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IACM-Bulletin of 30 August 2020

Israel: Reduced prices for medical cannabis and CBD no longer a narcotic

Health Minister Yuli Edelstein and his deputy Yoav Kisch published on 26 August regulations that will allow for lower prices for medicinal cannabis. The regulations are also expected to simplify the process required to go through for receiving a prescription. Three weeks ago, the Knesset's Labor, Welfare and Health Committee raised various issues relating to the medicinal cannabis reform that were brought to light since it came into effect. The committee guaranteed that a row of steps will be taken in order to address that issues.

One major legal change refers to CBD. The new regulations exclude for the first time CBD-based products from the Dangerous Drugs Ordinance from 1973, a step that will dramatically reduce prices for patients who use CBD-based products. This step will also allow for a new market with a huge economic potential, as is found in many EURopean countries today.

Jerusalem Post of 26 August 2020

Science/Human: Frequent cannabis use reduces opioid use

In a prospective study between 2005 and 2018 regular cannabis use was associated with an increased likelihood of stopping injection opioid use by 26%. The investigation by researchers of the British Columbia Centre on Substance Use in Vancouver, Canada, included over 2,000 people who inject drugs.

At-least-daily cannabis use was associated with swifter rates of injection cessation (adjusted hazard ratio = 1.16). A subanalysis revealed that this association was only significant for opioid injection cessation (adjusted hazard ratio  = 1.26). Cannabis use was not associated with an increased risk for relapse. Authors concluded that “at-least-daily cannabis use was associated with a 16% increase in the hazard rate of injection cessation, and this effect was restricted to the cessation of injection opioids.”

Reddon H, DeBeck K, Socias ME, Lake S, Dong H, Karamouzian M, Hayashi K, Kerr T, Milloy MJ. Frequent Cannabis Use and Cessation of Injection of Opioids, Vancouver, Canada, 2005-2018. Am J Public Health. 2020:e1-e8.

Science/Human: Cannabis use is associated with a reduced risk of diabetes in people with hepatitis C

An analysis of data of 10,445 patients with chronic hepatitis C infection showed that cannabis use was associated with a reduced risk for diabetes in this population. Conversely, male gender, tobacco use, elevated BMI, poverty, being a migrant and advanced fibrosis were associated with increased odds of diabetes. The study was performed by several French institutions including INSERM and Sorbonne University in Paris.

Chronic hepatitis C virus (HCV) infected patients are at a high risk of developing diabetes. Authors wrote that in “this large cross-sectional study of chronic HCV-infected patients, cannabis use was associated with a lower risk of diabetes independently of clinical and socio-behavioral factors.”

Barré T, Nishimwe ML, Protopopescu C, Marcellin F, Carrat F, Dorival C, Delarocque-Astagneau E, Larrey D, Bourlière M, Petrov-Sanchez V, Simony M, Pol S, Fontaine H, Carrieri P; ANRS/AFEF Hepather study group. Cannabis use is associated with a lower risk of diabetes in chronic hepatitis C-infected patients (ANRS CO22 Hepather cohort). J Viral Hepat. 2020 Aug 18. [in press]

Science/Human: Cannabis use reduced hospitalisation of patients with sickle cell disease

Patients with sickle cell disease, who are allowed to use medical cannabis have lower admission rates to the hospital compared to those, who had no legal access to cannabis. Scientists from the Division of Hematology at the Department of Internal Medicine of the Yale Cancer Center in New Haven, USA, compared 29 patients, who obtained cannabis and 25 patients, who did not have a certification for cannabis use.

Neither group had changes in opioid use. Patients who were certified for medical cannabis had higher rates of baseline opioid use and illicit cannabis use compared with those who did not request certification. Most patients with sickle cell disease who requested medical cannabis were already using cannabis illicitly. Authors wrote that “obtaining medical marijuana decreased inpatient hospitalizations.”

Curtis SA, Lew D, Spodick J, Hendrickson JE, Minniti CP, Roberts JD. Medical marijuana certification for patients with sickle cell disease: a report of a single center experience. Blood Adv. 2020;4(16):3814-3821.

News in brief

Science/Human: Cannabis improves obsessive-compulsive disorder in a case report
Physicians present the case of a 22-year-old male patient, who suffered from severe obsessive-compulsive disorder since childhood and improved after treatment with medicinal cannabis with markedly reduced specific symptoms and depression resulting in a considerable improvement of quality of life.
Clinic of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Germany.
Szejko N, et al. Front Psychiatry. 2020;11:681.

Science/Human: Cannabis had no effect on pain in adults with sickle cell disease
In a placebo controlled study with 27 patients suffering from pain due to sickle cell disease (SCD) there was no difference between inhaled cannabis and inhaled placebo cigarettes with regard to general activities, walking, sleep and enjoyment, but there was an improvement of mood. Authors concluded that this “randomized clinical trial found that, compared with vaporized placebo, vaporized cannabis did not statistically significantly reduce pain and associated symptoms, except interference in mood, in patients with SCD with chronic pain.”
Division of Hematology-Oncology, Department of Medicine, Zuckerberg San Francisco General Hospital, University of California, USA.
Abrams DI, et al. JAMA Netw Open. 2020;3(7):e2010874.

Germany/Spain: Spanish cannabis approved for import to Germany
The BfArM, the Federal Institute for Drugs and Medicinal Products, with oversight of the national cannabis program, has approved Spanish medical cannabis imports into the country. Indeed, three German companies are now finalizing their paperwork to allow the transfer to be completed. So far, Germany only imports medicinal cannabis from The Netherlands and Canada. Further countries are expected to follow.
Cannabis Industry Journal of 10 August 2020

Germany: Cansivita will be responsible for the distribution of cannabis produced in Germany
Medical cannabis grown in Germany will be distributed by the Frankfurt based company Cansativa. The company was the only one to be awarded the contract by the Federal Institute for Drugs and Medical Devices (BfArM) for logistics and services in the wholesale of cannabis flowers from German cultivation, as was announced on 20 August.
Handelsblatt of 20 August 2020

France: Flowers and leaves from hemp will be made available for users
Within the framework of the experimentation in France of cannabis for therapeutic purposes, the National Agency for Medicines (ANSM) should authorize, shortly, the valorization of the flower and the leaf of hemp, hitherto forbidden in France. Within the framework of a two-year experimentation, the ANSM must grant a new exemption to the valorisation of hemp. After the seed and the stem, the flower and the leaf could be authorized for harvesting. The new uses of the flower and the leaf, when they will be possible, will open two types of activities: the extraction of THC and the extraction of CBD for the manufacture of cosmetics, drinks, liquid for electronic cigarettes.
Terra of 20 August 2020

Science/Animal: Mechanism of CBD’s action on pain and anxiety
A study with rats shows an analgesic effect mediated by TRPV1 receptors and partially by 5-HT1A receptors, as well as an anxiolytic effect mediated by 5-HT1A receptors.
EURIDOL Graduate School of Pain, University of Strasbourg, France.
Schott M, et al. Pain Rep. 2019;4(5):e774.

Science: Cannabichromenic acid very effective against MRSA bacteria
Scientists investigated the antibiotic properties of several cannabinoids and found that one “phytocannabinoid, cannabichromenic acid (CBCA), demonstrated faster and more potent bactericidal activity than vancomycin, the currently recommended antibiotic for the treatment of MRSA infections.” Such infections are often life-threatening.
Discipline of Infectious Diseases and Immunology, School of Medical Sciences, University of Sydney, Australia.
Galletta M, et al. Antibiotics (Basel). 2020;9(8):E523.

Science/Cells: The anti-cancer effects of CBD are reduced in the presence of blood serum
Research shows that CBD exerts a markedly different effect on the viability of a human colon cancer cell line when cultured in presence of 0.5% serum in comparison to 10% serum, displaying a cytotoxic effect only in the former situation. In presence of 10% serum, no inhibitory effect of cannabidiol on DNA replication of cancer cells was detected.
GH Medical, Barcelona, Spain.
Sainz-Cort A, et al. BMC Res Notes. 2020;13(1):389.

Science/Animal: CBD reduces fever induced seizures
In an animal model of fever-induced seizures CBD reduced the severity of seizures. The cannabinoid significantly decreased excitability of nerve cells in the hippocampus, certain brain region. Researchers found additional details of the mechanism of action, including the reduction of AMPA receptor mediated excitation.
The Key Laboratory of New Drug Pharmacology and Toxicology, Hebei Medical University, Shijiazhuang, Hebei Province, China.
Yu Y, et al. Pharmacol Res. 2020:105128.

Science: Flavonoids and cannabinoids may be useful as anti-allergic compounds on the eye surface
Researchers suggest flavonoids of the cannabis plant and cannabinoids as promising complementary treatment for allergic diseases because of their anti-inflammatory and anti-allergic properties.
Hackensack Meridian School of Medicine, Springfield, USA.
Bielory L, et al. Curr Opin Allergy Clin Immunol. 2020;20(5):482-492.

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