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IACM-Bulletin of 19 December 2021

Science/Human: The use of cannabis is associated with a tendency for the normalisation of certain biomarkers in children with autism

Investigators of Cannformatics in San Francisco, USA, analysed potential cannabis-responsive biomarkers in saliva of 15 children with autism spectrum disorder (ASD) and 9 healthy children. Each child followed a unique regimen determined by their specific response over at least 1 year of treatment, which included THC-dominant cannabis (dosing range 0.05-50 mg per dose) in 40% of children and CBD-dominant cannabis (dosing range 7.5-200 mg per dose) in 60% of children. Samples from the ASD group were collected before treatment start and at time of maximal impact.

The results show that 65 potential cannabis-responsive biomarkers in the autism group exhibited a shift toward physiological levels found in healthy children. A similar qualitative improvement trend in children with ASD treated with cannabis was also observed in the behavioural surveys. 23 potential Cannabis-Responsive biomarkers exhibiting change toward normalisation were categorized as anti-inflammatory, bioenergy associated, neurotransmitters, amino acids, and endocannabinoids. Authors concluded that there “results suggest Cannabis-Responsive biomarkers shift … can potentially quantify benefit at the metabolic level.“

Siani-Rose M, Cox S, Goldstein B, Abrams D, Taylor M, Kurek I. Cannabis-Responsive Biomarkers: A Pharmacometabolomics-Based Application to Evaluate the Impact of Medical Cannabis Treatment on Children with Autism Spectrum Disorder. Cannabis Cannabinoid Res. 2021 Dec 6.

Science/Human: A certification for the use of medical cannabis is associated with reduced opiate use in pain patients

A medical cannabis certification is associated with a reduced use of opioids according to a retrospective analysis of 81 pain patients of a private pain management practice by investigators from Georgetown University in Washington DC, USA. Participants were concurrently being treated with opioid medications for chronic pain.

Overall, the average change in prescribed opioid use was found to be -12.3 morphine milligram equivalent (MME) units when including all individuals. Among the included individuals with baseline opioid use, medical cannabis certification was associated with a 31% average decrease in opioid use. When examining subgroups based upon pain location, 27 individuals with neck pain displayed a 42% average decrease in morphine MME (n = 27), while 58 individuals with low back pain were observed to have a 29% decrease in opioid use.

Balu A, Mishra D, Marcu J, et al. Medical Cannabis Certification Is Associated With Decreased Opiate Use in Patients With Chronic Pain: A Retrospective Cohort Study in Delaware. Cureus, 2021:13(12): e20240.

Science/Human: Cannabis use may be associated with improved or deteriorated sleep

In a survey, cannabis users reported both short and long sleep. Investigators of the Department of Anesthesiology and Pain Medicine at the University of Toronto, Canada, undertook a cross-sectional analysis of adults using the National Health and Nutrition Examination Survey data from 2005 to 2018. Respondents were dichotomized as recent users or non-users if they had used or not used cannabis in the past 30 days, respectively. The primary outcome was nightly sleep duration, categorized as short (<6 hours), optimal (6-9 hours), and long (>9 hours).

From a sample representing approximately 146 million adults in the USA, 14.5% reported recent cannabis use. Recent users were more likely than non-users to report either short sleep (OR 1.34) or long sleep (OR 1.56). Regular users, who used cannabis at least on 20 days in the past 30 days, were even more likely to be at the extremes of nightly sleep duration.

Diep C, Tian C, Vachhani K, Won C, Wijeysundera DN, Clarke H, Singh M, Ladha KS. Recent cannabis use and nightly sleep duration in adults: a population analysis of the NHANES from 2005 to 2018. Reg Anesth Pain Med. 2021:rapm-2021-103161.

Science/Human: Patients with inflammatory bowel diseases may profit from a treatment with cannabis according to a survey

According to a survey with 100 participants by investigators of the University of Puerto Rico Center for Inflammatory Diseases in San Juan patients suffering from inflammatory bowel disease ((IBD) may profit from a treatment with cannabis. They completed an anonymous questionnaire. The medical use of cannabis has become legal in Puerto Rico in 2017.

27% of the surveyed participants reported use of cannabis. Of these, 39% reported moderate knowledge and 53% reported little to no knowledge of medical cannabis. The majority did not discuss cannabis use with their physician (78%), and most saw improvement of their symptoms (68%). Authors noted that “cannabis is frequently considered by patients as a treatment option for IBD but most have limited knowledge about its use.”

School of Medicine, University of Puerto Rico, Medical Sciences Campus, San Juan, Puerto Rico.
Muñiz-Camacho LA, Negrón-Quintana FI, Ramos-Burgos LA, Cruz-Cruz JJ, Torres EA. Knowledge, Perception, and Use of Cannabis Therapy in Patients with Inflammatory Bowel Disease. P R Health Sci J. 2021;40(3):110-114.

Science/Human: CBD rich cannabis may be helpful in autism

Investigators of the Department of Pediatric Neurology of Çukurova Medical School in Balcalı, Turkey, describe positive effects of CBD rich cannabis in the treatment of children with autism spectrum disorder. The study included 33 children diagnosed with autism spectrum disorder, who were followed up between January 2018 and August 2020. The mean age was 7.7 years. The average daily dosage of CBD was 0.7 mg/kg/day. The median duration of treatment was 6.5 months. The preparations contained full-spectrum CBD and low amounts of THC of less than 3%.

According to the parents' reports, no change in daily life activity was reported in 6 (19.35%) patients. The main improvements were as follows: a decrease in behavioural problems was reported in 10 patients (32.2%), an increase in expressive language was reported in 7 patients (22.5%), improved cognition was reported in 4 patients (12,9%), an increase in social interaction was reported in 3 patients (9.6%), and a decrease in stereotypes was reported in 1 patient (3.2%). Authors concluded that “using lower doses of CBD and trace THC seems to be promising in managing behavioral problems associated with autism.”

Bilge S, Ekici B. CBD-enriched cannabis for autism spectrum disorder: an experience of a single center in Turkey and reviews of the literature. J Cannabis Res. 2021;3(1):53.

News in brief

Malta: The country became the first in EURope to allow cultivation of cannabis for personal use
Malta became the first EURopean country to allow limited cultivation and possession of cannabis for personal use, following a vote in parliament on 14 December. The law, which was approved by 36 votes to 27, allows adults in Malta to possess up to seven grams of cannabis and grow up to four plants. Smoking cannabis in public will not be allowed.
Reuters 15 December 2021

Science/Human: Cannabis use is not associated with an increased risk of adverse surgery outcomes
Patients with a history of moderate cannabis use are no more likely to experience adverse surgery outcomes than non-users. This is the result of a study with data from a single institution over a period of 14 months by Canadian investigators presented at the 2021 Meeting of the American Society of Regional Anesthesia and Pain Medicine.
Department of Anesthesia, McMaster University, Hamilton, Canada.
Zhang BH, et al. Poster presented at the annual meeting of the American Society Regional Anesthesia and Pain Medicine from 18 to 20 November 2021 in San Francisco, USA

Science/Human: CBD-rich cannabis has no effect on driving ability
In a placebo-controlled crossover study with 33 participants inhalation of 0.5 gram CBD-rich cannabis had no effect on driving ability as measured by the 3 dimensions of the Vienna Test System TRAFFIC examining reaction time, behaviour under stress, and concentration performance.
Department of Forensic Toxicology and Chemistry, Institute of Forensic Medicine, University of Bern, Switzerland.
Gelmi TJ, et al. Forensic Sci Res. 2021;6(3):195-207

Science/Human: THC was not effective in trichotillomania in clinical study
In a study with 50 adults with either trichotillomania or skin picking disorder, who either received 5 to 15 mg of THC or placebo for 10 weeks THC was not superior to placebo.
Department of Psychiatry and Behavioral Neuroscience, University of Chicago, USA.
Grant JE, et al. Int Clin Psychopharmacol. 2022 Jan 1;37(1):14-20.

Science/Human: Patients with autism often use CBD
In a survey with 269 participants those with autism were 3.5 times more likely than healthy people to have used CBD in the past 12 months and they used it on more days. Investigators did not find more cannabis use in patients with autism compared to controls.
Addiction and Mental Health Group (AIM), Department of Psychology, University of Bath, UK.
Hua DY, et al. BMJ Open. 2021;11(12):e053814.

Science/Human: Nurses have a more positive attitude towards the use of cannabis than physicians
In a survey with 430 patients, 65 nurses and 65 physicians in two large medical centres in Israel patients who used cannabis had a more positive attitude towards cannabis than healthcare professionals. Nurses had a more positive attitude than physicians.
School of Public Heath, University of Haifa, Israel.
HaGani N, et al. J Psychoactive Drugs. 2021, 10:1-10.

Science/Human: Caregivers of children with juvenile arthritis are interested in CBD
According to a survey with 136 caregivers of children with juvenile arthritis 34.percent reported no interest in using CBD, while 54% reported contemplating using CBD and 7% reported using it currently for their child.
Department of Pediatric Rheumatology, C.S. Mott Children's Hospital, Ann Arbor, USA.
Failing CJ, et al. Pediatr Rheumatol Online J. 2021;19(1):171.

Science/Cells: CBD may inhibit cell proliferation in Sertoli cells
CBD was shown to be toxic in human Sertoli cells. Sertoli cells are important for the production of sperm.
National Center for Toxicological Research, U.S. Food and Drug Administration, Jefferson, USA.
Li Y, et al. Food Chem Toxicol. 2021;159:112722.

Science/Human: Tobacco smokers are exposed to higher levels of toxicants than cannabis smokers
In a study with tobacco smokers, mixed cannabis and tobacco smokers, and only-cannabis smokers the latter were exposed to lower but still high levels of harmful constituents of smoke.
Department of Psychology, University of Wisconsin-Stevens Point, USA.
Meier E, et al. Nicotine Tob Res. 2022 Jan 1;24(1):125-129.

Science/Animal: Increased levels of anandamide had no effect in an animal model of Parkinson’s disease
In an animal model of Parkinson’s disease respiratory frequency is attenuated and this effect was not improved by an inhibitor of degradation of the endocannabinoid anandamide (URB 597). Authors wrote that these “results suggest that targeting anandamide may not be a suitable strategy to treat“ Parkinson’s disease.
Department of Pharmacology, Instituto de Ciencias Biomedicas, Universidade de Sao Paulo, Brazil.
Batista LA, et al. Exp Physiol. 2021.

Science/Animal: CBD showed antipsychotic-like effects in mice
In a mouse model of psychosis “the results show that CBD induces acute antipsychotic-like effects that last for 24-h.”
Department of Neurosciences and Behavioral Sciences, School of Medicine of Ribeirão Preto, University of São Paulo, Brazil.
Pedrazzi JFC, et al. Prog Neuropsychopharmacol Biol Psychiatry. 2021;111:110352.

Science/Animal: Beta-caryophyllene reduced seizure activity in a mouse model of Dravet syndrome
The cannabis compound beta-caryophyllene was active in a mouse model of Dravet syndrome “against seizuring activity (acute treatment) and against several comorbidities (repeated treatment), in both cases in association with its capability to reduce glial reactivity in areas related to these behavioural abnormalities.”
Departamento de Bioquímica y Biología Molecular, Facultad de Medicina, Universidad Complutense, Madrid, Spain.
Alonso C, et al. Neuropharmacology. 2021;205:108914.

Science/Animal: A combination of a CB2 receptor agonist and arginine attenuated diabetic heart damage
A combination of the CB2 receptor agonist beta-caryophyllene and the amino acid arginine was “shown to improve cardiac functions by attenuating inflammation” in diabetic rats thus protecting from cardiomyopathy, a form of heart damage.
Shobhaben Pratapbhai Patel School of Pharmacy & Technology Management, Mumbai, India.
Kumawat VS, et al. Can J Physiol Pharmacol. 2021.

Science/Human: Cannabis use was associated with an increased risk for heart attack
“In a large and systematic nationwide analysis, cannabis use was an independent risk factor” for the development of acute myocardial infarction (AMI). In this analysis the risk increased by 32%. “However, the prognosis of illicit drug users presenting with AMI was similar to patients without illicit drug use.”
Service de cardiologie, CHU Trousseau, 37044 Tours, France.
Ma I, et al. EUR Heart J Acute Cardiovasc Care. 2021;10(9):1027-1037.

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