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IACM-Bulletin of 15 March 2020

UNO: Commission on Narcotic Drugs postpones vote on regulation of cannabis

The United Nations Commission on Narcotic Drugs (CND) has decided to delay until December a vote due to take place in March on the potential global rescheduling of cannabis. The CND—which is meeting in Vienna, Austria from March 2-6—was due to vote on a set of recommendations from the World Health Organization (WHO) to loosen restrictions on cannabis and related substances like CBD and THC.

This is the second time the CND has refused to vote on the recommendations, which the WHO first presented in January 2019. The CND is the UN’s central drug policy-making body, comprising 53 member states representing each continent and region.
The WHO recommendations include among others the following: Remove cannabis flower and resin from Schedule 4 of the 1961 drug convention, the most restrictive category—for drugs deemed to be most liable for problematic use and to have no therapeutic effects. Cannabis would be transferred to the slightly less restrictive Schedule 1, and would still be strictly controlled.

Filter of 5 March 2020

Science/Human: Cannabis may be helpful in fibromyalgia according to observational study

An observational study with 102 fibromyalgia patients profited from a treatment with cannabis, especially in those with sleep dysfunctions. The study was presented by researchers of the Rheumatology Unit of the Luigi Sacco University Hospital in Milan, Italy. it included patients with pain above 3 on a visual analogue scale from 0 to 10 despite funded analgesic treatment. Patients received cannabis extracts prepared from 2 cannabis varieties (Bedrocan, Bediol).

The 6-month retention rate was 64%. A significant improvement in a sleep quality index and the FIQR (Fibromyalgia Impact Questionnaire) was observed in respectively 44% and 33% of patients. 50% showed a moderate improvement in anxiety and depression scales. Concomitant analgesic treatment was reduced or suspended in 47% of the patients. One-third experienced mild adverse events, which did not cause any significant treatment modifications.

Giorgi V, Bongiovanni S, Atzeni F, Marotto D, Salaffi F, Sarzi-Puttini P. Adding medical cannabis to standard analgesic treatment for fibromyalgia: a prospective observational study. Clin Exp Rheumatol. 2020 Jan-Feb;38 Suppl 123(1):53-59. [in press]

Science/Human: CBD may reduce arterial stiffness and improve function of the inner lining of arterie

In a study with 26 healthy men, who were given 600 mg of CBD or placebo for 7 days in a randomised placebo-controlled study, the cannabinoid caused a very low decrease in blood pressure. This effect was in no longer observed after 7 days. In addition, CBD improved arterial stiffness and improved endothelial function. The study was conducted at the School of Medicine of the University of Nottingham in the Royal Derby Hospital, UK. 13 received the placebo and 13 oral CBD.

Compared to placebo, CBD significantly reduced resting mean arterial pressure by a mean of 2 mm Hg after acute dosing, but not after repeated dosing. Seven days of CBD increased internal carotid artery diameter . Within the CBD group, repeated dosing reduced arterial stiffness by day 7 and improved function of the endothelial cells, the inner lining of arteries. Authors wrote that the “reduction in arterial stiffness and improvements in endothelial function after repeated CBD dosing are findings that warrant further investigation in populations with vascular diseases.”

Sultan SR, O'Sullivan SE, England TJ. The effects of acute and sustained cannabidiol dosing for seven days on the haemodynamics in healthy men: A randomised controlled trial. Br J Clin Pharmacol. 2020 Mar 3. [in press]

Science/Human: Lower doses of CBD were as effective as higher doses in the treatment of epilepsy in patients with Dravet syndrome

In a placebo-controlled study with 199 patients with Dravet syndrome aged 10 to 18 years CBD was given in addition to standard antiepileptic drugs. Patients received either 10 mg CBD per kg bodyweight, 20 mg CBD per kg bodyweight or a placebo in addition to at last one standard antiepileptic drug in equally divided doses for 14 weeks. The study was conducted in several countries. 190 patients completed the study.

The percentage reduction from baseline in convulsive seizure frequency was 48.7% for CBD10 group and 45.7% for the CBD20 group vs 26.9% for the placebo group. The most common adverse events were decreased appetite, diarrhea, somnolence, pyrexia, and fatigue. Five patients in the CBD20 group discontinued owing to adverse events. Authors concluded that “adjunctive cannabidiol at doses of 10 and 20 mg/kg/d led to similar clinically relevant reductions in convulsive seizure frequency with a better safety and tolerability profile for the 10-mg/kg/d dose.”

Miller I, Scheffer IE, Gunning B, Sanchez-Carpintero R, Gil-Nagel A, Perry MS, Saneto RP, Checketts D, Dunayevich E, Knappertz V; GWPCARE2 Study Group. Dose-Ranging Effect of Adjunctive Oral Cannabidiol vs Placebo on Convulsive Seizure Frequency in Dravet Syndrome: A Randomized Clinical Trial. JAMA Neurol. 2020 Mar 2. [in press]

Science/Human: Cannabis does not reduce cognitive function in older adults, but may improve brain health

A review by scientists of the School of Public Health of the University of Haifa, Israel, concluded that the “limited evidence on this important topic suggests that use in older ages may not be linked with poorer cognitive performance, thus detrimental effects of early-life cannabis use may not translate to use in older ages. Rather, use in old ages may be associated with improved brain health, in accordance with the known neuroprotective properties of several cannabinoids. Yet, firm conclusions cannot be drawn from the current evidence-base due to lack of research with strong methodological designs.”

The authors reviewed the literature from old animal models and human studies, focusing on the link between use of cannabis in middle- and old-age and cognition. The report highlights the gap in knowledge on cannabis use in late-life and cognitive health, and discusses the limited findings in the context of substantial changes in attitudes and policies.

Weinstein G, Sznitman SR. The implications of late-life cannabis use on brain health: A mapping review and implications for future research. Ageing Res Rev. 2020;59:101041.

Science/Human: Cannabis improved symptoms in cancer patients despite reduced opioid dose

Scientists of the Inspira Health Network in Vineland, USA, investigated additional cannabis administration in the management of cancer -related symptoms. They measured physical and emotional symptoms and opiate consumption converted in morphine milligram equivalents (MME). They identified 232 patients, of whom 95 did not use cannabis and 137 used cannabis.

Pain, physical and total symptoms measured with a symptom scale for cancer symptoms (ESAS) significantly improved for both groups. However, only cannabis users showed significant improvements in emotional symptoms. In addition, opiate use increased only in the non-cannabis group by 23%, while it remained stable in the cannabis group. Authors concluded, that cannabis “improved oncology patients' ESAS scores despite opioid dose reductions and should be considered a viable adjuvant therapy for palliative management.”

Pawasarat IM, Schultz EM, Frisby JC, Mehta S, Angelo MA, Hardy SS, Kim TWB. The Efficacy of Medical Marijuana in the Treatment of Cancer-Related Pain. J Palliat Med. 2020 Feb 26. [in press]

News in brief

Science/Human: Cannabis reduced agitation in a patient with brain injury
In a 38-year-old man, who was treated for anxiety 3 years after 2 brain injuries, cannabis significantly improved his symptoms. He met criteria for post-traumatic stress disorder, depression, agitation, including headbanging and hitting himself. Several treatment trials were unsuccessful. With the use of cannabis depression, agitation, aggression and anxiety decreased.
The Mind Research Network/Lovelace Biomedical and Environmental Research Institute, Pete & Nancy Domenici Hall, Albuquerque, USA.
Hergert DC, et al. Psychosomatics. 2020 Feb 25. [in press]

Science/UK: Many people wrongly think that e-cigarettes are as dangerous as tobacco smoking
More than half of UK smokers now wrongly believe that nicotine-containing “vapes” or e-cigarettes are as dangerous as tobacco cigarettes and these “false fears” are preventing smokers from switching, health experts said.
Reuters of 4 March 2020

Lebanon: Government wants to legalise medical and industrial cannabis cultivation
Lebanon's parliament is set to vote on a law that would legalise the cultivation of cannabis for medical and industrial use in an effort to boost its crippled economy and curb illicit production of the psychoactive plant. The draft law, which has been endorsed by parliamentary committees and is now headed for a final vote, would only affect cannabis that contains less than one percent of THC.
Al Jazeera of 12 March 2020

UK: Patients will receive faster access to their cannabis medicine
Patients in the United Kingdom who receive prescriptions for cannabis-based medicines will be able to get their treatment in days --rather than months-- as import restrictions in the United Kingdom changed on March 2nd. Licensed wholesalers will now be able to import larger quantities of cannabis-based products and hold supplies for future use by patients with prescriptions.
Fobs of 3 March 2020

Science/Human: CBD reduces oxidative stress in skin cells of healthy people, but increases stress in those of patients with psoriasis
Scientists analysed the effect of cannabidiol on oxidative stress in UVA/UVB-irradiated keratinocytes (skin cells) isolated from the skin of psoriatic patients or healthy volunteers. They observed a decrease in anandamide level in the UV-irradiated keratinocytes of healthy controls following CBD treatment, while in keratinocytes from patients treated with CBD, anandamide level was increased. They further demonstrated that CBD increases CB1 receptor expression, primarily in the keratinocytes of patients, and increases CB2 receptor expression in both the psoriatic and control groups.
Department of Analytical Chemistry, Medical University of Bialystok, Mickiewicza 2d, 15-222 Bialystok, Poland.
Jarocka-Karpowicz I, et al. Biomolecules. 2020 Feb 11. [in press]

Science/Animal: Animal studies show, that cannabinoids reduce tumour growth in glioblastoma
An analysis of animal studies on cannabinoids in glioblastoma, a brain cancer, showed that “treatment efficacy was observed for different types of cannabinoids, alone or in combination, and for different treatment durations.“
Universidade da Beira Interior, Covilhã, Portugal.
Luís Â, et al. EUR J Pharmacol. 2020 Mar 4:173055.

Science/Animal: Stimulation of brain cannabinoid CB1 receptors can ameliorate hypertension in rats
In a study with spontaneously hypertensive rats “stimulation of brain CB1 receptors can ameliorate hypertension accompanied by enhanced sympathetic outflow without affecting blood pressure under normotensive conditions.”
Department of Pharmacology, Kochi Medical School, Kochi University, Nankoku, Kochi, Japan.
Shimizu T, et al. Clin Exp Pharmacol Physiol. 2020 Mar 6. [in press]

Science: CBD is effective against resistant Gram -positive bacteria in combination with an antibiotic
It was demonstrated that CBD may help to kill resistant bacteria. In this study CBD potentiated the effect of bacitracin against Gram-positive bacteria (Staphylococcus species, Listeria monocytogenes, and Enterococcus faecalis) but appeared ineffective against Gram-negative bacteria.
Department of Biochemistry and Molecular Biology, University of Southern Denmark, Odense, Denmark.
Wassmann CS, et al. Sci Rep. 2020;10(1):4112.

Science: The new cannabinoid Cannabimovone may potentially be helpful in insulin resistant-related disorders
Scientists identified and characterised Cannabimovone (CBM), a cannabinoid from the cannabis plant, as a novel antagonist to the PPAR-Gamma. They wrote that there analysis candidate CBM as “a novel bioactive compound potentially useful for the treatment of insulin resistance-related disorders”.
Institute of Biomolecular Chemistry (ICB), National Research Council (CNR), Pozzuoli,Italy.
Iannotti FA, et al. Molecules 2020;25(5).

Science/Animal: High doses of CBD improved cognition in an animal model of Alzheimer’s disease
Chronic treatment with 50 mg/kg CBD improved cognition in an animal model of Alzheimer’s disease (AD). Authors wrote that the “findings emphasize the clinical relevance of CBD treatment in AD; however, the underlying mechanisms involved require further investigation.”
School of Medicine, Western Sydney University, Campbelltown, Australia.
Watt G, et al. J Alzheimers Dis. 2020 Feb 22. [in press]

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