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IACM-Bulletin of 20 July 2008

Science: Sativex improves objective neurophysiological marker of pain intensity in a clinical study

Researchers of the University of Rome, Italy, investigated changes in the so-called flexion reflex in a group of 17 patients with multiple sclerosis, who received either the cannabis extract Sativex or placebo. The flexion reflex or nociceptive withdrawal reflex is a reflex intended to protect the body from damaging stimuli. The classic example is when you touch something hot and withdraw your body part from the hot object. The flexion reflex is a widely used technique to assess the pain threshold and to investigate neurotransmitter systems involved in pain control. It consists of an early response (RII reflex) and a late response (RIII reflex). The RIII reflex threshold is thought to correspond to the pain threshold and the reflex size is related to the level of pain perception.

After patients used the cannabis extract the RIII reflex threshold increased and RIII reflex area decreased. Authors concluded that "the cannabinoid-induced changes in the RIII reflex threshold and area in patients with MS provide objective neurophysiological evidence that cannabinoids modulate the nociceptive system in patients with MS."

(Source: Conte A, Bettolo CM, Onesti E, Frasca V, Iacovelli E, Gilio F, Giacomelli E, Gabriele M, Aragona M, Tomassini V, Pantano P, Pozzilli C, Inghilleri M. Cannabinoid-induced effects on the nociceptive system: A neurophysiological study in patients with secondary progressive multiple sclerosis. EUR J Pain, 2008 Jul 4. [Electronic publication ahead of print])

Science: Nabilone effective in the treatment of agitation in Alzheimer's disease in a case report

A physician of the Department of Psychiatry of the University of British Columbia, Canada, reported of a dramatic improvement of agitation in a 72 year-old man with Alzheimer's disease with low doses of nabilone. The patient developed behavioural symptoms including wandering, agitation and aggression three years after diagnosis. He was transferred to a nursing home and numerous medication trials were undertaken to control the behaviour, including gabapentin, trazodone and quetiapine. These drugs had no or minimal impact on his symptoms, but the patient developed severe side effects. He was hospitalised. His severe aggression towards stuff during personal care required regular dosing with the sedative lorazepam, with variable effect. After trazodone was switched to citalopram some improvement was noted in his agitation, but severe restlessness persisted.

The synthetic THC derivative nabilone was started at a dose of 0.5 mg in the evening with prompt reduction in the severity of agitation and restlessness during evening personal care. The dose of nabilone was increased to 0.5 mg 2 times daily to facilitate personal care provision and his restlessness continued to improve, with no emergent side effects. After 6 weeks of dramatic improvement in all aspects of the behavioural symptoms, the patient was discharged to the nursing home. Three months later the patient's behavioural symptoms remained well controlled. The author of this case report noted that "there are few, if any, options currently available for patients with persistent dementia-related agitation and aggression who require prompt relief from medication that is well-tolerated and safe for long-term use."

(Source: Passmore MJ. The cannabinoid receptor agonist nabilone for the treatment of dementia-related agitation. Int J Geriatr Psychiatry 2008;23(1):116-7.)

Austria: Decriminalisation of cannabis for personal use regardless of quantity

A recent court ruling highlights the impacts of the new narcotics law. Although he had harvested more than 10 kg of cannabis leaves, an Austrian man was not sentenced and the public prosecutor recently dismissed the case - with a two-year probation period. According to the new law the prosecutor must refrain from prosecution if the suspect possessed the drug exclusively for personal use. However, if the suspect is again found to possess cannabis within the probation period he is threatened by prosecution since cannabis possession is not legal under the new law.

Prior to January 1, 2008, dismissal of a case was only possible if the suspect had been in possession of a "minor quantity" of a drug. For cannabis, that quantity was, as in Germany, in the range of a few grams. The revised law now no longer considers the quantity but the personal use of a drug. In the current case where the defendant had harvested leaves from allegedly discovered hemp field there was no evidence for his intent to sell the material. The main motivation for the recent amendment to the law was, according to an agent of the Ministry of Justice an EU decision regarding the fight against drugs. It had tightened measures against drug dealers. However, it was felt that this amendment required a stronger separation of drug dealing from personal use.

More at:

(Source: www.nachrichten.at of 2 July 2008)

News in brief

Science: Cannabis extract
According to research by the University of Milano, Italy, a cannabis extract (Sativex) was more effective in reducing neuropathic pain in animals than single dronabinol (THC). This additional effect was not mediated by cannabinoid receptors but by vanilloid receptors. Since cannabidiol (CBD) was the only component present at a high level in the extract able to bind to this receptor, researchers assume that CBD was responsible for this additional analgesic effect. (Source: Comelli F, et al. Phytother Res. 2008 Jul 10. [Electronic publication ahead of print])

Switzerland: Hemp Initiative
On 30 November 2008 Swiss citizen will decide in a referendum on a ballot initiative on "a rational hemp policy providing effective youth protection". It will exempt from punishment the acquisition, possession and consumption of the psychoactive constituents of the hemp plant. The Christian Democratic Peoples Party (CVP) recommends to their voters a rejection, the Social Democrats (SP) and the Liberal Democrats recommend voting in favour of it. (Source: 20min.ch of 28 June 2008).

USA: Drug policy
According to an essay by the former budget director of the White House Office of National Drug Control Policy (ONDCP) claims by the ONDCP that the USA is making "progress" in the so-called 'war on drugs' are not based on evidence. The ONDCP "claims that America has reached a turning point in the war on drugs. In reality, we have little reason to believe a significant change has occurred," John Carnevale writes. "Though Congress created ONDCP to formulate research-driven and performance-based policy, assess and modify policy through performance measures, ... ONDCP fails at all of those tasks," he continues. (Source: NORML of 17 July 2008)

Italy: Rastafari
Italy's Court of Cassation ruled on 10 July that since the Rastafari religion considers cannabis a sacrament, its members should be given special consideration when it comes to possession -- and how much makes a drug trafficker. The case before the judges dealt with a reggae musician who was sentenced to 16 months in prison by a lower court in Perugia after being found in possession of enough cannabis to roll 70 cigarettes. The Court of Cassation annulled his sentence, saying the amount appeared appropriate for personal use considering the heavy amounts that Rastafarians smoke, and ordered an appellate court in Florence to review the case. (Source: Reuters of 10 July 2008)

Argentina: Personal use
Recently a court of appeal (Cámara Federal) overruled the conviction of a man by a lower court, who cultivated cannabis on his balcony for personal use. The conviction was declared unconstitutional. (Source: www.asteriscos.tv of 10 June 2008)

Science: Leukaemia
Researchers of the University of London, UK, found synergistic effects of dronabinol (THC) and cytotoxic agents used in the treatment of leukaemia. Dronabinol sensitised leukaemic cells to these cytotoxic drugs. They concluded that "a combination approach with THC and established cytotoxic agents may enhance cell death in vitro." (Source: Liu WM, et al. Leuk Lymphoma. 2008 Jun 30:1-10. [Electronic publication ahead of print])

Science: Pain
Danish researchers compared the analgesic effects of low doses of a synthetic cannabinoid (WIN55,212-2) in cancer and neuropathic pain in animals. 18 days of treatment reduced pain related behaviour in the cancer pain model but not in the neuropathic pain model. (Source: Hald A, et al. Pharmacol Biochem Behav. 2008 Jun 20. [Electronic publication of print])

Science: New prodrug of THC
Researchers at the University of Mississippi, USA, investigated possibilities to stabilize a heat-labile novel prodrug of THC, THC-hemiglutarate (THC-HG). This THC compound was produced by hot-melt fabrication for systemic delivery of THC through the oral transmucosal route. (Source: Thumma S, et al. EUR J Pharm Biopharm. 2008 Jun 18. [Electronic publication of print])

Science: Violent television
According to research by the University of New York watching violent television programs in late adolescence was associated to later nicotine dependence and later dependence from illegal drugs. (Source: Brook DW, et al. Am J Addict 2008;17(4):271-7.)

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