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IACM-Bulletin of 02 June 2013

World: Three-quarters of doctors would give a cannabis prescription to an advanced cancer patient in pain

Three-quarters of doctors who responded to a survey about medical cannabis said they would approve the use of the drug to help ease pain in an older woman with advanced breast cancer. In a February issue of the New England Journal of Medicine, doctors were presented with a case, as well as arguments both for and against the use of medical cannabis. Doctors were then asked to decide whether or not they would approve such a prescription for this patient. The case presented to the doctors was Marilyn, a 68-year-old woman with breast cancer that had spread to her lungs and spine. She was undergoing chemotherapy, and said she had little appetite and a great deal of pain. She had tried various medications to relieve her pain, including the opioid oxycodone. She lives in a state where the medical use of cannabis is legal, and asks her physician for a prescription.

Seventy-six per cent of the 1,446 doctors who responded said they would give the woman a prescription for medical cannabis. Doctors came from 72 countries. However, despite the global participation, the vast majority of votes (1063) came from the United States, Canada, and Mexico. Outside North America, the greatest participation was from countries in Latin America and EURope, and overall results were similar to those of North America, with 78% of voters supporting the medical use of cannabis.

Adler JN, Colbert JA. Medicinal Use Marijuana - Polling Results. N Engl J Med 2013;368(22):e30

WebMD of 29 May 2013

News in brief

USA: Illinois will likely become the next state to legalise the medical use of cannabis
On 17 May the Illinois Senate voted to approve the use of cannabis for medical purposes, which if signed into law would make it the second-most-populous state in the nation after California to allow the drug's use for medical purposes. The bill, approved by the Illinois House in April, now moves to Governor Pat Quinn's desk to await his signature. Quinn has indicated he is sympathetic to the bill, especially as it would benefit injured veterans.
Reuters of 17 May 2013

USA: Recreational cannabis now legal in Colorado
On 28 May Governor John Hickenlooper signed into law measures to regulate the recreational use of cannabis in Colorado, including blood-level limits for motorists and setting up a voter referendum to impose a tax on the non-medical sale of cannabis. One of the bills signed by Hickenlooper calls for a referendum in November on setting a 15 per cent excise tax and an additional 10 per cent sales tax on cannabis sales. Other measures included in the legislative package are setting blood limits for driving while under the influence of marijuana at 5 nanograms per milliter, and limiting purchases of cannabis to non-Colorado residents.
Reuters of 29 May 2013

Science/Animal: Endocannabinoid system impaired in animal model of autism
In an animal model of autism the endocannabinoid system was significantly impaired. Researchers wrote that this raises “the possibility that alterations in endocannabinoid signalling may contribute to autism pathophysiology.”
Department of Molecular and Cellular Physiology, Stanford University Medical School, USA.
Földy C, et al. Neuron 2013;78(3):498-509.

Science/Animal: Ultra-low doses of THC provide protection to the heart
Mice, which received a very low dose of THC (0.002 mg per kg of body weight) before myocardial infarction (heart attack) showed a better outcome than non-treated mice. Researchers applied three forms of treatment: a single dose of THC 2 hours or 48 hours or continuous treatment over 3 weeks. All treatments were effective. They concluded that “a single ultra-low dose of THC before ischemia is a safe and effective treatment that reduces myocardial ischemic damage.”
Felsenstein Medical Research Center, Rabin Medical Center, Petah Tiqwa, Israel.
Waldman M, et al. Biochem Pharmacol 2013;85(11):1626-33.

Science/Animal: Tetrahydrocannabivarin may be beneficial in diabetes
In studies with obese mice, which received different doses of tetrahydrocannabivarin (THCV), this natural cannabinoid did not significantly affect food intake or body weight gain, but reduced glucose intolerance and increased insulin sensitivity. Researchers concluded that “THCV is a new potential treatment against obesity-associated glucose intolerance with pharmacology different from that of CB1 inverse agonists/antagonists.”
Clore Laboratory, University of Buckingham, UK.
Wargent ET, et al. Nutr Diabetes 2013;3:e68.

Science/Human: Accidental ingestion of cannabis products by children
In a children’s hospital emergency department in Colorado the number of admitted children younger than 12 years due to ingestion of cannabis products increased from 0 of 790 between 2005 and 2009 to 14 of 588 between 2009 and 2011. Seven of these exposures were from food products.
Department of Pediatrics, The University of Colorado Denver, USA.
Wang GS, et al. JAMA Pediatr. 2013 May 27:1-4. [in press]

Science/Human: Omega-3-fatty acids reduce anandamide levels in obese men
In a clinical study with 11 obese men dietary supplementation with krill powder, which contains high amounts of long-chain omega-3-fatty acids, for 24 weeks reduced levels of triglycerides and of the endocannabinoid anandamide in blood. Researchers concluded that “these data confirm that dietary krill powder reduces peripheral endocannabinoid overactivity in obese subjects.”
Endocannabinoid Research Group, Istituto di Chimica Biomolecolare, CNR, Pozzuoli, Italy.
Berge K, et al. Lipids Health Dis 2013;12(1):78.

Science/Human: Cannabis use is associated with an earlier onset of psychosis
In a group of 502 patients with first-episode psychosis level of cannabis use was associated with a younger age at presentation. Cannabis users who reduced or stopped their use following contact with services had the greatest improvement in symptoms at 1 year compared with continued users and non-users.
Imperial College London, UK.
Stone JM, et al. Psychol Med. 2013 May 24:1-8. [in press]

Science/Human: Cannabis alone did not increase number of strokes, but did so in combination with tobacco
In a group of 160 stroke patients admitted to hospital 25 (15.6%) had positive cannabis drug screens. Cannabis use was associated with a doubled risk of ischemic stroke. However after adjusting for tobacco use, an independent influence of cannabis could not be confirmed.
Departments of Neurology, Microbiology, and General Medicine, Auckland City Hospital, New Zealand.
Barber PA, et al. Stroke. 2013 May 21. [in press]

Science/Animal: Neuroprotective effects of the endocannabinoid AraS
The endocannabinoid AraS (N-arachidonoyl-L-serine) improved the outcome after traumatic brain injury in mice even after given only 7 days after the injury.
Medical Faculty, Hebrew University of Jerusalem, Israel.
Cohen-Yeshurun A, et al. J Cereb Blood Flow Metab. 2013 May 22. [in press]

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