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IACM-Bulletin of 17 January 2021

Science/Human: Cannabis is not associated with an increased risk of cardiovascular disease in adults

According to a large retrospective study using the Behavioral Risk Factor Surveillance System (BRFSS) database cannabis use was not associated with an increased risk of cardiovascular disease. The study was conducted by investigators at Florida International University of the Herbert Wertheim College of Medicine in Miami, USA. Patients who completed the questionnaire and answered all questions in relation to cannabis use and the diagnosis of cardiovascular disease in 2017 were a part of this study. Subjects were excluded if they were children or had missing data for cannabis use or cardiovascular disease.

A total of 56,742 subjects were included in the analysis. After adjustment with all variables, an adjusted model showed a moderate reduction in risk, which however was not statistically significant. Authors concluded that “although previous literature has shown that marijuana use has a negative impact on cardiovascular health, our study suggests that users and non-users of marijuana did not have an association with the prevalence of cardiovascular disease.”

Jivanji D, Mangosing M, Mahoney S P, Castro G, Zevallos J, Lozano J. Association Between Marijuana Use and Cardiovascular Disease in US Adults. Cureus 2020;12(12):e11868.

Science/Human: Cannabis use may allow cessation of opioid use in a large number of pain patients

According to data of 1181 patients from three medical cannabis practice sites in the USA a large proportion of pain patients were able to completely cease opiate medication after initiation of cannabis use. The study was conducted by the Society of Cannabis Clinicians in Sebastopol, USA. Of this overall group of patients responding to an online survey 525 patients had used prescription opioid medications for at least 3 months to treat chronic pain and were using medical cannabis.

Overall, about 40% reported that they stopped all opioids, about 45% reported some decrease in their opioid usage, 13% reported no change in opioid usage, and 1% reported an increase in opioid usage. A majority of 65% reported that they sustained the opioid change for over a year. Almost half (48%) reported a 40-100% decrease in pain while 9% had no change in pain and 3% had worsening pain. Authors concluded that patients in this study “reported that cannabis was a useful adjunct and substitute for prescription opioids in treating their chronic pain and had the added benefit of improving the ability to function and quality of life.”

Takakuwa K M, Sulak D. A Survey on the Effect That Medical Cannabis Has on Prescription Opioid Medication Usage for the Treatment of Chronic Pain at Three Medical Cannabis Practice Sites. Cureus 2020;12(12): e11848.

Mexico: Health ministry publishes rules for the regulation of medicinal cannabis

Three years after Mexico passed a law permitting the medicinal use of cannabis , the government on 12 January published the underlying regulations governing everything from who can prescribe it to who can grow it.

Multiple government agencies from the health and agriculture ministries will oversee a system intended to permit research into cannabis medical uses and development of pharmaceuticals while avoiding related criminal activities, according to regulation published in the federal register. Mexico is now considering legalizing cannabis use for adults and a vote could come as early as February.

Reuters of 12 January 2021
Tricitynews of 12 January 2021

Science/Human: Cannabis extracts were effective in the treatment of multiple sclerosis according to observational study

According to a prospective observational study with 28 patients with multiple sclerosis different cannabis extracts reduced symptom severity. The study was conducted by investigators of the Danish Multiple Sclerosis Center at the University of Copenhagen, Denmark. Patients were treated with medical cannabis oils (THC-rich, CBD-rich and THC+CBD combined products) and were followed during a period of four weeks. Mean doses of THC and CBD were 4.0 mg and 7.0 mg, respectively, and primarily administered as a once-daily evening dose.

Pain decreased from a median score of 7 to 4, spasticity decreased from a mediane score of 6 to 2.5 and sleep disturbances decreased from a median score of 7 to 3. Authors concluded that “treatment with medical cannabis oils was safe and well tolerated, and resulted in a reduction in pain intensity, spasticity and sleep disturbances in MS patients. This suggests that medical cannabis oils can be used safely, especially at relatively low doses and with slow titration, as an alternative to treat MS-related symptoms when conventional therapy is inadequate.”

Gustavsen S, Søndergaard Hb, Linnet K, Thomsen R, Rasmussen Bs, Sorensen Ps, Sellebjerg F, Oturai Ab. Safety and efficacy of low-dose medical cannabis oils in multiple sclerosis. Mult Scler Relat Disord. 2020;48:102708.

Science/Human: Patients with fibromyalgia report experiencing relief from CBD

According to an anonymous survey among individuals with fibromyalgia conducted by investigators of the Anesthesiology Department at the University of Michigan Medical School in Ann Arbor, USA, CBD may be helpful in reducing symptoms. After excluding incomplete surveys, the study population consisted of 2701 participants with fibromyalgia, primarily in the United States.

Overall, about 38% reported never using CBD, 29% reported past CBD use, and 32% reported current CBD use. Past-year cannabis use was strongly associated with past or current CBD use. Those using CBD typically did so due to inadequate symptom relief, while those not using CBD typically cited safety concerns as their reason for not using CBD. Two-thirds of participants disclosed CBD use to their physician, although only 33% asked for physician advice on using CBD. Participants used CBD for numerous fibromyalgia-related symptoms, most commonly pain, and generally reported slight to much improvement across symptom domains. Around half of participants reported side effects, which were typically minor.

Boehnke KF, Gagnier JJ, Matallana L, Williams DA. Cannabidiol Use for Fibromyalgia: Prevalence of Use and Perceptions of Effectiveness in a Large Online Survey. J Pain. 2021:S1526-5900(20)30117-6.

News in brief

USA: Patients Out of Time 25th Anniversary and virtual conference
To celebrate its 25th anniversary Patients Out of Time is holding a virtual symposium on 13 and 14 February 2021.
Conference website

USA: New York may legalize cannabis use for adults
New York Governor Andrew Cuomo, facing an economic chasm resulting from COVID-19 shutdowns, wants to follow neighboring New Jersey in legalizing mobile sports betting and legalization of cannabis for adults to help his state regain its financial footing. The legalization of cannabis for adults is expected to eventually generate more than 300 million dollars (about 250 million EURos) in tax revenue. “The governor’s proposal builds on years of work to understand and decriminalize cannabis for adult use,” the Cuomo administration said in a statement.
Reuters of 6 January 2021

USA: Illinois expunges nearly 500,000 cannabis-related criminal records
Illinois started off the new year with nearly half a million less cannabis-related criminal records. Governor J.B. Pritzker announced in a series of Twitter posts on Thursday the state had expunged "nearly 500,000 low-level cannabis related records."
UPI of 2 January 2021

UK: More than 300,000 cannabis patients expected by the end of 2024
The Medical Cannabis Clinics (TMCC) has revealed it recently reached the significant milestone of consulting and prescribing for over 1,500 patients in the last 12 months. This works out at 60 percent of an estimated total of 2,500 cannabis patients in the UK. Numbers are supposed to increase to more than 300,000 by the end of 2024.
Statista of 14 February 2020
Cannabis Health News of 7 January 2021

Czech Republic: Cannabis for medicinal use has quadrupled in 2020
Consumption of medical cannabis in the Czech Republic has quadrupled year-on-year. While in 2019 patients were prescribed 17 kilograms of cannabis, last year the amount increased to 66.8 kilograms. According to data published by the Office of the Government’s Drug Policy Department, the Ministry of Health, and the Public Institute for Drug Control, the increase was due to the fact that since last year, 90 percent of the price of cannabis has been covered by health insurance.
Prague Morning of 7 January 2021

UK: Cannabis supplies from abroad have been interrupted due to Brexit
The government has said it is working urgently with Dutch authorities to “find a solution” after supplies of medical cannabis imported from the Netherlands were halted due to Brexit, endangering the lives of up to 40 children in the UK with severe epilepsy. Supplies of the prescribed medication are set to run out in a matter of weeks.
Independent of 7 January 2021

USA: New Mexico Judge rules that inmates have a right to access medical cannabis
A state district judge in New Mexico has ruled that inmates and parolees have a right to use medical cannabis and that correctional institutions must provide access to cannabis to qualified patients, even if they are behind bars. Last week’s ruling from 2nd Judicial District Judge Lucy Solimon was entered in a lawsuit against Bernalillo County’s Metropolitan Detention Center brought by Joe Montaño, an Albuquerque resident who was convicted of drunk driving in 2019.
High Times of 4 January 2021

Science/Cells: Cannabinoids exhibit anti-inflammatory activity in COVID-19-related inflammation
A cannabis extract substantially reduced levels of pro-inflammatory cytokines (interleukin 6 and interleukin 8) in lung cells. The extract contains cannabidiol, cannabigerol, and tetrahydrocannabivarin. Authors wrote that this formulation of a cannabis extract may be helpful in lung inflammation, but “there is a need of caution proposing cannabis as treatment for COVID-19.”
Institute of Plant Science, Agriculture Research Organization, Volcani Center, Rishon LeZion, Israel.
Anil SM, et al. Sci Rep. 2021;11(1):1462.

Science/Human: Young people increase alcohol use after starting cannabis abstinence
In a study with 160 young people aged 14 to 25 years who were assigned to and abstinence program 60% increased alcohol consumption in frequency and quantity. This increase resolved with resumption of cannabis use.
Center for Addiction Medicine, Department of Psychiatry, MA General Hospital, Boston, USA.
Schuster RM, et al. Prog Neuropsychopharmacol Biol Psychiatry. 2020;107:110205.

Science/Cells: Cannabis induces cell death in human lung cancer cells
Extracts from Echinacea and cannabis induced programmed cell death, apoptosis, in lung cancer cells from humans. This effect seemed to be mediated by the CB2 receptor. Authors wrote that “these effects deserve receiving more attention as alternative anti-cancer agents.”
Department of Biochemistry, School of Medicine, Iran University of Medical Sciences, Tehran, Iran.
Hosami F, et al. BMC Complement Med Ther. 2021;21(1):37.

Science/Human: Endocannabinoid dysfunction in patients with anorexia nervosa
A hair analysis of patients suffering from anorexia nervosa revealed that the levels of anandamide and all other investigated endocannabinoids were elevated. This dysfunction of the endocannabinoid system may be of therapeutic relevance.
Division of Psychological and Social Medicine and Developmental Neurosciences, Faculty of Medicine, Technische Universität Dresden, Germany.
Tam F, et al. Prog Neuropsychopharmacol Biol Psychiatry. 2021:110243.

Science/Human: Cannabis use increased in the USA in the past 5 years mainly in the higher age groups
Prevalence of past-month cannabis use increased significantly from 2015 to 2019 by about one third from 8.3%-11.5%. There was a 53% increase among those aged 65 years or older and a considerable increase among patients with the permission to use medical cannabis. Investigators used data from the US National Survey on Drug Use and Health with about 280,000 participants.
New York University Grossman School of Medicine, Department of Population Health, New York, USA.
Palamar JJ, et al. Drug Alcohol Depend. 2021;219:108494.

Science/Human: Age-related differences in the choice for different cannabis products
In a sample of 1406 people using cannabis the kind of prefer products usually differed depending on age. Rates of use for cannabis oils, products for external use, and tinctures were the lowest and showed no age or gender-related differences.
Department of Psychology, University at Albany, State University of New York, Albany, USA.
Ueno LF, et al. J Psychoactive Drugs. 2021:1-7.

Science/Cells: Activation of the CB1 receptor decreases lung cancer cell growth
In a study with cells from so-called non-small cell lung cancer (NSCLC) a synthetic cannabinoid (ACPA), which activates the CB1 receptor caused programmed cell death (apoptosis) and reduced proliferation.
Hacettepe University, Graduate School of Science and Engineering, Department of Bioengineering, Ankara, Turkey.
Boyacıoğlu Ö, et al. Cell Death Dis. 2021;12(1):56.

Science/Cells: CBD inhibits growth of melanoma cells
CBD inhibited the growth of melanoma cells and concentrations of 0.2 mg/mL and 0.04 mg/mL, while lower concentrations were not effective.
Department of Biology, Purdue University Fort Wayne, USA.
Burch R, et al. J Immunoassay Immunochem. 2021:1-7.

Science/Animal: CBD may reduce reinstatement of cocaine intake after abstinence
In cocaine-dependent mice CBD was able to reduce stress-induced reinstatement of cocaine use after period of abstinence.
Departamento de Psicobiología, Facultad de Psicología, Universitat de València, Spain.
Calpe-López C, et al. J Psychopharmacol. 2021 Jan 9:269881120965952.

Science/Human: Cannabis use increased during the COVID-19 pandemic
According to survey with 1,563 cannabis users from the Netherlands 41% of all respondents indicated that they had increased their cannabis use since the lockdown measures, 49% used as often as before, 6.6% used less often, and 2.8% stopped (temporarily). One-third of those who were not daily users before the lockdown became (almost) daily users.
Trimbos Institute, The Netherlands Institute of Mental Health and Addiction, Utrecht, Netherlands.
van Laar MW, et al. Front Psychiatry. 2020;11:601653.

Science/Animal: Development of CBD nasal delivery system
Nanostructured lipid carriers were developed as a CBD nasal delivery system. The product caused lasting pain relieving effect in animals with neuropathic pain.
Faculty of Pharmaceutical Sciences, Federal University of Alfenas, Brazil.
Matarazzo AP, et al. EUR J Pharm Sci. 2021;159:105698.

Science/Human: No negative effect of cannabis use on liver transplant recipients
According to the analysis of data from 900 patients cannabis use had no negative effect on liver transplant outcomes.
Department of Surgery, David Geffen School of Medicine at UCLA, USA.
Guorgui J, et al. Clin Transplant. 2021 Jan 6:e14215.

Science/Human: Severity of withdrawal symptoms in people using medical cannabis for chronic pain may vary considerably
Withdrawal symptoms were analysed in a group of 527 adults with chronic pain seeking medical cannabis certification or re-certification. They appeared to experience mild to severe withdrawal symptoms. authors wrote that “withdrawal symptoms tend to be stable over a 2-year period, but younger age is predictive of worse symptoms and of an escalating withdrawal trajectory.”
Addiction Center, Department of Psychiatry, University of Michigan, USA.
Coughlin LN, et al. Addiction. 2021 Jan 5. [in press]

Science/Animal: Cannabichromene and related cannabinoids have anticonvulsant effects
In a mouse model of Dravet syndrome CBC (cannabichromene), CBC acid (CBCA) and cannabichromevarinic acid (CBCA) had anticonvulsants properties.
Brain and Mind Centre, The University of Sydney, Australia.
Anderson LL, et al. ACS Chem Neurosci. 2021 Jan 4. [in press]

Science/Human: Cannabis users may need more propofol for sedation during medical procedures
Investigators have proved an increase in the whole propofol dose in endoscopy in relation to cannabis use.
Gastroenterología, Agencia Sanitaria Alto Guadalquivir. J Andalucía, España.
Cerezo Ruiz A, et al. Rev Esp Enferm Dig. 2021 Jan 4. [in press]

Science/Human: Legalization of cannabis for adult use had negligible effect on use by young adults in California
According to data 563 young adults aged 18 to 24 years legalization of cannabis for adult use had a negligible overall impact on days of use among young adults, but may have prompted increased interest in cannabis among some, particularly women and e-cigarette users.
Department of Psychiatry, University of California, San Diego, USA.
Doran N, et al. Addict Behav. 2020;115:106782.

Science/Animal: Chronic CBD use caused antidepressant effects associated with increased levels of serotonin and noradrenaline
Chronic administration of CBD induces antidepressant effects in a mouse model of depression. Chronic CBD administration in a dose of 100 mg per kg body weight resulted in significant increases in serotonin and noradrenaline levels in the hippocampus, a certain brain area.
Chinese Academy of Sciences, Shanghai, China.
Abame MA, et al. Neurosci Lett. 2020;744:135594. [in press]

Science/Animal: Endocannabinoids attenuate the virulence of certain bacteria in the bowel
Possible effects of the endocannabinoid 2-AG on intestinal infection “raise questions about the possible benefits of using cannabinoids to treat intestinal bacterial infections.”
Laboratoire Microbiologie Santé et Environnement, Doctoral School of Sciences and Technology, Faculty of Public Health, Lebanese University, Tripoli, Lebanon.
Osman M, et al. Trends Microbiol. 2020:S0966-842X(20)30325-5.

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