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IACM-Bulletin of 28 May 2017

Science/Human: Cannabidiol effective against epilepsy in Dravet syndrome

A clinical study with 120 children and young adults suffering from Dravet syndrome, which shows that CBD (cannabidiol) is effective in symptom control, was now published in the New England Journal of Medicine. Several centres across the USA participated in the placebo-controlled trial of 14 weeks of treatment.

The median frequency of convulsive seizures per month decreased from 12.4 to 5.9 with CBD, as compared with a decrease from 14.9 to 14.1 with placebo. The percentage of patients who had at least a 50% reduction in convulsive-seizure frequency was 43% with CBD and 27% with placebo. The patient's overall condition improved by at least one category on a standard scale in 62% of the CBD group as compared with 34% of the placebo group.

Devinsky O, Cross JH, Laux L, Marsh E, Miller I, Nabbout R, Scheffer IE, Thiele EA, Wright S; Cannabidiol in Dravet Syndrome Study Group. Trial of Cannabidiol for Drug-Resistant Seizures in the Dravet Syndrome. N Engl J Med. 2017;376(21):2011-2020.

Science/Human: Cannabis is used as a substitute for prescription drugs according to a large survey

According to an online survey with 2774 participants, who reported having used cannabis at least once in the previous 90 days about a half said that they used cannabis as a substitute for prescription drugs. This is the result of research by scientists of the Center for Medical Cannabis Education in Del Mar, Bastyr University Research Institute in Kenmore and the Department of Medical Research, Center for the Study of Cannabis and Social Policy in Seattle, USA.

A total of 1,248 (46%) respondents reported using cannabis as a substitute for prescription drugs. The most common classes of drugs substituted were narcotics/opioids (35.8%), anxiolytics/benzodiazepines (13.6%) and antidepressants (12.7%). A total of 2,473 substitutions were reported or approximately two drug substitutions per substituting respondent. Authors wrote that “these patient-reported outcomes support prior research that individuals are using cannabis as a substitute for prescription drugs, particularly, narcotics/opioids, and independent of whether they identify themselves as medical or non-medical users.”

Corroon JM Jr, Mischley LK, Sexton M. Cannabis as a substitute for prescription drugs - a cross-sectional study. J Pain Res. 2017;10:989-998.

USA: The State of Washington allows self-cultivation of cannabis by patients

Governor Jay Inslee has signed legislation, Senate Bill 5131, expanding patients' access to medical cannabis. The new law for the first time allows registered patients to legally purchase cannabis seeds, clones, and immature plants from licensed providers.

Other provisions in the law permit non-patients to legally share cannabis products with one another, and task the State Liquor and Cannabis Board to make recommendations regarding whether to permit the home cultivation of limited quantities of cannabis by adults. Washington is the only state that regulates the adult use of and commercial sale of cannabis, but does not permit adults to legally grow the plant themselves.

NORML of 24 May 2017

Uruguay: Foundation of the Uruguayan Society of Endocannabinology

In a press release the Board of Directors reported the foundation of the Uruguayan Society of Endocannabinology (SUEN, Sociedad Uruguaya de Endocannabinología) on 15 May in Montevideo. In their press release the association says: “The main objectives of SUEN are to disseminate knowledge and advances in Endocannabinology in academic areas and in the general population, promote education and research in Endocannabinology, and access to cannabis and cannabinoid treatments that benefit health, always from the deep respect for human rights and the principles of medical ethics and public health.”

The Board of Directors consists of Dr Raquel Peyraube (President), Dr Julia Galzerano (Vice President), Dr Leticia Cuñetti (Secretary), Dr Richard Clark (Treasurer), and Dr Alejandro Scaramelli (Speaker).

Press release by SUEN of 19 May 2017.

La Diaria of 17 May 2017

Chile: Citizens increasingly grow their own medical cannabis

Chileans are increasingly growing their own cannabis for medical purposes as the conservative South American nation begins loosening legal prohibitions on the formerly illegal plant. In 2015, Chile legalized the use of medical cannabis. Earlier in May, pharmacies in the capital city of Santiago began selling cannabis-based medicines, the first time such treatments have been offered by drugstores in Latin America.

Supporters of the medical use of the plant make sure that Chileans with severe medical conditions get the knowledge to grow the plant themselves, even if this is happening in a legal grey area. In Santiago on 19 May, Chile's Daya Foundation hosted a workshop teaching those with medical conditions how to grow the plant on their own.

Reuters of 22 May 2017.

News in brief

Science: Key talks at the ICR Conference 2017 available online
Keynote talks by Dr Carl Hart, Dr Raphael Mechoulam and Dr Alexandros Makriyannis at the 2017 meeting of the ICR (e.g. Institute of Cannabis Research) are available online:
Dr Carl Hart: How and Why Marijuana Research is Biased toward Negative Effect.
Dr Raphael Mechoulam: The Endocannabinoid System: A Look Back and Ahead.
Dr. Alexandros Makriyannis: Cannabis and the Endocannabinoid System: Therapeutic Opportunities.

Science/Human: Early onset of cannabis use was associated with lower educational attainment, while late onset was not
In a study with 1103 subjects aged 22-35 years, early cannabis initiators were more likely than non-users to have low educational attainment. Late cannabis initiators did not have lower educational attainment than non-users. Early cannabis use and educational attainment appeared more strongly associated in young women than in young men.
INSERM, Paris, France.
Melchior M, et al. Int J Epidemiol. 2017 May 18. [in press]

Science/Human: Capsaicin was helpful in the treatment of cannabis hyperemesis syndrome
Cannabis use may cause a state of nausea and vomiting, so-called cannabis hyperemesis syndrome. The vanilloid 1 receptor (TRPV1) may be involved in this syndrome. In 13 patients with the syndrome authors applied capsaicin, which binds to the TRPV1, to the skin, which resulted in improvement of symptoms.
University of Massachusetts Medical School, Worcester, USA.
Dezieck L, et al. Clin Toxicol (Phila). 2017 May 11:1-6.

Science/Animal: Activation of the CB2 receptor may improve stem cell-based therapy in heart disease
A synthetic cannabinoid, which activates the CB2 receptor (AM1241), improved the survival of stem cells. In animals the stem cells together with the cannabinoid improved function of the heart and reduced oxidative stress to the heart.
Chinese PLA General Hospital, Beijing, China.
Han D, et al. Oncotarget. 2017 May 4. [in press]

Science/Human: Heavy cannabis use may reduce adherence to medication in patients with psychosis
In a study with 233 patients with a first episode of psychosis heavy use of cannabis was associated with a reduced adherence to the anti-psychotic medication, while infrequent use or use of cannabis with low THC concentrations did not decrease use of the standard medication.
Institute of Psychiatry, Psychology & Neuroscience, King's College London, UK.
Schoeler T, et al. Psychiatry Res. 2017;255:36-41.

Science/Human: Migraine is not associated with a generalized deficiency of endocannabinoids
In a study with 26 healthy women and 38 with migraine there were no differences in blood concentrations of endocannabinoids. Authors wrote that “it is concluded that migraine is not associated with a generalised (as opposed to localised) deficiency in these lipids.”
Department of Chemistry, Umeå University, Sweden.
Gouveia-Figueira S, et al. Prostaglandins Leukot Essent Fatty Acids. 2017;120:15-24

Science/Human: Cannabis users seeking treatment differ from cannabis users in the general population
Researchers compared characteristics of cannabis users in a clinic, who wanted to stop use, with characteristics of users in the general population. In the clinical setting there were more often older adults, African Americans, Hispanic/Latinos, adults with more education, non-tobacco users, and daily and almost daily cannabis users.
Medical University of South Carolina, Charleston, USA.
McClure EA, et al. Drug Alcohol Depend. 2017;176:14-20

Science/Cells: Endocannabinoids may reduce consequences of chronic reduced blood supply to the brain
Disruption of the blood-brain barrier, which may be caused by chronic reduced blood supply to the brain was prevented by inhibition of FAAH (fatty acid amide hydrolase), which results in the increase of endocannabinoid concentrations.
Tong Ji University School of Medicine, Shanghai, China.
Wang DP, et al. Biomed Pharmacother. 2017;91:872-879.

Science/Cells: The activation of the CB1 receptor may have a negative effect during development of the placenta
In cell experiments with human placenta cells activation of the CB1 receptor by the synthetic cannabinoid WIN-55,212-2 induced a stop of cell growth. Authors wrote that their research “may reveal the impact of cannabinoids consumption during placental development.”
Faculdade de Farmácia, Universidade do Porto, Portugal.
Almada M, et al. Toxicology. 2017 May 8. [in press]

Science/Human: Substance-induced psychotic disorders increase the risk for the development of schizophrenia
In a study with 3486 patients, who were admitted to hospital after a substance-induced psychotic disorder, 17.3% developed schizophrenia within the following years. The risk for cannabis, stimulants and opiates were similar. Risk factors included male gender, younger age and longer first admission.
Queen Margaret Hospital, Dunfermline, UK.
Alderson HL, et al. Psychol Med. 2017 May 3:1-8.

Science: Genes involved in the transport, action, and metabolism of cannabinoids
A new article gives an overview on genes of the human body involved in endocannabinoid action. Authors divided them into: receptor genes - CNR1, CNR2, TRPV1, and GPR55, transporter genes - ABCB1, ABCG2, SLC6A, genes for proteins for biotransformation, biosynthesis, and bioactivation – CYP3A4, CYP2C19, CYP2C9, CYP2A6, CYP1A1, COMT, FAAH, COX2, ABHD6, ABHD12, and also MAPK14.
Institute of Human Genetics, Polish Academy of Sciences, Poznan, Poland.
Hryhorowicz S, et al. EUR J Drug Metab Pharmacokinet. 2017 May 22. [in press]

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