CANNABINOID THERAPY IN AMYOTROPHIC LATERAL SCLEROSIS: PHARMACOLOGICAL TARGETS AND LIMITATIONS OF ACCESS IN THE BRAZILIAN PUBLIC HEALTH SYSTEM

Abstract

Amyotrophic Lateral Sclerosis (ALS) is a fatal neurodegenerative pathology characterized by progressive loss of motor neurons. Due to the limited efficacy of conventional therapies, the endocannabinoid system emerges as a strategic pharmacological target. This study aimed to analyze the neuroprotective mechanisms of cannabinoids in ALS and investigate access barriers within the Brazilian Unified Health System (SUS). To this end, an integrative literature review was conducted using PubMed, Scopus, Web of Science, ScienceDirect, and SciELO databases, selecting 35 references published between 2020 and 2025. The results demonstrate that the activation of CB1, CB2, and PPAR-gamma receptors promotes a reduction in glutamatergic excitotoxicity and modulation of neuroinflammation, while the 1:1 CBD/THC ratio shows efficacy in controlling spasticity, pain, and sialorrhea. In the discussion, it was observed that despite clinical evidence, incorporation into the SUS faces obstacles such as the lack of specific Clinical Protocols, high import costs, and dependence on judicialization, which violates the principle of healthcare equity. It is concluded that cannabinoids have high potential as an adjuvant therapy in ALS; however, its democratization in Brazil requires public policies that integrate these products into the RENAME and promote regulated national production to ensure universal and safe access.