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IACM-Bulletin of 20 August 2017

Science/Human: Cannabis use may decrease mortality in trauma patients

In a large study with 28,813 patients of the Arizona State Trauma Registry, who were admitted to an intensive care unit due to a trauma, screening positive for cannabis use was associated with improved survival. Of these 2,678 patients were included in an analysis, of whom 1,339 were cannabis positive and 1,339 were cannabis negative.

Mean age was 31 years. There was no difference between the two groups in hospital (6.4 versus 5.4 days) or days in the intensive care unit (3 versus 4 days). 55.3% of the cannabis positive and 32% of cannabis negative patients received mechanical ventilation. Of patients who received mechanical ventilation, cannabis positive patients had a higher number of ventilator days (2 versus 1 day) and a lower mortality rate (7.3% versus 16.1%) than those who were cannabis negative. Authors concluded that “a positive marijuana screen is associated with decreased mortality in adult trauma patients admitted to the ICU [intensive care unit].”

Singer M, Azim A, O'Keeffe T, Khan M, Jain A, Kulvatunyou N, Gries L, Jehan F, Tang A, Joseph B. How Does Marijuana Effect Outcomes After Trauma in ICU Patients? A Propensity Matched Analysis. J Trauma Acute Care Surg. 2017 Aug 5. [in press]

Science/Human: A study, which links cannabis use to hypertension, may be flawed

A review of U.S. health survey data found that cannabis users were three times more likely to die from causes related to high blood pressure, said lead researcher Barbara Yankey, a doctoral student at the Georgia State University School of Public Health in Atlanta. The researchers tracked 1213 participants. Participants were asked whether they had ever used cannabis. Those who answered yes were considered cannabis users. However, the researchers found no association between cannabis use and death from either heart disease or stroke. And they found no proof that cannabis caused deaths attributed to high blood pressure.

However, a cardiologist said the study was flawed, mainly because it relied on survey data that failed to answer key questions about the possible link between cannabis and high blood pressure. "If there's any value in it, it's that it is thought-provoking," said American Heart Association spokesman Dr Willie Lawrence. "It's hard to believe they've added much to our understanding, other than to suggest there may be some increase in mortality and that mortality may be related to hypertension," Lawrence said. And he added that this study has too many problems to effectively prove an association.

Yankey BA, Rothenberg R, Strasser S, Ramsey-White K, Okosun IS. Effect of marijuana use on cardiovascular and cerebrovascular mortality: A study using the National Health and Nutrition Examination Survey linked mortality file. EUR J Prev Cardiol. 2017 Aug 8. [in press].

UPI of 10 August 2017

News in brief

IACM: Meeting of partner organisations and IACM ambassadors at the IACM Conference
On the first evening of the 9th IACM Conference on Cannabinoids in Medicine in September in Cologne we will present ideas on scientific networking and exchange, the IACM ambassador programme and partnership with the IACM and discuss them with interested participants.
Programme of the IACM Conference from 29-30 September 2017

IACM: New publications in Cannabis and Cannabinoid Research
New articles have been published in the CCR, the partner journal of the IACM:
”Cannabinoid Receptor 1 Gene by Cannabis Use Interaction on CB1 Receptor Density” by Ariel Ketcherside, Lindsey J. Noble, Christa K. McIntyre, Francesca M. Filbey.
”Cannabis Roots: A Traditional Therapy with Future Potential for Treating Inflammation and Pain” by Natasha R. Ryz, David J. Remillard, Ethan B. Russo.
”Anatomy of a Joint: Comparing Self-Reported and Actual Dose of Cannabis and Tobacco in a Joint, and How These Are Influenced by Controlled Acute Administration” by Chandni Hindocha, Tom P. Freeman, H. Valerie Curran.

USA/WHO: U.S. authorities and the WHO are examining the abuse potential of CBD and ask for comments
The U.S. medicines Agency FDA is requesting interested persons to submit comments concerning abuse potential, actual abuse, medical usefulness, trafficking, and impact of scheduling changes on availability for medical use of 17 substances, including CBD (cannabidiol). These comments will be considered in preparing a response from the United States to the World Health Organization (WHO) regarding the abuse liability and diversion of these substances.
Request for comments on cannabidiol by the FDA

Germany: Cannabis expert entered a hunger strike
The German cannabis expert Dr Franjo Grotenhermen entered a hunger strike on 17 August to hint to problems associated with the new law on the medical use of cannabis and cannabinoids, which since March 2017 allows the prescription of cannabis in Germany. He calls for a clarification in the narcotics act, according to which patients, who need a treatment with cannabis or cannabinoids according to the conviction of a doctor, should no longer be prosecuted. The narcotics act was made to protect people from the damage by narcotics and not to damage ill people, he states in a video.
Website on hunger strike

Science/Human: A cannabis extract did not reduce pain in advanced cancer patients, who did not respond to opioids
In two large studies the cannabis extract Sativex was not superior to placebo in reducing pain in patients with advanced cancer, which was not sufficiently reduced by opioid therapy.
Edinburgh Cancer Research Centre, University of Edinburgh, UK.
Fallon MT, et al. Br J Pain. 2017;11(3):119-133.

Science/Human: Speechlessness in Tourette syndrome may be treated with cannabis/THC according to case reports
In a 19-year old patient with vocal blocking tics due to Tourette syndrome, which causes speechlessness, cannabis in a dose of 0.1 g daily significantly improved symptoms and was well tolerated. The same effect was achieved in a 16-year old patient with about 30 mg of dronabinol (THC).
Hannover Medical School, Germany.
Jakubovski E, et al. Int J Mol Sci. 2017;18(8).

Science/Human: Perceived harms and cannabis use by adolescents in Colorado
Data from 40 schools were surveyed before and after cannabis legalization was implemented (2013: 12,240 students; 2014: 11,931 students) in Colorado. Adolescent cannabis use behaviours and perceptions of risk of harm were unchanged from baseline to one-year follow-up. Perceived ease of access to cannabis increased (from 46% to 52%).
University of Colorado Anschutz Medical Campus, Aurora, USA.
Harpin SB, et al. Subst Use Misuse. 2017 Aug 17:1-6. [in press]

Science/Animal: Endocannabinoids reduce the toxicity of paraoxon
Paraoxon is a poison, which causes damage to the brain and may be used by the military as nerve agent. Research with rats shows that inhibition of the degradation of endocannabinoids is able to prevent this damage.
University of North Carolina, Pembroke, USA.
Farizatto KLG et al. J Mol Neurosci. 2017 Aug 12. [in press]

Science/Human: More than 80% of patients believe that cannabis may reduce pain
An anonymous questionnaire was administered to 501 patients before surgery in a large hospital. More than 80% of this group believed that cannabis could be at least somewhat effective for the treatment of pain after surgery and would be willing to use cannabinoid compounds if prescribed by their physician.
Icahn School of Medicine at Mount Sinai, New York, USA.
Khelemsky Y, et al. Reg Anesth Pain Med. 2017 Aug 7. [in press]

Science/Animal: CBD may be useful in the treatment of opioid addiction
In mice liking of morphine was reduced by 10 mg CBD per kg body weight. Authors wrote that cannabidiol “may be useful in addiction treatment settings.”
University of Mississippi, USA.
Markos JR, et al. Planta Med. 2017 Aug 9. [in press]

Science/Human: CBD interacts with other anti-epileptic drugs
In an open study with 39 adults and 42 children an epilepsy treatment with CBD increased blood levels of topiramate, rufinamide, and N-desmethylclobazam and decreased the levels of clobazam. The effect depended on CBD dose. Increases in serum levels of zonisamide and eslicarbazepine with increasing CBD dose were seen in adults. Except for clobazam and desmethylclobazam, all noted mean level changes were within the accepted therapeutic range.
Department of Neurology, University of Alabama at Birmingham, USA.
Gaston TE, et al. Epilepsia. 2017 Aug 6. [in press]

Science/Human: Induction of placebo effect by oral cannabis
In a study 20 participants were told that they would receive an edible cannabis lollipop containing a high dose of THC, but were instead given a placebo. Measures of intoxication and mood were taken at baseline, 30 minutes, and 60 minutes after ingestion. There were significant changes in intoxication and negative mood. Changes in positive mood were not significant.
Palo Alto Health Care System, Menlo Park, USA.
Loflin MJE, et al. J Psychoactive Drugs. 2017 Aug 3:1-5. [in press]

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