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IACM-Bulletin of 30 December 2012

Science/Human: Cannabis users have a decreased risk for the development of diabetes according to a large study

According to a representative study with 10,896 citizens of the United States cannabis users had a significant lower risk for the development of diabetes mellitus compared to non-users. The study was headed by Dr Tripathi B. Rajavashisth, Professor at David Geffen School of Medicine, University of California in Los Angeles. Authors used data from the National Health and Nutrition Examination Survey conducted by the National Center for Health Statistics of the Centers for Disease Control and Prevention. The study included four groups: non-cannabis users (61.0%), past cannabis users (30.7%), light (one to four times/month) (5.0%) and heavy (more than five times/month) current cannabis users (3.3%).

Cannabis users had a lower prevalence of diabetes compared to non-cannabis users (odds ratio: 0.42). In a statistic model controlling for socio-demographic and other factors the risk further decreased (adjusted odds ratio 0.36). This means that the risk decreases to 36 per cent to those of non-cannabis users. Author concluded that cannabis use was "associated with a lower prevalence of DM [diabetes mellitus]. Further studies are needed to show a direct effect of marijuana on DM.”

Rajavashisth TB, Shaheen M, Norris KC, Pan D, Sinha SK, Ortega J, Friedman TC. Decreased prevalence of diabetes in marijuana users: cross-sectional data from the National Health and Nutrition Examination Survey (NHANES) III. BMJ Open. 2012 Feb 24;2:e000494.

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Science/Human: Inhaled cannabis improved neuropathic pain in clinical study

According to a clinical study at the University of California with 39 patients suffering from neuropathic pain both low and moderate doses of inhaled cannabis were effective in reducing pain. The study was headed by Dr Barth L. Wilsey from VA Northern California Health Care System in Sacramento. Participants either received a medium dose or a low dose of cannabis inhaled by a vaporizer or a placebo. Most of them were experiencing central or peripheral neuropathic pain despite conventional treatments.

There were no significant differences between the two groups receiving low and medium doses of cannabis. An average of about three patients had to be treated for one patient to benefit with a pain reduction of more than 30%. Authors noted that these results "are compatible to those of traditional neuropathic pain medications" and that psychoactive effects were minimal and well tolerated. They concluded that "vaporised cannabis, even at low doses, may present an effective option for patients with treatment-resistant neuropathic pain."

Wilsey B, Marcotte T, Deutsch R, Gouaux B, Sakai S, Donaghe H. Low-Dose Vaporized Cannabis Significantly Improves Neuropathic Pain. J Pain. 2012 Dec 10. [in press]

Canada: Government wants to change regulations of the medical cannabis program until 2014

On 16 December Minister of Health Leona Aglukkaq announced that the Government of Canada intends to make changes to the way Canadians access cannabis for medical purposes. "Current medical marihuana regulations have left the system open to abuse," said Minister Aglukkaq. In the past decade, Health Canada's Marihuana Medical Access Program has grown exponentially, from under 500 authorized persons in 2002 to over 26,000 today.

The Government will no longer produce and distribute cannabis for medical purposes, opening up the market to companies which meet strict security requirements. Production will no longer take place in homes. Patients will no longer need to apply for an approval for the medical use of cannabis to the Health Ministry. Doctors will be able to sign a medical document similar to a prescription, and then patients can purchase the appropriate amount from an authorized vendor. It is the Government's intention to fully implement this new system by 31 March 2014.

Press release by Health Canada of 16 December 2012

Germany: Under strict conditions patients may grow cannabis, Supreme Administrative Court rules

Under strict conditions severely ill Germans may be allowed to grow cannabis at home, the Supreme Administrative Court of Munster said in a judgment of 7 December 2012. Patients for whom no other therapies are available or effective can make an application to the Federal Institute for Drugs and Medical Devices (BfArM) in Bonn, Ulrich Lau, the spokesman of the court, said. In the context of a self-treatment, accompanied and monitored by their doctor, it would be possible to grow cannabis plants at home. "This ruling is a milestone on the path to a better supply of German citizens with cannabis-based medicines," said Franjo Grotenhermen, chairman of the German Association for Cannabis as Medicine. "It will increase the pressure on lawmakers to improve access to cannabis products for medicinal purposes."

Patients whose health insurances cover the costs of a treatment with cannabinoid-based medications however do not get a permit for self-cultivation the court made clear. In the particular case of a plaintiff suffering from multiple sclerosis the judges ruled in favour of the Federal Republic of Germany, which had denied him an approval for self-cultivation. The plaintiff had not been able to convince the court that the cannabinoid dronabinol, which is reimbursed by his health insurance, has not the same medical effect as cannabis cultivated by him.

The arguments of the BfArM for a general denial of approvals for self-cultivation by patients were completely rejected by the court, however. The ruling clarifies: "If an affordable treatment option is missing, a license for personal cultivation of cannabis has to be taken into consideration - at the discretion of the BfArM." A medically supervised treatment with cannabis or single cannabinoids in Germany is currently possible in two different ways: first, dronabinol, the synthetic THC derivative nabilone and the cannabis extract Sativex may be prescribed (currently a few thousand patient). However, costs are mostly not covered by health insurances, with the exception of Sativex in spasticity due to MS. Secondly, the medical use of herbal cannabis from the pharmacy imported from the Netherlands is possible. This however requires a special permit from the Federal Institute for Drugs and Medical Devices (currently about 120 patients).

The ruling of the Supreme Administrative Court has not yet become final. It is expected that it may take months or even years before the Federal Institute for Drugs and Medical Devices complies with the ruling given the experience with previous reactions of the institute to court rulings.

Judgment of 7 December 2012, OVG NRW 13 A 414/11.

Press release by the German ACM of 20 December 2012.

News in brief

USA: Medical cannabis program starts in Washington D.C.
Fifteen years after voters gave the green-light to a medical cannabis program in the capital a few companies got the approval to grow or sell the drug and will set up shop a few months into the new year, according to city officials.
Washington Times of 25 December 2012.

Science/Cells: Endocannabinoid stimulates white blood cells to release factors against microbes
Very low concentrations of the endocannabinoid 2-AG and of arachidonic acid given to certain white blood cells (neutrophils) inhibited the infectivity with herpes simplex virus and other microbes by releasing certain factors. Authors wrote: “Considering that nanomolar concentrations of AA or 2-AG were sufficient to impair viral infectivity, this suggests potential physiological roles for 2-AG and AA as regulators of host defense in vivo.”
Institut Universitaire de Cardiologie et de Pneumologie de Québec, Département de Médecine, Québec City, Canada.
Chouinard F, et al. J Leukoc Biol. 2012 Dec 12. [in press]

Science/Animal: Cannabinoid-2 receptors influence severity of Huntington’s disease
In a mouse model of Huntington’s disease animals without CB2 receptors showed an acceleration of the onset of motor deficits and an increase in severity. Treatment of mice with cannabinoids that bind to the CB2 receptor however, increased life span. Authors wrote that their findings “provide a novel therapeutic approach to treat HD.”
Neuroscience Program, University of California San Francisco, USA.
Bouchard J, et al. J Neurosci 2012;32(50):18259-18268.

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