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IACM-Bulletin of 17 March 2019

Science/Human: Cannabis may be an effective treatment of delayed gastric emptying according to a survey

Many patients with gastroparesis (delayed gastric emptying) and related symptoms may profit from a treatment with cannabis. Out of 197 patients, who filled out a questionnaire on their symptoms and current treatments, nearly half (92 participants) reported current or past cannabinoid use including THC and CBD. Doctors of the Section of Gastroenterology at the Department of Medicine of Temple University School of Medicine in Philadelphia, USA, asked their patients with symptoms suggestive of gastroparesis, among them nausea, vomiting, heartburn and stomach pain.

Of the 92 patients using cannabinoids 93.5 percent perceived improvement of symptoms by THC and 81.3 percent with CBD. Cannabinoids were used most commonly via smoking (46 patients). Patients taking cannabinoids were younger (41 versus 48 years on average) and had a higher Gastroparesis Cardinal Symptom Index total score (3.4 versus 2.8 on average) compared with patients with no history of cannabinoid use.

Jehangir A, Parkman HP. Cannabinoid Use in Patients With Gastroparesis and Related Disorders: Prevalence and Benefit. Am J Gastroenterol. 2019 Mar 8. [in press]

Science/Human: Cannabis use may increase satisfaction with orgasm in women

“Marijuana appears to improve satisfaction with orgasm,” researchers of the Department of Obstetrics, Gynecology, and Women's Health of Saint Louis University School of Medicine, USA, wrote in an article for Sexual Medicine. Patients were given a questionnaire at their visit and asked to complete it anonymously and place it in a locked box after their visit.

Of the 373 participants, 34% reported having used cannabis before sexual activity. Most women reported increases in sex drive, improvement in orgasm, and decrease in pain. Women who reported cannabis use before sexual activity had 2.13 higher odds of reporting satisfactory orgasms than women who reported no cannabis use. Authors wrote that a better understanding of the endocannabinoid system may “could help lead to development of treatments for female sexual dysfunction.”

Lynn BK, López JD, Miller C, Thompson J, Campian EC. The Relationship between Marijuana Use Prior to Sex and Sexual Function in Women. Sex Med. 2019 Mar 1. [in press]

Science/Human: Cancer patients report symptom relief by cannabis

“Patients with cancer enrolled in Minnesota's medical cannabis program showed significant reduction across all eight symptoms assessed within 4 months of program participation,” researchers at the Minnesota Department of Health in St Paul, and of HealthPartners Institute in Minneapolis, USA, wrote. They assessed the following symptoms: anxiety, lack of appetite, depression, disturbed sleep, fatigue, nausea, pain, and vomiting.

A significant reduction in scores was found across all symptoms when comparing baseline scores with the average score submitted within the first 4 months of program participation. The proportion of patients achieving 30% or greater symptom reduction within the first 4 months of program participation varied from 27% (fatigue) to 50% (vomiting), with a smaller proportion both achieving and maintaining those improvements. Adverse effects were reported in a small proportion of patients (10.5%). Authors concluded that “medical cannabis was well tolerated, and some patients attained clinically meaningful and lasting levels of improvement.”

Anderson SP, Zylla DM, McGriff DM, Arneson TJ. Impact of Medical Cannabis on Patient-Reported Symptoms for Patients With Cancer Enrolled in Minnesota's Medical Cannabis Program. J Oncol Pract. 2019 Mar 12 [in press]

Belgium: A parliament committee approves the implementation of a cannabis agency

The parliamentary Health Committee almost unanimously adopted a bill facilitating the creation of a cannabis agency, enabling production of the drug for medical purposes. According to a bill it is intended to make cannabis available on prescription for patients for whom standard medicines have proven to be of little or no use.

The cannabis agency would work under the auspices of the Federal Agency for Medicines. It will be permitted to supply authorizations for future plantations and producers, and will manage cannabis crop harvests. The agency will also ensure the monopoly on cannabis imports and exports, so that the drug is not used for illegal purposes. The agency will make cannabis available for pharmacists and hospitals.

Brusselstimes of 27 February 2019

News in brief

Science/Human: Cannabis may reduce complications of Crohn’s disease
In an analysis of 43,317 patients with Crohn’s disease from the USA, of whom 615 were regarded as cannabis users, showed that cannabis users were less likely to have the following complications: active fistulising disease and intra-abdominal abscess ( 12% versus 16%) and colectomy (4% vs. 8%) among others. Authors concluded that “cannabis use may mitigate several of the well-described complications of Crohn's disease among hospital inpatients.”
John H Stroger Hospital of Cook County, Chicago, USA.
Mbachi C, et al. Dig Dis Sci. 2019 Mar 2. [in press]

USA: Legalisation of cannabis presents a “long-term risk” to the alcohol industry
According to a new report, cannabis legalisation poses a risk to the alcohol industry. The risk to alcohol “is expected to expand as cannabis acceptance and consumption grows, particularly among beer and spirits drinkers”. “Though not yet mainstream, cannabis adoption is certainly growing in states where it’s legal and does pose a risk to the beverage alcohol industry in the future,” said Brandy Rand, the US president of the International Wines and Spirits Record.
The Spirits Business of 22 February 2019

Thailand: Cannabis amnesty program for patients
It is now possible to legally possess cannabis for medicinal purposes. Thanks to a cannabis amnesty program instituted by the government, those who had cannabis in their possession for medical use before legalization took effect will be able to petition the government to keep it. Both Thai nationals and foreigners are eligible for the amnesty program and medical cannabis possession.
Thai Law Forum of 4 March 2019

Australia: Most patients buy cannabis on the black market
Despite government claims that a streamlined medicinal cannabis system has led to an increase in prescriptions, at least 100,000 people are self-medicating through the black market, outweighing legal supply in Australia by over 30 to one. Experts say significant barriers to legal access have produced a failed system and are calling for an independent regulator.
ABC of 22 February 2019

Bosnia: President announced to pardon a MS patient convicted to jail sentence
President Kolinda Grabar-Kitarović announced that he would pardon Huanita Luksetić, a patient suffering from multiple sclerosis, whose condition is relieved by cannabis. He was convicted to 2 years in jail due to the illegal use of cannabis.
IndexHR of 22 February 2019

Israel: Prime Minister Netanyahu open to cannabis legalisation
The Israeli Prime Minister Benjamin Netanyahu said he’s looking into legalizing cannabis in an interview on his Likud party’s Facebook newscast.
Bloomberg of 12 March 2019

The Netherlands: Experiment for legalisation of cannabis
The government has decided to experiment for four years to see if legalising cannabis for supply is a success. The first step is to change the law to legalise the supply of the drug. The government will also licence growers and set up a research body. Currently, cannabis is available in 573 coffee shops. However, the production of cannabis to be sold in the shops is still illegal.
Sciclonic of 6 March 2019

Science/Human: The medical use of cannabis was associated with lower probability of illegal drug use in the USA
According to a study with 210 medical cannabis patients and 156 non-patient cannabis users aged 18 to 26 years, the medical use of cannabis was associated with a lower probability of illegal drug use, while the use of cannabis concentrates increased probability for illegal drug use.
Drexel University, Philadelphia, USA.
Fedorova EV, et al. Drug Alcohol Depend. 2019;198:21-27.

Science/Human: The presence of a legal dispensary for cannabis may reduce opioid-related mortality
Researchers used data from the Centers for Disease Control to analyse the association between medical cannabis laws in the US and opioid-related deaths. Unlike previous work, they found only “little evidence” that the enactment of medical cannabis laws has reduced opioid death rates. However, they found “that the presence of a legal dispensary may reduce opioid deaths.”
Lafayette College, Pennsylvania, USA.
Averett S, Smith E. Economics Bulletin, AccessEcon. 2019;39:347-357.

Science/Animal: Beta-caryophyllene may reduce neuropathic pain associated with diabetes
In an mouse model of neuropathic pain due to diabetes beta-caryophyllene, a terpene, which activates the CB2 receptor, reduced pain, depression-like behaviour and pro-inflammatory cytokines such as interleukin-1-beta, tumour necrosis factor alpha and interleukin-6.
Laboratory of Research and Pharmaceutical Development, University of Guadalajara, Mexico.
Aguilar-Ávila DS, et al. J Med Food. 2019 Mar 13. [in press]

Science: CBD can help to bring nanocapsules through the blood-brain barrier into the brain
Researchers showed that the transport of nanomedicines through the blood-brain barrier into the brain can considerably be improved by CBD (cannabidiol). They wrote that these combinations may “represent auspicious platforms for the design and development of novel therapies for CNS diseases.”
Department of Pharmaceutics and Food Technology, Complutense University, Madrid, Spain.
Aparicio-Blanco J, et al. Mol Pharm. 2019 Mar 13. [in press]

Science/Human: The endocannabinoid system is altered in patients with irritable bowel syndrome and bowel cancer
Researchers found altered plasma levels of endocannabinoids and endocannabinoid-like lipids in irritable bowel syndrome and colorectal cancer.
Otto Loewi Research Center, Division of Pharmacology, Medical University of Graz, Austria.
Grill M, et al. Sci Rep. 2019;9(1):2358.

Science/Human: Cannabis use increases positive affect and reduces anxiety
In a study with 183 men and 183 women representing heterosexual cannabis-using couples, who made daily reports of affect and cannabis use episodes for 30 consecutive days, immediately after cannabis use, positive affect increased, and hostile and anxious affect decreased. Authors wrote that “the improved affect immediately after use suggests a mechanism of positive reinforcement.”
Department of Psychology and Clinical and Research Institute on Addictions, University at Buffalo, New York, USA.
Testa M, et al. Addict Behav. 2019;95:64-69.

Science/Human: Loss of CB1 receptors in tissues was associated with leiomyomas
According to an analysis of CB1 receptors and other components of the endocannabinoid system in tissues of patients with leiomyomas loss of CB1, FAAH, GPR55, and PEA production were linked to the pathogenesis of uterine leiomyomas. A leiomyoma is a benign smooth muscle tumour, which can occur in any organ, but most often in the uterus.
Department of Cancer Studies and Molecular Medicine, University of Leicester, UK.
Ayakannu T, et al. Med Sci Monit Basic Res. 2019;25:76-87.

Science/Animal: Activation of the CB2 receptor may prevent from damage to the heart by doxorubicin
In a study with rats administration of beta-caryophyllene, which activates the CB2 receptor protected from the heart damaging effects of doxorubicin, a chemotherapeutic agent used for the treatment of cancer.
College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates.
Meeran MFN, et al. Chem Biol Interact. 2019 Mar 2. [in press]

Science/Human: The number of CB1 receptors is associated with the severity of menstrual cramps
In a study with myometrium tissue from 78 women researchers found that the severity of dysmenorrhoea (menstrual cramps) were associated with the level of CB1 receptors. Authors wrote that these “data suggest that cannabinoid receptor CB1 may be involved in the pathogenesis of dysmenorrhea in adenomyosis and may be a potential therapeutic target.”
Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing, China.
Shen X, et al. Reprod Sci. 2019 Mar 4 [in press]

Science/Animal: Cannabis had small effects on sleep in rats
Administration of cannabis by vaporisation during the resting phase of the day produced a small increment of sleep. There was no effect during the active phase of the day.
Facultad de Medicina, Universidad de la República, Montevideo, Uruguay.
Mondino A, et al. Pharmacol Biochem Behav. 2019;179:113-123.

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