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IACM-Bulletin of 29 January 2023


Science/Human: Cannabis may improve agitation and sleep in Alzheimer’s disease according to observational study

A retrospective, observational trial aimed to investigate the clinical action of THC: CBD cannabis extract administration in patients with Alzheimer’s disease on severe symptoms such as agitation, weight loss, cognitive impairment, and sleep disturbance. Thirty patients (9 men and 21 women) diagnosed with mild, moderate, or severe Alzheimer’s disease, aged 65-90 years, were enrolled by the Second Opinion Medical Network in Modena, Italy. They used olive oil-diluted cannabis extract twice a day for 12 weeks.

Questionnaires demonstrated a reduction in agitation, apathy, irritability, sleep disturbances, and eating disturbances, consequently improving caregiver distress. Levels of physically and verbally aggressive behaviours were lower in all patients. In addition, cognitive impairments were improved in 45% of patients. Authors concluded that their “anecdotical, spontaneous, and observational study demonstrated the efficacy and safety of oil-diluted cannabis extract in patients with AD.”

Palmieri B, Vadalà M. Oral THC: CBD cannabis extract in main symptoms of Alzheimer disease: agitation and weight loss. Clin Ter. 2023;174(1):53-60.

Science/Human: CBD has an anti-seizure effect comparable to other antiepileptic medications

According to a retrospective multi-centre study with 311 patients CBD was effective in several kinds of epilepsy. The study analysed the efficacy and tolerability of CBD in patients with epilepsy at 16 epilepsy centres across Germany. It comprised data of 235 children and adolescents as well as 76 adults aged 0 to 72 years (median age: 11 years).

CBD titration regimens were slower than recommended, with good tolerability of higher doses particularly in children. Of all patients, 36.9% experienced a reduction in seizure frequency of >50%, independent of their epilepsy subtype or clobazam co-medication. The median observation period was 15.8 months. About one third of all patients discontinued therapy within the observation period due to adverse effects or lack of efficacy.

Kühne F, Becker LL, Bast T, Bertsche A, Borggraefe I, Boßelmann CM, Fahrbach J, Hertzberg C, Herz NA, Hirsch M, Holtkamp M, Janello C, Kluger GJ, Kurlemann G, Lerche H, Makridis KL, von Podewils F, Pringsheim M, Schubert-Bast S, Schulz J, Schulze-Bonhage A, Steinbart D, Steinhoff BJ, Strzelczyk A, Syrbe S, De Vries H, Wagner C, Wagner J, Wilken B, Prager C, Klotz KA, Kaindl AM. Real world data on cannabidiol treatment of various epilepsy subtypes: a retrospective, multicenter study. Epilepsia Open. 2023 Jan 24 [in press].

Science/Human: Cannabis may be used in sexual dysfunction according to a large survey

Results of a survey with 811 participants ranging in age from 18 to 85 years provide “implications for improving sexual quality.” Researchers of Human Development and Family Science at East Carolina University in Greenville, USA, wrote that “implications of this study include the possible use of cannabis for treating sexual dysfunctions, especially within women.”

Age and gender were not found to have significant effects on cannabis use and sexual functioning and satisfaction. Over 70% of participants reported increased desire and orgasm intensity. Participants who reported masturbating indicated that cannabis enhanced their pleasure while masturbating. Participants also stated that cannabis enhanced their sense of taste and touch. “Overall, results indicated that both men and women perceived that cannabis use increased their sexual functioning and satisfaction, particularly increased desire and orgasm intensity.”

Moser A, Ballard SM, Jensen J, Averett P. The influence of cannabis on sexual functioning and satisfaction. J Cannabis Res. 2023;5(1):2.

France: Positive results in medical cannabis program

An experiment with free medicinal cannabis for 3,000 patients in France was recently extended and the initial results are positive, especially for patients with pain conditions. The experiment is not intended "to assess the effectiveness of medicinal cannabis, even if clinical data is collected," said Nathalie Richard, director of this experiment at the l'Agence nationale de sécurité du médicament (ANSM). Overall, 91% of patients are satisfied with the medication.

Since the launch of the experiment, 2,204 patients have been admitted to the programme (as of 18 October 2022). Currently there are 1,453, including 792 for refractory neuropathic pain, 215 for painful spasticity due to multiple sclerosis, 181 for drug-resistant epilepsy, 105 for oncology, 104 for palliative situations and 56 for spasticity. The government has already presented an evaluation report to the House of Representatives at the end of September 2022. This showed a positive assessment in favour of the feasibility of the circuit for dispensing medicinal cannabis. There were no problems with cannabis abuse. of 18 January 20230

Science/Human: Cannabis may improve sleep according to the controlled study

As part of a larger, randomized trial, 181 adults seeking cannabis for insomnia, pain, or anxiety or depressive symptoms were randomized to obtain a medical cannabis card immediately or a waitlist control and completed 12-weeks of daily web-based surveys on cannabis use and sleep, pain, and depressive symptoms. The study was conducted by investigators of the Center for Addiction Medicine of the Department of Psychiatry at Massachusetts General Hospital and Harvard Medical School in Boston, USA.

Daily reports of cannabis use were consistent with monthly interview assessments and urinalysis. The cannabis group increased cannabis use frequency in the 12 weeks following randomization. Self-reported sleep quality was significantly higher on cannabis use days, compared to nonuse days. The cannabis group displayed long-term sleep improvements, consistent with increasing cannabis frequency. No improvements were found for pain or depressive symptoms.

Tervo-Clemmens B, Schmitt W, Wheeler G, Cooke ME, Schuster RM, Hickey S, Pachas GN, Evins AE, Gilman JM. Cannabis use and sleep quality in daily life: An electronic daily diary study of adults starting cannabis for health concerns. Drug Alcohol Depend. 2023;243:109760.

Science/Human: 90% of pain patients report strong or moderate improvement by cannabis-based medicines

 All chronic pain patients at three pain centres in the German federal state of Saarland, Germany, who had received at least one prescription of cannabis-based medicines in the past were included in a cross-sectional study from January 1 to December 31, 2021. Patients and their physicians completed a self-developed questionnaire separately.

 All 187 contacted patients participated in the study. Since the start of the cannabis therapy, 44.9% of patients reported to be much or very much, 43.3% to be moderately and 8.0% to be slightly improved overall. From the patients' point of view, the symptoms most frequently reported to have substantially improved were sleep problems (36.4%), muscle tension (25.1%) and appetite problems (22.1%). The most frequent bothersome side effects were sweating (6.4%), concentration problems (4.2%) and nausea (4.1%). Physicians noted substantial pain relief in 60.7%, improvement of sleep in 65.7% and of mental well-being in 34.3%. A complete cessation of opioids was achieved in 64.7%, of anticonvulsants in 57.9% and of antidepressants in 60% of patients.

 Böttge-Wolpers C, Bialas P, Gottschling S, Juckenhöfel S, Konietzke D, Madlinger A, Welsch P, Häuser W. [Benefits and harms of cannabis-based medicines from the viewpoint of patients with chronic pain and their physicians : A cohort study in three pain centers of the German federal state Saarland]. Schmerz. 2023 Jan 20. [in press].

News in Brief

Science/Human: Regular cannabis use does not have a negative impact on public health

According to results of a survey administered to a representative sample of regular cannabis users in Catalonia, Spain, it “seems that regular cannabis use, despite contributing to problems related to sleep quality or dependence, does not have a negative impact on public health in a manner detectable using health indicators.”

International Center for Ethnobotanical Education, Barcelona, Spain.

Jiménez JH, et al. Cannabis Cannabinoid Res. 2023 Jan 13. [in press].

Science/Human: Cannabis use has no effect on lung function

According to a longitudinal study “cigarette smoking (with or without cannabis use) is associated with reduced airflow. There is no consistent association between cannabis use and measures of lung function. The co-use of tobacco and cannabis appears to entail no additional risk to lung function beyond the risks associated with tobacco use alone.”

School of Public Health, Faculty of Medicine, The University of Queensland, Australia.

Najman JM, et al. Respir Med. 2023:107124.

Argentina: Government counts on cannabis exports

On 25 January the government launched the first working group of a new national agency to regularize and promote the country's nascent cannabis industry, which ministers hope will create new jobs and exports generating fresh income for the South American nation."

Reuters of 26 January 2023

Czech Republic: Cannabis legalisation bill will be presented in March

According to David Hluštík of the Government’s Drug Policy Coordination Department, the draft law under preparation includes rules for taxation, legal cultivation, operation of cannabis clubs, licensed sales, and export. However, it imposes restrictions on who can produce and sell cannabis, where and under what licenses.

Born2Invest of 25 January 2023                                           

Science/Human: Cannabis legalisation in Canada was associated with increased cannabis-related problems

Cannabis legalization in Canada was associated with an increased likelihood of cannabis use, daily cannabis use and cannabis-related problems.

Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, Canada.

Imtiaz S, et al. Drug Alcohol Depend. 2023;244:109765.

Science/Human: Many regular cannabis users have a preference for sativa or indica cannabis strains

In a study with 101 regular cannabis users the majority of participants (78%) had a preference for either sativa or indica and reported reasons for their preference. Authors wrote that cultivars “classified as indica dominant were associated with greater low-arousal effects in models that accounted for both within- and between-person variation, despite the scientific challenges distinguishing between sativa and indica. Preliminary findings also suggest terpenes may play a role in subjective effects.”

 Department of Psychology, Arizona State University, Tempe, USA.

Okey SA, et al. Cannabis Cannabinoid Res. 2023 Jan 16. [in press].

Science/Animal: Both CBD and THC may be helpful in generalised epilepsy

Researchers investigated the effects of CBD and THC in mice subjected to the maximal electroshock seizure test. “Both CBD alone and CBD+THC in combination might be useful in the treatment of generalized-onset seizures. The advantage of adding THC to CBD, however, might be less than in the treatment of focal-onset seizures.”

Department of Pharmacology and Toxicology, University of Toronto, Canada.

Dlugosz L. et al. Epilepsy Res. 2023;190:107087.

Science/Human: The interest in cannabis-based medicines may be influenced by personality

According to interviews with 180 patients with rheumatic arthritis personality influenced the seeking of a cannabis treatment for pain relief, associating dynamically with higher disease activity/severity and tobacco use. Contrary to other available information, it did not relate to psychopathology or the recreational use of cannabis.

Department of Immunology and Rheumatology, Mexico City, Mexico.

Galindo-Donaire JR, et al. PLoS One. 2023;18(1):e0280219.

Science/Human: Cannabis use in patients with psychosis may be associated with lower levels of endocannabinoids

In a study with 38 cannabis users and 45 non-users, who were all diagnosed with psychosis, cannabis use was associated with low plasma levels of the endocannabinoid anandamide.

Department of Psychiatry, Yale School of Medicine, New Haven, USA.

Bassir Nia A, et al. J Psychopharmacol. 2023:2698811221148604.

Science/Cells: CBD may rescue proliferation of dental pulp stem cells inhibited by inflammation

In a study with dental pulp stem cells researchers demonstrated that CBD is able to rescue TNF-alpha-inhibited proliferation, migration, and osteogenic/odontogenic differentiation of these cells. Researchers wrote that these “results indicate the possible application of CBD on ... pulp and bone regeneration.”

Department of Preventive Dentistry, Affiliated Stomatology Hospital of Guangzhou Medical University, Guangdong Engineering Research Center of Oral Restoration and Reconstruction, China.

Yu L, et al. Biomolecules. 2023;13(1):118.

Science/Animal: CBD may decrease inflammation in horses

In a study with 27 horses, of whom 13 horses received CBD, a “significant decrease was determined for whole blood inflammatory cytokine expression of IFN-γ at day 60, and for IL6 at day 60 and 90 for CBD-treated horses when compared to control horses. CBD did not significantly affect any other immune factors, HI titers, or health parameters.”

M. H. Gluck Equine Research Center, Department of Veterinary Science, University of Kentucky, Lexington, USA.

Turner S, et al. Vet Immunol Immunopathol. 2023;257:110549.

Science: Differences of cannabinoid and terpene content between commercially grown and natural cannabis

Investigators “compared the terpene and cannabinoid profiles … for commercial cannabis from genetically identical plants grown indoors using artificial light and artificially grown media or outdoors grown in living soil and natural sunlight. By analyzing the cannabinoids, we found significant variations in the metabolomic profile of cannabis for the different environments.”

Department of Chemistry, Columbia University, New York, USA.

Zandkarimi F, et al. Molecules. 2023;28(2):833.

Science/Cells: CBD, CBC and THC may be effective against neck squamous cell carcinoma

The anti-tumoural effects of 24 cannabis extracts containing different cannabinoids including CBD (cannabidiol), CBC (cannabichromene) and THC on neck squamous cell carcinoma cells were investigated. “The cytotoxic effect could be maximized by combining CBD with either CBC or THC in a ratio of 2:1.”

Department of Oral and Maxillofacial Surgery, Hadassah Medical Center, Faculty of Dental Medicine, The Hebrew University of Jerusalem, Israel.

Blal K, et al. Cancers (Basel). 2023;15(2):497.