IACM-Bulletin of December 7, 2008

Germany — First Patients receive herbal cannabis from the Dutch Cannabis Program

On 27. November 2008 four patients were notified by the Federal Institute for Pharmaceuticals and Medical Products (BfArM) of the Federal Ministry of Health that they will receive medical cannabis, produced under the Dutch cannabis program, beginning in early 2009. Since July 2007 some 30 patients have received permission from the BfArM to use medical cannabis. However, the permission generally refers to a liquid cannabis extract produced by a German firm from Dutch cannabis. This extract did not offer a satisfactory solution for a number of these patients.

On 3. December the Health Committee of the German Parliament rejected, as was expected, two largely identical proposals by the Greens and the Left Party that would have decriminalized the medical use of physician-recommended cannabis. Medical use continues to be limited to exceptional cases. The government parties justified their rejection by saying that regulatory approval of cannabis-based drugs under federal drug law would meet the demand by patients. An ongoing multi-centre study is aimed at achieving the approval of dronabinol for patients with multiple sclerosis suffering from chronic pain. No information on the status of the study is available because the participating physicians and clinics are committed to confidentiality.

(Source: Personal communication)

Science — China: In a tomb of a shaman in China 2700 year old THC containing cannabis was discovered

The Journal of Experimental Botany has recently published an article on the biochemical and genetic examination of a 2700 year old 789 gram cannabis sample from a tomb in Xinjiang, China. The plant material was buried alongside a light-haired, blue-eyed Caucasian man, likely a shaman of the Gushi culture, near Turpan in north-western China. The extremely dry conditions and alkaline soil resulted in a good preservation, allowing a team of scientists to carefully analyse the cannabis, which still looked green though it had lost its distinctive odour.

The multidisciplinary team from China, UK, Italy, USA and other countries demonstrated that this material was cultivated, and contained THC and its metabolites, as well as THCA synthase, the enzyme which allows the plant to produce THC. The implications are that the Gushi culture employed cannabis as a medicine or aid to divination. "To our knowledge, these investigations provide the oldest documentation of cannabis as a pharmacologically active agent," says the paper of lead author Dr. Ethan Russo.

More at:

http://www.thestar.com/sciencetech/article/544684

The original article and a supplement with additional photos are available online:

http://jxb.oxfordjournals.org/cgi/reprint/59/15/4171

http://jxb.oxfordjournals.org/cgi/data/ern260/DC1/1

(Sources: Personal communication by Ethan Russo; Canadian Press of 27 November 2008; Russo EB, Jiang HE, Li X, Sutton A, Carboni A, Del Bianco F, Mandolino G, Potter DJ, Zhao YX, Bera S, Zhang YB, Lü EG, Ferguson DK, Hueber F, Zhao LC, Liu CJ, Wang YF, Li CS.Phytochemical and genetic analyses of ancient cannabis from Central Asia. J Exp Bot 2008;59(15):4171-82.)

Holland — New association for the medicinal use of cannabis

The Dutch Association for Legal Cannabis and its Constituents as Medicine (in Dutch: "Nederlandse Associatie voor legale Cannabis en haar Stoffen als Medicatie" or NCSM) was recently founded as a response to the positive developments of the Dutch medicinal cannabis program. It is an independent non-profit organization, and is able to perform its activities through donations.

The NCSM is a knowledge platform and discussion forum on the medicinal use of cannabis. The mission of the NCSM is to improve the acceptance of medicinal cannabis through dialogue and using a science-based approach. At the same time there is a clear intention to listen to the opinions and experiences of patients and their care-takers. The NCSM works only with professionals in the field of medicinal cannabis. The NCSM will actively participate in medicinal cannabis policy, research and education.

More information at:

http://www.ncsm.nl

(Source: Personal communication by Arno Hazekamp)

Science — THC in chronic pain

In an open clinical study the efficacy and adverse events of oral THC (dronabinol) were investigated in 13 patients with chronic pain unresponsive to conventional pharmacotherapy.

Five out of 13 patients reported adequate response to the treatment while eight patients reported inadequate or no response. Seven patients did not experience any adverse events, six patients reported adverse events, which resulted in discontinuation of treatment by two patients. The US-American researchers concluded from their observations that "oral THC may be a valuable therapeutic option for selected patients with CNMP [chronic non-malignant pain] that are unresponsive to previous treatments."

(Source: Haroutiunian S, Rosen G, Shouval R, Davidson E. Open-Label, Add-on Study of Tetrahydrocannabinol for Chronic Nonmalignant Pain. J Pain Palliat Care Pharmacother 2008;22(3):213-217.)

News in brief

Switzerland — No legalisation

On 30 November Swiss voters rejected an initiative for the legalisation of cultivation and possession of cannabis. 36.8 per cent of the voters voted in favour of the initiative, 63.2 against it. An amendment of the narcotics law was accepted by a broad majority of 68 per cent. Among others it is intended to ease the medical use of dronabinol (THC). There is however uncertainty about the concrete effects of this amendment on this issue. (Sources: Swissinfo.ch, personal communications)

USA — Hawaii

The number of medical cannabis patients in Hawaii (inhabitants: 1.3 millions) has grown by 87 per cent in the past two years. According to the state Department of Public Safety, 4,200 patients were registered state-wide on 30 June 2008. One reason for the increase is that more doctors have been certifying patients for the program (85 physicians in 2008). (Source: Honolulu Advertiser of 24 November 2008)

USA — California

On 1 December the U.S. Supreme Court rejected without comment an appeal by a Californian city that asked the justices to overturn a lower court ruling requiring police to return medical cannabis that they seize from a patient. The state Supreme Court refused to review the case earlier this year, and the nation's high court also denied to review the case without comment. "It's now settled that state law enforcement officers cannot arrest medical marijuana patients or seize their medicine," said a representative of Americans for Safe Access. (Source: San Francisco Chronicle of 2 December 2008)

Science — Cannabidiol

According to animal research the non-psychotropic cannabinoid cannabidiol (CBD) is a wake-inducing compound that activates nerve cells in wake-inducing brain areas. (Source: Murillo-Rodríguez E, et al. Behav Neurosci 2008;122(6):1378-82.)

USA — Death in jail

The mother of a quadriplegic inmate who died in 2004 at the jail of Washington D.C. has reached financial settlements with the District government. The settlements were reached in the controversial death of Jonathan Magbie, a 27-year-old Maryland man who was paralysed from the neck down. Magbie died four days into a 10-day jail sentence for possessing cannabis, which he used for medical purposes. The jail was not equipped with the ventilator he needed to breathe at night, so that he died from breathing problems. (Source: Washington Post of 3 December 2008)

USA — California

Someone who supplies cannabis to a patient who has a doctor's approval for it can be prosecuted for drug-dealing, the state Supreme Court ruled on 24 November. Advocates on both sides of the case agreed that the unanimous ruling would encourage Californians to obtain medical cannabis from patient cooperatives, which are authorized by a 2003 state law, rather than from an individual supplier. (Source: San Francisco Chronicle of 24 November 2008)

Science — Cannabis and nicotine

In a large twin study the relationship between cannabis use and nicotine dependence was investigated. The researchers concluded that people who start cannabis use early are at increased risk for nicotine dependence, but this risk is attributable largely to common genetic vulnerability. "There is no evidence for a causal relationship between cannabis use and nicotine dependence," they wrote. (Source: Agrawal A, et al. Addiction 2008;103(11):1896-904.)