Dear Alice,

A friend of mine has an essential tremor disorder. She smokes weed almost everyday because she said it helps her to stop shaking. She tried all kind of medicines doctors have prescribed her, and botox and acupuncture. None of them helped her. Any advice?

— very concerned about my friend

Dear very concerned about my friend,

Your friend is lucky to have someone who deeply cares for them and even reaches out for advice on their behalf. Recently, the medical community has become increasingly interested in the use of marijuana as a potential treatment for essential tremor disorder; however, the jury is still out on whether or not it’s safe and effective. While marijuana may offer some people relief (as your friend reports with her use), it might exacerbate tremors in other people or offer no relief at all. Yet, regardless of whether or not marijuana safely treats tremors, it also comes with its share of desirable and undesirable health effects (more on those in a bit!). As such, it may be helpful for your friend to visit her health care provider to talk about any alternative treatment options that may work for her.

Before jumping into advice for your friend, it may help to start off with some basics on essential tremor disorder and existing treatments. Essential tremor is a neurological disorder that causes involuntary and rhythmic shaking and is a symptom of multiple conditions. Typically, tremors begin on one side of the body and gradually spread across it to the remaining limbs. Half of all essential tremor cases arise due to a genetic mutation, while the other half arise from a non-genetic mutation. The genetic variety is observed in people with parents who also had a mutated or defective gene, whereas the non-genetic variety is commonly randomly observed in people ages 40 and older. Yet, regardless of the cause of the tremor, the treatments are typically the same. Current treatments include beta-blocker medications, anti-seizure medications, tranquilizers, and onabotulinumtoxinA (brand name: Botox) injections. Additional treatments include physical or occupational therapies and, in severe cases, deep brain stimulation surgery.

Unfortunately, both the symptoms of essential tremor and the search for a suitable treatment option may be increasingly frustrating and tiring to handle. While essential tremor isn’t life-threatening, tremors might interfere with daily activities and make even the “simplest” of tasks (such as eating with both hands or holding a glass of water) feel like a chore. On days when tremors are triggered by emotional stress, fatigue, caffeine, or extreme temperatures, some daily tasks may seem impossible. In some cases where medications have either resulted in unpleasant sides effects or haven’t provided a desirable solution, people have turned to marijuana as an alternative treatment to tremors.

With marijuana’s classification as a Schedule I drug and the numerous restrictions on related research, many researchers face difficulty investigating its potential medical benefits. However, the minimal existing research has been optimistic for marijuana use with essential tremors, with one study showing that 9-tetrahydrocannabinol (also called THC, which is a compound found in marijuana) may improve handwriting in people with tremors. That said, no studies have confirmed that marijuana treats tremors. In fact, the American Academy of Family Physicians (AACP) argues that marijuana use may actually cause tremors and decrease coordination. Though your friend has already turned to marijuana for tremor-relief, it’s crucial that she speaks with her health care provider before continuing to pursue it as a treatment method. While preparing for this conversation, she might journal symptoms experienced and other key personal information, including stress levels, life changes, and any medications or drugs she's using. She might then use this journal to guide the conversation with the provider, to find appropriate forms of treatment and resources (including support groups).

Finally, it’s key to remind your friend that people may have complicated reactions to marijuana use — whether or not they experience tremors. Its complex chemical composition, as well as its effects on a person’s behavior, level of physical activity, and psychological well-being might reduce, exacerbate, or have no effect on their tremors. In the short-term, marijuana use may increase risk for heart palpitations, provide pain relief, and alter perceptions of time and space. In the long-term, a person may face greater risk for dependence and may negatively impact lung health. Furthermore, since marijuana appears to have a complicated relationship with mental health, marijuana may reduce, exacerbate, or induce symptoms of mental illnesses, such as depression, anxiety, and psychosis. Additionally, its use is illegal at the federal level and in most states in the US.

Ultimately, it may be best for your friend to turn to a health care provider on how to move forward with treatments for the tremors. If your friend hasn't found relief from the treatment options being provided by her current health care provider, you may want to suggest to her that she seek a second opinion from another provider who may be able to suggest other alternative treatments. If you're still looking for more information about marijuana use, consider checking out the Marijuana, Hash, & Other Cannabis category in the Go Ask Alice! Alcohol & Other Drugs archives.

Best of luck!

Alice!

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