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IACM-Bulletin of 19 May 2013

Israel: Patients go on hunger strike to protest against restrictions on the medical use of cannabis

Patients and doctors are organizing a hunger strike opposite the home of Health Minister Yael German on 23 May to protest new restrictions on the use of medical cannabis. The new procedure, implemented immediately, established a list of conditions for which a patient can receive approval for treatment with cannabis. Among others on the list are patients with metastasizing cancer, Crohn's disease, ulcerative colitis, HIV patients with extreme weight loss, multiple sclerosis patients with muscle spasms and terminal patients with a life expectancy of up to half a year. Patients with pain of neural origin will receive authorization for cannabis only after a year of treatment at recognized pain clinic and following the failure of previous treatments.

The demonstrators want other conditions to be included in the list, including Parkinson's disease, glaucoma and psychiatric conditions and disorders. Recently four doctors from the Doctors' Forum for Safe Access to Cannabis sent a letter to German protesting the new procedure. Forum chairman Dr Ilya Reznick of the Reut Hospital in Tel Aviv, Dr Jonathan Greenfeld, director of the palliative oncology medicine service at Assaf Harofeh Hospital, Dr Alan Flashman of the Hebrew University of Jerusalem, and Dr Yakir Rotenberg of the Hadassah Medical Centre warn that the new procedure could cause patients who are no longer on the list to purchase drugs from illegal sources. According to them, the announced procedures are "arbitrary and discriminate among patients with different conditions without any logical explanation, and are liable to lead to damage to the continuity of treatment for some of them, contrary to the Patients' Rights Law.” Currently, about 11,000 patients are allowed to use cannabis for medicinal purposes in Israel.

Haaretz of 17 May 2013.

Science/Human: Cannabis use was associated with lower insulin resistance and reduced risk of diabetes

Despite increased appetite and caloric intake a representative survey shows that cannabis use is associated with lower levels of fasting insulin, lower insulin resistance and smaller waist circumference. This is the result of an epidemiological study with 4657 adults conducted by researchers of the University of Nebraska, College of Medicine in Omaha, the Department of Epidemiology of Harvard School of Public Health in Boston, and the Cardiovascular Epidemiology Research Unit at Beth Israel Deaconess Medical Center in Boston, USA. Of the participants, 579 were current cannabis users and 1975 were past users.

Current cannabis use was associated with 16% lower fasting insulin levels and 17% lower HOMA-IR. The homeostatic model assessment (HOMA) is a method used to quantify insulin resistance and function of the cells, which produce insulin in the pancreas, the so-called beta-cells. Researchers also found significant associations between cannabis use and smaller waist circumferences. These cannabis effects may be protective against the development of diabetes. Researchers speculate that their results may be related to effects on the hormone adiponectin, which is secreted from fat tissue. Adiponectin modulates a number of metabolic processes, including glucose regulation. Levels of the hormone are higher in adults with high fat percentage. I

Penner EA, Buettner H, Mittleman MA. The Impact of Marijuana Use on Glucose, Insulin, and Insulin Resistance among US Adults. Am J Med. 2013 May 16. [in press]

Science/Human: Cannabis improved symptoms of Crohn’s disease in a placebo-controlled study

Inhalation of cannabis improved symptoms and disease activity in patients with Crohn’s disease. This is the result of a clinical study with 21 participants, who did not respond to a therapy with steroids, immunomodulators, or anti-tumour necrosis factor-alpha agents, conducted at the Department of Gastroenterology and Hepatology of Tel Aviv University, Israel. Patients received either cannabis cigarettes twice daily or placebo cannabis cigarettes for eight weeks.

Complete remission was achieved by 5 of 11 subjects in the cannabis group and 1 of 10 in the placebo group. A clinically significant improvement was observed in 10 of 11 subjects in the cannabis group and 4 of 10 in the placebo group. Three patients in the cannabis group were weaned from steroid dependency. Subjects receiving cannabis reported improved appetite and sleep, with no significant side effects. Authors concluded that “a short course (8 week) of THC-rich cannabis produced significant clinical, steroid-free benefits to 11 patients with active CD, compared to placebo, without side effects.”

Naftali T, Bar Lev L, Dotan I, Lansky EP, Sklerovsky BF, Konikoff FM. Cannabis Induces a Clinical Response in Patients with Crohn's Disease: a Prospective Placebo-Controlled Study. Clin Gastroenterol Hepatol. 2013 May 3. [in press]

News in brief

Science/Human: Cannabis and baclofen acted synergistically in a patient with multiple sclerosis
In a patient with secondary progressive multiple sclerosis, whose spasticity did not respond to conventional treatment, a combination of baclofen injections into the cerebrospinal fluid and very low doses of the cannabis extract Sativex was highly effective. Baclofen alone was not effective. Researchers remarked a “supra-additive effect in combining” both medications.
Department of Neurology, St Josef-Hospital, Ruhr-University Bochum, Germany.
Stroet A, et al. Ther Adv Neurol Disord 2013;6(3):199-203.
Free full text.

Science/Human: Better cognition in patients with psychosis, who use cannabis
Researchers examined grey matter of the brain in 28 patients with first-episode psychosis and a history of cannabis use, 78 patients without a history of cannabis use and 80 healthy controls who had not used cannabis. Patients with a history of cannabis use had less brain abnormalities as well as less cognitive impairments compared to patients without a history of cannabis use.
Department of Psychiatry, Faculty of Medicine, University of São Paulo, Brazil.
Cunha PJ, et al. Schizophr Res. 2013 May 11. [in press]

Italy: Sativex soon available
GW Pharmaceuticals announced that their cannabis extract Sativex got commercialization approval in Italy. The company expects commercial launch in September by GW’s partner, Almirall.
Press release by GW Pharmaceuticals of 7 May 2013

USA: Colorado legislature votes to tax recreational cannabis
The Colorado legislature passed and sent to the governor a bill to establish what would be the first tax ever collected on commercial sales of cannabis purchased for recreational use in the United States. The measure was approved as part of a package of measures to implement Colorado's cannabis legalization law enacted by voters last November. Democratic Governor John Hickenlooper was expected to sign the legislation.
Reuters of 9 May 2013

Georgia: Government considers legalizing cannabis
Georgia’s government is considering a possibility of legalizing cannabis in the country, Labor, Health and Social Affairs Minister David Sergeyenko said. “As far as drugs are concerned, ban-related mechanisms very often entail a ricochet effect, which means strengthening and development of other directions etc.,” the press agency Novosti-Georgia quoted Sergeyenko.
RIA Novosti of 10 May 2013

Science/Animal: Cannabinoids attenuates responses to certain pain receptors in cancer pain
The synthetic cannabinoid WIN 55,212-2 reduced the response to pain receptors of so-called C-fibres in mice with cancer pain. C-fibres are responsible for the sensation of pain after stimuli of strong intensity.
Department of Diagnostic and Biological Sciences, University of Minnesota, Minneapolis, USA.
Uhelski ML, et al. Neuroscience. 2013 May 11. [in press]

Science/Human: Patients with post-traumatic stress disorder have changes of the endocannabinoid system
Compared to 29 healthy persons 10 patients suffering from post-traumatic stress disorder had significantly higher concentrations of the endocannabinoids anandamide and 2-AG and presented with some other changes of the endocannabinoid system. Authors wrote that this “may have pathophysiological and diagnostic consequences.”
Department of Anaesthesiology, Ludwig-Maximilians-University, Munich, Germany.
Hauer D, et al. PLoS One 2013;8(5):e62741.

Science/Animal: Cannabidiol reduces seizures in a mouse model of epilepsy
Cannabidiol (CBD) reduced seizures in mice, in which seizures were caused by a chemical substance and electroshocks.
Neuroscience Research Centre, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
Shirazi-Zand Z, et al. Epilepsy Behav 2013;28(1):1-7.

Science/Animal: Cannabidiol facilitates fear extinction
Repeated microinjections of CBD into a certain brain region (infralimbic cortex) of mice facilitated fear extinction. This effect was mediated by the CB1 receptor. Researchers concluded that these observations “suggest a potential therapeutic use of CBD for extinction-based therapies of aversive memories in humans.”
Departamento de Farmacologia, Universidade Federal de Santa Catarina, Florianópolis, Brazil.
Do Monte FH, et al. Behav Brain Res. 2013 May 1. [in press]

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