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IACM-Bulletin of 22 January 2017

Germany: Cannabis flowers will be available on prescription for medicinal purposes from March 2017 on according to a law passed by the Bundestag

The German Bundestag, the lower house of parliament, on 19 January passed a law that legalizes the use of cannabis for medicinal purposes. The law was adopted unanimously by the members of the Bundestag without abstention. Those suffering from serious illnesses such as multiple sclerosis and chronic pain could be prescribed cannabis flowers, cannabis extracts as well as cannabis-based medicines such as the cannabis extract Sativex, dronabinol and nabilone by every German doctor. The law does not limit the possibility to prescribe cannabis and cannabis-based medicines to certain illnesses.

The law says patients will only have the right to be treated with cannabis in justified exceptional cases, but patients will not be allowed to grow their own cannabis. "Those who are severely ill need to get the best possible treatment and that includes health insurance funds paying for cannabis as a medicine for those who are chronically ill if they can't be effectively treated any other way," said Health Minister Hermann Groehe. A Health Ministry spokeswoman said cannabis would only be used as a last resort when nothing else seemed to work. She said a scientific study would simultaneously be carried out to assess the effects of cannabis use in such cases. Health insurances will have to cover the costs of the treatment. She said the law was likely to take effect in March after a procedural reading by the upper house of parliament (German Bundesrat). State-supervised cannabis plantations will be set up in Germany in future and until then cannabis will be imported, currently from the Netherlands and Canada.

“This is a tremendous achievement of all patients, doctors and lawyers, who since many years worked for the improvement of the medical care of the population with cannabis within the German Association for Cannabis as Medicine (ACM), increasingly supported by other people, organizations and politicians,” said Dr Franjo Grotenhermen, Chairman of the ACM. “But”, he added, “the battle is not yet finished. Today is the day to thank the many, who contributed to this development and continue to work for our goals.” The main steps, which finally resulted in the current law, were brought forward by a complaint of 8 patients before the Federal Constitutional Court in 1999. In this context the Federal Administrative Court emphasised the high value of the right to life and physical integrity based on the constitution (Grundgesetz) in the year 2005: "The right of physical integrity cannot only be violated in that bodies of the state themselves produce an assault or inflict pain through their actions. The extent of protection of this fundamental right is also affected if the government takes measures to prevent a medical condition to be cured or at least be mitigated and thereby physical suffering is continued and maintained needlessly.” This court decision forced the Federal Government to issue approvals for the use of cannabis flowers to severely ill patients under certain conditions.


Reuters of 19 January 2017

Video of the debate in the German Bundestag of 19 January 2017

Information on the law on the website of the Federal Health Ministry

Science/USA: New report of the National Academy of Sciences on cannabis

In 1999 the Institute of Medicine of the US National Academy of Sciences issued a report on the health effects of marijuana. Now the Academy issued an update. The new report says that current medical science has proven there are legitimate medical uses for marijuana and cannabis-derived drugs. Conclusive or substantial scientific evidence has shown that cannabis products are effective at treating chronic pain, calming muscle spasms caused by multiple sclerosis, and easing nausea from chemotherapy, the report said. However, there's little to no evidence supporting any of the other numerous health claims related to marijuana, the report said.

And there's a downside as well -- marijuana use comes with a host of potential health risks, whether someone is using the drug medicinally or recreationally, according to the report. The report calls on government to ease regulations that hamper research into cannabis, so scientists can sort the wheat from the chaff when it comes to medical claims and health risks associated with cannabis. The National Academy of Sciences released The Health Effects of Cannabis and Cannabinoids on 12 January, following an extensive review of all available medical research. Among the 16 members of the committee, which prepared the report are IACM Board member Dr Donald Abrams from the University of California and the editor of Cannabis and Cannabinoid Research Dr Daniele Piomelli.

The Health Effects of Cannabis and Cannabinoids: The Current State of Evidence and Recommendations for Research

UPI of 12 January 2017

News in brief

Brazil: Sativex will be available under the name Mevatyl
Brazilian healthcare regulator Anvisa on 16 January said it had issued the country's first license for sale of a cannabis-based drug in the country. The multiple sclerosis treatment, an oral spray developed by Britain's GW Pharmaceuticals, is known as Sativex internationally and will be sold in Brazil under the brand name Mevatyl.
Reuters of 16 January 2017

Science/Ireland: Most general practitioners support the medical use of cannabis
In a survey among Irish general practitioners with a response rate of 15% (n=565) over half of them (58.6%) supported the legalization of cannabis for medicinal use.
Irish College of General Practitioners, Dublin, Ireland.
Crowley D, et al. Harm Reduct J. 2017;14(1):4.

Science/Human: Cannabis use is more frequent among people with spinal cord injury than among the general population
In Denmark 1101 patients with spinal cord injury were interviewed and 537 participants completed the questionnaire. Of these, 36% had tried cannabis at least once and 9% were current users. 59% reported at least good effect on pain and spasticity. Those who had never tried cannabis reported that they would mainly use cannabis to alleviate pain and spasticity if it were legalized.
Spinal Cord Injury Centre of Western Denmark, Regional Hospital of Viborg, Denmark.
Andresen SR, et al. J Rehabil Med. 2017 Jan 18. [in press]

Science/Animal: The number of CB2 receptors is increased in dogs with damage to the spinal cord
In the spinal cord of dogs with degenerative myelopathy the number of CB2 receptors was increased, mainly in activated astrocytes. Authors wrote that “such receptors may be used as a potential target to enhance the neuroprotective effects exerted by these glial cells.”
Facultad de Medicina, Universidad Complutense, Madrid, Spain.
Fernández-Trapero M, et al. Dis Model Mech. 2017 Jan 9. [in press]

Science/Animal: Why CB2 receptors may be a promising target for inflammatory pain
Studies with adult rats show that endocannabinoid signalling in a certain region of the central nervous system, which plays a major role in pain processing, the rostral ventromedial medulla, is altered in persistent inflammation. Authors wrote that this observation “provides additional rationale for the development of CB2 receptor-selective agonists as useful therapeutics for chronic inflammatory pain.”
Department of Neurological Surgery, Oregon Health & Science University, Portland, USA.
Li MH, et al. J Neurosci. 2017;37(3):626-636.

Science/Animal: Mice fed with high fat and sugar presented with a dysregulated endocannabinoid system
In comparison with mice, which received a standard rodent chow, mice fed with a diet high in fat and sugar (Western diet, WD) for 60 days exhibited a large increase in body weight. This was associated with a dysregulated endocannabinoid system. Authors wrote that their results “suggest that hyperphagia associated with WD-induced obesity is driven by enhanced endocannabinoid signalling at peripheral CB1Rs.”
University of California, Riverside, USA.
Argueta DA, et al. Physiol Behav. 2017;171:32-39.

Science/Human: Cannabis use during adolescence not associated with weight in midlife
In an analysis of 712 Danish adolescents aged between 15 and 19 years at the beginning of the study cannabis use was not associated with weight change from adolescence to midlife according to data taken 20-22 years later.
School of Molecular Bioscience, University of Sydney, Camperdown, Australia.
Jin LZ, et al. PLoS One. 2017;12(1):e0168897.

Science/Human: No relevant association between cannabis use and anxiety in the general population
An analysis of 5 high-quality studies on the relationship between cannabis use and anxiety in the general population found no significant association (odds ratio=1.04; 95% confidence interval 0.91 to 1.19).
School of Psychology, University of Southampton, UK.
Twomey CD. J Epidemiol Community Health. 2017 Jan 4. [in press]

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