IACM-Bulletin of May 11, 2008

USA — A man dies after denied a liver transplant because he used cannabis for medicinal purposes

A man who was denied a liver transplant largely because he used cannabis with medical approval to ease the symptoms of hepatitis C has died. Timothy Garon, 56, died on 1 May, a week after a doctor told him a University of Washington Medical Center committee had again denied him a spot on the liver transplant list. The team had previously told him it would not consider placing him on the list until he completed a 60-day drug-treatment class. The case highlights an ethical consideration for those allocating organs for transplant: whether using cannabis with a doctor's blessing should be held against a dying patient in need of a transplant.

The United Network for Organ Sharing, which oversees the transplant system of the USA, leaves it to individual hospitals to develop criteria for transplant candidates. At some, people who use "illicit substances" - including cannabis for medicinal purposes, even in the dozen states that allow it - are automatically rejected. Dr. Brad Roter, who authorized the patient to smoke cannabis to alleviate nausea and abdominal pain and to stimulate his appetite, said he did not know it would be such a hurdle if Mr. Garon were to need a transplant. No one tracks how many patients are denied transplants over medical cannabis use, but this is not a single case.

(Source: Associated Press of 26 April and 2 May 2008)

News in brief

Holland — Tax revenues

The Dutch state earns 400 million euros annually in tax revenues from the sales of cannabis in coffee shops. Sales in the sector total around 2 billion euros, according to conservative estimates by TV programme Reporter. Reporter calculates that the some 730 coffee shops in the Netherlands sell around 265,000 kilos of hashish and cannabis annually. The bulk of this is grown in the Netherlands. (Source: NIS News Bulletin of 3 May 2008)

UK — Reclassification

Cannabis is to be reclassified as a class B drug, home secretary Jacqui Smith has said. She said that she wanted to reverse Tony Blair's 2004 downgrading of the drug because of "uncertainty" over its impact on mental health. The move from class C means the maximum prison sentence for possessing cannabis rises from two years to five years. Her statement to Members of Parliament came despite the Advisory Council on the Misuse of Drugs' review - commissioned by Gordon Brown - saying cannabis should stay in class C. (Source: BBC News of 7 May 2008)

USA — Letter to DEA

House Judiciary Committee Chairman John Conyers wants the Drug Enforcement Administration (DEA) to explain its increased use of "paramilitary-style enforcements raid" and property forfeiture orders against medical cannabis patients and suppliers in California. With drug trafficking and violence from international cartels on the rise, "do you think the DEA's limited resources are best utilized conducting enforcement raids on individuals and their caregivers who are conducting themselves legally under California law?" he said in a letter of 29 April to the agency. Californian mayors and lawmakers were urging him to hold hearings, but first, "I want to give you the opportunity to respond to these complaints." The letter is available for download at: http://www.safeaccessnow.org/downloads/Conyers_DEA_Letter.pdf

(Source: San Francisco Chronicle of 7 May 2008)

Science — Psychosis

According to a study conducted by Dutch researchers in Trinidad with 472 participants (aged 12-23 years) cannabis use increased the risk of experiencing psychotic symptoms, but only if cannabis use was started early. Thus, exposure before but not after the age of 14 years was associated with an increased rate of psychotic symptoms. Researchers concluded that "early adolescence may be a critical period with regard to the psychotogenic effect of cannabis." (Source: Konings M, et al. Acta Psychiatr Scand. 2008 Apr 28 [Electronic publication ahead of print])

Science — Depression

In a study of Brown University in Rhode Island, USA, the association between substance use disorders and major depressive disorder was investigated in 460 participants with depression at ages 24 and 30. Stimulant use and depression were prospective risk factors for each other over the 6-year-period. Alcohol and cannabis use disorders were not robustly associated with depression. (Source: Leventhal AM, et al. Am J Drug Alcohol Abuse 2008;34(3):259-67)