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IACM-Bulletin of 15 April 2018

Science/Human: Legalisation of cannabis for medical use is associated with reduced prescriptions of opioids according to two studies

The implementation of medical cannabis laws in the USA is associated with reduced prescriptions of opioids according two studies published in the journal JAMA Internal Medicine. In the first study researchers of the University of Kentucky in Lexington and Emory University investigated the relationship between cannabis laws and opiate prescriptions in patients enrolled in the Medicaid program, a joint federal and state program that helps with medical costs for some people with limited income and resources. Authors found that, “state implementation of medical marijuana laws was associated with a 5.88 percent lower rate of opioid prescribing. Moreover, the implementation of adult-use marijuana laws, which all occurred in states with existing medical marijuana laws, was associated with a 6.38 percent lower rate of opioid prescribing.”

In the second study researchers of the University of Georgia in Athens investigated the association between state laws on medical cannabis and opiate prescriptions among certain patients in the Medicare program, a national social insurance program administered by the federal government. They wrote: "This longitudinal analysis of Medicare Part D found that prescriptions filled for all opioids decreased by 2.11 million daily doses per year from an average of 23.08 million daily doses per year when a state instituted any medical cannabis law. Prescriptions for all opioids decreased by 3.742 million daily doses per year when medical cannabis dispensaries opened.” They concluded that "combined with previously published studies suggesting cannabis laws are associated with lower opioid mortality, these findings further strengthen arguments in favor of considering medical applications of cannabis as one tool in the policy arsenal that can be used to diminish the harm of prescription opioids."

Wen H, Hockenberry JM. Association of Medical and Adult-Use Marijuana Laws With Opioid Prescribing for Medicaid Enrollees. JAMA Intern Med. 2018 Apr 2. [in press]

Bradford AC, Bradford WD, Abraham A, Bagwell Adams G. Association Between US State Medical Cannabis Laws and Opioid Prescribing in the Medicare Part D Population. JAMA Intern Med. 2018 Apr 2. [in press]

Science/Human: A CBD-rich cannabis extract improved symptoms of ulcerative colitis in a controlled clinical study

A CBD-rich cannabis extract may be beneficial for symptomatic treatment of ulcerative colitis. This is the result of a placebo controlled study conducted by scientists of Guy's and St Thomas' NHS Foundation Trust in London, UK. Of 60 patients 29 received a capsulated cannabis extract and 31 received a placebo for 10 weeks. Authors noted that the extract also contained a number of other compounds including up to 4.7 percent THC. Mean daily doses of CBD were about 300 mg, taken in two doses of 150 mg in the morning and evening, corresponding to an additional dose of about 14 mg of THC.

There was no difference between the cannabis group and the placebo group in the percentage of patients in remission after treatment. However, quality-of-life and global assessment of illness severity was better in the cannabis group than in the placebo group. There was a number of adverse effects, which according to the authors may be attributed to the THC in the extract. However, improvements may have also been caused by THC.

Irving PM, Iqbal T, Nwokolo C, Subramanian S, Bloom S, Prasad N, Hart A, Murray C, Lindsay JO, Taylor A), Barron R), Wright S). A Randomized, Double-blind, Placebo-controlled, Parallel-group, Pilot Study of Cannabidiol-rich Botanical Extract in the Symptomatic Treatment of Ulcerative Colitis. Inflamm Bowel Dis. 2018;24(4):714-724.

News in brief

IACM: New publications in Cannabis and Cannabinoid Research
New articles have been published in the CCR, the partner journal of the IACM:
“Hallucinations” Following Acute Cannabis Dosing: A Case Report and Comparison to Other Hallucinogenic Drugs by Frederick S. Barrett, Nicolas J. Schlienz, Natalie Lembeck, Muhammad Waqas, Ryan Vandrey.
New York Physicians' Perspectives and Knowledge of the State Medical Marijuana Program by Alexandra Sideris, Fahad Khan, Alina Boltunova, Germaine Cuff, Christopher Gharibo, Lisa V. Doan.
A National Needs Assessment of Canadian Nurse Practitioners Regarding Cannabis for Therapeutic Purposes by Lynda G. Balneaves, Abeer Alraja, Daniel Ziemianski, Fairleth McCuaig, Mark Ware.
Verbal Memory Performance and Reduced Cortical Thickness of Brain Regions Along the Uncinate Fasciculus in Young Adult Cannabis Users by Nina Levar, Alan N. Francis, Matthew J. Smith, Wilson C. Ho, Jodi M. Gilman.

World/USA: Comments on the medical usefulness of cannabis
The Food and Drug Administration (FDA) is requesting interested persons to submit comments concerning abuse potential, actual abuse, medical usefulness, trafficking, and impact of scheduling changes on availability for medical use of five drug substances. These comments will be considered in preparing a response from the United States to the World Health Organization (WHO) regarding the abuse liability and diversion of these drugs. Comments have to be submitted not later than 23 April 2018.
Request of comments on abuse potential and medial usefulness of cannabis by the FDA

Science/Human: The legalisation of cannabis reduces crime
According to an analysis of data on crime and other issues in the states of Washington and Oregon the legalisation of cannabis for recreational use was associated with a significant reduction in rapes and property crimes, and in the use of other drugs including alcohol. Four possible mechanisms were discussed by the authors: “the direct psychotropic effects of cannabis; substitution away from violence-inducing substances; reallocation of police effort; reduced role of criminals in the marijuana business.”
University of Bologna, Department of Economics, Italy.
Dragone D, et al. JEBO 2018, Feb 20. [in press]

Science/Human: THC is found in breast milk of cannabis using mothers
According to a study, which investigated the transfer of THC from cannabis using mothers into breast milk, 2.5 percent of the maternal dose is transferred into the mother’s milk. The estimated daily infant dose was 8 micrograms per kilogram, which would be 0.04 milligrams for a child of 5 kg, if the mother inhaled cannabis containing 23 mg THC as used in the study.
Texas Tech University Health Sciences Center, Amarillo, USA.
Baker T, et al. Obstet Gynecol. 2018 Apr 6. [in press]

Science/Human: Bisphenol A may inhibit endocannabinoid degradation
Bisphenol A, which is a chemical widely used in the industry, may inhibit FAAH (fatty acid amide hydrolase), which may cause a rise of plasma endocannabinoid levels.
Medical University of Bialystok, Poland.
Zbucka-Kretowska M et al. Chemosphere. 2018;203:387-392.

Science/Animal: CBD reduces withdrawal symptoms
In a study mice have been given a synthetic cannabinoid (CP-55,940), which acts similar as THC at the CB1 receptor, for several days. CBD reduced their withdrawal symptoms after discontinuation and changes caused by the administration of CP-55,940.
Instituto de Neurociencias, Universidad Miguel Hernández-CSIC, Alicante, Spain.
Navarrete F, et al. Br J Pharmacol. 2018 Apr 6. [in press]

Science/Human: CBD did not improve cognition in patients with schizophrenia
In a placebo-controlled study with 36 patients with schizophrenia, who received stable antipsychotic medication, CBD had no effect on cognitive impairments. Participants received either 600 mg of oral CBD for 6 weeks or placebo. There were no differences in side effects between placebo and CBD with the exception of sedation, which was found more often in the CBD group.
Schizophrenia and Neuropharmacology Research Group at Yale, VA Connecticut Healthcare System, West Haven, USA.
Boggs DL, et al. Psychopharmacology (Berl). 2018 Apr 5. [in press]

Science/Human: Increase in cannabis-associated emergency department visits by adolescents in Colorado
A survey of emergency department visits in Colorado from 2005 to 2015 revealed 4202 cannabis -related visits and an increase of cannabis -related visits by adolescents between 2009 (before the legalisation of cannabis) and 2015 (after the legalisation of cannabis).
University of Colorado Anschutz Medical Campus, Aurora, USA.
Wang GS, et al. J Adolesc Health. 2018 Mar 30. [in press]

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