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IACM-Bulletin of November 12, 2006


USA — Narrow defeat of a measure that would have legalized the medical use of cannabis in South Dakota

A measure that would have made South Dakota the 12th state with a medical cannabis law got a support by only 48 per cent of voters at the elections on 7 November. This is the first defeat of a medical cannabis measure presented to voters in the United States. Measures that would have legalized the possession of small amounts of cannabis by adults in Colorado and Nevada got support by 40 and 44 per cent, respectively.

On the federal level supporters of medical cannabis welcomed the outcome of the elections for the House of Representatives. Nancy Pelosi, the new speaker of the House of Representatives, has been a strong supporter of the Hinchey-Rohrabacher amendment, aimed at ending federal attacks on medical cannabis patients in states where medical use of cannabis is permitted. Many opponents of medical cannabis were defeated and many of the new members of the House are expected to be supporters, among them Stephen Cohen, who introduced medical cannabis legislation as a Tennessee state senator.

(Sources: Associated Press of 9 November 2006, Denver Post of 8 November 2006, press releases of the Marijuana Policy Project and NORML)

Science Canada — GW Pharmaceuticals seeks approval for the use of Sativex in cancer pain

On 19 October GW Pharmaceuticals and Bayer HealthCare announced that GW has submitted a regulatory application in Canada for their cannabis extract Sativex to seek approval for a new indication, for the treatment of pain in patients with advanced cancer that has not been adequately relieved by opioid medications.

According to the press release GW has completed a positive Phase III study in Europe in 177 patients with cancer pain. The trial was a multi-centre placebo-controlled study. Patients in the study had advanced cancer and were experiencing pain that was not responding adequately to strong opioid medication. In addition to study medication, all patients remained on their existing opioid and other analgesic medication during the trial. Sativex achieved a statistically significant improvement in comparison with placebo in pain. 43 per cent of patients on Sativex showed a greater than 30 per cent improvement in their pain as measured on a numerical rating scale.

In 2005, Health Canada approved Sativex for the symptomatic relief of neuropathic pain in adults with multiple sclerosis. Canada became the first country in the world to approve Sativex.

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(Source: Press release by GW Pharmaceuticals of 19 October 2006)

Science — Long-term use of a cannabis extract in patients with multiple sclerosis

An open study in 137 MS patients with symptoms not controlled satisfactorily using standard drugs was conducted with an oral cannabis extract (Sativex) to investigate long-term efficacy and safety. Participants had completed a 10-week, placebo-controlled study and were followed for an average of 434 days (range 21-814).

A total of 58 patients (42.3 per cent) withdrew due to lack of efficacy (24 patients), adverse events (17), and other reasons (17). Patients reported 292 unwanted effects, of which 86 per cent were mild to moderate, including oral pain (28 patients), dizziness (20), diarrhoea (17), nausea (15) and oromucosal disorder (12). Three patients had five serious adverse events (two seizures, one fall, one pneumonia, one inflammation of the bowel). Four patients had first-ever seizures.

The improvements recorded and dosage taken in the acute study remained stable. Planned, sudden interruption of cannabis administration for two weeks in 25 patients did not cause a consistent withdrawal syndrome, although 11 (46 per cent) patients reported at least one withdrawal symptom (tiredness, interrupted sleep, hot and cold flushes, mood alteration, reduced appetite, emotional lability, intoxication or vivid dreams). The authors concluded that long-term use of a cannabis extract "maintains its effect in those patients who perceive initial benefit. The precise nature and rate of risks with long-term use, especially epilepsy, will require larger and longer-term studies."

(Source: Wade DT, Makela PM, House H, Bateman C, Robson P. Long-term use of a cannabis-based medicine in the treatment of spasticity and other symptoms in multiple sclerosis. Mult Scler 2006;12(5):639-45.)

News in brief

Science — Multiple sclerosis

Patients with multiple sclerosis attending neurology outpatient clinics at two hospitals in London and one in Kent, UK completed a questionnaire on their use of cannabis. 254 patients participated. 43 per cent had used cannabis at some stage. Of these, 68 per cent (75 of 110) had used cannabis to alleviate symptoms of MS. 46 (18 per cent) had used cannabis in the last month, of whom 12 per cent (31 of 254) had used it for symptom relief. Researchers concluded that "a large proportion of MS patients had tried cannabis for symptom control, however current use was small. A subgroup with greater disability appears to derive some symptomatic benefit." (Source: Chong MS et al. Mult Scler 2006;12(5):646-51.)

USA — 10 years of Proposition 215

Ten years ago the voters in California passed the first medical cannabis law in the USA. Later further ten states followed this example (Alaska, Colorado, Hawaii, Maine, Montana, Nevada, Oregon, Rhode Island, Vermont and Washington). The medical cannabis laws generally allow those with a doctor's recommendation to grow or possess small amounts of the drug. The federal government still refuses to recognize Proposition 215, the law approved by 56 percent of voters. An analysis of Proposition 215 by the Marijuana Policy Project is available at: (Source: Associated Press of 3 November 2006)

Science — Cancer of the liver

Chinese researchers investigated the consequences of a high expression of cannabinoid receptors on disease development in 13 patients with cancer of the liver (hepatocellular carcinoma, HCC). In 8 of 13 patients the number of CB1 receptors was augmented and in 7 of 13 the CB2 receptors were augmented. Overexpression of both receptors, that is a high density of receptors in the liver cells, was associated with a more favourable course of the disease. Researchers concluded that "CB1 and CB2 have potential as prognostic indicators and [the results] suggest possible beneficial effects of cannabinoids on prognosis of patients with HCC." (Source: Xu X, et al. Cancer Genet Cytogenet 2006;171(1):31-89)

Science — Male fertility

According to a research of the University of New York at Buffalo a synthetic cannabinoid, called cannabinoid-1346, that binds to cannabinoid receptors improves the fertility of male cigarette smokers. Previous studies have shown that cigarette smokers’ sperm cannot fasten as well to the outside of human eggs, explains Dr. Lani Burkman of the University at Buffalo. The cannabinoid appeared to double the ability of the sperm to bind to the shell of the egg compared with the untreated smokers’ sperm. It might have boosted the binding ability of some sperm back to the normal levels seen in non-smokers, says Burkman.

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(Source: New Scientist of 24 October 2006)