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IACM-Bulletin of 08 December 2019

Science/Human: Cannabis may be helpful in the treatment of migraine and other forms of headache

An app, which allows medical cannabis patients to track their symptoms before and after using cannabis shows, that cannabis provided significant reductions in headache ratings. The study was conducted by researchers of the Department of Psychology and the Translational Addiction Research Center of Washington State University in Pullman, USA. Scientists also wanted to know, whether gender, cannabis strain, dose and THC and CBD content played a role.

They analysed data from 12,293 sessions where cannabis was used to treat headache and 7,441 sessions where cannabis was used to treat migraine. Men showed larger reductions in headache than women and use of concentrates was associated with larger reductions in headache than flowers. Further, there was evidence of tolerance to these effects. Authors wrote that “inhaled cannabis reduces self-reported headache and migraine severity by approximately 50%. However, its effectiveness appears to diminish across time and patients appear to use larger doses across time, suggesting tolerance to these effects may develop with continued use.”

Cuttler C, Spradlin A, Cleveland MJ, Craft RM. Short- and Long-Term Effects of Cannabis on Headache and Migraine. J Pain. 2019 Nov 9. [in press]

Science/Human: Cannabis may be helpful in drug-resistant epilepsy according to a case series

Scientists from the University “Federico II” of Naples, Italy, presented a retrospective case series of 5 patients with epilepsy refractory to standard medication, who profited from cannabis treatment. Olive OIL extracts were prepared following standard extraction protocols from medical grade cannabis.

After treatment with the cannabis OIL, all patients reported a reduction in seizure frequency and severity, and some reported improved mood, sleep quality, and general well-being without relevant side effects. Authors concluded that despite “the small sample size and open-label nature of the data, we show that MGC (medical grade cannabis) may be successfully used to treat DRE (drug-resistant epilepsy). This is especially true when considering that no valid therapeutic option exists for these patients and that MGC was extremely well tolerated.”

Pane C, Saccŕ F. The use of medical grade cannabis in Italy for drug-resistant epilepsy: a case series. Neurol Sci. 2019 Nov 27. [in press]

Science/Human: No negative effects on cognition in patients using cannabis

In a study with 22 cannabis patients, who received a cannabis product with 20% THC there was no negative effect on cognition during the intoxication with the drug. Scientists from several institutions in Canada and the USA participated in this new research. Participants were administered the same brief neurocognitive battery three times during a six-hour period: at baseline, once after they consumed the cannabis product, and once again several hours later.

The average self-reported level of cannabis intoxication prior to the second assessment was 5 out of 10. Authors wrote that “contrary to expectations, performance on neuropsychological tests remained stable or even improved during the acute intoxication stage (…), and continued to increase during recovery. Interestingly, the failure rate on performance validity indicators increased during THC. Contrary to our hypothesis, there was no psychometric evidence for a decline in cognitive ability following THC intoxication.”

Olla P, Rykulski N, Hurtubise JL, Bartol S, Foote R, Cutler L, Abeare K, McVinnie N, Sabelli AG, Hastings M, Erdodi LA. Short-term effects of cannabis consumption on cognitive performance in medical cannabis patients. Appl Neuropsychol Adult. 2019 Dec 2:1-11.

Science/Human: CBD OIL applied to the skin may be helpful in peripheral neuropathic pain

In a placebo-controlled study with 29 patients with symptomatic peripheral neuropathy CBD OIL, administered to the skin reduced pain. Several institutions from the US participated in this study. 15 patients were randomized to the CBD group with the treatment product containing 250 mg CBD/3 fluid ounce (about 90 ml), and 14 patients were randomized to the placebo group. After four weeks, the placebo group was allowed to crossover into the treatment group.

The mean age of the study population was 68 years. There was a statistically significant reduction in intense pain, sharp pain, cold and itchy sensations in the CBD group when compared to the placebo group. No adverse events were reported in this study. Authors concluded that their “findings demonstrate that the transdermal application of CBD OIL can achieve significant improvement in pain and other disturbing sensations in patients with peripheral neuropathy.”

Xu DH, Cullen BD, Tang M, Fang Y. The Effectiveness of Topical Cannabidiol OIL in Symptomatic Relief of Peripheral Neuropathy of the Lower Extremities. Curr Pharm Biotechnol. 2019 Dec 1. [in press]

Science/Human: Frequency of illegal opioid use in chronic pain patients is lower in daily cannabis users

The study included data from 1152 Canadians with the median age of 49 years with major or persistent pain between 2014 and 2017. In total, 40% reported daily illicit opioid use, and 36% reported daily cannabis use during at least one 6-month follow-up period. The most commonly reported therapeutic reasons for cannabis use were pain (36%), sleep (35%), stress (31%), and nausea (30%).

Daily cannabis use was associated with significantly lower daily illicit opioid use (adjusted odds ratio 0.50). Authors concluded that despite study limitations these “findings provide longitudinal observational evidence that cannabis may serve as an adjunct to or substitute for illicit opioid use among PWUD (people who use drugs) with chronic pain.”

Lake S, Walsh Z, Kerr T, Cooper ZD, Buxton J, Wood E, Ware MA, Milloy MJ. Frequency of cannabis and illicit opioid use among people who use drugs and report chronic pain: A longitudinal analysis. PLOS x, 2019 Nov 19. [in press]

News in brief

Brazil: The laws allow cannabis-based products for medical use but no cultivation in the country
Brazilian pharmaceutical regulator Anvisa approved regulations for the roll-out of medicinal cannabis-based products but in a separate vote blocked a proposal to allow domestic medical cannabis plantations. Anvisa said that cannabis-based products will only be available for sale in registered pharmacies, and with a prescription.
Reuters of 3 December 2019

USA: Warning by the health authorities to companies selling CBD
The U.S. Food and Drug Administration issued warning letters to 15 companies for illegally selling products containing cannabidiol (CBD) in ways that violate the Federal Food, Drug, and Cosmetic Act. The FDA also published a revised Consumer Update detailing safety concerns about CBD products more broadly. Based on the lack of scientific information supporting the safety of CBD in food, the FDA is also indicating today that it cannot conclude that CBD is generally recognized as safe among qualified experts for its use in human or animal food.
FDA of 25 November 2019

Science/Human: Harms from vaping may be caused by vitamin E acetate
A study of lung illnesses in Minnesota supports the notion that a compound known as vitamin E acetate, present in many "black market” products, could be to blame for severe health consequences, including death, from the use of some vaping products. The study found that while vitamin E acetate was not found in most illicit vape products tested in Minnesota in 2018, a year later -- coinciding with the recent illness outbreak -- nearly all such samples contained the chemical.
Healthy Day of 26 November 2019

USA: Research team gets 3.5 million dollars for research of cannabis in chronic pain
Ziva Cooper, research director of the UCLA Cannabis Research Initiative, has been awarded a 3.5 dollar million grant from the National Institutes of Health to conduct a five-year study assessing the pain-relieving effects of cannabis and cannabinoids. The grant will fund the first clinical study for the Cannabis Research Initiative, which was founded in 2017. Cooper joined the initiative as its first research director in January.
News Medical Life Sciences 14 November 2019

Science/Human: Cannabis effective in the case of metastatic mesothelioma
Researchers of a British university hospital presented a case report of a 64 year old man with mesothelioma, where CBD and THC improved the disease within 6 months.
St George's University Hospital, London, UK.
Dalgleish AG, et al. Respir Med Case Rep. 2019;29:100971.

Science/Human: CBD reduced anxiety in teenagers according to a placebo controlled study
In a study with 37 Japanese teenagers, who either received 300 mg of CBD or placebo for 4 weeks “CBD significantly decreased anxiety measured by both scales.” Authors concluded that their results “indicate that CBD could be a useful option to treat social anxiety.”
Primate Research Institute, Kyoto University, Inuyama, Japan.
Masataka N, et al. Front Psychol. 2019 Nov 8;10:2466.

Science/Animal: Cannabinoids may increase or decrease the effects of certain antidepressants
In studies with mice a study showed “that activation and inhibition of CB1 receptors as well as inhibition of CB2 receptors may increase the antidepressant activity of tianeptine, whereas only inhibition of CB1 and CB2 receptors has a potential to augment the antidepressant activity of agomelatine.”
Department of Applied and Social Pharmacy, Medical University of Lublin, Poland.
Poleszak E, et al. Pharmacol Biochem Behav.2019 Nov 27:172833.

Science/Animal: Cannabis may be helpful in symptom management of cancer
According to her qualitative survey of 19 cancer survivors of medical cannabis may “offer potential benefits for symptom management and side effect relief, especially in reducing and managing pain.”
Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, United States.
Victorson D, et al. Complement Ther Med. 2019 Dec;47:102204.

Science/Human: CBD was helpful in a very serious case of epilepsy due to Lennox-Gastaut syndrome
The very serious case of our 28-year-old male with Lennox-Gastaut syndrome was presented, who remained seizure-free after a combination of CBD and anti-epileptic medication.
Department of Pharmacy, Royal Prince Alfred Hospital, Camperdown, Australia.
Capra S, et al. J Clin Pharm Ther. 2019 Nov 26. [in press]

Science/Animal: Activation of the CB2 receptor was helpful in hepatorenal syndrome
In a study with mice activation of the CB2 receptor was beneficial in hepatorenal syndrome. This is a life-threatening complication of end-stage liver disease characterized by the rapid decline of kidney function.
Laboratory of Cardiovascular Physiology and Tissue Injury, National Institute on Alcohol Abuse and Alcoholism (NIAAA), USA.
Trojnar E, et al. Free Radic Biol Med. 2019 Nov 23. [in press]

Science/Animal: Activation of the CB2 receptor may be helpful in sepsis
In a rat model of sepsis activation of the CB2 receptor by the synthetic cannabinoid JWH-133 reduced damage to the brain, heart, lung and liver and several signs of inflammation.
Department of Physiology, Faculty of Medicine, Yozgat Bozok University, Yozgat, Turkey.
Çakır M, et al. Int Immunopharmacol. 2019 Nov 22:105978.

Science/Animal: Activation by natural and synthetic agonists of the CB2 receptor improved signs of bladder inflammation
Both the natural CB2 receptor agonists beta caryophyllene and the synthetic cannabinoid HU308 reduced signs of bladder inflammation (interstitial cystitis, IC). Authors concluded that these cannabinoids “may serve as an adjunct and/or alternative treatment option for alleviating symptoms of inflammation and pain in the management of IC.”
Department of Anesthesia, Pain Management and Perioperative Medicine, Dalhousie University, Halifax, Canada.
Berger G, et al. Molecules. 2019;24(23).

Science/Animal: Reduced activity of the CB2 receptor may increase the susceptibility to seizures
In a rat model of epilepsy reduced activity of the CB2 receptor “is associated with increased seizure susceptibility.” Authors concluded that activation of the CB2 receptor “might therefore provide a therapeutic target for the treatment of some forms of epilepsy.”
Department of Human Genetics, Emory University, Atlanta, USA.
Shapiro L, et al. Epilepsia. 2019 Nov 22. [in press]

Science/Human: Cannabis may be helpful in delayed gastric emptying (gastroparesis)
According to a survey with 506 patients with symptoms of gastroparesis (delayed gastric emptying) 59 used cannabis. Authors found that “patients with severe nausea and abdominal pain were more likely to use marijuana and perceive it to be beneficial for their symptoms.”
NIH Gastroparesis Clinical Research Consortium, Bethesda, USA.
Parkman HP, et al. Dig Dis Sci. 2019 Nov 22. [in press]

Science/Human: CBDV may have effects on the glutamate-GABA system in patients with autism
In a study with 34 healthy men with or without autism spectrum disorder CBDV in a dose of 600 mg had effects on the glutamate-GABA system, but there were inter-individual differences. Authors wrote that “future studies should examine the effect of CBDV on behaviour and if the response to an acute dose of CBDV could predict a potential clinical treatment response in ASD.”
Department of Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, Psychology & Neuroscience, King's College London, UK.
Pretzsch CM, et al. Transl Psychiatry. 2019;9(1):313.

Science/Cells: A combination of CBD and CBG may be helpful in inflammation of the nervous system
According to a study with nerve cells a combination of CBD (cannabidiol) and CBG (cannabigerol) may be effective in reducing inflammation of the brain and nerve cells.
IRCCS Centro Neurolesi "Bonino Pulejo", Italy.
Mammana S, et al. Medicina (Kaunas). 2019;55(11).

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