IACM-Bulletin of April 2, 2006

Science — Cannabis and THC reduce incontinence in multiple sclerosis in large clinical trial

Clinical study data published in March 2006 show that both a cannabis extract and isolated THC caused a significant reduction in incontinence compared to placebo. The study was part of a multicentre trial on cannabinoids in 630 multiple sclerosis patients (CAMS study) conducted in the UK, whose main results had already been published in 2004.

Participants received either the encapsulated cannabis extract Cannador, the THC preparation Marinol or a placebo for fifteen weeks at a maximum daily dose of 10-25 mg THC depending on body weight. Subjects completed incontinence diaries. The cannabis extract resulted in a reduction of incontinence by 38 per cent, THC by 33 per cent, and placebo by 18 per cent. Researchers concluded that these "findings are suggestive of a clinical effect of cannabis on incontinence episodes in patients with MS."

(Source: Freeman RM, Adekanmi O, Waterfield MR, Waterfield AE, Wright D, Zajicek J. The effect of cannabis on urge incontinence in patients with multiple sclerosis: a multicentre, randomised placebo-controlled trial (CAMS-LUTS). Int Urogynecol J Pelvic Floor Dysfunct 2006 Mar 22; [electronic publication ahead of print])

USA — Raids at manufacturers of cannabis products in California

Hundreds of boxes of cannabis-laced sweets and thousands of cannabis plants were seized on 16 March in five simultaneous Drug Enforcement Administration (DEA) raids in three Californian cities (Oakland, Emeryville, Lafayette). Authorities called it the largest West Coast cannabis manufacturing and distribution operation of its type.

Twelve people were arrested and face charges of cannabis distribution. According to the DEA the boxes were intended to be distributed to cannabis clubs and over the Internet. Medical cannabis advocates pointed out that these were legitimate medical cannabis manufacturers under California law. The packaging of the sweets came complete with nutrition labels and dosage recommendations as well with a note that they were intended for medical use only. Local police departments assisted in the raids.

(Source: The Oakland Tribune of 17 March 2006)

News in brief

USA — Rhode Island

The medical cannabis law of Rhode Island became effective on 31 March. In January the state became the 11th state of the USA to legalize the medical use of cannabis. The Medical Marijuana Program gives people with debilitating illnesses, such as multiple sclerosis and glaucoma, photo identification cards that let them grow up to 12 cannabis plants or buy 2.5 ounces of cannabis. (Source: Associated Press of 31 March 2006)

Italy — Certificate of exemption

The former Health Minister Francesco Storace issued a certificate of exemption to a man from South Tyrol with multiple sclerosis that allows him the medical use of the cannabis extract Sativex. This caused some sensation in Italy, since it set a precedence. (Source: Die Neue Suedtiroler Tageszeitung of 23 March 2006)

Germany — Cannabis pharmacy

According to information of the cannabis pharmacy (www.hanfapotheke.org), so far 29 patients got access to the cannabis pharmacy through recommendation by a physician working with the pharmacy. Of these, 22 could be supplied with cannabis through a donator, who is sending cannabis for free and anonymously to the patient. At present 12 patients are regularly sponsored by a donator who reliably takes over the supply of a patient. 11 patients are on the waiting list without supply. (Source: Personal communication of 10 March 2006)

Holland — Isolation of cannabinoids

Farmalyse BV announced that the company in cooperation with the University of Leiden had developed a new method for the isolation of cannabinoids from the cannabis plant. Many of the cannabinoids the company is offering would not be available from any other supplier. In an e-mail Farmalyse wrote that the purity for the isolated THC (dronabinol) reached more than 99 per cent. "Together with Feyecon BV, a new formulation has been developed. This new formulation, in which the active is encapsulated, enables sublingual administration. THC is encapsulated, such that it becomes a dry powder allowing the production of tablets." (Source: E-mail of Farmalyse BV of 27 March 2006)

USA — Opinion on cannabis and alcohol

According to a survey by the Pew Research Center on modern morals of the citizens of the USA smoking of cannabis is regarded not as bad as drinking to excess. 1,502 people were questioned in February and results were published on 28 March. 10 issues were ranked on the basis of what is viewed the more morally wrong. At the top of the list, about 88 per cent of respondents said married people having an affair was wrong. Third on the morality scale was drinking too much alcohol (61 per cent) and smoking cannabis was number 5 (50 per cent). (Sources: Chicago Tribune of 29 March 2006, http://pewresearch.org/)

Science — Respiration and spasticity

A case report of a patient with spasticity of the belly and the legs due to a traumatic lesion of the spinal cord at the level of the neck is presented. He had breathing problems, but was able to breath during the day without apparative assistance. Since all standard therapeutic measures against spasticity failed he was administered THC in a dosage of 2.5 mg twice daily, which resulted in an improvement of the symptoms. However, breathing problems increased after three days of treatment and THC administration had to be discontinued. (Source: Neuburger M, et al. Schmerz. 2006 Mar 16; [electronic publication ahead of print])

Science — Echinacea

Researchers of the Swiss Federal Institute of Technology in Zurich demonstrated that compounds of Echinacea, so-called alkylamides, exert their immunomodulatory effects by several mechanisms that are partly dependent and partly independent of the activation of CB2 receptors. They showed that several alkylamides of Echinacea bind to the CB2-receptor more strongly than endocannabinoids. They reduce inflammation by effects on cytokines, e.g. by the inhibition of TNF-alpha (tumour necrosis factor alpha). (Source: Raduner S, et al. J Biol Chem 2006 Mar 17; [electronic publication ahead of print])

Science — Pain

Researchers of the University of Arizona in Tucson demonstrated by different means that the activation of the CB2 receptor indeed resulted in the reduction of pain. They used specific cannabinoid receptor antagonists and genetically modified mice. (Source: Ibrahim MM, et al. Pain 2006 Mar 21; [electronic publication ahead of print])

Science — Pain

Scientists of Schering-Plough in Italy presented animal research that showed that CB2 receptors in the spinal cord may be involved in analgesic effects mediated by this receptor. So far, it was known that the activation of peripheral CB2 receptors causes pain reduction. This research confirms that CB2 receptors are present in the central nervous system, which contribute to effects of CB2 agonists. (Source: Beltramo M, et al. Eur J Neurosci 2006;23(6):1530-8)