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IACM-Bulletin of 13 July 2014

Science/Human: THC effective in severely disabled children

THC shows significant positive effects in children with regard to pain, spasticity, agitation and sleep disorders. This is the result of a case series by doctors of the University Hospital of the Saarland, Germany. 17 children in the age of six months to 17 years with pain, agitation and severe spasticity (10 children with infantile cerebral palsy, two with leukodystrophy, three with metabolism defects and two with hypoxic-ischaemic brain damage) were treated. Most of the children received other medications besides THC. THC doses ranged from 0.1 to 1.1 mg per kilogram of body weight.

16 children showed a clinically significant reduction in pain, 14 a reduction in spasticity, and 12 children an improvement in agitation and sleep disorders at night. In five children opioid doses could be reduced, in two children the pain medication could be tapered off completely. Authors wrote, that "larger prospective multi-centre trials are highly desirable."

Gottschling S, Müller S, Theurer J, Bialas P, Ebinger F, Meyer S, Gronwald B. Dronabinol bei schwerst-mehrfach-behinderten Kindern mit Spastik, Schmerzen und Unruhe. Palliativmedizin 2014;15-PD356.

Science/Human: Nabilone effective in the treatment of posttraumatic stress disorder

Nabilone caused significant improvements in insomnia, nightmares, chronic pain and other symptoms in patients suffering from posttraumatic stress disorder (PTSD). This is the result of a retrospective study of 104 male patients with serious mental illness prescribed nabilone analysed by scientists of the Department of Psychiatry at the University of Ottawa, Canada, published in the Journal of Clinical Psychopharmacology.

The results showed that nabilone, a synthetic derivative of THC with similar pharmacological effects, targeted a mean of 3.5 indications per patient. The mean final dosage was 4.0 mg. Medications associated with greater risk for adverse effects or abuse than nabilone were often able to be discontinued with the initiation of nabilone, most often antipsychotics and sedative/hypnotics. Authors concluded that “this study supports the promise of nabilone as a safe, effective treatment for concurrent disorders in seriously mentally ill" patients.

Cameron C, Watson D, Robinson J. Use of a Synthetic Cannabinoid in a Correctional Population for Posttraumatic Stress Disorder-Related Insomnia and Nightmares, Chronic Pain, Harm Reduction, and Other Indications: A Retrospective Evaluation. J Clin Psychopharmacol. 2014 Jul 1. [in press]

Science/Human: Cannabis effective in intractable nausea after stroke

A case report of a 78-year-old woman with intractable nausea after cerebellar stroke, who responded well to treatment with THC, was presented by physicians of the Department of Care of the Elderly at Glan Cluryd Hospital in Rbyl, United Kingdom. Her initial symptoms were intractable nausea, vertigo and ataxia. Even though ataxia and vertigo improved after rehabilitation, nausea persisted. It became so intense that she became sick with the slightest movement. She had no benefit from a range of standard medications, which have been tried.

Because her symptoms were so disabling, she agreed to try cannabis and procured cannabis illegally. She was supplied with cannabis cakes and started taking small amounts spread on her toast once a day. Her symptoms improved within a week, and she was able to walk around and go out of the house. Even though she was still nauseous, she was not distressed by it and has not experienced any adverse effect in two years. Authors concluded, that "cannabis might be an option to treat intractable nausea after stroke but only after all other treatments fail."

Adhiyaman V, Arshad S. Cannabis for intractable nausea after bilateral cerebellar stroke. J Am Geriatr Soc. 2014 Jun;62(6):1199.

News in brief

Domenica: Prime minister wants to review cannabis laws
Prime Minister Roosevelt Skerrit says the time has come to review Dominica’s cannabis laws. A regional committee could soon be established to dialogue with experts on the matter. Dominica is an island nation in the Caribbean Sea.
Dominica Vibes of 8 July

Science/Animal: High anandamide in the brain associated with better stress tolerance
Animal research indicates that brain anandamide levels predict acute stress-induced anxiety. Authors concluded that increase of endocannabinoid levels “is a viable pharmacological strategy for the treatment of stress-related neuropsychiatric disorders.”
Department of Psychiatry, Vanderbilt University School of Medicine, Nashville, USA.
Bluett RJ, et al. Transl Psychiatry 2014;4:e408.

Science/Animal: Strength training reduces pain by activation of the endocannabinoid system
Resistance exercise, also known as strength training, reduces pain. A single session of resistance exercise in rats was shown to activate the endocannabinoid system to induce pain reduction.
Federal University of Minas Gerais, Belo Horizonte, Brazil.
Galdino G, et al. Anesth Analg. 2014 Jun 26. [in press]

Science/Human: Stimulant but not cannabis intoxication is associated with excessive alcohol consumption
An online survey of 1994 young Australians who had drunk alcohol in the past year revealed that “stimulant intoxication, but not cannabis intoxication, is associated with binge drinking among young adults.”
The Australian National University, Canberra, Australia.
McKetin R, et al. Drug Alcohol Rev. 2014 Jun 30. [in press]

Science/Human: Differences between bipolar adolescents with and without cannabis use
A study with 67 adolescents showed that adolescents with bipolar disorder and comorbid cannabis use do not exhibit the same over-activation of the brain regions involved in emotional processing as seen in adolescents with bipolar disorder alone. Authors wrote that this “suggests that these individuals may have a unique endophenotype of bipolar disorder or that cannabis use may alter brain activation uniquely in bipolar disorder patients who use cannabis.”
University of Cincinnati, USA.
Bitter SM, et al. Addiction. 2014 Jun 24. [in press]

Science/Human: Acetylcholine is important for cannabis-induced memory impairment
The neurotransmitter acetylcholine plays an important role in cannabis-induced memory impairment. This is the result of a study with 15 occasional cannabis users, who received different medications after the inhalation of cannabis. When they were treated with rivastigmine, a cholinergic agent, memory impairment was partially reversed.
Department of Neuropsychology and Psychopharmacology, Maastricht University, The Netherlands.
Theunissen EL, et al. Psychopharmacology (Berl). 2014 Jul 8. [in press]

Science/Animal: Activation of the CB2 receptor protects the heart in early stages of cardiomyopathy
The cannabinoid-2 receptor plays a key role in the protection of the heart during the initial phase of ischemic cardiomyopathy development, studies with mice show.
Department of Cardiac Surgery, University Clinical Centre Bonn, Germany.
Duerr GD, et al. Basic Res Cardiol 2014;109(4):425.

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