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IACM-Bulletin of 03 February 2008

Science: THC effective in intractable nausea in a patient undergoing gastric bypass surgery

Californian doctors presented a case-report of a 31-year old woman with a long history of obesity, who underwent gastric bypass surgery to reduce her food intake. Within the following weeks she developed severe nausea and inability to tolerate fluids or food and was admitted to hospital seven times. A variety of anti-emetic drugs were tried including a serotonin antagonist, which only provided limited relief. Finally, the patient asked her gastric bypass be reversed. As a last resort, oral THC was prescribed with a maximum of 15 mg per day. She noticed a significant improvement in her symptoms within 1-2 days and tolerated the medication well. Her mood and energy levels improved quickly and she began tolerating more foods and liquids by mouth. She used THC for less than 4 weeks.

Gastric bypass surgery makes the stomach smaller and allows food to bypass part of the small intestine. The patients feel full more quickly, which reduces food intake. Bypassing part of the intestine also results in fewer calories being absorbed leading to weight loss. Nausea is a well-documented post-operative complication of this intervention, which often responds to standard treatments, but occasionally is unresponsive. The authors noted that "THC could have a useful role in treating this serious and debiliating post-operative complication."

(Source: Merriman AR, Oliak DA. Use of medical marijuana for treatment of severe intractable nausea after laparoscopic Roux-en-Y gastric bypass surgery: case report. Surg Obes Relat Dis 2008 Jan 26 [Electronic publication ahead of print])

USA: Employers are allowed to fire employees if they use medical cannabis under state law, the Supreme Court of California ruled

The Californian State Supreme Court ruled on 24 January that employers were within their rights to fire employees who fail drug tests, because they use medicinal cannabis. The ruling involved a former Air Force mechanic, Gary Ross, who injured his lower back in a fall off an airplane wing in 1983. In 1999, a doctor, acting under the state’s medical cannabis law (Compassionate Use Act), prescribed cannabis to relieve Mr. Ross’s pain.

Two years after he began using the drug, Mr. Ross was fired from a job as a systems administrator with a telecommunications company after failing a drug test. Mr. Ross filed suit, contending that his dismissal violated state laws barring wrongful termination and discrimination based on disability. But the state’s highest court firmly rejected that argument. "The Compassionate Use Act does not eliminate marijuana’s potential for abuse or the employer’s legitimate interest in whether an employee uses the drug," Justice Kathryn M. Werdegar wrote.

(Source: New York Times of 25 January 2008)

News in brief

Science: Diabetes
In a press release GW Pharmaceuticals reported that it has generated highly promising results in both pre-clinical pharmacology studies and a Phase I trial of a new potential cannabinoid treatment for type 2 diabetes and related metabolic disorders. The natural cannabinoid delta-9-tetrahydrocannabivarin (THCV), which in earlier studies was shown to behave as an antagonist at the CB1 receptor, had positive effects on hormones such as insulin in animal models of diabetes and was well tolerated by healthy humans. The company announced to start a Phase II trial in type 2 diabetes patients already in 2008. (Source: Press release by GW Pharmaceuticals of 22 January 2008)

Science: Interaction of anandamide and 2-AG
Italian researchers made a surprising discovery. The endocannabinoid anandamide inhibited the metabolism of another endocannabinoid, 2-arachidonoylglycerol (2-AG), by activation of the vanilloid-1 receptor. This effect was observed in a brain region, called the striatum. More research will be needed to determine the relevance of such interaction between endocannabinoids. (Source: Maccarrone M, et al. Nat Neurosci 2008;11(2):152-9)

Science: Glaucoma
Scientists from Virginia, USA, demonstrated that topical administration of the synthetic cannabinoid WIN55,212-2 to the eyes of rats alleviated intraocular hypertension in these animals. This effect was mainly mediated by the CB1 receptor. No systemic effects on circulation were observed. (Source: Oltmanns MH, et al. J Ocul Pharmacol Ther 2008 Jan 17 [Electronic publication ahead of print])

Science: ADHD and post-traumatic stress disorder
Californian researchers observed an association between variants of the gene that codes the cannabinoid-1 receptor with attention deficit hyperactivity disorder (ADHD) and post traumatic stress disorder. (Source: Lu AT, et al. Am J Med Genet B Neuropsychiatr Genet 2008 Jan 22 [Electronic publication ahead of print])

Science: Lung emphysema
Researchers of Monash University in Melbourne, Australia, reported of a series of 10 patients with bullous emphysema in the upper and mid zones of the lung. All were regular cannabis and tobacco smokers. Reasons for the presentation to a doctor were dyspnoea (n = 4), pneumothorax (n = 4) and chest infection (n = 2). Authors noted that in subjects who smoke cannabis these pathological changes occur at a younger age (approximately 20 years earlier) than in tobacco smokers. (Source: Hii SW, et al. Respirology 2008;13(1):122-7)

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