Cannabis Spray Reduces Spasticity in ALS: First Positive Trial
What Researchers Found About Als and Cannabis
The Study at a Glance
Published
The Lancet Neurology, 2019
Researchers
Italian Motor Neuron Disease Centers (Italy)
Study Type
Randomized Controlled TrialParticipants
59 patients · 6 weeks
Key Finding
Nabiximols had a positive effect on spasticity symptoms in patients with motor neuron disease and had an acceptable safety and tolerability profile. This is the first positive proof-of-concept trial for cannabinoids in ALS spasticity.
Key Finding: Nabiximols had a positive effect on spasticity symptoms in patients with motor neuron disease and had an acceptable safety and tolerability profile. This is the first positive proof-of-concept trial for cannabinoids in ALS spasticity.
What Researchers Studied About Als and Cannabis
Spasticity is a major cause of disability and reduced quality of life in patients with motor neuron disease (including ALS). Cannabinoids have been approved for spasticity in multiple sclerosis, raising the question of whether they might help ALS patients too.
This was a phase 2, randomized, double-blind, placebo-controlled trial conducted at four tertiary motor neuron disease centers in Italy.
The study investigated whether nabiximols (a mouth spray containing THC and CBD) could reduce spasticity in people with motor neuron disease.
How This Randomized Controlled Trial Was Conducted
Eligible patients were aged 18-80 years with amyotrophic lateral sclerosis (ALS) or primary lateral sclerosis. They had to have spasticity symptoms for at least 3 months and spasticity scores of 1 or greater in at least 2 muscle groups on the Modified Ashworth Scale.
60 participants were randomized: 29 to nabiximols, 30 to placebo, with 59 included in the final analysis.
Nabiximols was delivered as an oromucosal spray (each spray: 2.7 mg THC and 2.5 mg CBD). Patients self-titrated over 14 days up to a maximum of 12 sprays per day, then maintained that dose for 4 weeks.
The primary outcome was change in the Modified Ashworth Scale score after 6 weeks.
Als Treatment Results
The Main Results:
- 1Nabiximols group: spasticity scores IMPROVED by mean 0.11 points (SD 0.48)
- 2Placebo group: spasticity scores WORSENED by mean 0.16 points (SD 0.47)
- 3Difference between groups: -0.32 points favoring nabiximols (p=0.013)
- 4No participants withdrew from the double-blind phase
- 5No serious adverse effects occurred
- 6Nabiximols was well tolerated
By the Numbers
| Statistic | What It Means |
|---|---|
| 59 patients | Participants in the final analysis (29 nabiximols, 30 placebo) |
| -0.32 | Difference in spasticity scores favoring nabiximols over placebo (p=0.013) |
| 0% | Dropout rate during the double-blind phase (no withdrawals) |
| 12 sprays/day | Maximum allowed dose (each spray: 2.7mg THC + 2.5mg CBD) |
Participants in the final analysis (29 nabiximols, 30 placebo)
Difference in spasticity scores favoring nabiximols over placebo (p=0.013)
Dropout rate during the double-blind phase (no withdrawals)
Maximum allowed dose (each spray: 2.7mg THC + 2.5mg CBD)
What This Means for Als Patients
If you have ALS or another motor neuron disease and struggle with spasticity, this trial offers encouraging news. It is the first proof-of-concept study showing that nabiximols (a THC/CBD mouth spray) can help.
Patients who used nabiximols saw improvement in their spasticity, while those on placebo got worse. No one dropped out due to side effects, and no serious adverse events occurred.
However, this was a small trial (59 patients) over just 6 weeks. Larger, longer studies are needed before nabiximols can be recommended as standard treatment for ALS spasticity.
If spasticity significantly impacts your quality of life and current treatments are not working, discuss this research with your neurologist.
Quick Answers: Als and Cannabis
Direct answers based on the findings of this study:
Research Summary: Answers are based on published peer-reviewed studies and represent research findings, not medical recommendations. Individual results may vary. Always consult a healthcare provider before making treatment decisions.
Can medical marijuana help ALS symptoms?
Yes, for spasticity specifically. A 2019 Lancet trial found nabiximols (THC/CBD spray) improved spasticity in ALS patients vs placebo (p=0.013). This is the first positive proof-of-concept trial for cannabinoids in motor neuron disease.
Source: Riva et al., Lancet Neurology, 2019 (PMID: 30554828)
Is cannabis safe for people with ALS?
Well tolerated with no dropouts. In this 6-week trial, nabiximols was well tolerated with no serious adverse events. However, this was a small, short trial. Larger studies are needed to confirm long-term safety.
Source: Riva et al., Lancet Neurology, 2019 (PMID: 30554828)
What cannabis products help ALS spasticity?
Nabiximols is the only product studied. It is a mouth spray with 2.7mg THC and 2.5mg CBD per spray. Patients used up to 12 sprays daily and showed significant improvement vs placebo.
Source: Riva et al., Lancet Neurology, 2019 (PMID: 30554828)
This is educational content, not medical advice
The research summarized here is for informational purposes only. Individual results may vary, and what works in studies may not work the same way for everyone. Always consult with a qualified healthcare provider before making changes to your treatment plan or starting medical cannabis therapy.
Important Limitations
This study has some caveats to keep in mind when interpreting the results:
- Small sample size (59 patients)
- Short duration (6 weeks)
- Phase 2 proof-of-concept trial, not definitive phase 3
- Single country (Italy)
- Long-term efficacy and safety unknown
- Needs confirmation in larger trials
The Bottom Line on Cannabis for Als
This Lancet Neurology trial provides the first evidence that nabiximols (THC/CBD spray) can help spasticity in motor neuron disease patients. Spasticity improved in the treatment group while worsening in placebo, with good tolerability and no serious adverse events. While promising, this is a small proof-of-concept study. Larger trials are needed before this becomes a standard treatment option for ALS spasticity.
Do You Qualify for Medical Marijuana?
If you're living with Als, you may qualify for a medical marijuana card. Our licensed physicians can evaluate you from home via telehealth.
Related Research & Resources
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Source
Riva N, Mora G, Soraru G, et al. "Safety and efficacy of nabiximols on spasticity symptoms in patients with motor neuron disease (CANALS): a multicentre, double-blind, randomised, placebo-controlled, phase 2 trial" The Lancet Neurology. 2019. DOI: 10.1016/S1474-4422(18)30406-X
Important Information
Study Age: This study was published 7 years ago. Newer research may have updated or refined these findings.
Not Medical Advice: This research summary is for educational purposes only. It should not be used to diagnose, treat, cure, or prevent any disease or medical condition. Always consult a qualified healthcare provider before starting or changing any treatment.
Individual Variation: Research findings represent group averages. Your individual response to cannabis may differ based on genetics, other medications, underlying conditions, and many other factors.
Last reviewed: January 25, 2026
Important Notices
Research Summary Disclaimer
This content represents our interpretation of published scientific research for educational purposes. It should not be used to make treatment decisions without consulting a qualified healthcare provider. Individual results may vary from study findings.
FDA Notice
These statements have not been evaluated by the FDA. Cannabis is not intended to diagnose, treat, cure, or prevent any disease. The FDA has not approved cannabis for any medical condition except specific prescription medications.
Copyright & Fair Use
Research summaries are provided under fair use (17 U.S.C. § 107) for educational purposes. We provide brief summaries with attribution, not full reproductions. All studies remain the intellectual property of their respective authors and publishers.
Data Sources
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FAQs: Cannabis for Als
Does cannabis help ALS spasticity?
Yes, in this trial. Nabiximols (THC/CBD mouth spray) improved spasticity scores in ALS patients while placebo patients worsened (p=0.013). This is the first positive proof-of-concept trial for cannabinoids in motor neuron disease.
Is cannabis safe for ALS patients?
Well tolerated in this trial. No participants withdrew from treatment, and no serious adverse events occurred. However, larger, longer studies are needed to confirm safety.
What form of cannabis was used for ALS in this study?
Nabiximols, an oromucosal spray containing 2.7 mg THC and 2.5 mg CBD per spray. Patients self-titrated up to 12 sprays per day. This is the same product approved for MS spasticity in some countries.