IACM-Bulletin of August 31, 2003

Holland — Patients receive cannabis from pharmacies

Dutch patients with a doctor’s prescription will be able to obtain cannabis from chemists starting from 1 September. Pharmacies will offer two sorts of cannabis, with the cheapest batch priced at 40 EUR per five grams, and the other variant 50-55 EUR per five grams. But the pharmacy association KNMP said patients will have to pay for their cannabis themselves because the drug is not yet included in the ziekenfonds health insurance scheme as a claimable reimbursement.

The chemist-supplied cannabis is more expensive than the cannabis sold in coffee shops, where users can buy a gram for prices ranging between 5 and 6 EUR. Two Dutch cultivators, The Stichting Institute of Medical Marijuana and the firm Bedrocan are supplying pharmacists with the cannabis, making them the first legal suppliers of the drug in Europe. The Office for Medicinal Cannabis of the Health Ministry inspects the cannabis for quality control and organises its distribution.

Cannabis had been inoffically available in pharmacies for several years provided by the Dutch firm Maripharm. On 17 March 2003 a change of the narcotic law took effect that paved the way for a legal supply.

More in the presentation of Willem Scholten of the Office of Medicinal Cannabis at the IACM 2nd Conference on Cannabinoids in Medicine: www.Cologne2003.org

(Source: Expatica.com of 29 August 2003)

Science — Marijuana does not accelerate HIV infection, study shows

Smoked cannabis and oral THC given over a course of 21 days did not adversely affect CD4+ cell counts or viral loads in HIV-infected patients, according to a study led by Dr. Donald Abrams at the University of California in San Francisco. In fact, there was a small non-significant positive effect of cannabis and THC on these laboratory parameters compared to placebo. Cannabis and THC also increased appetite and caused weight gain.

The study started in May 1998 and results were presented at the ICRS Meeting in June 2000. However, they needed more than 3 year to get published in a medical journal, which is quite a long time and raises the question whether there was pressure to delay the publication.

All of the patients had been receiving the same anti-HIV medication for at least 8 weeks before the study began. 62 study participants were eligible (marijuana group, 20 patients; dronabinol group, 22 patients; and placebo group, 20 patients). Although not statistically significant, compared with placebo use the application of marijuana and THC was associated with a slight drop in viral load of 15% and 8%, respectively.

See: http://www.cannabis-med.org/studies/study.php

(Source: Abrams DI, et al. Short-term effects of cannabinoids in patients with HIV-1 infection: a randomized, placebo-controlled clinical trial. Ann Intern Med 2003;139(4):258-266; Reuters of 18 August 2003)

Science — THC causes weight gain and reduces agitation in Alzheimer’s disease

An open study with 48 patients suffering from Alzheimer’s disease shows that oral THC causes weight gain in patients with appetite loss. It may also reduce agitation, improve function and mental abilities. The open study conducted at the Meridian Institute for Aging in Manchester Township, USA, was presented at the Eleventh International Congress of the International Psychogeriatric Association on 17-22 August 2003 in Chicago.

THC (dronabinol), 5 mg/day in 2 divided doses was given initially and titrated up to a maximum of 10 mg/day. Weight gain was reported in all patients. Agitation significantly improved in 65%. In 37% mental abilities improved. Functional improvement was reported in 69%.

In 1997 a first placebo-controlled study by Volicer and colleagues had shown that THC not only increased appetite but also reduced agitation in Alzheimer patients. Results of the new study had already been presented on 15 May at the annual meeting of the American Geriatrics Society.

See: http://www.cannabis-med.org/studies/study.php

(Source: Patel S, et al. PC-037 Safety and efficacy of dronabinol in the treatment of agitation in patients with Alzheimer’s disease with anorexia: A retrospective chart review. Poster presented at the IPA's Eleventh International Congress on 17-22 August 2003 in Chicago)

News in brief

Canada — First government grown cannabis provided to patients

The first bags of officially produced medical marijuana are finally making their way into the hands of patients. The first patients received their supply which contains about 10% THC from their doctor. Each 30-gram pack costs $150 - about $100 cheaper than street prices - and additional sales tax. The program announced in July 2003 by Health Minister Anne McLellan provides marijuana grown by the government in a former copper mine in Manitoba. (Source: Associated Press of 27 August 2003)

UK — Cannador to be tested for pain relief

A multi-centre study will start in 36 hospitals across the UK to investigate the efficacy of a capsulated cannabis extract in relieving the pain of post-operative patients. 400 patients will take one of four medications, cannabis capsules called Cannador, THC capsules, a standard pain-relieving drug or placebo capsules after surgery. The study will be funded by the Medical Research Council with about 500,000 British Pounds (about 720,000 EUR) and be led by Dr. Anita Holdcroft of Imperial College London. (Sources: Reuters of 20 August 2003, BBC News of 20 August 2003)

USA — Lawsuit against DEA blocked

On 28 August a federal judge dismissed a lawsuit brought by Santa Cruz County and Wo/Men's Alliance for Medical Marijuana that attempted to block the U.S. Drug Enforcement Administration (DEA) from raiding a farm that cultivated medical marijuana. U.S. District Court Judge Jeremy Fogel ruled that federal laws make growing cannabis illegal in California despite the Californian medical cannabis laws, which allows the drug to be grown for medical purposes. (Source: Associated Press of 29 August 2003)

USA — Grinspoon criticizes "pharmaceuticalization"

In an article for the Boston Globe Dr. Lester Grinspoon criticizes the "pharmaceuticalization" of cannabis and concludes: "Even if pharmaceutical companies invest the many millions of dollars it will take to develop useful cannabinoid products, they will not displace natural marijuana for most purposes. And because the primary, and for many the only, advantage of these drugs will be legality, their manufacturers will have an interest in vigorously enforced prohibition that raises the price of the competitive product, street marijuana.” Dr. Grinspoon is an emeritus professor of psychiatry at Harvard Medical School and author of "Marijuana, the Forbidden Medicine." (Source: Boston Globe of 17 August 2003)

Science — Neuropathic pain

New basic research at the University of Pecs, Hungary, supports the benefits of cannabinoids in the treatment of chronic neuropathic pain. The endocannabinoids anandamide and palmitylethanolamide inhibited the RTX-induced release of two neuropeptides, that play an important role in the development of neuropathic hyperalgesia. RTX (resiniferatoxin) provokes the release of neuropeptides. Additionally, the two endocannabinoids significantly decreased neuropathic mechanical hyperalgesia (increased pain sensation) 7 days after damage to the sciatic nerve in animals. (Source: Helyes Z, et al. Life Sci 2003 Sep 19;73(18):2345-53)

Science — Quality of life

About 6,000 Danes participated in a survey on drug use and quality of life. There was no difference in quality of life between cannabis users and those who had never used psychotropic drugs, while users of LSD had a 10% lower quality of life score. The groups with the lowest quality of life were users of heroin, morphine, methadone, and a mixture of alcohol and tranquilizers. (Source: Ventegodt S, Merrick J. ScientificWorldJournal 2003 Aug 18;3(8):694-706.)

Science — Withdrawal

In a study at the University of Vermont, USA, the time course of withdrawal symptoms was analysed in 18 cannabis users. For 5 days they smoked as usual which was followed by a 45-day abstinence phase. Withdrawal symptoms, e.g. aggression, anxiety, decreased appetite, irritability, restlessness, and sleep problems, typically set in between days 1-3, peaked at days 2-6 and lasted 4-14 days. (Source: Budney AJ, et al. J Abnorm Psychol 2003 Aug;112(3):393-402)