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IACM-Bulletin of 31 August 2008

Science: Nabilone effective in the treatment of night sweats of four patients with advanced cancer

A researcher at a Division of Palliative Medicine of the University of Toronto, Canada, presented four cases of successful treatment of night sweats in advanced cancer with nabilone, a synthetic derivative of dronabinol. The four patients had been referred to the hospital and identified night sweats as one of their most significant symptomatic concerns. On an 11-point scale with 0 indicating absence of night sweats and 10 indicating worst possible severity, mean baseline score was 7.75. Two patients received 1 mg nabilone daily taken at bedtime and two patients, who also suffered from severe pain, nausea and appetite loss received 1 mg nabilone twice daily. All patients reported improvement within 48 hours. Two days after treatment onset night sweat scores decreased to a mean of 2.75 and after 14 days to a mean of 2.00. No relevant side effects occurred.

Night sweats are one of many symptoms experienced by patients with advanced cancer. Persistent night sweats tend to decrease quality of life through interference with sleep. A recent study has demonstrated that night sweats occur as part of a symptom pattern, and are associated with appetite and weight loss. In addition, night sweats represent one of the symptoms that displays a tendency not to improve as patients with advanced cancer approach end of life. Other available medications are often ineffective.

(Source: Maida V. Nabilone for the treatment of paraneoplastic night sweats: a report of four cases. J Palliat Med 2008;11(6):929-34.)

Science: Dronabinol effective against a hyperkinetic movement disorder due to a rare cell dysfunction in a case report

A researcher at the Department of Neurology at Michigan State University, USA, presented a case report of a 24-year-old woman with a complex hyperkinetic movement disorder due to a rare cell dysfunction (mitochondrial cytopathy), who responded well to a treatment with cannabis products. Both self-medication with smoked cannabis and a treatment with oral dronabinol (5 mg three times a day) were effective. She presented with tremor, generalized dystonia, and hyperkinetic movement disorder. She had difficulty maintaining her body weight of 36 kg, most likely due to the increased caloric demands of her hyperkinetic movements in combination with mild appetite loss.

At the age of 26 years she became pregnant. Dronabinol (THC) was employed as a strategy to control her hyperkinetic involuntary movements and promote weight gain during her pregnancy. Other drugs that can be used to control hyperkinetic movements may be contraindicated in pregnancy. She continued to experience an improvement of her hyperkinetic movement disorder with the regular use of dronabinol with no signs of tolerance or requirement for dose escalation. Dronabinol stimulated her appetite and assisted with weight gain. She gained a total of 20 kg weight during her pregnancy and ultimately delivered a healthy appearing baby with no complications.

(Source: Farooq MU, Ducommun E, Goudreau J. Treatment of a hyperkinetic movement disorder during pregnancy with dronabinol. Parkinsonism Relat Disord. 2008 Aug 7. [Electronic publication ahead of print]

News in brief

Science: Anti-bacterial activity
Italian researchers found out that several natural cannabinoids (cannabidiol, cannabichromene, cannabigerol, dronabinol, and cannabinol) show potent anti-bacterial activity against a variety of dangerous Staphylococcus strains, which are resistant against several antibiotics. They noted that the use of cannabinoids as systemic antibacterial agents has to be tested in clinical trials, but their topical application to reduce resistant Staphylococcus bacteria on the skin "seems promising." (Source: Appendino G, et al. J Nat Prod 2008;71(8):1427-30.)

Australia: Support for medical use
According to the 2007 National Drug Strategy Household Survey, in which more than 23,000 Australians over the age of 12 were interviewed about their drug use and their attitudes toward various drug policy positions, 68.6 per cent of respondents supported "a change in legislation permitting the use of marijuana for medical purposes." More at:
www.aihw.gov.au/publications/index.cfm/title/10579#full_publication. Survey data are found in Section 4 ("Community support for drug-related policy"). (Source: Australian 2007 National Drug Strategy Household Survey)

USA: California
A bill that passed through the state senate this week would make it illegal to fire a person solely because he uses medicinal cannabis. The bill would reverse a court decision made earlier this year in which the court upheld the firing of a worker for failing a drug test after telling his employers in advance that he was using medical cannabis to treat an ailment when not at work. The bill still has to be signed by Governor Arnold Schwarzenegger. (Source: Ukiah Daily Journal of 25 August 2008)

USA: California
On 25 August California Attorney General Jerry Brown issued new guidelines on the medical use of cannabis. According to the guidelines, qualified patients and caregivers may possess up to 8 ounces (about 230 grams) of dried marijuana, and may maintain no more than six mature plants or 12 immature plants, unless a doctor recommends more. Brown's 11-page recommendation tells local law-enforcement officers not to arrest patients, who use medical cannabis, under federal law if their conduct is legal under state law. Furthermore, the directive states that a properly run dispensary operating as a non-profit is legal. The guidelines caused a controversial discussion. (Sources: Times-Standard of 26 August 2008, Inland Valley Daily Bulletin of 27 August 2008)

Science: Neurocognitive performance
24 subjects (12 occasional cannabis users and 12 heavy cannabis users) participated in tests on neurocognitive performance after cannabis use. Both groups received single doses of placebo cigarettes and 0.5 mg/kg dronabinol as cannabis cigarettes, resulting in 22.5-47.5 mg THC depending on body weight. THC significantly impaired performance of occasional cannabis users in most tests, but did not affect the performance of heavy cannabis users except in a test on reaction time. Researchers concluded that "cannabis use history strongly determines the behavioural response to single doses of THC." (Source: Ramaekers JG, et al. J Psychopharmacol 2008 Aug 21. [Electronic publication ahead of print]

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