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IACM-Bulletin of 06 December 2020

UNO: UN drug agency loosens control on cannabis by following the advice of WHO

On 2 December the U.N. drug agency’s member states narrowly voted to remove cannabis from the most tightly controlled category of narcotic drugs, following the World Health Organization’s recommendation to make research into its medical use easier.

The annual Commission on Narcotic Drugs, the U.N. Office on Drugs and Crime’s governing body, voted 27-25 with one abstention to remove cannabis and cannabis resin from Schedule IV of the 1961 Single Convention on Narcotic Drugs, a global text governing drug controls, a U.N. statement said. The vote followed a 2019 WHO recommendation that “cannabis and cannabis resin should be scheduled at a level of control that will prevent harm caused by cannabis use and at the same time will not act as a barrier to access and to research and development of cannabis-related preparation for medical use.” Other drugs in Schedule IV include heroin, fentanyl analogues and other opioids that are dangerous and often deadly. Cannabis, by contrast carries no significant risk of death and it has shown potential in treating pain and conditions such as epilepsy, the WHO found.

Reuters of 2 December 2020
FAAAT press release of 2 December 2020
Statement: Support patient access to medicine, vote yes!
Statement: Towards science-based scheduling of cannabis sativa and other controlled herbal medicines

Science/Human: Most cancer survivors used cannabis for the treatment of pain and improved sleep according to a survey

According to a survey among 190 Israeli cancer survivors cannabis was mainly used for the treatment of pain, sleeping disorder and anxiety. This research was conducted by investigators of Ben Gurion University of the Negev and the Cancer Centre of Sheba Medical Center, Israel.

The mean monthly dosage of cannabis consumed was 42 grams. 96% of respondents reported not consuming cannabis regularly before being diagnosed with cancer. The most common way of intake was smoking, and most of the participants reported taking cannabis throughout the day. The most common symptoms for which participants took medical cannabis were pain (89%), sleeping disorder (76%) and anxiety (42%). Twenty patients reported on mild side effects.

Zolotov Y, Eshet L, Morag O. Preliminary assessment of medical cannabis consumption by cancer survivors. Complement Ther Med. 2020;56:102592.

Science/Human: The use of cannabis has beneficial effects among palliative cancer patients according to a survey

According to a survey with 108 oncology patients different cannabis strains with varying THC and CBD concentrations reduced several symptoms, including pain, distress and sleep. The study was conducted by researchers of several Israeli institutions in Haifa, Nahariya and Afula. Participants used THC-dominant (n = 57%), CBD-dominant (n = 19%), and mixed (n = 33%) treatments.

Most parameters improved significantly within one month of cannabis use, including pain intensity, affective and sensory pain, sleep quality and duration, cancer distress, and both physical and psychological symptom burden. Generally, there were no differences between the three cannabis treatments in pain intensity and in most secondary outcomes. THC-dominant treatments showed significant superiority in their beneficial effect only in sleep duration compared to CBD-dominant treatments. Authors noted that “caregivers should also consider CBD-dominant products as a useful treatment for cancer-related symptoms.

Aviram J, Lewitus GM, Vysotski Y, Uribayev A, Procaccia S, Cohen I, Leibovici A, Abo-Amna M, Akria L, Goncharov D, Mativ N, Kauffman A, Shai A, Hazan O, Bar-Sela G, Meiri D. Short-Term Medical Cannabis Treatment Regimens Produced Beneficial Effects among Palliative Cancer Patients. Pharmaceuticals (Basel). 2020;13(12):E435.

Science/Human: Cannabis may improve chronic pelvic pain in women according to a survey

While side effects are common self-treatment with cannabis may improve symptoms in chronic pelvic pain. This is the result of an anonymous, confidential survey conducted by scientists of the Mayo Clinic in Jacksonville and Rochester, USA, which included women with pelvic and perineal pain, dyspareunia, or endometriosis.

A total of 240 patients were approached, with 113 responses (47% response rate). There were 26 patients who used cannabis (23%). The majority used at least once per week (72%). Most users (96%) reported improvement in symptoms, including pain, cramping, muscle spasms, anxiety, depression, sleep disturbances, libido, and irritability. Side effects, including dry mouth, sleepiness, and feeling "high," were reported by 84%.

Carrubba AR, Ebbert JO, Spaulding AC, DeStephano D, DeStephano CC. Use of Cannabis for Self-Management of Chronic Pelvic Pain. J Womens Health (Larchmt). 2020 Nov 16. [in press]

Science/Human: Elder adults find cannabis useful in the treatment of several chronic medical conditions according to interviews

According to interviews with 10 adults 64 years or older by two scientists of the College of Graduate and Studies/Center for Gerontology at Concordia University-Chicago in River Forest, USA, cannabis may be helpful in the management of chronic conditions. Researchers relied on qualitative inquiry in the form of semi-structured, one-on-one interviews.

Their findings suggest that older adults are open to medical cannabis as an alternative to pharmaceutical drugs, hopeful with regard to the management of symptoms and pain, and aware of and astute at managing issues related to stigma both from their physicians and family and friends. Furthermore, older adults describe the frustrations with education, awareness, and lack of support with dosing.

Manning L, Bouchard L. Medical Cannabis Use: Exploring the Perceptions and Experiences of Older Adults with Chronic Conditions. Clin Gerontol. 2020:1-10.

Science/Human: Cannabis may be more effective in the treatment of migraine than standard medication according to survey

In an online survey with 161 patients suffering from migraine cannabis was found to be effective for symptom relief. The study was conducted by researchers of the University of Colorado in Boulder, USA. Participants were 589 adult cannabis users living in states with full legal access, of whom 161 reported experiencing migraines.

Of those participants with migraine 76% endorsed using cannabis to treat their migraines. 70% of them also used non-cannabis products (over-the-counter pain medication, triptans and others) to treat their migraines. Although their subjective health was similar, migraineurs who used cannabis to treat their migraines reported more migraines compared to those who did not. Migraineurs reported significantly more migraine relief from cannabis compared to non-cannabis products, even after controlling for migraine severity.

Gibson LP, Hitchcock LN, Bryan AD, Bidwell LC. Experience of Migraine, its Severity, and Perceived Efficacy of Treatments among Cannabis Users. Complement Ther Med. 2020:102619.

Science/Human: Impaired driving performance after inhaled THC is no longer detectable after 4 hours, while CBD does not impair driving performance according to on-road tests

In a clinical trial with 26 healthy occasional cannabis users THC caused impairments at 40 and 100 minutes following consumption, but no longer after 4 and 5 hours. CBD did not cause any effect. Participants inhaled THC-dominant, CBD-dominant, THC/CBD-equivalent, and placebo cannabis by a vaporiser, who all completed 8 on-road driving tests. THC and CBD doses were 13.75 mg. The primary endpoint was SDLP (standard deviation of lateral position, which is a measure of lane weaving). The study was conducted by investigators of the Lambert Initiative for Cannabinoid Therapeutics at the University of Sydney, Australia, Sydney, and other institutions from Australia and the Netherlands.

Impairment as measured by SDLP following vaporized THC-dominant and THC/CBD-equivalent cannabis compared with placebo was significantly greater at 40 to 100 minutes but not 240 to 300 minutes. There were no significant differences between CBD-dominant cannabis and placebo. Authors noted that “the effect size for CBD-dominant cannabis may not have excluded clinically important impairment, and the doses tested may not represent common usage.”

Arkell TR, Vinckenbosch F, Kevin RC, Theunissen EL, McGregor IS, Ramaekers JG. Effect of Cannabidiol and Δ9-Tetrahydrocannabinol on Driving Performance: A Randomized Clinical Trial. JAMA. 2020;324(21):2177-2186.

Science/Human: Parent and patient perceptions of medical cannabis in the childhood cancer context according to interviews

Fifteen parents and their children with cancer were interviewed at the Section of Pediatric Hematology and Oncology of the Department of Pediatrics at Yale School of Medicine in New Haven, USA. Investigators examined their attitudes, beliefs, and experiences regarding the medical use of cannabis. Interviews were audio-recorded, transcribed, and coded using both descriptive and inductive coding approaches.

Participants most often endorsed the use of cannabis for relief of nausea, anorexia, and pain. Simultaneously, participants identified concerns about cannabis, including potential physiologic and psychological effects on children and lack of research. However, concerns were frequently minimized, relative to chemotherapy or supportive care medications with perceived greater side effect profiles. Few participants had discussed cannabis use with their oncologist, instead seeking guidance from the internet, family, or peers.

Ananth P, Revette A, Reed-Weston A, Das P, Wolfe J. Parent and patient perceptions of medical marijuana in the childhood cancer context. Pediatr Blood Cancer. 2020:e28830.

European Union: CBD is not a narcotic the highest court of the EURopean Union ruled

CBD (cannabidiol) is not a narcotic drug because “it does not appear to have any psychotropic effect or any harmful effect on human health”, the EU’s highest court has ruled. The decision by the court of justice of the EURopean Union deals a severe blow to efforts by some EU countries to limit the sale of CBD, while simultaneously giving the CBD industry a boost. Many products are currently sold in the EU in a legal grey area.

The court ruled that the French ban on the marketing of hemp-derived CBD products contradicted EU law on the free movement of goods. “The national court must assess available scientific data in order to make sure that the real risk to public health alleged does not appear to be based on purely hypothetical considerations,” the court wrote. “A decision to prohibit the marketing of CBD, which indeed constitutes the most restrictive obstacle to trade in products lawfully manufactured and marketed in other [EU] member states, can be adopted only if that risk appears sufficiently established.”

The Guardian of 19 November 2020

News in brief

USA: House of Representatives votes to decriminalize cannabis at federal level
The U.S. House of Representatives voted am 4. Dezember to decriminalize marijuana at the federal level, but the legislation is not expected to advance further as long as the Senate remains in Republican hands. It was the first time either chamber of Congress has voted to end the federal ban on marijuana since the drug was listed as a “controlled substance” in 1970.
Reuters of 4 December 2020

Thailand: The country removes cannabis plants from the list of narcotics
The Narcotics Control Board of Thailand decided to remove cannabis plants from the list of narcotics, category 5 to allow wider use for medicinal purposes. The removal is to pave the way for more access to use cannabis for medical purposes as well as in textile, cosmetic and pharmaceutical industries. Hemp plants will be promoted as the new cash crops. However, initially only government agencies and community enterprises who work with the government agencies can grow cannabis and must seek permission from a government agency.
The Malaysian Reserve of 26 November 2020

Mexico: Senate approves cannabis legalisation bill
Mexico’s Senate approved a cannabis legalization bill in a landslide vote on 20 November paving the way for the creation of the world’s largest legal cannabis market if the initiative passes the next hurdle in the lower house of Congress. Senators voted 82 to 18 to approve the measure, with seven abstentions.
Reuters of 20 November 2020

Israel: The number of cannabis patients is expected to reach more than 80,000 in 2021
The number of cannabis patients in Israel increased by a further 3.8% during October 2020 and is expected to cross the 80,000 mark towards 2021. In total, patients are entitled to 2.68 tons of cannabis per month, 40,000 of them for chronic pain and most of them in 20 grams per month.
Cannabis of 23 November 2020

Uzbekistan: Production of cannabis for medicinal purposes allowed in the country
A Malta-based firm will be allowed to grow and produce medical cannabis in Uzbekistan, state news agency UzA reported on 29 November, in the first such deal for the Central Asian country. The region has a long history of growing cannabis but the drug is prohibited, despite regular calls for its legalisation.
Reuters of 29 November 2020

Malawi: The country wants to start commercial production of cannabis
Malawi is ready to start commercial production and processing of cannabis for medicinal and industrial use, the southern African country’s new Cannabis Regulatory Authority said on 24 November. Malawi’s parliament passed a bill in February that makes it legal to cultivate and process cannabis for medicines and hemp fibre used in industry, but stops short of decriminalising recreational use.
Reuters of 24 November 2020

Science/Human: Recommendations for the use of cannabis in tapering opioids for chronic pain
A number of scientists developed recommendations for the use of cannabinoids in tapering opioids for chronic pain control. They suggested that in “patients with chronic pain taking opioids not reaching treatment goals, there was consensus that cannabinoids may be considered for patients experiencing or displaying opioid-related complications, despite psychological or physical interventions. There was consensus observed to initiate with a cannabidiol (CBD)-predominant oral extract in the daytime and consider adding tetrahydrocannabinol (THC). When adding THC, start with 0.5-3 mg, and increase by 1-2 mg once or twice weekly up to 30-40 mg/day. Initiate opioid tapering when the patient reports a minor/major improvement in function, seeks less as-needed medication to control pain, and/or the cannabis dose has been optimized.”
University of British Columbia, Faculty of Pharmaceutical Sciences, Vancouver, Canada.
Sihota A, et al. Int J Clin Pract. 2020:e13871.

Science/Human: Cannabis may be helpful in the treatment of cancer in women
In a survey with 31 women suffering from gynaecologic cancers 83% reported that cannabis provided relief from cancer treatment -related symptoms including appetite loss, insomnia, several forms of pain, anxiety, nausea. 80% reported that cannabis works similar or better than standard medication.
Department of Obstetrics, Gynecology and Reproductive Sciences, Yale New Haven Hospital, USA.
Webster EM, et al. Gynecol Oncol Rep. 2020;34:100667.

Science/Cells: CBD enhances effects of anti-cancer drugs in human head and neck cancer cells
CBD was toxic to head and neck squamous cell carcinoma and it “enhanced the efficacy of chemotherapy drugs. Apoptosis and autophagy processes were involved in CBD-induced cytotoxicity.”
Department of Otorhinolaryngology-Head and Neck Surgery, Korea University Guro Hospital, South Korea.
Go YY, et al. Sci Rep. 2020;10(1):20622.

Science/Cells: Bisphenol A deranges the endocannabinoid system in cells relevant for sperm production
Bisphenol A may be found in plastics and may negatively affect sperm production. Researchers found that Bisphenol A is cytotoxic to Sertoli cells, which play an important role in the production of sperm, by deranging their endocannabinoid system.
Department of Life, Health and Environmental Sciences, University of L'Aquila, Italy.
Rossi G, et al. Int J Mol Sci. 2020;21(23):E8986.

Science/Animal: CBD may protect skin cells from damaging effects of UVA and UVB radiation
Topical application of CBD to the skin of nude rats exposed to UVA and UVB radiation changed the lipid profile of keratinocytes, certain skin cells, and improved “the status of the transepidermal barrier.”
Department of Analytical Chemistry, Medical University of Bialystok, Poland.
Łuczaj W, et al. Antioxidants (Basel). 2020;9(12):E1178.

Science/Cells: CBD was effective in reducing growth of several cancer cells of dogs
CBD was administered to 5 cancer cell lines observed in dogs in concentrations of 2.5 to 10 mcg/mL alone or in combination with chemotherapeutic agents. Authors concluded that “CBD is effective at hindering cell proliferation and induction of autophagy and apoptosis rapidly across neoplastic cell lines and further clinical trials are needed to understand its efficacy and interactions with traditional chemotherapy.”
Cornell University College of Veterinary Medicine, Department of Clinical Sciences, Ithaca, USA.
Henry JG, et al. Vet Comp Oncol. 2020 Nov 28. [in press]

Science/Human: No relevant effect of CBD on cognition in patients with epilepsy
In a study with 31 patients with treatment-resistant epilepsy, who received CBD, researchers tested memory, attention and executive function. They found that “more than 89% of all individual test results remained stable or showed reliable improvement (…). Improvements in short-term/working memory were significantly related to better therapy response.”
Epilepsy Center, Medical Center-University of Freiburg, Faculty of Medicine, Germany.
Metternich B, et al. Epilepsy Behav. 2020:107558.

Science/Human: Regular cannabis use may impair connectivity among certain brain cells
In a study 24 adults with at least weekly cannabis use the past 6 months were compared to 24 adults without cannabis use. Cannabis users performed within normal range on a visual selective attention task, but researchers found some changes in nerve cell connectivity, which “may reflect compensatory processing.”
Institute for Human Neuroscience, Boys Town National Research Hospital, Boys Town, USA.
Rangel-Pacheco A, et al. Psychopharmacology (Berl). 2020 Nov 25. [in press]

Science/Animal: Endocannabinoids regulates the psychostimulant effects of ketamine
According to studies in mice “endocannabinoid signalling plays a critical role in mediating the psychostimulant and reinforcing properties of ketamine.”
West China Hospital, Sichuan University, People's Republic of China.
Xu W, et al. Nat Commun. 2020;11(1):5962.

Science/Animal: CBD may be helpful in cocaine withdrawal
Cocaine withdrawal in mice induces certain alterations. Researchers found that “CBD alleviates these behavioural and gene expression alterations suggesting its potential for the management of cocaine withdrawal.”
Instituto de Neurociencias, Universidad Miguel Hernández-CSIC, Avda. de Ramón y Cajal s/n, San Juan de Alicante, Spain.
Gasparyan A, et al. Neurotherapeutics. 2020 Nov 23. [in press]

Science/Animal: Early-life stress changes the endocannabinoid system
Studies in mice show that early-life stress promotes behavioural and molecular changes in the sensitivity to cannabinoids, which are mediated by alterations in the CB1 receptor in limbic areas, certain areas in the brain, which “could interfere in emotional memories formation.”
Department of Experimental and Health Sciences, Universitat Pompeu Fabra, Barcelona, Spain
Martín-Sánchez A, et al. Neuropharmacology. 2020:108416.

Science: Production of cannabinoids by yeast
Authors describe techniques of cannabinoid production by transforming certain cell elements into specific “micro-factories” in yeast.
Department of Plant and Environmental Sciences, University of Copenhagen, Denmark.
Dusséaux S, et al. Proc Natl Acad Sci U S A. 2020:202013968.

Science/Animal: CBD may reduce the risk for relapse in dependency from methylphenidate
In studies with rats cannabidiol attenuated the maintenance and reinstatement of extinguished methylphenidate-induced conditioned place preference in rats and thus may reduce the risk for methylphenidate relapse.
Laboratory of Neurosciences and Behavior, Department of Physiological Sciences, University of Brasilia, Brazil.
Kashefi A, et al. Brain Res Bull. 2020:S0361-9230(20)30707-3.

Science/Animal: THC use in adolescence may impair working memory
Studies suggest that “adolescent THC treatment of mice markedly affected the establishment, and persistence of working memory, while having little effect on decision-making, social preference or anxiety behaviors.“
Department of Psychology and Brain Sciences, Indiana University, Bloomington, USA.
Chen HT, et al. Front Psychiatry. 2020;11:576214.

Science/Human: Heavy cannabis use may cause reduction of a certain brain area
Researchers followed 20 heavy cannabis users and 22 non-users for about 3 years. From their measurements they concluded that “heavy cannabis use in early adulthood is a risk factor for a greater rate of decrease in the volume of the right hippocampus.” The hippocampus is a brain region with relevance to memory and emotions.
Jiangsu Provincial Key Laboratory of Special Children's Impairment and Intervention, Nanjing Normal University of Special Education, China.
Wang Y, et al. Psychiatry Res. 2020:113588.

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