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IACM-Bulletin of 26 February 2023

Science/Human: Cannabis use may have a favourable effect on hospital stays of patients with inflammatory bowel disease

Cannabis users suffering from inflammatory bowel disease are less likely to be hospitalised then non-users. Investigators at the Department of Internal Medicine of the Ohio State University Wexner Medical Center in Columbus, USA, compared hospitalised adult patients in Colorado and Washington before (2011) and after (2015) recreational cannabis legalization.

Reported cannabis use by patients increased after legalization (1.2% vs 4.2%). On multivariable analysis, in 2011, cannabis users were less likely to need total parenteral nutrition, and in 2015 had less hospital charges. The impact of cannabis legalization and use on inflammatory bowel disease is difficult to analyze but may have implications on hospitalization.

Pusateri A, Anaizi A, Nemer L, Hinton A, Lara L, Afzali A. Impact of Cannabis Use on Inpatient Inflammatory Bowel Disease Outcomes in 2 States Legalizing Recreational Cannabis. Crohns Colitis 360. 2022;4(2):otac015.

Science/Human: Cannabis may have favourable effects on pain in Charcot-Marie-Tooth Disease

Chronic pain is a major problem for patients with Charcot-Marie-Tooth (CMT) disease. According to a survey of 56 patients with CMT by investigators at the Department of Medical Education of the Geisinger Commonwealth School of Medicine in Scranton, USA, cannabis may be beneficial. The online survey contained 52 multiple choice questions about demographics, medical cannabis use, symptomology, efficacy, and adverse effects.

Nearly all (91 %) of respondents reported experiencing pain with 92 % of respondents indicating cannabis provided at least 50% pain relief. The most frequent response was an 80% reduction in pain. Moreover, 80% of respondents reported using less opiates, 69% noted using less sleep medication, and 50% reported using less anxiety/antidepressant medications. One-third (34%) possessed a medical cannabis certificate.

Canals PC, Aguilar AG, Carter GT, Shields CM, Westerkamp A, D'Elia M, Aldrich J, Moore RN, Moore AT, Piper BJ. Patient Reported Outcomes Using Medical Cannabis for Managing Pain in Charcot-Marie-Tooth Disease. Am J Hosp Palliat Care. 2023:10499091231158388.

Science/Human: CBD may improve healing of recurrent aphthous ulcers

Although topical steroids constitute the first-line therapy for recurrent aphthous ulcers (RAUs), their long-term use often leads to side effects. Investigators at the Pathum Thani Provincial Public Health Office of the Ministry of Public Health in Pathum Thani, Thailand, randomly assigned 69 RAU subjects to one of three groups, who received one of the following topical interventions: 0.1% CBD, 0.1% triamcinolone acetonide (TA), or placebo. These were applied on the ulcers 3 times/day for 7 days.

CBD and TA significantly reduced ulcer size more than placebo at all time points. The erythematous size reduction was higher in the CBD intervention than the placebo on day 2, while TA reduced the erythematous size at all time points. The pain score in the CBD group was lower compared with placebo on day 5, whereas TA reduced pain more than placebo on day 4, 5, and 7. The subjects receiving CBD reported higher satisfaction than placebo.

Umpreecha C, Bhalang K, Charnvanich D, Luckanagul J. Efficacy and safety of topical 0.1% cannabidiol for managing recurrent aphthous ulcers: a randomized controlled trial. BMC Complement Med Ther. 2023;23(1):57.

Science/Human: Cannabis improves quality of life in patients with pain and anxiety

Cannabis was shown to improve pain and anxiety in pain patients also suffering from anxiety. Investigators of the Imperial College Medical Cannabis Research Group at the Department of Surgery and Cancer in London, UK, compared the effects of cannabis on two groups: 711 chronic pain patients with anxiety and 543 pain patients without anxiety.

Significant improvements in pain, sleep and quality of life were observed in both cohorts at all timepoints. The anxiety cohort reported greater improvements in quality of life index values, but there were no consistent differences in pain outcomes.

Bapir L, Erridge S, Nicholas M, Pillai M, Dalavaye N, Holvey C, Coomber R, Hoare J, Khan S, Weatherall MW, Rucker JJ, Platt M, Sodergren MH. Comparing the Effects of Medical Cannabis for Chronic Pain Patients With and Without Co-Morbid Anxiety: A Cohort Study. Expert Rev Neurother. 2023 Feb 20 [in press].

Science/Human: THC in combination with atomoxetine may improve obstructive sleep apnoea

In an open-label trial with 15 patients suffering from obstructive sleep apnoea the combination of THC (dronabinol) and atomoxetine improved disease severity. Investigators of the Division of Sleep and Circadian Disorders at the Departments of Medicine and Neurology of the Brigham & Women's Hospital & Harvard Medical School in Boston, USA, administered increasing doses of the 2 drugs. Dose escalation was performed every week, starting from 40 mg atomoxetine and 2.5 mg THC until finally 80 mg atomoxetine and 10 mg THC.

80 mg atomoxetine and 5 mg THC improved severity of obstructive sleep apnoea. Drug administration was characterized by several potentially harmful side effects and treatment discontinuation in 1/3 of cases. It “led to subjective improvement in those who could tolerate the combination.”

Messineo L, Norman D, Ojile J. The combination of atomoxetine and dronabinol for the treatment of obstructive sleep apnea: a dose escalating, open-label trial. J Clin Sleep Med. 2023 Feb 21. J Clin Sleep Med. 2023 Feb 21. [in press].

Science/Human: CBD reduces blood pressure in patients with hypertension

In a placebo-controlled study with 54 patients with Grade 1 hypertension CBD administration reduced arterial blood pressure. Investigators at the Department of Pathophysiology of the University of Split School of Medicine, Croatia, found out that CBD influenced blood levels of catestatin, a peptide implicated in the development of hypertension.

5-week administration of CBD but not placebo reduced serum catestatin concentration in comparison to baseline. Serum catestatin levels at the start of the treatment period demonstrated a negative correlation with the extent of reduction in mean arterial pressure. Moreover, the extent of change in catestatin serum levels showed a strong correlation with the extent of mean arterial pressure reduction.

Kumric M, Dujic G, Vrdoljak J, Svagusa K, Kurir TT, Supe-Domic D, Dujic Z, Bozic J. . CBD supplementation reduces arterial blood pressure via modulation of the sympatho-chromaffin system: A substudy from the HYPER-H21-4 trial.

News in Brief

Science: CBD and CBG exert antimicrobial activity without compromising skin microbiota

CBD (cannabidiol) and CBG (cannabigerol) inhibited the growth of Pseudomonas aeruginosa and Escherichia coli (ranging from 400 to 3180 µM), and inhibited Staphylococci adhesion to keratinocytes, with CBG demonstrating higher activity than CBD. The extracts did not alter the natural bacterial colonization of the skin.

Centro de Biotecnologia e Química Fina (CBQF)-Laboratório Associado, Escola Superior de Biotecnologia, Universidade Católica Portuguesa, Porto, Portugal.

Luz-Veiga M, et al. Int J Mol Sci. 2023;24(3):2389.

Science/Cells: Rare cannabinoids of the cannabis plant exert anti-inflammatory effects in skin cells

In tests with skin cells cannabigerol (CBG), cannabichromene (CBC), tetrahydrocannabivarin (THCV) and cannabigerolic acid (CBGA) significantly blocked inflammation by reducing the release of pro-inflammatory cytokines.

Department of Veterinary Medicine, University of Teramo, Italy.

Tortolani D, et al. Int J Mol Sci. 2023;24(3):2721.

Science/Human: Cannabis may be helpful in hyperhidrosis according to a case report

A case report of treatment resistant hyperhidrosis was presented. “We found a remarkable reduction in the volume of sweat and an improvement to the patient's quality of life using this novel low-cost and low-impact approach.”

Department of Dermatology and Allergy, University Hospital, LMU Munich, Germany.

Kaemmerer T, et al. J Dermatolog Treat. 2023;34(1):2127308.

Science/Animal: LSD has an effect on the endocannabinoid system

In a study with mice administration of lysergic acid diethylamide (LSD) was accompanied by alterations of the endocannabinoid system in the hippocampus and the composition of the gut microbiota.

Neurobiological Psychiatry Unit, Department of Psychiatry, McGill University, Montreal, Canada.

Inserra A, et al. Br J Pharmacol. 2023;180(6):721-739.

Science/Animal: CBD may be useful in pulmonary hypertension

In a study with rats with pulmonary hypertension CBD inhibited pulmonary lung proliferation and authors suggest CBD as an adjuvant treatment in this disorder.

Department of Experimental Physiology and Pathophysiology, Medical University of Bialystok, Poland.

Krzyżewska A, et al. Biomed Pharmacother. 2023;159:114234.

Science/Animal: How CBD reduces seizures in epilepsy

In a study with mice researchers found “that CBD exerts potential anti-seizure effects by blocking lysophosphatidylinositol synaptic effects and dampening hyperexcitability.”

Department of Neuroscience & Physiology and Neuroscience Institute, NYU Langone Medical Center, New York, USA.

Rosenberg EC, et al. Neuron. 2023:S0896-6273(23)00066-1.

Science/Human: Cannabis has no negative effects on kidney function

In a study with 94 participants, who were followed for a mean of 4.5 years cannabis consumption was not associated with measures of kidney function.

Barbara T. Murphy Division of Nephrology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, USA.

Rein JL, et al. Cannabis Cannabinoid Res. 2023 Feb 15. [in press].

Science/Cells: A new mechanism of CBD in ovarian cancer treatment

Researchers found that CBD inhibits ovarian cancer cell growth by disrupting LAIR-1-mediated interference with mitochondrial bioenergy metabolism. The leukocyte-associated immunoglobulin-like receptor 1 (LAIR-1) is a member of the immunosuppressive receptor family.

School of Basic Medical Sciences, Binzhou Medical University, Shandong Province, China.

Ma L, et al. Environ Toxicol. 2023 Feb 22. [in press].