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IACM-Bulletin of 10 June 2018

World/UN: Expert Committee on Drug Dependence of the WHO reviews the status of cannabis in international drug treaties

70 years after the foundation of the World Health Organisation in 1948 its expert committee on drug dependence has started to analyse the harms and benefits of cannabis for health. Their conclusions are likely to change international laws. The 40th meeting of the ECDD (Expert Committee on Drug Dependence) started with a hearing of patients, doctors and experts in the field. The IACM was invited to participate with a video statement. In addition, representatives of non-governmental organisations, among them Michael Krawitz, patient representative of the IACM, presented an extended written statement.

In the 1950’s the WHO gave the green light to the inclusion of Cannabis in the strictest United Nations’ drug control Schedules. These Schedules classify cannabis and its derivatives as “particularly liable to abuse and to provide ill effects” with “no or very few therapeutic effects.” A real formal scientific review of Cannabis has never been done – although the WHO, by mandate, has been responsible since the 1960’s for undertaking risk assessments of all drugs that have dependence or abuse potential and furthermore mandated since the 2000’s for updating its reviews every 20 years.

Fortieth meeting of the Expert Committee on Drug Dependence of the WHO
Press release by the FAAAT of 7 June 2018
Joint Civil Society Contribution
Video presentation of the IACM at the ECDD meeting on 4 June 2018

Science/Human: Pain patients often substitute opioids with cannabis

In a survey of 2032 patients, who use cannabis for therapeutic purposes, opioids were often substituted with cannabis. According to the study by US and Canadian scientists 21 illnesses were treated with cannabis and pain syndromes accounted for 42.4%. They focused on the treatment of 505 headache patients, who mostly (88%) fulfilled criteria of migraine.

Most headache patients preferred hybrid strains, that is strains with both sativa and indica characteristics. The most preferred strain had high concentrations of THC and low concentrations of CBD. It contains high concentrations of the terpenes beta-caryophyllene and beta-myrcene, which have anti-inflammatory and analgesic properties.

Baron EP, Lucas P, Eades J, Hogue O. Patterns of medicinal cannabis use, strain analysis, and substitution effect among patients with migraine, headache, arthritis, and chronic pain in a medicinal cannabis cohort. J Headache Pain. 2018;19(1):37.

Science/Human: Palmitoylethanolamide improves treatment of autistic children in a clinical study

According to a clinical study with 70 children with autism the addition of the endocannabinoid PEA (palmitoylethanolamide) to the usual treatment with neuroleptics improved some symptoms of the disease. Scientists of the Tehran University of Medical Sciences, Iran, published their research on children aged 4 to 12 years in the Journal of Psychiatric Research. They investigated the addition of PEA to risperidone on behaviour of the children within a treatment period of 10 weeks compared to placebo.

The combination of PEA and risperidone improved irritability and hyperactivity measured with a standard test, the ABC-C (Aberrant Behaviour Checklist-Community Edition). There was also a tendency to an improvement of inappropriate speech at the end of the trial for PEA compared to placebo. Authors wrote that “PEA may augment therapeutic effects of risperidone on autism-related irritability and hyperactivity.”

Khalaj M, Saghazadeh A, Shirazi E, Shalbafan MR, Alavi K, Shooshtari MH, Laksari FY, Hosseini M, Mohammadi MR, Akhondzadeh S. Palmitoylethanolamide as adjunctive therapy for autism: Efficacy and safety results from a randomized controlled trial. J Psychiatr Res. 2018;103:104-111.

News in brief

Science/Human: Cannabis use was associated with a small increase in heart failure and stroke
Using a large database of patients from the USA scientists found, that cannabis use increased the risk of heart failure by 10% and for cerebrovascular events, for example stroke, by about 24%.
Einstein Medical Center, Philadelphia, USA.
Kalla A, et al. J Cardiovasc Med (Hagerstown). 2018 Jun 6. [in press].

Science/Animal: The addition of cannabinoids to opioids improves the tolerability of opioid treatment in monkeys
Addition of THC or a synthetic cannabinoid (CP 55,940) to morphine and fentanyl did not increase negative effects of the opioids on respiration, but improved pain relieving effects. Authors concluded, that “the therapeutic window is greater for opioids when they are combined with cannabinoid receptor agonists, indicating a possible advantage for these drug mixtures in treating pain.”
University of Texas Health Science Center at San Antonio, USA.
Weed PF, et al. EUR J Pharmacol. 2018 May 26;833:94-99

Science/Human: Long-term efficacy of a cannabis spray in the treatment of spasticity due to multiple sclerosis
In a study with 106 MS patients, who responded to a treatment with the cannabis spray Sativex during a treatment period of 4 weeks and received the cannabis spray or a placebo for another 12 weeks in addition to their standard medication, cannabis “provided better and clinically relevant improvement of resistant MS spasticity compared with adjusting first-line antispasticity medication alone.”
Thomayer's Hospital, Praha, Czech Republic.
Markovà J, et al. Int J Neurosci. 2018:1-26.

Science/Cells: Effects of cannabinoids on kidney cancer
The synthetic cannabinoid WIN55,212-2 induced cell death in kidney cancer cells, and this effect remained even after blocking the CB1 and the CB2 receptor by use of appropriate antagonists.
Military Institute of Medicine, Warsaw, Poland.
Khan MI, et al. BMC Cancer. 2018;18(1):583.

Science/Human: Social norms around the medical use of cannabis remain unfavourable for many users in Canada
Despite the fact that the medical use of cannabis is legal in Canada for more than 10 years a survey with 276 patients, who use cannabis for therapeutic purposes, showed that there are still problems with acceptance. Only 38% perceived their doctor being supportive, while support from the family and from friends (66.3%) was much higher.
School of Public Health and Health Systems, University of Waterloo, Waterloo, Canada.
Leos-Toro C, et al. Drug Alcohol Rev. 2018 Jun 5. [in press]

Science/Animal: The mechanism of action of CBD’s antidepressant effects
In a study with mice CBD showed fast anti-depressant effects. And this effect was associated with elevated levels of BDNF (brain-derived neurotrophic factor) in certain brain regions (medial prefrontal cortex, hippocampus). Authors wrote that their data “support a promising therapeutic profile for CBD as a new fast-acting antidepressant drug.”
University of São Paulo, Ribeirão Preto, Brazil.
Sales AJ, et al. Mol Neurobiol. 2018 Jun 4. [in press]

Science/Human: Cannabinoids may be useful in sleep disorders according to a review
According to a review cannabinoids may be effective in some parasomnias. Parasomnias are a kind of sleep disorders characterised by abnormal movements, behaviours, perceptions, emotions and dreams, for example bruxism.
Sleep Medicine and Epilepsy Unit, IRCCS Mondino Foundation, Pavia, Italy.
Manni R, et al. Curr Treat Options Neurol. 2018;20(7):26.

Science/Human: Time of cannabis use onset has no effect on cognitive performance in psychosis
In a study with 349 patients with a first episode of psychosis, of whom 38.7% used cannabis, the drug had no influence on cognition. Of them, 53 started cannabis use early (before the age of 16) and 82 started later. Patients were followed for 3 years. Authors wrote there were no “differences between the early-onset group and the other two groups in long-term cognitive performance, even if they kept consuming cannabis during the first three years of disease progression.”
University Hospital, Department of Psychiatry, University of Cantabria, Santander, Spain.
Setién-Suero E, et al. Schizophr Res. 2018 May 31. [in press]

Science/Animal: Naltrexone and CBD act synergistically in reducing alcohol consumption
In a study with mice low doses of naltrexone and cannabidiol (CBD) reduced the intake of alcohol. Authors wrote that the “combination of low doses of CBD plus NTX was more effective to reduce ethanol consumption and motivation to drink.”
Institute of Neuroscience, University of Alicante, Spain.
Viudez-Martínez A, et al. Br J Pharmacol. 2018 Jun 2. [in press]

Science/Human: A cannabis spray has positive effects on activities of daily living in patients with Multiple Sclerosis
According to a retrospective analysis patients treated with the cannabis spray Sativex 96.9% of participants had a positive global impression of change during treatment time (mean: 31.9 months). Activities of daily living, for example ability of standing up, were maintained or slightly improved.
Unidad de Neurología, Hospital General de Elda, Spain.
Mallada Frechín J, et al. Dis Manag. 2018 May 31. [in press]

Science/Animal: Inhibition of endocannabinoid degradation in the kidneys increases urination
Infusion of a substance which inhibits an enzyme called FAAH (fatty acid amide hydrolase) responsible for the degradation of the endocannabinoid anandamide into the kidneys of mice increased urination.
Virginia Commonwealth University, USA.
Ahmad A, et al. Am J Physiol Renal Physiol. 2018 May 30. [in press]

Science/Animal: 2-AG improves memory consolidation
Scientists tested the effects of the endocannabinoid 2-AG (2-arachidonoylglycerol) on memory consolidation in rats. 2-AG facilitated memory consolidation and this effect was mediated by activation of the CB2 receptor.
Sapienza University of Rome, Italy.
Ratano P, et al. Neuropharmacology. 2018 May 26. [in press]

Science/Cells: THC reduces viability and motility of endometrial cancer cells
THC inhibited the viability of aggressive endometrial cancer cells and their motility. This effect was mediated by inhibition of the so-called epithelial-mesenchymal transition (EMT) and by the down-regulation of matrix metalloproteinase-9 (MMP-9).
Zhejiang University School of Medicine, China.
Zhang Y, et al. Oncol Lett. 2018 Jun;15(6):8527-8535.

Science/Animal: Endocannabinoids protect nerve cells against toxins
In a study with rats increased levels of the endocannabinoid anandamide protected nerve cells against the toxic effects of quinolinic acid. This substance causes an overactivation of the neurotransmitter NMDA, which may participate in the onset and development of neurological disorders.
National Institute of Neurology and Neurosurgery Manuel Velasco Suárez, Mexico City, Mexico.
Aguilera-Portillo G, et al. Mol Neurobiol. 2018 May 25. [in press]

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