
Allowed for adults in some adult-use states.
A physician’s review
With a medical card
Your diagnoses and medicines are looked at by a licensed physician.
Buying recreationally
None.
How much a card could save depends on your state’s tax rates and how much you buy, so this page does not guess a number. The tax side is laid out in medical vs recreational cannabis taxes, and your state’s page has its current rates and limits.
States where our physicians see patients. Each state’s page keeps its current condition list, limits, patient taxes and home-grow rules.
Medical marijuana laws by state · Which states accept out-of-state cards
Legal protections: firearms, employment and privacy
A card makes cannabis legal under state law for the patient. It does not change federal law or every rule an employer, a gun dealer or the motor vehicle department follows. Pick a topic.
Driving
Driving under the influence of cannabis is illegal in every state, card or not. With ALS the question of driving often comes up earlier anyway, as weak hands or slow foot movement change reaction times.
Firearms
Cannabis is still a controlled substance under federal law, and federal law bars people who use a controlled substance unlawfully from buying or owning firearms [25]. A state card does not change that.
Work
States differ widely in whether they protect card holders from being fired or refused a job, and federal and safety-sensitive jobs follow stricter testing rules. Your state’s page on laws and regulations covers it.
Privacy
The evaluation creates a medical record protected by the federal HIPAA Privacy Rule [26]. State patient registries are confidential, and in most states a dispensary or officer can confirm only that a card is valid. The diagnosis is not printed on the card.
How to get a medical card with ALS online
The whole evaluation happens from home, which matters when getting to a clinic takes half a day and a wheelchair van. Only the first two steps need you at a screen.
-
About 5 minutes
Fill in the short form
Your state, diagnoses and current medicines, plus the neurologist’s note if you have it. Someone can type for you.
-
About 15 minutes
See a physician licensed in your state
One-on-one and online. You settle the start time with the physician, who can run late with an earlier patient, so plan on an hour around it.
-
In as little as 15 minutes after the appointment, depending on your state
Receive the signed recommendation
If the physician decides cannabis is appropriate, the document appears in your account.
-
Timing set by the state
Register with the state
Registry states issue the card themselves, on their own schedule.
Who runs the appointment
Across 250 reviews from patients in the states where we are licensed. We do not sort them by score and do not hide the low ones.
- 150,000+patients evaluated – everyone who has been through an appointment with us, in every state where we are licensed
- Since 2017doing only this: online evaluations for medical cannabis programs, and nothing else on the side
Every appointment is with a physician licensed in the patient’s state; they are listed on our doctors page, and the full process is on how the medical card works.
What happens after the appointment
The physician’s decision
Made at the appointment and never promised beforehand.
In your account
The signed document waits in your account to download or print; to move a booking, use your appointments.
State registration
Where your state runs a registry, you send the recommendation there; your state’s rules list what it needs.
At a dispensary
With the card or recommendation your state accepts and a photo ID, you buy lab-tested, labeled products at a licensed dispensary.
Renewing your card as ALS progresses
Renewal means a fresh evaluation, and with ALS that is useful: strength, breathing, swallowing and medicines change over a year, and the physician should hear what changed. If symptoms shift sharply before the date, book a review sooner.
Renewing from home
Book before the card expires and bring an updated medicine list. State renewal pages are in the state lookup; the medical card FAQ answers the common questions.
If the card is lost
The program that issued it replaces it, usually through its own portal. Steps for a lost medical card.
What’s included in the price
Two fees can be involved, and they go to different places.
| Fee | Paid to | When you see it |
|---|---|---|
| Evaluation fee | Dr. Weedy, for the review and the appointment with a licensed physician | On screen at checkout; nothing is added later |
| State registration fee | The state program, not us | Only where the state runs a registry |
| Reduced-cost options | Programs for veterans and for people on a low income | Check before you start |
Whether a recommendation is issued is the physician’s medical decision. What happens to the fee if it is not is set out in the medical card FAQ, so you can read it before paying.
Who wrote and reviewed this page
This guide was written by the Dr. Weedy editorial team and checked by the Dr. Weedy medical team, physicians licensed in the states where we work; their names and licenses are on our doctors page. The update and review date sits under the buttons at the top.
- Every research figure carries a citation to a study in the reference list at the end.
- Each study is labeled by type, so a mouse result is never shown as a result in patients.
- Studies that found no benefit stay on the page and say so.
- Nothing here promises an outcome; that is decided at an appointment with a licensed physician.
Spotted something wrong or out of date? The feedback form at the end of this page goes straight to the editors.
Amyotrophic lateral sclerosis and medical cannabis: FAQ
Is amyotrophic lateral sclerosis chronic?
Yes. ALS is a chronic, progressive disease of the motor neurons. It does not go away, and how fast it moves differs a lot from person to person.
Is ALS genetic, and how do you get it?
About 5 to 10% of cases run in families [5], often through genes such as SOD1 or C9orf72. The rest are sporadic, with no known cause. ALS is not contagious. More in what causes ALS.
Can ALS be prevented?
No proven way exists, and cannabis has not been shown to prevent it.
How many people have ALS?
A 2022 review puts it at about 1.75 to 3 people per 100,000 [5]. It is rare, and most often starts between the late fifties and sixties.
What is the life expectancy with ALS?
Does cannabis help ALS cramps?
In the one placebo-controlled trial included in a Cochrane review, THC 10 mg a day did not ease cramps more than placebo [1]. Other forms and doses have not been tested in ALS.
Can CBD slow ALS?
Is ALS the same as MS?
No. MS attacks the coating of nerve fibers; ALS destroys the motor neurons. Cannabis research on MS spasticity does not carry over. See ALS vs MS and multiple sclerosis.
Is CBD different from THC for ALS?
Yes. THC causes the high and most of the sleepiness and dizziness; CBD does not cause a high but changes how the liver handles other drugs. Neither is proven for ALS symptoms, and the choice belongs to the physician who sees your medicine list.
Can I use medical cannabis in hospice?
It depends on the hospice and on where care happens. At home, state law and your card apply; facilities and programs set their own policies. Tell the hospice team so sedation is not doubled. More in hospice and comfort care.
Can someone sit with me during the appointment?
Yes. You take part and agree to any plan yourself, and a family member can sit with you to help with speech, typing and the medicine list. See when speaking or typing is hard.
What about delta-8 THC or CBD sold in stores?
Hemp-derived products are less tightly regulated than dispensary products, and labels may not match contents. Delta-8 acts much like ordinary THC, with the same sleepiness and interaction risks. If you are unsure what a product contains, ask for its lab certificate before you use it.
Where do I buy after I get the card?
At a licensed medical dispensary in your state, with the card or recommendation and a photo ID. Your document is in your account; how dispensary products differ is explained in medical vs recreational cannabis.
Can I use my card in another state?
Sometimes. Reciprocity, one state honoring another’s card, exists in some places only. Check which states accept out-of-state cards and traveling with cannabis.
What if my card is lost?
Ask the state program that issued it for a replacement. The steps are in what to do about a lost card.
Is an online evaluation legitimate?
Yes, in states whose law allows telemedicine for medical cannabis evaluations. The physician holds a license in your state, sees you one-on-one and signs the same recommendation an office visit would produce. See how the medical card works.
What is the ICD-10 code for ALS?
G12.21, within G12.2, motor neuron disease [6]. Cannabis use codes (F12) are a different category.
How much does it cost, and what if I’m not approved?
The evaluation price for your state appears at checkout; state program fees are separate. Approval is never promised. What happens to the fee in that case is in the medical card FAQ, and the fees are broken down in what’s included in the price.
More research on cannabis and amyotrophic lateral sclerosis
This page cites a selection of studies. Our research library holds every study we track on cannabis and amyotrophic lateral sclerosis, from laboratory work to clinical trials, and lets you filter them by cannabinoid, study type and year.
- studies
- 98
- in people
- 50
- clinical trials
- 6
Talk to a licensed physician about ALS and medical cannabis
What cannabis may do: take the edge off pain, stiffness or broken nights for some people, under a physician’s eye.
What it cannot do: slow ALS, restore strength, or replace the care you already have.
The appointment is from home with a physician licensed in your state, the fee for your state is shown at checkout, and the physician decides whether a recommendation is right.
Share your experience
References
28 sources
- 1. Treatment for cramps in amyotrophic lateral sclerosis/motor neuron disease. DOI: 10.1002/14651858.CD004157.pub2 PMID: 22513921
- 2. A Systematic Review of Management of Cramping Pain in Patients with Amyotrophic Lateral Sclerosis. DOI: 10.1159/000548820 PMID: 41042709
- 3. National Institute of Neurological Disorders and Stroke. Amyotrophic Lateral Sclerosis (ALS). 2025.
- 4. NHS. Motor neurone disease. 2025.
- 5. The Multifaceted Role of GPCRs in Amyotrophic Lateral Sclerosis: A New Therapeutic Perspective? DOI: 10.3390/ijms23094504 PMID: 35562894
- 6. Centers for Disease Control and Prevention, National Center for Health Statistics. ICD-10-CM: International Classification of Diseases, Tenth Revision, Clinical Modification. 2026.
- 7. U.S. Food and Drug Administration. FDA approves treatment of amyotrophic lateral sclerosis associated with a mutation in the SOD1 gene. 2023.
- 8. American Academy of Neurology. Clinical practice guidelines. 2026.
- 9. European Academy of Neurology. EAN guidelines. 2026.
- 10. National Institute for Health and Care Excellence. Motor neurone disease: assessment and management (NG42). 2019.
- 11. Early and Divergent Lipid Mediator Remodelling in Fast Versus Slow Skeletal Muscles of Female hSOD1G93A Mice. DOI: 10.1002/jcsm.70357 PMID: 42551865
- 12. Study protocol for a randomised, double-blind, placebo-controlled study evaluating the Efficacy of cannabis-based Medicine Extract in slowing the disease pRogression of Amyotrophic Lateral sclerosis or motor neurone Disease: the EMERALD trial. DOI: 10.1136/bmjopen-2019-029449 PMID: 31719072
- 13. Could the Combination of Two Non-Psychotropic Cannabinoids Counteract Neuroinflammation? Effectiveness of Cannabidiol Associated with Cannabigerol. DOI: 10.3390/medicina55110747 PMID: 31752240
- 14. Real world experience of patients with amyotrophic lateral sclerosis (ALS) in the treatment of spasticity using tetrahydrocannabinol:cannabidiol (THC:CBD). DOI: 10.1186/s12883-019-1443-y PMID: 31493784
- 15. U.S. Food and Drug Administration. Marinol (dronabinol) prescribing information. 2017.
- 16. U.S. Food and Drug Administration. FDA approves first drug comprised of an active ingredient derived from marijuana to treat rare, severe forms of epilepsy. 2018.
- 17. The CB2 cannabinoid agonist AM-1241 prolongs survival in a transgenic mouse model of amyotrophic lateral sclerosis when initiated at symptom onset. DOI: 10.1111/j.1471-4159.2006.04346.x PMID: 17241118
- 18. Relevance of a peripheral site of action outside the brain-blood barrier for the beneficial effects of CB2 receptor activation in experimental ALS in male mice. DOI: 10.1186/s12964-025-02418-2 PMID: 41074141
- 19. Fatty acid amide hydrolase inhibition for treatment of amyotrophic lateral sclerosis DOI: 10.1172/jci.insight.198842 PMID: 42275159
- 20. Can cannabinoids be a potential therapeutic tool in amyotrophic lateral sclerosis? DOI: 10.4103/1673-5374.197125 PMID: 28197175
- 21. Inactivation of the CB2 receptor accelerated the neuropathological deterioration in TDP-43 transgenic mice, a model of amyotrophic lateral sclerosis. DOI: 10.1111/bpa.12972 PMID: 33983653
- 22. BiP Heterozigosity Aggravates Pathological Deterioration in Experimental Amyotrophic Lateral Sclerosis. DOI: 10.3390/ijms222212533 PMID: 34830414
- 23. NF-κB activation in astrocytes drives a stage-specific beneficial neuroimmunological response in ALS. DOI: 10.15252/embj.201798697 PMID: 29875132
- 24. Altered presymptomatic AMPA and cannabinoid receptor trafficking in motor neurons of ALS model mice: implications for excitotoxicity. DOI: 10.1111/j.1460-9568.2008.06041.x PMID: 18279310
- 25. Legal Information Institute, Cornell Law School. 18 U.S. Code § 922: Unlawful acts. 2024.
- 26. U.S. Department of Health and Human Services. The HIPAA Privacy Rule. 2024.
- 27. ALS Association. Understanding ALS. 2026.
- 28. U.S. National Library of Medicine. ClinicalTrials.gov. 2026.