Medical Marijuana for ALS (Lou Gehrig's disease)

Quick answer

Yes, in many places. 26 state programs name ALS (Lou Gehrig's disease) on the official list, and 9 more let the certifying provider decide. Either way, a provider licensed in your state has to evaluate you and agree that cannabis is appropriate.

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Understanding ALS (Lou Gehrig's disease)

ALS, also called Lou Gehrig's disease, is a progressive condition that damages the nerve cells controlling voluntary muscles. It is rare, affecting roughly 5 in every 100,000 people in the US, and is most often diagnosed between ages 40 and 70.

As ALS progresses, walking, using your hands, speaking, swallowing and eventually breathing become harder. Care usually combines FDA-approved medicines such as riluzole with physical, speech and respiratory therapy, nutrition support and symptom management through a specialist ALS clinic.

Symptoms patients hope to ease

Painful muscle cramps and twitching
Stiffness and spasticity in the arms and legs
Loss of appetite and unwanted weight loss
Trouble falling or staying asleep
Excess saliva and drooling
Low mood and anxiety that come with a serious diagnosis

Does ALS (Lou Gehrig's disease) qualify in your state?

What the research says

Not enough research. Research is limited to small studies. Patients mainly use cannabis for cramps, spasticity, appetite, drooling and sleep.

There is very little research on cannabis specifically for ALS, so most people use it for related symptoms rather than the disease itself.
Small trials of oral THC for ALS muscle cramps have not shown a clear benefit over placebo.
Evidence from other conditions, such as the 2017 National Academies review on spasticity and chronic pain, is what doctors usually draw on when discussing symptom relief.
Laboratory studies have explored whether cannabinoids protect nerve cells, but there is no evidence that cannabis slows ALS in people.

Sources: National Academies of Sciences, Engineering, and Medicine, The Health Effects of Cannabis and Cannabinoids (2017); FDA approvals; published trials. General information, not medical advice.

How doctors approach ALS (Lou Gehrig's disease)

Doctors often consider tinctures or sprays placed under the tongue, since smoking can irritate weakened lungs and capsules may be hard to swallow.
A product with some THC may be discussed for appetite and sleep, while CBD-dominant options may be tried for daytime use to limit sedation.
Evening use is a common starting point when the main goals are sleep, cramps or night-time stiffness.
Starting with a very low amount and increasing slowly matters more in ALS because weakness and fatigue can make side effects harder to handle.

Risks and precautions

Sedating effects can add to breathing weakness, so tell your doctor about any breathing problems, sleep apnea or use of a breathing machine.
Smoking or vaping can irritate the airways and is generally avoided when lung function is reduced.
Cannabis can add to the drowsiness caused by medicines for spasticity, saliva, sleep, pain or mood, such as baclofen, benzodiazepines or opioids.
CBD can raise liver enzymes, so let your ALS team know if you take riluzole, which is also monitored with liver tests.
Dizziness and slowed reactions can raise the risk of falls and choking, especially if swallowing is already affected.
Not recommended during pregnancy or breastfeeding, and never drive while impaired.

What to bring to your evaluation

A diagnosis letter or clinic notes from your neurologist or ALS clinic confirming ALS.
A current list of all your medicines, including riluzole, edaravone, muscle relaxants and sleep aids.
Recent notes on breathing tests and swallowing assessments, if you have them.
A short diary of the symptoms you most want help with, such as cramps, sleep or appetite.
A government photo ID and proof that you live in your state.

Don't have records handy? Many patients are evaluated on their history alone.

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How to get certified for ALS (Lou Gehrig's disease)

Answer a few questions
Pick your state, tell us your symptoms and what you've already tried. Review your answers and contact you to schedule your video visit.
Meet your doctor by video
Join from your phone or laptop. Have a photo ID ready. The doctor reviews your history and decides whether cannabis is right for you.
Get certified and registered
Pay the evaluation fee, then submit your state registry form. The doctor files your certification. We walk you through the state form line by line.

ALS (Lou Gehrig's disease): 9 common questions

Does ALS (Lou Gehrig's disease) qualify for a medical marijuana card?

Yes, in many places. 26 state programs name ALS (Lou Gehrig's disease) on the official list, and 9 more let the certifying provider decide. Either way, a provider licensed in your state has to evaluate you and agree that cannabis is appropriate.

Which states list ALS (Lou Gehrig's disease) as a qualifying condition?

As of our latest check of each state's official list: Alabama, Arizona, Arkansas, Connecticut, Florida, Georgia, Hawaii, Illinois, Iowa, Kentucky, Louisiana, Massachusetts, Michigan, Minnesota, Mississippi, Missouri, New Hampshire, New Jersey, New Mexico, North Dakota, Ohio, Pennsylvania, South Dakota, Texas, Utah and West Virginia. Providers can also certify it in Alaska, California, Colorado, Delaware, Maine, New York, Oklahoma, Virginia and 1 more, which don't use a fixed list. Lists change, so confirm on your state's page before you apply.

Can I get certified for ALS (Lou Gehrig's disease) online?

Yes, in 21 of those states — including Arizona, Arkansas, Connecticut, Hawaii, Illinois and 16 more — your first evaluation can happen by video with a provider licensed there. In 11 others, such as Alabama, Florida, Kentucky and 8 more, the first visit must be in person, and renewals can usually be done online.

Can cannabis slow the progression of ALS?

No, there is no evidence that cannabis slows ALS or changes the course of the disease in people. Some lab studies have looked at this question, but those results have not carried over to human trials. If you try cannabis, think of it as one possible tool for symptoms like cramps, sleep or appetite, alongside your regular ALS care.

Does cannabis help with ALS muscle cramps?

Some people with ALS report that cannabis eases cramps and stiffness, but the small trials done so far have not shown a clear benefit over placebo. Results vary a lot from person to person. If cramps are your main concern, ask your ALS team about proven options too, and track whether cannabis makes a real difference for you.

Is it safe to use cannabis if my breathing is weak?

Weak breathing muscles call for extra care, because sedation can make shallow breathing worse, especially at night. Smoking and vaping also irritate the lungs. Talk with your pulmonary or ALS team before starting, and favor non-inhaled forms at low amounts if you go ahead.

What form of cannabis is easiest to take with swallowing problems?

Many people with swallowing difficulties find tinctures or sprays placed under the tongue or in the cheek easier than capsules. Some products can also be given through a feeding tube, but this should be planned with your care team. Ask your speech therapist or dietitian how to take any new product safely.

Can cannabis help with appetite and weight loss in ALS?

THC is known to increase appetite in some people, and keeping weight up is an important goal in ALS. However, there is little research testing this specifically in ALS. Work with your dietitian so cannabis is part of a wider nutrition plan rather than a replacement for it.

Will cannabis interact with my ALS medicines?

Cannabis can add to the drowsiness from muscle relaxants, sleep aids, anxiety medicines and opioids that are often used in ALS care. CBD can also affect how the liver processes some drugs and may raise liver enzymes. Bring a full medicine list to your visit and tell your neurologist before you start.

Medical marijuana for ALS (Lou Gehrig's disease)