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IACM-Bulletin of 29 June 2014

USA: New York will become the 23rd state to legalize the medical use of cannabis

New York state lawmakers gave final approval on 20 June to a bill that would allow limited access to medical cannabis in New York, joining 22 other states where cannabis has been legalized for therapeutic purposes. Governor Andrew Cuomo is expected to sign the bill into law.

Under New York's measure, the Health Department would license five private companies in the state to produce and distribute medical cannabis products through dispensaries. Patients will not be allowed to smoke cannabis, but may purchase edibles and other non-smokable forms of the drug. Patients aged at least 21, who suffer from any one of a list of specified ailments - epilepsy, multiple sclerosis, Lou Gehrig's disease, Parkinson's disease, Huntington's disease, neuropathies, spinal cord injuries, cancer and HIV/AIDS - would be eligible to use cannabis as treatment. The Health Department would have discretion to approve other "serious conditions" for use of the drug as needed.

Reuters of 21 June 2014.

Science/Human: THC beneficial in post-traumatic stress disorder in clinical study

THC causes significant improvements in post-traumatic stress disorder (PTSD). This is the result of an open study with 10 patients by researchers at Hadassah Hebrew University Medical Centre in Jerusalem, Israel. Many patients with post-traumatic stress disorder achieve only partial remission with current treatments. Cannabis is often used as therapy in treatment-resistant patients.

The new study evaluates the tolerance and safety of oral THC for chronic PTSD. Ten patients on stable medication received 5 mg of THC twice a day as additional treatment. There were mild adverse effects in three patients, none of which led to treatment discontinuation. The intervention caused a statistically significant improvement in global symptom severity, sleep quality, frequency of nightmares, and hyperarousal symptoms.

Roitman P, Mechoulam R, Cooper-Kazaz R, Shalev A. Preliminary, Open-Label, Pilot Study of Add-On Oral Δ(9)-Tetrahydrocannabinol in Chronic Post-Traumatic Stress Disorder. Clin Drug Investig. 2014 Jun 17. [in press]

Science/Human: Cancer patients may profit from cannabis use

Cannabis use “is perceived as highly effective” by some patients with advanced cancer. This is the result of the analysis of questionnaires and medical records of adult cancer patients treated at a single institution, conducted by researchers of the University of Tel Aviv, Israel. Of approximately 17,000 cancer patients seen, 279 received a permit for cannabis from an authorized institutional oncologist.

Of 113 patients alive and using cannabis at one month, 69 (61%) responded to the detailed questionnaire. Improvement in pain, general well-being, appetite and nausea were reported by 70%, 70%, 60% and 50%, respectively. Side effects were mild and consisted mostly of fatigue and dizziness.

Waissengrin B, Urban D, Leshem Y, Garty M, Wolf I. Patterns of Use of Medical Cannabis Among Israeli Cancer Patients: A Single Institution Experience. J Pain Symptom Manage. 2014 Jun 14. [in press]

Science/Human: CBD extract Epidiolex effective in children with treatment-resistant epilepsy

An experimental CBD extract of the British company GW Pharmaceuticals has produced promising results in a small study of children with hard-to-treat epilepsy. The latest findings for its new product Epidiolex follow an assessment of 27 children and young adults with treatment-resistant epilepsy who were given the drug in two U.S. hospitals.
Epidiolex is given as a strawberry-lime flavoured syrup twice a day. The medicine does not contain THC.

GW said on 17 June that results after 12 weeks of therapy in the open-label study were "encouraging", with a reduction in seizure frequency of more than 50 percent. It now plans to start a Phase II/III clinical trial in the second half of the year. CBD may help children with severe epilepsy syndromes such as Dravet and Lennox-Gastaut, where seizures often persist despite high doses of multiple anti-epileptic drugs.

Reuters of 17 June 2014.

Science/Human: Genetic predisposition to schizophrenia associated with increased use of cannabis.

Genes that increase the risk of developing schizophrenia may also increase the likelihood of using cannabis, according to a new study led by King's College London, published today in Molecular Psychiatry. Previous studies have identified a link between cannabis use and schizophrenia, but it has remained unclear whether this association is due to cannabis directly increasing the risk of the disorder.

The new results suggest that part of this association is due to common genes, but do not rule out a causal relationship between cannabis use and schizophrenia risk. The study included 2,082 healthy individuals of whom 1,011 had used cannabis. Each individual's 'genetic risk profile' was measured -- that is, the number of genes related to schizophrenia each individual carried. The researchers found that people genetically pre-disposed to schizophrenia were more likely to use cannabis, and use it in greater quantities than those who did not possess schizophrenia risk genes. Dr Robert Power, lead author of the study says: "We know that cannabis increases the risk of schizophrenia. Our study certainly does not rule this out, but it suggests that there is likely to be an association in the other direction as well -- that a pre-disposition to schizophrenia also increases your likelihood of cannabis use."

Power RA, Verweij KJ, Zuhair M, Montgomery GW, Henders AK, Heath AC, Madden PA, Medland SE, Wray NR, Martin NG. Genetic predisposition to schizophrenia associated with increased use of cannabis. Mol Psychiatry. 2014 Jun 24. [in press]

Schizophrenia and cannabis use may share common genes

News in brief

The Netherlands: 2014 Medicinal Cannabis Masterclass
Bedrocan is now accepting applications for the 2014 Medicinal Cannabis Masterclass: MC4 - Bridging Gaps in a Budding World, November 16 – 22, Leiden & Groningen, The Netherlands. Some of the world’s leading authorities will present in an intimate setting on topics such as pharmaceutical production, cannabis plant chemistry and genetics, medicinal cannabis under existing regulations for medicines, clinical reviews and more for a maximum of 20 participants.
Information and registration.

Science/Human: No increased risk of lung cancer with cannabis smoking
In a review researchers found only “little evidence for an increased risk of lung cancer among habitual or long-term cannabis smokers.”
Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital, Toronto, Canada.
Zhang LR, et al. Int J Cancer. 2014 Jun 20. [in press]

Science/Human: Increased CB1 receptor activity tries to fight progression of Alzheimer’s disease
CB1 activity was high in early stages of Alzheimer’s disease in certain brain areas (hippocampus, frontal cortex). Researchers wrote that this indicates “an attempt to compensate for the initial synaptic impairment, which is then surpassed by disease progression. These results suggest that initial CB1 stimulation might have therapeutic relevance.”
Department of Pharmacology, Faculty of Medicine and Odontology, University of the Basque Country, Leioa, Spain.
Manuel I, et al. J Alzheimers Dis. 2014 Jun 19. [in press]

Science/Animal: Anandamide is helpful in traumatic brain injury
A substance called PF3845, which reduces the degradation of the endocannabinoid anandamide and thus increases its concentration promoted survival of nerve cells, attenuated inflammation and improved recovery in mice with traumatic brain injury.
University of the Health Sciences, Bethesda, USA.
Tchantchou F, et al. Neuropharmacology. 2014 Jun 14. [in press]

Science/Animal: Beta-caryophyllene reduces anxiety and depression
The terpene beta-caryophyllene, which is prevalent in cannabis, pepper and other spices, activates the CB2 receptor and reduces anxiety and depression. Authors concluded that “CB2 receptors may provide alternative therapeutic targets for the treatment of anxiety and depression” offering “exciting prospects for future studies.”
College of Medicine & Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates.
Bahi A, et al. Physiol Behav. 2014 Jun 13. [in press]

Science/Animal: Activation of CB2 receptors reduces bacterial translocation
A new animal study suggests that cannabinoids, which activate the CB2 receptor, have the potential to treat bacterial translocation through the inhibition of intestinal oxidative stress and inflammatory cytokines in liver cirrhosis. Bacterial translocation is the migration of bacteria or bacterial products from the intestinal lumen to lymph nodes. Bacterial translocation is known to be increased in liver cirrhosis.
National Yang-Ming University School of Medicine, Taiwan.
Yang YY, et al. J Hepatol. 2014 Jun 19. [in press]

Science/Animal: CB1 receptors involved in respiration and circulation
The first systematic study of cardiovascular function in mice without CB1 receptors revealed that CB1 receptors are involved in the control of respiration and circulation. They protect mice from negative consequences of a high-fat diet. For example breathing during the night was irregular in mice without CB1 receptors, especially in those with a high-fat diet.
Department of Biomedical and Neuromotor Sciences, University of Bologna, Italy.
Silvani A, et al. PLoS One. 2014 Jun 20;9(6):e100536.

Science/Human: No effect of legal status of cannabis on frequency of suicide
Researchers did not find a consistent association between the number of cannabis registrants in US states and completed suicide.
Denver Health, Colorado, USA.
Rylander M, et al. Am J Drug Alcohol Abuse. 2014 Jun 20:1-5. [in press]

Science/Human: Sativex effective and safe in clinical practice
Researchers found that “real-life data confirm the long-term effectiveness and tolerability of nabiximols [Sativex] for the treatment of resistant MSS [multiple sclerosis spasticity] in everyday clinical practice.”
Neurological Rehabilitation Centre Quellenhof, Bad Wildbad, Germany.
Flachenecker P, et al. EUR Neurol 2014;72(1-2):95-102.

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