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IACM-Bulletin of 30 July 2023

Albania: Parliament legalised cannabis for medical purposes

The Parliament voted 69-23 to allow limited and controlled growth of cannabis plants, a move harshly contested by the opposition. It was not clear how the medical cannabis will be regulated. The government believes that allowing limited production of cannabis can boost tax revenue.

Cannabis growing flourished in Albania in the past as drug traffickers exploited a lack of strong governance in the post-Communist country. After coming to power in 2013, the left-wing Socialist Party government of Prime Minister Edi Rama set destroying cannabis plants as a main target.

ABC News of 21 July 2023

Ghana: Parliament allows cannabis cultivation for industrial and medicinal purposes

Ghana’s parliament has passed into law the Narcotics Control Commission Bill. As a result, the Ministry of Interior has been bestowed with the responsibility of issuing licenses for the cultivation of cannabis, opening up avenues for the utilization of this versatile plant in various beneficial applications.

This milestone was reached after the Supreme Court intervened and declared a section of the bill unconstitutional, hindering the smooth passage of the bill.

Africa News of 13 July 2023

Science/Human: Cannabis extract helpful in chronic back pain in open study

In an open study with 28 patients a cannabis extract containing 10 mg/ml THC and 25 mg/ml CBD improved chronic back and neck pain. Investigators of the Faculty of Medicine and Health of the University of Sydney, Australia, started with 0.5 ml once daily and escalated until 1.5 mL twice daily.

Median age of participants was 63.3 years, and half were female. The median history of neck/back pain was 10 years. There were dose-dependent improvements in numerical pain rating scores, with clinically significant reductions in pain at 1.0 mL and 1.5 mL twice daily doses (28.8% and 34.1% reductions, respectively). Depressive symptoms and stress had dose-dependent reductions. Authors concluded that “in patients with chronic neck/back pain, CBD and delta-9-THC are well tolerated and doses of 1.0 mL bd and 1.5 mL bd showed clinically significant reductions in pain compared to baseline pain scores.”

Glare P, Chye R, Bloch M, Arya M, Moore A, Montgomery J. Tolerability and Efficacy of a 10:25 Preparation of Δ9-Tetrahydrocannabinol and Cannabidiol for Treatment of Chronic Back or Neck Pain: A Multiple-Dose Escalation Study. Med Cannabis Cannabinoids. 2023;6(1):66-76.

Science/Human: Cannabis users need less opioid prescriptions following neck surgery

According to a retrospective analysis of data from patients undergoing anterior cervical discectomy and fusion those with a history of cannabis use filled fewer opioid prescriptions after surgery. All 1339 patients with a previous diagnosis of cannabis use, dependence, or abuse were included in the study group. A control group was then created by investigators of UConn Health Center at the University of Connecticut School of Medicine in Farmington, USA, matched on age and gender and comorbidity index, also composed of 1339 patients.

The number of patients filling prescriptions was lower in the cannabis group than in the control group at 3 days postoperatively. The average total morphine equivalent per day as prescribed was lower in the cannabis group than the control group at 60 days post-op (49 vs. 59, respectively).

Silver J, Pavano C, Bellas N, Hewitt C, Torre B, Solomito M, Kostyun R, Esmende S. Cannabis use is associated with decreased opioid prescription fulfillment following single level anterior cervical discectomy and fusion (ACDF). N Am Spine Soc J. 2023;14:100226.

Science/Human: Cannabis may manage opioid cravings among people who use unregulated opioids

Cannabis may help to reduce opioid use among people use unregulated opioids (PWUO). This is the result of a survey conducted by investigators of the British Columbia Centre on Substance Use in Vancouver, Canada. A total of 205 people who use cannabis and opioids were enrolled in the present study from December 2019 to November 2021.

Cannabis use to manage opioid cravings was reported by 118 (58%) participants. In the multivariable analysis, cannabis use to manage opioid cravings (adjusted Odds Ratio = 2.13) was significantly associated with self-reported reductions in opioid use. In the sub-analyses of pain, cannabis use to manage opioid cravings was only associated with self-assessed reductions in opioid use among people living with moderate to severe pain. Authors concluded that their “findings indicate that cannabis use to manage opioid cravings is a prevalent motivation for cannabis use among PWUO and is associated with self-assessed reductions in opioid use during periods of cannabis use.”

Reddon H, Lake S, Socias ME, Hayashi K, DeBeck K, Walsh Z, Milloy MJ. Cannabis use to manage opioid cravings among people who use unregulated opioids during a drug toxicity crisis. Int J Drug Policy. 2023;119:104113.

Science/Human: Cannabis may be a viable alternative to opioids in chronic pain

According to survey data of 450 patients with chronic pain cannabis may be a viable alternative to opioids. Investigators of the Department of Medicine of the University of Illinois Chicago, and other US academic institutions collected cross-sectional survey data. They compared those who use only cannabis with those who use cannabis and opioids.

While 16% of the respondents were cannabis-only users, 84% of the respondents were co-users of opioids and cannabis. Both groups considered opioid use risky (100% cannabis-only, 89% co-users). The majority (73%) of respondents sought to completely stop or never start using opioids for chronic pain. Cannabis-only users reported lower levels of pain compared to co-users.

Bobitt J, Kang H, Arora K, Bhagianadh D, Milavetz G, Kaskie B. Offering an Alternative to Persons with Chronic Pain: How Access to Cannabis May Provide an Off-Ramp from Undesired Prescription Opioid Use. Conflict of intere 1. Cannabis. 2023;6(2):113-122.

Science/Human: Some patients with dystonia reported significant improvement with cannabis use

Investigators of the Movement Disorder Unit of the Neurological Institute at Tel Aviv Sourasky Medical Center, Israel, and other researchers from Israel and the UK employed a structured interview to obtain data on the cannabis treatment regimen.

Twenty-three subjects were interviewed. The most common way of administration was smoking (n = 11). Following an average of 2.5 years of use, those with widespread dystonia (generalized, hemi and multifocal, n = 11) self-reported on a numeric rating scale an average 63% (range 0%-100%) reduction in symptoms of dystonia, while those with more focal dystonia patterns reported a significantly lower treatment effect of 32%. Participants reported a positive impact in related pain and quality of life.

Anis S, Faust-Socher A, Sverdlov D, Lassman S, Hezi N, Anis O, Leor G, Korczyn AD, Giladi N, Gurevich T. A single-center real-life study on the use of medical cannabis in patients with dystonia. Front Neurol. 2023;14:1218300.

Science/Human: CBD may prevent taste alterations in patients undergoing cancer chemotherapy

In a study with 32 patients undergoing chemotherapy with oxaliplatin or paclitaxel those, who received 300 mg of CBD daily for 8 days            were better able to differentiate taste strengths than those in the control group without CBD. Investigators of the Department of Clinical Oncology at Zealand University Hospital in Roskilde, Denmark, followed patients for three cycles of chemotherapy.

Twenty-two/ten patients (intervention/control group) were evaluable. At baseline, the control group was able to differentiate between weak and strong saltiness and weak and strong sweetness but lost this ability after three cycles of chemotherapy. At baseline, the intervention group was unable to differentiate between the concentrations but gained the ability to significantly differentiate between weak and strong sweetness.

Dominiak HSH, Hasselsteen SD, Nielsen SW Andersen JR, Herrstedt J. Prevention of Taste Alterations in Patients with Cancer Receiving Paclitaxel- or Oxaliplatin-Based Chemotherapy-A Pilot Trial of Cannabidiol. Nutrients. 2023;15(13):3014.

Science/Human: CBD may be effective in drug resistant epilepsy in patients with Rett syndrome

investigators of the Pediatric Neurology department - Timone Enfant - Assistance Publique - Hôpitaux de Paris (APHP), France, conducted a longitudinal observational study through a monocentric cohort of 46 patients with Rett syndrome. They were treated with a CBD extract. 26 patients had associated epilepsy (56%), and 38% were treated with CBD, in combination with clobazam in 50% of cases.

CBD reduced the incidence of seizures in seven out of ten patients (70%) with one seizure-free patient, two patients with a reduction of seizures of more than 75%, and four patients with a decrease of more than 50%. Half of the patients showed a reduction in agitation and/or anxiety attacks, and an improvement in spasticity was reported in 40% of patients.

Desnous B, Beretti T, Muller N, Neveu J, Villeneuve N, Lépine A, Daquin G, Milh M. Efficacy and tolerance of cannabidiol in the treatment of epilepsy in patients with Rett syndrome. Epilepsia Open. 2023 Jul 24. [in press)

Science/Human: CBD may improve symptoms in patients with gastroparesis according to controlled study

In a double-blind placebo-controlled study with 44 patients CBD provided symptom relief in patients with gastroparesis with delayed gastric emptying. Investigators of the Division of Gastroenterology and Hepatology at Mayo Clinic in Rochester, USA, administrated up to 20 mg CBD per kilogram bodyweight and day or a placebo for 4 weeks.

5 patients did not tolerate full dose escalation; 3 withdrew before completing 4 weeks' treatment. Compared to placebo, CBD reduced scores of a gastroparesis symptom index, improved the inability to finish a normal-sized meal, number of vomiting episodes/24 hours, and overall symptom severity. authors concluded that “CBD provides symptom relief in patients with gastroparesis and improves the tolerance of liquid nutrient intake.”

Zheng T, Bousaba J, Taylor A, Dilmaghani S, Busciglio I, Carlson P, Torres M, Ryks M, Burton D, Harmsen Ws, Camilleri M. A Randomized, Controlled Trial of Efficacy and Safety of Cannabidiol in Idiopathic and Diabetic Gastroparesis. Clin Gastroenterol Hepatol. 2023:S1542-3565(23)00543-8.

Science/Human: Cannabis may be helpful to manage the consequences of work-related injuries

According to a survey of 1196 workers, who experienced a work-related physical injury/illness resulting in one or more days of lost time cannabis may be helpful to manage consequences of their condition. Participants were interviewed 18 or 36 months after their injury/illness by investigators of the Institute for Work and Health in Toronto, Canada.

In total, 27.4% of the sample reported using cannabis (14.1% for their work-related condition). Workers using cannabis for their condition were less likely to be working (58.0%) and more likely to have quite a bit/extreme pain interference (48.5%), psychological distress (26.0%) and sleep problems most/all the time (62.1%) compared with those not using cannabis. Authors concluded from their research that “cannabis may be used to manage the consequences of work-related injuries/illnesses, yet most do not receive clinical guidance.”

Carnide N, Nadalin V, Mustard C, Severin CN, Furlan AD, Smith PM. Cannabis use among workers with work-related injuries and illnesses: results from a cross-sectional study of workers' compensation claimants in Ontario, Canada. BMJ Open. 2023;13(7):e072994.

Science/Human: Cannabis may be helpful in patients with amyotrophic lateral sclerosis

Investigators of the Service de Pharmacologie Clinique et Pharmacovigilance of Aix-Marseille University, France, conducted a survey among patients with amyotrophic lateral sclerosis to get information of the real-life situation regarding the use of cannabis in this illness. There were 129 respondents and 28 reported the use of cannabis (21.7%) to relieve symptoms of ALS.

Participants mostly reported the use of cannabidiol (CBD) oil and cannabis weed and declared benefits both on motor (rigidity, cramps, fasciculations) and non-motor (sleep quality, pain, emotional state, quality of life, depression) symptoms and only eight reported minor adverse reactions (drowsiness, euphoria and dry mouth).

Lacroix C, Guilhaumou R, Micallef J, Bruneteau G, Desnuelle C, Blin O. Cannabis for the treatment of amyotrophic lateral sclerosis: What is the patients' view? Rev Neurol (Paris). 2023:S0035-3787(23)00971-2

News in brief

Science/Human: Patients perceive cannabis as effective in chronic pain

According to interviews with 51 adults receiving medical cannabis treatment for chronic pain suggest that “most participants perceived medical cannabis to be overall effective for chronic pain management.”

Department of Epidemiology, University of Florida, USA .

McMahon AN, et al. Cannabis. 2023;6(2):62-75.

Science/Animal: The mechanism of action of CBD against inflammation

In a study with diabetic mice CBD ameliorated inflammatory response partly by “advanced glycation end products-receptor of advanced glycation endproducts (AGE-RAGE) pathway-related genes CCL2 and interleukin-1β.“

College of Animal Science and Technology, Northeast Agricultural University, Harbin, China.

Li S, et al. Drug Dev Res. 2023 Jul 24.[in press]

Science/Animal: Cannabis may be effective against hepatocellular carcinoma

In studies with rats cannabis demonstrated anti-hepatocellular carcinoma potential. Its anticancer potential is mediated through antiangiogenic, proapoptotic, cycle arrest, and anti-inflammatory mechanisms.”

Department of Biochemistry, Phyto-chemistry and Bio-computing Research Laboratory, College of Biosciences, Federal University of Agriculture, Abeokuta, Nigeria.

Akinloye DI, et al. J Cannabis Res. 2023;5(1):27.

Science/Animal: Anandamide protects against kidney injury

In a study with rats anandamide protected against mercuric chloride-induced acute kidney injury

Pharmacology and Toxicology Department, Faculty of Pharmacy, Cairo University, Egypt.

Abdallah DM, et al. Sci Rep. 2023;13(1):11899.

Science: Use of cannabis by young adolescents in the UK

In a survey with 6672 13- to 14--year-old adolescents across England and Wales 5.2% reported using of cannabis, 1.9% reported using cannabidiol and 0.6% reported using synthetic cannabinoids.

Old Age Psychiatry, Penn Hospital, Black Country Healthcare NHS Foundation Trust, UK.

Hotham J, et al. Br J Psychiatry. 2023:1-7.

Science/Cells: CB2 receptor agonists may be effective against breast cancer cells

A synthetic activator of the CB2 receptor “demonstrated to impair proliferation of triple negative breast cancer BT549 cells and to attenuate the release of pro-inflammatory cytokines in a CB2-dependent manner.”

Department of Pharmacy-Pharmaceutical Sciences, University of the Studies of Bari "Aldo Moro", Bari, Italy.

Gambacorta N, et al. Eur J Med Chem. 2023;259:115647.

Science/Animal: Beta-caryophyllene and L-arginine may ameliorate kidney damage

Activation of the CB2 receptor by beta-caryophyllene in combination with L-arginine ameliorate kidney damage caused by diabetes in rats by suppressing inflammation and fibrosis.

Shobhaben Pratapbhai Patel School of Pharmacy & Technology Management, Mumbai, India.

Kumawat VS, et al. Naunyn Schmiedebergs Arch Pharmacol. 2023 Jul 14. [in press]