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IACM-Bulletin of 24 November 2019

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

Cannabis with high CBD and low THC (ratio of 75/1) may be helpful in the treatment of autism according to an observational study with 15 patients. The study was conducted by researchers from the University of Minas Gerais in Belo Horizonte and the University of Brasília, Brazil. A group of 18 autistic patients were included. Among the 15 patients who adhered to the treatment (10 non-epileptic and five epileptic) only one patient showed lack of improvement in autistic symptoms.

Due to adverse effects, three patients discontinued cannabis use before 1 month. After 6-9 months of treatment, most patients, including epileptic and non-epileptic, showed some level of improvement in more than one of the eight symptom categories evaluated: Attention Deficit/Hyperactivity Disorder; Behavioural Disorders; Motor Deficits; Autonomy Deficits; Communication and Social Interaction Deficits; Cognitive Deficits; Sleep Disorders and Seizures, with very infrequent and mild adverse effects. The strongest improvements were reported for Seizures, Attention Deficit/Hyperactivity Disorder, Sleep Disorders, and Communication and Social Interaction Deficits.

Fleury-Teixeira P, Caixeta FV, Ramires da Silva LC, Brasil-Neto JP, Malcher-Lopes R. Effects of CBD-Enriched Cannabis sativa Extract on Autism Spectrum Disorder Symptoms: An Observational Study of 18 Participants Undergoing Compassionate Use. Front Neurol. 2019;10:1145

Science/Human: Cannabis may be helpful in the treatment of endometriosis

A cross-sectional online survey was conducted between October and December 2017 by scientists of Western Sydney University in Penrith and other Australian institutions. A total of 484 responses were included for analysis, with 76% of the women reporting the use of general self-management strategies within the last 6 months. Of those using self-management, 13% reported using cannabis for symptom management.

Self-reported effectiveness in pain reduction was high (7.6 of 10), with 56% also able to reduce pharmaceutical medications by at least half. Women reported the greatest improvements in sleep and in nausea and vomiting. Adverse effects were infrequent (10%) and minor.

Sinclair J, Smith CA, Abbott J, Chalmers KJ, Pate DW, Armour M. Cannabis Use, a Self-Management Strategy Among Australian Women With Endometriosis: Results From a National Online Survey. J Obstet Gynaecol Can. 2019 Nov 7. [in press]

Science/Human: A CBD-rich hemp extract may reduce opiate use in chronic pain patients

According to a prospective study with 97 patients recruited from a private pain management centre in Philadelphia, USA, who completed an 8-week study a hemp extract rich in CBD helped to reduce opioids. An initial sample of 131 patients was recruited from a private pain management centre’s investigative population. Patients had to be on opioids for at least one year.

Over half of chronic pain patients (53%) reduced or eliminated their opioids within 8 weeks after adding CBD-rich hemp extract to their regimens. Almost all CBD users (94%) reported quality of life improvements. Authors wrote, that “CBD could significantly reduce opioid use and improve chronic pain and sleep quality among patients who are currently using opioids for pain management.”

Capano A, Weaver R, Burkman E. Evaluation of the effects of CBD hemp extract on opioid use and quality of life indicators in chronic pain patients: a prospective cohort study. Postgrad Med. 2019 Nov 12:1-6.

USA: A committee of the House of Representatives passes landmark bill to decriminalize cannabis

On 20 November the House Judiciary Committee passed a landmark bill to federally decriminalize cannabis by removing it as a Schedule 1 drug of the Controlled Substances Act and to pave the way for the expungement of cannabis convictions from criminal records. The bill, known by its acronym the MORE Act, passed 24 to 10 and will now be forwarded on to the full House for consideration.

Committee chairman and the bill's sponsor Jerry Nadler, Democrats, told the House before the vote that it was a mistake to have criminalized cannabis and that mistake was further compounded by racial disparity enforcement laws. "These steps are long overdue," he said. "For far too long, we have treated marijuana as a criminal justice problem instead of a matter of personal choice and public health. Whatever one's views on the use of marijuana for recreational or medicinal purposes, arresting, prosecuting and incarcerating users at the federal level is unwise and unjust."

UPI of 20 November 2019

UK: Medical cannabis trial will include 20,000 patients

Up to 20,000 patients in the UK are to be given medical cannabis over a two-year period in an initiative that aims to create the largest body of evidence on the drug in EURope. The move is backed by one of the UK’s leading medical bodies and it is hoped it will persuade the NHS to prescribe the drug for a range of conditions. Although medical cannabis was legalised in the UK a year ago, it remains unobtainable for many patients, according to campaigners.

“Medical cannabis is still out of reach for far too many,” said Professor David Nutt from the independent scientific body Drug Science, the organisation behind the launch of Project Twenty21, which will see 20,000 patients supplied with subsidised cannabis products by the end of 2021.

The Guardian of 3 November 2019

News in brief

Science/Human: CBD reduced pain in patients with myofascial pain in placebo controlled study
In a placebo-controlled study with 60 patients suffering from pain in the face topical CBD significantly reduced pain and muscle activity of the masseter, a face muscle. Patients received either topical CBD to the face or a placebo. Pain intensity and muscle activity were measured on days 0 and 14. Pain reduction was 70% and 10% in the placebo group. Authors concluded that “application of CBD formulation over masseter muscle reduced the activity of masseter muscles and improved the condition of masticatory muscles in patients with myofascial pain.”
Department of Temporomandibular Disorders, Medical University of Silesia in Katowice, Zabrze, Poland.
Nitecka-Buchta A, et al. J Clin Med. 2019;8(11).

Mexico: Supreme Court gives Congress until April 2020 to legalise cannabis for adults
According to a note by the Supreme Court of 31 October 2019 the Court gives Congress until April 2020 to legalise cannabis for adults. The Senate had asked the court for extension of the original deadline by 6 months.
Suprema Corte de Justicia de la Nacion of 31 October 2019

USA: Two-thirds of Americans support cannabis legalization
Two-thirds of Americans say the use of cannabis should be legal, reflecting a steady increase over the past decade, according to a new Pew Research Center survey. The share of adults who oppose legalization has fallen from 52% in 2010 to 32% today. Meanwhile, an overwhelming majority of adults (91%) say cannabis should be legal either for medical and recreational use (59%).
Pew Research Center of 14 November 2019

USA: Most CBD products are often not compliant with regulations in the US
A new study of 300 online cannabidiol merchants by compliance firm LegitScript found that 98% were non-compliant with regulations in at least one category, with several selling products that made fraudulent claims and one that even contained toxic levels of lead.
Bloomberg of 20 October 2019

USA: Health authorities support clinical study at University of Yale
The federal Food and Drug Administration has given the Yale School of Medicine and medical cannabis supplier CT Pharma approval to begin a human drug trial that will study the effectiveness of cannabis-based medicine. The focus will be on the effectiveness of cannabis at alleviating stress and pain.
WNPR of 10 November 2019

USA: 400,000 patients in Florida are allowed to use cannabis as a medicine
Since this time last year, the number of medical cannabis patients in Florida has more than doubled. In fact, the state of Florida is the second-fastest-growing medical cannabis market in the country, according to a recent study done by Marijuana Business Daily. In November 2016, medical cannabis became legal for Florida residents.
CBS Miami of 12 November 2019

Australia: Rules for prescription of cannabis have been improved
Changes to medical cannabis rules will allow general practitioners to prescribe medical cannabis to patients but specialist approval will still be needed for children under 16 and patients with a history of drug abuse.
The Sydney Morning Harold of 12 November 2019

Israel: Company will produce 5 tons of medical cannabis for about 1.5 EURos per gram
The Israeli company Together will cultivate at least 5 tons annually of medical cannabis in Ashkelon for Canna-Tech for 5.5 shekel (about 1.5 EURos) per gram.
Globes of 13 November 2019

USA: Legalisation of cannabis for adults increased cannabis use
In the four states where cannabis was legal for adults by 2016, there was a small uptick in cannabis use disorder among adults and teens, and a general rise in use by adults, a new study suggests. Researchers looking at data on cannabis use between 2008 and 2016 found that rates of problematic use among teens and adults over age 26 rose faster in states where cannabis use had been legalized for adults than in other states, according to the report published in JAMA Psychiatry.
Reuters of 13 November 2019

Science/Human: Cannabis effective in the treatment of stiff person syndrome
A 60-year-old woman, who developed stiff person syndrome after successful treatment of breast cancer in 2010 profited from a treatment with a cannabis tincture with a CBD/THC ratio of 1:1 and additional CBD. Cannabis markedly reduced her stiffness and the intensity and frequency of spasms.
Department of Supportive Care Medicine, Moffitt Cancer Center, Tampa, USA.
Portman D, et al. J Pain Symptom Manage. 2019 Nov 16. [in press]

Science/Human: Cannabis use may increase the risk for cerebral vascular accidents
In a study with 8944 cannabis using patients regular cannabis use was significantly associated with an increased risk for cerebral vascular disease but not with an increased risk for heart attack.
Addiction Sciences Division, Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati College of Medicine, USA.
Winhusen T, et al. Am J Drug Alcohol Abuse. 2019 Nov 19:1-8.

Science/Human: No causal relationship between cannabis legalisation and changes of alcohol or cigarette sales per person
According to data from all 50 US states researchers found no relationship between cannabis policy and alcohol and cigarette use per person. In another analysis cannabis legalisations (both medical and recreational) were associated with significantly decreased cigarette sales. However, these reductions were apparent at least 2 years before policy abduction.
Master of Population Health Sciences Program, Washington University, St. Louis, USA.
Veligati S, et al. Int J Drug Policy. 2019;75:102585.

Science/Animal: THC reduces vomiting caused by NK1-receptor activation via stimulation of the CB1 receptor
Scientists induced vomiting by activation of the neurokinin NK1 receptor and THC reduced this effect by activation of the CB1 receptor.
Department of Basic Medical Sciences, College of Osteopathic Medicine of the Pacific, Western University of Health Sciences, Pomona, USA.
Darmani NA, et al. EUR J Pharmacol. 2019:172806.

Science/Animal: Regular exercise increase cannabinoid receptor expression in certain immune cells
In a study with rats performing treadmill running for a period of 10 weeks there was a certain decrease in certain immune cells (CD4+ and other subpopulations of lymphocytes) and an increase of cannabinoid receptors expression in these cells.
Ciudad Universitaria, Ciudad de México, México.
Valencia-Sánchez S, et al. PLoS One. 2019;14(11):e0220542.

Science/Human: Cannabis use was associated with the prevalence of tinnitus
Cannabis users during the past year were more likely to experience tinnitus. However, there was no association between the severity and the frequency of tinnitus with cannabis use.
Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, USA.
Qian ZJ, et al. Am J Otolaryngol. 2019:102314.

Science/Cells: THC and synthetic cannabinoids increased programmed cell death in placental cells
THC and several synthetic cannabinoids reduced viability and apoptosis of certain placental cells and this effect was mediated by the CB1 and the CB2 receptor. Authors wrote that “cannabinoids have the potential to disrupt gestational fundamental events.”
UCIBIO, REQUIMTE, Laboratory of Biochemistry, Faculty of Pharmacy, University of Porto, Portugal.
Almada M, et al. Toxicol Lett. 2019 Nov 12. [in press]

Science/Human: Exercise performed by patients with substance use disorder increased anandamide concentration
In 21 patients with substance use disorder, who stopped using drugs, exercise for 30 minutes 3 times per week reduced craving, tension, depression and anger. It increased the concentration of the endocannabinoid anandamide in the blood.
Department of Kinesiology, University of Wisconsin, Madison, USA.
Patel RS, et al. Brellenthin AG, et al. Subst Abus. 2019 Nov 15:1-12.

Science/Animal: Activation of the CB2 receptor reduced bladder inflammation caused by a chemotherapeutic agent
In a study with rats activation of the CB2 receptor by the synthetic cannabinoid JWH-133 reduced inflammation of the urinary bladder by the chemotherapeutic agent cyclophosphamide. CB2 receptor activation also protected from the condition.
Department of Urology, Qilu Hospital of Shandong University, Jinan, China.
Liu Q, et al. Neurourol Urodyn. 2019 Nov 14. [in press]

Science/Human: Australian researchers want to conduct a large study with a cannabis extract in patients with amyotrophic lateral sclerosis
Researchers presented a study protocol for a randomised, double-blind, placebo-controlled study evaluating the efficacy of a cannabis extract in slowing the disease progression of amyotrophic lateral sclerosis.
Neurology, Gold Coast Hospital and Health Service, Southport, Australia.
Urbi B, et al. BMJ Open. 2019;9(11):e029449.

Science/Cells: CBD may protect nerve cells against the toxicity of cadmium
Researchers investigated the effects of CBD on cadmium treatment in a neuroblastoma cell line. CBD was applied 24 hours before and removed during cadmium treatment. Authors concluded from their research “that CBD may represent a potential option to protect neuronal cells from the detrimental effects of Cd toxicity.”
Department of Experimental and Clinical Medicine, Histology and Anatomy Section, University of Firenze, Italy.
Branca JJV, et al. Int J Environ Res Public Health. 2019;16(22).

Science/Human: Endocannabinoid levels are altered in patients with anorexia nervosa
Anorexia nervosa patients reported less hunger than control subjects during fasting and at the end of a pilot study. The blood concentrations of the endocannabinoid anandamide were significantly lower in patients with anorexia nervosa. There were no changes in the levels of 2-AG. These changes persisted after normalisation of weight in anorexia nervosa patients. Authors wrote that there is an anandamide deregulation before and after food intake in this patient group.
Unit of Clinical and Health Psychology, University of Fribourg, Switzerland.
Piccolo M, et al. EUR Eat Disord.
2019 Nov 11. [in press]

Science/Human: Cannabis use may increase the risk for growth reduction in the foetus
In a study with 192 cannabis users there were 26 cases of growth reduction of the foetus in the third trimester compared to 6 cases in 192 control women. No differences were found in the first and second trimester.
Las Vegas School of Medicine Department of Obstetrics and Gynecology, University of Nevada, Las Vegas, USA.
Brar BK, et al. J Matern Fetal Neonatal Med. 2019 Nov 11:1-5.

Science/Animal: CBD increases pain threshold in a mouse model of Parkinson’s disease
In a mouse model of Parkinson’s disease CBD increased the pain threshold. Authors noted, that CBD may prevent from pain in Parkinson’s disease due to pain threshold reduction and that their results “suggest that CB1 and TRPV1 receptors are important for CBD-induced analgesia and that CBD could produce these analgesic effects by increasing endogenous anandamide levels.”
Department of Basic and Oral Biology, School of Dentistry of Ribeirao Preto, University of Sao Paulo, Ribeirao Preto, Brazil.
Crivelaro do Nascimento G, et al. Neuropharmacology. 2019 Nov 7:107808

Science/Animal: THCA may be useful for the treatment of obesity
In a study with obese mice administration of THCA (THC acid) reduced fat mass and body weight gain, improved glucose intolerance and prevented liver steatosis. Authors wrote that THCA may be “capable of substantially improving the symptoms of obesity-associated metabolic syndrome and inflammation.”
Maimonides Biomedical Research Institute of Córdoba (IMIBIC), Córdoba, Spain.
Palomares B, et al. diet-induced obesity. 2019;171:113693

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