IACM-Bulletin of June 22, 2003

Science USA — More HIV patients use cannabis for mental than for physical reasons

A survey of the San Mateo Medical Center in California found that more HIV patients smoked marijuana for mental rather than physical reasons. 252 HIV patients were surveyed, of whom 58 patients admitted to use cannabis in the last four weeks. When asked for the main reasons they used the drug, most cited several reasons. 57 percent say they smoked it to relieve anxiety or depression, 52 percent against nausea and loss of appetite, 28 percent to alleviate pain.

Dr. Cheryl Koopman, an associate professor of psychiatry at Stanford university, said that many of her colleagues were fascinated by the survey results presented at the American Psychiatric Association conference in May. "There was a lot of interest," she said. "Because of the illegality of marijuana there's a lack of research. We don't know if self-medication is systemic. It's another reason for large studies to be conducted in a scientifically rigorous way."

The San Mateo Medical Center has managed to complete one round of clinical trials studying medical effects of cannabis in HIV patients, but Dr. Dennis Israelski, chief researcher at the Medical Center, is still negotiating for federal approval for two more studies. The first round of clinical trials focused on marijuana's effect on peripheral neuropathy, a severe leg pain that may occur in HIV patients. For the next trials, the Medical Center research team wants to expand the study to include potential effects on nausea, gastrointestinal disorders and wasting syndromes associated with HIV.

(Source: San Francisco Examiner of 12 June 2003)

USA — Californian doctors under attack

California doctors who recommend cannabis under Proposition 215 (the Californian medical marijuana law) say they have become the next target of opponents of the medical use of cannabis.

Police, sheriffs, and prosecutors throughout California have brought complaints against at least nine doctors, who are being investigated by the state Medical Board. According to the doctors, not one of the investigations has been triggered by a complaint brought by a patient, a patient's family, or health care professionals. The Medical Board is actively investigating complaints against doctors David Bearman, Frank Lucido, and Marian Fry. Investigations involving doctors Tod Mikuriya and William Eidelman are pending with the state Attorney General's Office. Complaints against doctors Stephen Ellis and Mike Alcalay have been dismissed. And two others, Robert Newport and Stephen Banister, are on probation.

Hallye Jordan, a spokesperson for state attorney general Bill Lockyer denied that board investigations target doctors who recommended cannabis. "They don't have anything to do with medical marijuana," Jordan said. "These investigations are dealing with a lack of providing adequate screening, diagnosis, and medical care." Robert Elsberg, past president of the California Narcotics Officers Association, said many law enforcement agents believe Proposition 215 is abused by patients and doctors.

Mikuriya pointed out that the Medical Board has never defined a standard of medical practices for evaluating medical cannabis patients, leaving doctors vulnerable to prosecution and investigations. He submitted proposed standards of care in March to the Medical Board but received no response. "Right now we have functional anarchy," he said. Patients and doctors were at risk of arbitrary acts of local police chiefs.

(Source: San Francisco Bay Guardian of 11 June 2003)

Science Canada — Cancellation of first Canadian study with smoked cannabis

The Community Research Initiative of Toronto (CRIT) announced on 19 June the cancellation of the first Canadian clinical study evaluating the therapeutic effects of smoked cannabis, a direct result of Health Canada's decision not to renew funding for the project.

The study was to have assessed whether smoking cannabis can alleviate nausea and weight loss experienced by many persons living with HIV/AIDS. Research was to have begun this spring as a pilot study, involving a total of 32 individuals. "Health Canada has just cancelled funding of an important, groundbreaking research project," explained Derek Thaczuk, Chair of the CRIT Scientific Committee. "This about-face on its previous commitments has come at the very time the study was about to start enrolling, and at a time when Health Canada itself is proclaiming the need for well-conducted scientific studies of marijuana's health effects."

The CRIT does not have the resources necessary to continue the cannabis project without funding support from Health Canada. This study represented more than three years of development and planning. Thaczuk concludes: "What is most painful is the abandonment of this project just when all of that labour was about to bear fruit."

(Source: Canada NewsWire of 19 June 2003)

News in brief

Canada — No legal basis for charges on cannabis possession

Superior Court Justice Steven Rogin upheld the decision of a lower court that there was no legal basis to ban simple possession of cannabis since the federal government failed to comply with a July 2000 order to create a new law dealing with marijuana. In January the lower court acquitted a teenager charged with cannabis possession. The ruling was appealed and resulted in the confirmation by judge Rogin. Police officials in Ontario have said they will not lay any charges for possession under 30 grams until the legal situation can be clarified. (Source: Canadian Press of 10 June 2003)

Science — Cannabis reduces opiate dose

Three cases from Canada were presented in the Journal of Pain and Symptom Management, where patients suffering from chronic pain (multiple sclerosis, HIV neuropathy, back and leg pain following an accident) were able to considerable reduce opiate doses by using cannabis. The patient with HIV neuropathy could reduce 360 mg long-acting morphine per day to 180 mg per day within four months and even to nothing within nine months. (Source: Lynch ME, and Clark AJ. J Pain Symptom Manage. 2003 Jun;25(6):496-8)

UK — Sativex ready for release at the end of the year

GW Pharmaceuticals said on 19 June Sativex, which contains extracts from whole cannabis plants, is ready for release after approval by the Medicines and Healthcare Products Regulatory Agency (MHRA) and should be available on prescription by the end of the year. (Source: Times Online of 19 June 2003)

Economy — Dexanabinol

The Israel based company Pharmos Corporation announced on 10 June that it had received a Notice of Allowance from the United States Patent and Trademark Office for a patent application relating to the synthetic and non-psychotropic cannabinoid dexanabinol. The allowed claims cover novel synthetic dextrocannabinoids developed by Pharmos, including several derivatives of dexanabinol, and their use in the treatment of inflammatory disorders, neurodegenerative disorders, brain ischemia, autoimmune diseases and pain. Dexanabinol is currently undergoing clinical testing as a treatment for traumatic brain injury and as a preventive agent against post-cardiac surgery cognitive impairment. (Source: Press release by Pharmos of 10 June 2003)

Science — Immune system

New research found more evidence that immune modulation produced by cannabinoids involves multiple mechanisms, which seem to be both cannabinoid receptor-dependent and -independent. (Source: Faubert Kaplan BL, et al. J Pharmacol Exp Ther. 2003 Jun 12 [Electronic publication ahead of print])

Science — Vomiting

The anti-emetic effects of THC against cisplatin induced vomiting in ferrets were shown to be caused by activation of CB1 receptors in the brainstem, in the so-called dorsal vagal complex. Cisplatin is a substance used in cancer chemotherapy and often causes severe nausea and vomiting. (Source: Van Sickle MD, et al. Am J Physiol Gastrointest Liver Physiol. 2003 Jun 4 [Electronic publication ahead of print])

Correction — Heartburn

In the IACM-Bulletin of 25 May we reported about the effects of THC on a reflex that can result in reflux of stomach acid into the esophagus. Erronously we reported that this reflex was attenuated by THC in animal research. Indeed, the reflex was increased in intensity. (Source: Partosoedarso ER, et al. J Physiol 2003, May 16; [electronic publication ahead of print])