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IACM-Bulletin of 24 February 2013

Italy: New national and regional laws facilitate the medical use of cannabis-based medicines

On 23 January the Federal Ministry of Health issued a decree for the introduction of plant-based medicinal cannabis drugs (substances and herbal preparations, including extracts and tinctures) into the unified law on narcotics (Table II, Section B, law 309/90). So far, cannabis was considered to be devoid of therapeutic properties and only THC was accepted as a medicinal drug.

In 2012 the regional parliaments of Tuscany, Liguria, Veneto and Friuli Venezia Giulia had already approved similar laws with broad political support, aimed at facilitating the use of drugs based on natural and synthetic cannabinoids available abroad and imported into Italy. Through the regional healthcare system these medications are intended to be distributed free of charge by hospitals to patients. Currently there are talks on how the regional laws should be implemented and on the medical conditions, for which these medicines may be used.

Source: personal communication by Dr Gianpaolo Grassi.

Science/Human: Experience with Sativex in everyday clinical practice from Germany, Spain and the UK

Observations from the use of the cannabis extract Sativex in patients with spasticity in multiple sclerosis show that the medication is effective in a large number of patients and well-tolerated in the long-term. Data from Germany, Spain and the UK, presented at the 28th Congress of the EURopean Committee for Treatment and Research in Multiple Sclerosis (ECTRIMS) last year in Lyon, France, were now published in Expert Review of Neurotherapeutics.

According to an observational study in Germany under the guidance of Dr Peter Flachenecker, professor at the Neurological Rehabilitation Center Quellenhof in Bad Wildbad, Germany, with 300 patients 4 out of 10 MS patients found an improvement in spasticity by 20% or more. After three months, the improvement observed was 30% or more. In addition, improvements were noted in activities of daily living and quality of life. According to two years of experience in the UK and Spain presented by Dr Juan Antonio García-Merino, professor at the Hospital Universitario Puerta de Hierro in Madrid, Spain, “data from the UK as well as Spanish Sativex safety registries confirm that clinical benefit is maintained over the longer term despite the expected trend for deterioration owing to disease progression. Even after more than 2 years of use, no new safety/tolerability signals have emerged with Sativex.”

Flachenecker P. A new multiple sclerosis spasticity treatment option: effect in everyday clinical practice and cost-effectiveness in Germany. Expert Rev Neurother 2013;13(3 Suppl 1):15-9.

García-Merino A. Endocannabinoid system modulator use in everyday clinical practice in the UK and Spain. Expert Rev Neurother 2013;13(3 Suppl 1):9-13.

News in brief

Science/Animal: Cannabigerol effective in experimental inflammatory bowel disease
Cannabigerol (CBG), a non-psychotropic cannabinoid, was effective in a mouse model of colitis. It reduced nitric oxide production in macrophages and reduced formation of free radicals in cells of the intestine. Authors concluded that “CBG could be considered for clinical experimentation in IBD [inflammatory bowel disease] patients.”
Department of Experimental Pharmacology, University of Naples Federico II, Italy.
Borrelli F, et al. Biochem Pharmacol. 2013 Feb 12. [in press]

Science/Animal: Cannabichromene improves experimental colitis
The non-psychotropic cannabinoid cannabichromene (CBC) is known to activate the ion channel TRPA1 and to inhibit endocannabinoid inactivation. In experiments with mice CBC ameliorated inflammation of the colon.
Department of Experimental Pharmacology, University of Naples Federico II, Naples, Italy.
Romano B, et al. Br J Pharmacol. 2013 Feb 4. [in press]

Science/Human: Cigarette smoking and cannabis use equally associated with psychotic-like experiences
In a survey with 1929 young adults cigarette smoking and cannabis use were equally strongly associated with the frequency of psychotic-like experiences. Researchers concluded that “smoking is an equally strong independent predictor of frequency of PLEs [psychotic-like experiences] as monthly cannabis use.”
University Medical Center Utrecht, Department of Psychiatry, The Netherlands.
van Gastel WA, et al. Psychol Med. 2013 Feb 18:1-9. [in press]

Science/Human: Use of synthetic cannabinoids associated with kidney injury
A total of 16 cases of acute kidney injury attributed to the use of synthetic cannabinoids were reported in the past year in 6 US states by the Centers for Disease Control and Prevention.
Centers for Disease Control and Prevention (CDC), USA.
NN. MMWR Morb Mortal Wkly Rep 2013;62:93-8.
Free full text

Science/Animal: Cannabinoid receptors are involved in the effects of the analgesic parecoxib
In normal rats suffering from neuropathic pain the pain medication parecoxib reduced pain, while it had only a marginal effect in rats without CB1 receptors. Authors concluded that these differences “might be due to modification of the cannabinoid system.” Parecoxib is approved in many EURopean countries for short term perioperative pain control.
Faculty of Medicine, Institute of Pharmacology and Toxicology, University of Magdeburg, Germany.
Becker A, et al. Naunyn Schmiedebergs Arch Pharmacol. 2013 Feb 1. [in press]

Science/Animal: Cannabinoids ameliorate memory impairment induced by chronic stress
A synthetic cannabinoid (WIN55,212-2), which activates both the CB1 and the CB2 receptor ameliorated impairments of cognitive functions in rats, which had undergone chronic stress, including memory deficits. Authors concluded that “cannabinoid receptor activation could represent a novel approach to the treatment of cognitive deficits that accompany a variety of stress-related neuropsychiatric disorders.”
Department of Psychology, University of Haifa, Israel.
Abush H. and Akirav I. Neuropsychopharmacology. 2013 Feb 20. [in press]

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