IACM-Bulletin of November 12, 2000

Australia — New South Wales considers legal use of cannabis for medicinal purposes

Patients suffering chronic pain or debilitating or terminal illnesses would be allowed to use cannabis under a drug law reform program being considered in New South Wales (NSW).

The reforms were recommended by a working party chaired by Professor Wayne Hall, Director of the National Drug and Alcohol Research Centre. It also included medical academics/clinicians, representatives from the NSW Cancer Council, the AIDS Council of NSW, the Law Society of NSW, the Australian Medical Association, government agencies and others.

Patients would effectively be given short term exemptions from criminal laws, allowing them to smoke cannabis and grow up to five plants for personal use during the period approved by their doctor. The NSW Prime Minister, Bob Carr, has given in principle agreement to the recommendations.

In his letter to the State Premier Dr. Hall says: "(...) cannabinoid substances may have value in the treatment of a limited range of medical conditions, namely, HIV-related wasting, nausea caused by cancer chemotherapy, muscle spasm in some neurological disorders, and pain that is unrelieved by conventional analgesics. (...) The Working Party has concluded that crude cannabis cannot be prescribed and is unlikely to ever be prescribed in Australia. (...) At best it will be some years before any cannabinoid drugs are registered for medical use in Australia. Given evidence that patients with some of the conditions indicated are currently using smoked cannabis for therapeutic reasons, the Working Party has recommended a regime for limited compassionate provision of cannabis to patients who may benefit from its use."

The report is available at:

http://www.druginfo.nsw.gov.au/druginfo/reports/medical_cannabis.html

(Sources: Sydney Morning Herald of 2 November 2000; Personal communication by Wayne Hall; Working Party on the Use of Cannabis for Medical Purposes: The Use of Cannabis for Medical Purposes. Report to the Prime Minister of New South Wales, Sydney 2000)

Science — Endocannabinoids inhibit bronchospasm and cough

An international research group has discovered why marijuana causes coughing in some situations but may inhibit bronchospasm and cough in others. This finding could lead to better treatments of respiratory diseases.

In a report in the journal Nature scientists from the Institute of Experimental Medicine in Budapest (Hungary), the University of Naples (Italy) and the University of Washington (USA) showed how the endocannabinoid anandamide influences the airways in the lungs. In animal studies with guinea pigs and rats, anandamide exerted a dual effect on bronchial responsiveness. If the muscles in the lungs were constricted by an irritant (capsaicin) the endocannabinoid relaxed the smooth muscles and strongly inhibited coughing. But if the airways were relaxed (by removing the constricting effect of the vagus nerve) anandamide caused a coughing spasm.

Anandamide is synthesized in lung tissues and its effects are mediated by cannabinoid receptors. A CB1 receptor antagonist but not a CB2 antagonist inhibited the relaxing effect of anandamide but the CB1 receptor antagonist caused no effect on its own. Thus, anandamide seems to be active only if the bronchial muscles are contracted, as during capsaicin-evoked bronchospasm.

"We think that by targeting cannabinoid receptors in the upper airways we can control coughs in a number of conditions," Dr. Daniele Piomelli, one of the researcher of the team and pharmacologist at the University of California said in an interview. "That's important because most treatments currently available basically act on the brain cough centre, a small region of the brain that is the target for codeine and similar drugs." The group hopes to begin tests in humans soon.

(Sources: Reuters of 1 November 2000; Calignano A, et al: Bidirectional control by airway responsiveness by endogenous cannabinoids. Nature 2000;408:96-101)

USA — Initiatives for the medical use of marijuana passed in Colorado and Nevada

Federal laws against marijuana didn't stop two states, Colorado and Nevada, from voting to permit its medical use in the general election of 7 November. In the last four years, similar medical-marijuana measures have become law in California, Oregon, Washington, Alaska, Maine and Hawaii.

In Nevada, 67 percent of the voters said yes to Question 9, legalizing the medical use of marijuana. Two years ago voters approved the initiative with 59 percent. Voters had to support the measure in two consecutive elections. Patients will need to register with the state in order to be protected by the state law.

54 percent of the voters in Colorado approved Amendment 20, which like the Nevada initiative, permits patients suffering from cancer, glaucoma, HIV/AIDS, multiple sclerosis and chronic nervous system disorders to use marijuana with the recommendation of a physician. Patients in Colorado will be allowed to possess up to two ounces of marijuana or cultivate six cannabis plants.

California voters passed Proposition 36 with 61 percent of the vote. This measure requires first and second-time non-violent drug offenders to enter drug treatment programs, and eliminates the threat of jail.

(Sources: Associated Press of 8 November 2000, NORML of 9 November 2000)

News in brief

Science

Pharmos Corporation will commence patient enrolment in a Phase III clinical trial of dexanabinol for traumatic brain injury in seven European countries and Israel after appropriate approval by the authorities. The Company recently hosted an investigators meeting attended by over 100 representatives from European trauma centres that are participating in the trial. Approximately 40 centres in Europe and Israel are expected to participate. Dexanabinol, a non-psychotropic synthetic cannabinoid, has demonstrated significant anti-inflammatory and neuroprotective properties in several tests. A recent successful Phase II clinical study showed dexanabinol to be safe and well-tolerated in severe head trauma patients. (Source: PR Newswire of 7 November 2000)

UK

Britain could legalise cannabis use in a limited medical capacity in the next two years, although wider liberalization of soft drugs has been ruled out, government officials said on 7 November. Minister Mo Mowlam said that scientific tests were underway to assess the effectiveness of marijuana in several diseases. "We hope that by the end of next year, these scientific results will be out," she told the BBC, adding that the government would use them to decide whether to allow limited cannabis use. But Keith Hellawell, the government's drug tsar , played down the chances of a broader loosening in policy. (Source: Reuters of 7 November 2000)