IACM-Bulletin of April 19, 2015

Science/Human — Inhaled cannabis reduced diabetic peripheral neuropathy pain in controlled study

Inhaled cannabis demonstrated a dose dependent reduction in peripheral treatment-refractory neuropathic pain in 16 patients with diabetes. These results of a clinical study by researchers of the University of California in San Diego were published in The Journal of Pain. In a cross-over design, each participant was exposed to a single dosing session of placebo, low (1% THC), medium (4% THC), or high (7% THC) doses of cannabis. After inhalation by a vaporizer the pain intensity and subjective highness score was measured at 5, 15, 30, 45, and 60 minutes and then every 30 minutes for an additional 3 hours.

There was a significant difference in spontaneous pain scores between doses. There was also a significant effect of the high dose on pain evoked by a foam brush and fibers (so-called von Frey hairs). Authors noted that “this adds preliminary evidence to support further research on the efficacy of the cannabinoids in neuropathic pain.”

Wallace MS, Marcotte TD, Umlauf A, Gouaux B, Atkinson JH. Efficacy of Inhaled Cannabis on Painful Diabetic Neuropathy. J Pain. 2015 Apr 2. [in press]

USA — Georgia legalizes cannabis for limited medical use

People with seizure disorders, multiple sclerosis and other illnesses will be allowed to use a non-smoking form of cannabis in Georgia after the state's Republican governor signed a measure legalizing the drug on 16 April 2015. But patients still may find it difficult to obtain the cannabis oil for their treatment, advocates said.

Under the law, which takes effect immediately, patients who complete a screening process will be provided with documentation allowing them to possess cannabis oil with a low percentage of

THC Governor Nathan Deal said in a statement. Those with cancer, amyotrophic lateral sclerosis, Crohn’s disease, mitochondrial disease, Parkinson’s and sickle cell disease also will be eligible for cannabis. The bill's sponsor, state Representative Allen Peake, said there are pharmaceutical companies that will ship the oil with 5% THC to Georgia, where it remains illegal to grow cannabis.

Reuters of 17 April 2015

Science/Human — Oral cannabis extracts were effective in one third of children with epilepsy in an open study

About one third of children suffering from different forms of epilepsy experienced a more than 50 % reduction in seizures by the use of oral cannabis extracts, researchers at the Medical Campus of the University of Colorado in Denver reported in the journal Epilepsy & Behavior. They conducted a retrospective chart review of children and adolescents who were given cannabis extracts. Seventy-five patients were identified of which 57% reported any improvement in seizure control and 33% reported a more than 50% reduction in seizures (responders).

The responder rate varied based on epilepsy syndrome: Dravet 23%, Doose (Myoclonic astatic epilepsy) 0%, and Lennox-Gastaut syndrome 88.9%. Additional benefits reported included: improved behavior/alertness (33%), improved language (10%), and improved motor skills (10%). Adverse events occurred in 44% of patients including increased seizures (13%) and somnolence/fatigue (12%). Rare adverse events included developmental regression, abnormal movements, status epilepticus requiring intubation, and death.

Press CA, Knupp KG, Chapman KE. Parental reporting of response to oral cannabis extracts for treatment of refractory epilepsy. Epilepsy Behav 2015;45:49-52.

Poland — Police raids homes of medical cannabis patients and arrests cannabis activist

The police raided homes of cannabis patients in the region of Dolny Slask (Lower Silesia) and arrested Jakub Gajewski, vice-president of the Wolne Konopie (Free Cannabis) movement. He was in possession of a large amount of cannabis extract destined for severely ill cancer patients. He faces 15 years in prison. On 20 April in Warsaw there will be a solidarity event to demand his acquittal and it will be a demand for the very basic human right of patients to cure themselves with any available substance.

Polish cannabis laws are harsh. For simple posession of any amount the sentence may be prison for up to 3 years. Though the cannabis extract Sativex is available on prescription in Poland there are only few patients who can benefit from it. The average cost of a monthly treatment is comparable to an average monthly salary.

Source: Personal communication by Wolne Konopie.

News in brief

Science/Human — The activation of CB2 receptors in certain brain cells may be neuroprotective in patients with Parkinson’s disease

The number of CB2 receptors is elevated in microglial cells, immune cells in the brain, of patients with Parkinson’s disease. In addition, experiments with a mouse model of Parkinson’s disease researchers demonstrated that the activation of the CB2 receptor has neuroprotective effects.

Universidad Complutense, Madrid, Spain.

Gómez-Gálvez Y, et al. Prog Neuropsychopharmacol Biol Psychiatry. 2015 Apr 8. [in press]

Science/Animal — The activation of CB1 receptors reduces anxiety in pain

Mice without CB1 receptors suffering from chronic pain presented with more anxiety than normal mice suffering from chronic pain. Authors wrote that “the endocannabinoid system affects chronic pain-induced mood changes through CB1 receptors.”

Institute of Molecular Psychiatry, University of Bonn, Germany

Rácz I, et al. Brain Res Bull. 2015 Apr 8. [in press]

Science/Animal — The activation of the CB2 receptor reduced pain in multiple sclerosis

A synthetic cannabinoid (JWH-133), which selectively activates the CB2 receptor decreased hyperalgesia, an increased sensitivity to pain, in a rat model of multiple sclerosis.

University of Kentucky Medical Center, Lexington, USA.

Fu W, et al. Neurosci Lett 2015;595:1-6.

Science/Animal — Cannabis may slow progression of multiple sclerosis

In a mouse model of multiple sclerosis (Theiler's murine encephalomyelitis) a cannabis extract, which was similar to Sativex, slowed the progression of the disease.

CSIC, Madrid, Spain

Feliú A, et al. Br J Pharmacol. 2015 Apr 8. [in press]

Science/Human — Patients with a high number of CB2 receptors in breast cancer cells have a worse prognosis

According to an analysis of 649 samples of breast tumour cells those with a high number of CB2 receptors were associated with lower survival, a higher probability of relapse and higher risk of metastases. Authors wrote that their results “suggest that CB2 may be a biomarker with prognostic value in these tumors.”

Complutense University, Madrid, Spain.

Pérez-Gómez E, et al. J Natl Cancer Inst 2015;107(6).

Science/Human — Leptin is negatively associated with 2-AG

In the cerebrospinal fluid of patients with arthritis there was a negative association between the endocannabinoid 2-AG and leptin levels. Leptin is a hormone produced by fat cells, which reduces hunger. Authors wrote that “this is consistent with pre-clinical studies in animals, demonstrating that leptin controls the levels of hypothalamic endocannabinoids that regulate feeding behavior.”

Stony Brook University, New York, USA.

Nicholson J, et al. PLoS One 2015;10(4):e0123132.

Science/Human — The level of endocannabinoids is increased in the blood of patients with hepatitis C

Compared with healthy people anandamide and 2-AG (2-arachidonoyl glycerol) levels were increased in blood plasma of patients with hepatitis C, but not in liver tissues. Authors wrote that this “might reveal immunosuppressive and profibrogenic effects” of endocannabinoids.

Department of Clinical Research, University of Bern, Switzerland.

Patsenker E, et al. Int J Mol Sci 2015;16(4):7057-76.