Medical Marijuana for ALS (Lou Gehrig's Disease) in Washington State

Amyotrophic lateral sclerosis (ALS), also known as Lou Gehrig's disease, is a progressive neurodegenerative disease that affects motor neurons. ALS is not one of the conditions named in Washington's qualifying-condition list (RCW 69.51A.010). Whether a patient's situation meets a condition the statute does name is decided by a licensed provider at an individual evaluation. For ALS patients, cannabis can meaningfully improve quality of life by addressing some of the most distressing symptoms of the disease.

What Washington law says about ALS

ALS is not named in RCW 69.51A.010, and a diagnosis alone does not meet the requirement. The statute's list is closed — there is no separate pathway for terminal illness. Washington's named conditions are cancer, HIV, multiple sclerosis, epilepsy or other seizure disorders, spasticity disorders, intractable pain, glaucoma, Crohn's disease, hepatitis C, diseases (including anorexia) that cause nausea, vomiting, wasting, appetite loss, cramping, seizures, muscle spasms or spasticity, post-traumatic stress disorder (PTSD), and traumatic brain injury. Whether a patient's situation meets one of them is decided by a licensed provider at an individual evaluation, from the patient's records.

How cannabis may help ALS patients

Research on cannabis specifically for ALS is limited compared to some other conditions — ALS's rarity makes large clinical trials difficult. However, preclinical evidence and case reports suggest several relevant benefits:

• Muscle cramps and spasticity — muscle cramps are among the most common and painful ALS symptoms. Cannabis is well-established for spasticity (as in MS), and ALS-related spasticity responds similarly. Both THC and CBD contribute to muscle relaxation through different mechanisms.
• Neuropathic pain — some ALS patients experience significant pain from muscle cramps, joint stress, and possibly direct neural involvement. Cannabis addresses neuropathic pain through CB1/CB2 receptor mechanisms.
• Appetite and weight maintenance — dysphagia (swallowing difficulty) and muscle wasting make weight maintenance difficult in ALS. THC's appetite-stimulating properties can help, though delivery form needs to accommodate swallowing ability.
• Bronchodilation — some patients report that vaporized cannabis temporarily improves breathing comfort, though evidence is anecdotal and inhaled cannabis is contraindicated when respiratory function is severely compromised.
• Anxiety, depression, and sleep — ALS carries a profound psychological burden. Cannabis can address anxiety and sleep disruption, improving quality of remaining life.
• Possible neuroprotection — preclinical (animal model) studies show cannabinoids may slow ALS disease progression through antioxidant and anti-inflammatory mechanisms. Human clinical evidence is not yet established, but it represents an area of active research.

Delivery method considerations

ALS progressively affects the ability to swallow, breathe, and use the hands. Delivery method planning should account for current and anticipated functional status:

• Early ALS — any delivery method may work; tinctures, capsules, and vaporization all appropriate
• With dysphagia — sublingual tinctures (held under tongue, don't need to swallow) preferred over capsules or edibles; vaporization may still work if respiratory function is maintained
• With hand weakness — pre-measured tincture syringes or caregiver-administered capsules; avoid products requiring manual dexterity
• With respiratory compromise — inhaled forms (vaping, smoking) contraindicated; switch entirely to oral or sublingual delivery

Getting your authorization

For ALS patients, a first evaluation is in person, as Washington law requires; Green Wellness can often accommodate home visits, and renewals can be done by telehealth if travel is difficult. Send us documentation of your ALS diagnosis from your neurologist before your visit. Your provider will discuss cannabis approaches that are appropriate for your current functional status and disease stage.

New patient evaluations are $175. Renewals are $145 and available via telehealth.

Book your ALS evaluation →