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IACM-Bulletin of November 21, 2021


Germany — The future federal government may legalise the use of cannabis for adults

The working group on health and care, one of the working groups preparing the agreement for the coalition between the Social Democrats, the Greens and the Free Democrats has agreed on the legalisation of cannabis for adults. The negotiators are said to have stated in a result paper: "We will introduce the controlled distribution of cannabis to adults for consumption purposes in licensed shops".

It is not yet known what the exact details will be. The three parties have a majority in the Bundestag and are expected to provide the next Chancellor. The election of the new federal government is to take place this year. However, the amendment of the Narcotics Act requires the approval of the Bundesrat, the second chamber, which consists of the representatives of the 16 Laender. So far, the Christian Democrats of the current Federal Chancellor Angela Merkel have the majority there, who reject the legalisation of cannabis.

Frankfurter Allgemeine Zeitung of 19 November 2021

Science/Human — THC prolongs survival in patients in palliative care according to a retrospective analysis

According to an analysis of 800 patients undergoing special palliative care (SAPV) in several German centres, THC-containing drugs had a significant positive effect on survival. All patients treated between 1 April 2017 and 30 September 2021 were included.

Altogether 137 received THC containing medications. The cannabis-based therapy was associated with prolonged median survival after initiation of SAPV treatment from 44 to 65 days. In women, THC prolonged survival to 64 days compared to 43 days in non-treated. In the group of patients aged 75 years or older, survival was 62 days in the treated group compared to 37.5 days without cannabis medication.

Gastmeier K, Gastmeier A, Böhm R, Bimberg R, Herdegen T. Cannabis-based medicines prolong survival time in patients treated under the Specialized Palliative Outpatient Care. Poster presented at: “35th years of palliative care in the region and 10 years of SAPV”, IABSP, Kleinmachnow , Germany, 10 November 2021.

Science/Human — Cannabis may result in better pain control of cancer patients according to placebo-controlled study

In a study with 30 cancer patients with stage IV cancer requiring opioids the administration of cannabis resulted in improved pain control. This is the result of a study conducted by the Cancer Research Center of HealthPartners/Park Nicollet in Minneapolis, USA and other institutions in the US. Participants were randomized either to receive early cannabis or delayed start cannabis. The early group obtained 3 months of cannabis through a state program at no charge, while the delayed group received standard oncology care without cannabis for the first 3 months.

The estimated mean daily THC and CBD allotments at 3 months were 34 mg and 17 mg, respectively. A higher proportion of early patients achieved a reduction in opioid use and improved pain control. No serious safety issues were reported, and patients reported high satisfaction. Authors concluded that the addition of cannabis “to standard oncology care was well-tolerated and may lead to improved pain control and lower opioid requirements.”

Zylla DM, Eklund J, Gilmore G, Gavenda A, Guggisberg J, VazquezBenitez G, Pawloski PA, Arneson T, Richter S, Birnbaum AK, Dahmer S, Tracy M, Dudek A. A randomized trial of medical cannabis in patients with stage IV cancers to assess feasibility, dose requirements, impact on pain and opioid use, safety, and overall patient satisfaction. Support Care Cancer. 2021;29(12):7471-7478.

Science/Human — Cannabis may improve sleep according to a placebo-controlled study

A cannabis extract may improve sleep in patients suffering from insomnia according to a crossover study conducted by investigators of the University of Western Australia in Crawley, Flinders University in Adelaide, and other researchers from Australia.

Twenty-three of 24 randomized participants completed the protocol. No serious adverse events were reported. A large battery of standard parameters measuring sleep duration and quality of sleep were improved following cannabis use. Authors concluded that “two weeks of nightly sublingual administration of a cannabinoid extract (ZTL-101) is well tolerated and improves insomnia symptoms and sleep quality in individuals with chronic insomnia symptoms.”

Walsh JH, Maddison KJ, Rankin T, Murray K, McArdle N, Ree MJ, Hillman DR, Eastwood PR. Treating insomnia symptoms with medicinal cannabis: a randomized, crossover trial of the efficacy of a cannabinoid medicine compared with placebo. Sleep. 2021;44(11):zsab149.

Science/Human — The use of cannabis improved chronic pain and sleep in case series

In a case series of 110 patients suffering from chronic pain from the UK Medical Cannabis Registry, a treatment with a cannabis oil improved pain, quality of life and sleep quality. Investigators from the Imperial College Medical Cannabis Research Group in London and other institutions from the UK conducted the study.

Authors wrote that “treatment of chronic pain with Adven CBMP oils was associated with an improvement in pain-specific outcomes, health-related quality of life, and self-reported sleep quality. Relative safety was demonstrated over medium-term prescribed use. “

Kawka M, Erridge S, Holvey C, Coomber R, Usmani A, Sajad M, Platt MW, Rucker JJ, Sodergren MH. Clinical Outcome Data of First Cohort of Chronic Pain Patients Treated With Cannabis-Based Sublingual Oils in the United Kingdom: Analysis From the UK Medical Cannabis Registry. J Clin Pharmacol. 2021;61(12):1545-1554.

News in brief

Brazil — Federal Court in Pernambuco authorizes Recife association to use cannabis for medicinal purposes

The Federal Court in Pernambuco (JFPE) has authorized the Recife-based association Amme Medicinal to plant, manipulate and produce products derived from cannabis for medicinal purposes only. The Judge of the 12th Federal Court, Joana Carolina Lins Pereira, signed the injunction on November 15th. Amme Medicinal is an association located in the Madalena neighbourhood, in the West Zone of Recife, which serves patients who make use of therapeutic cannabis oil for various pathologies.

Folha de Pernambuco of 18 November 2021

USA — Republicans in the House of Representatives want to decriminalise cannabis on a federal level

Republicans in the U.S. House of Representatives introduced legislation on 15 November that would decriminalize cannabis at the federal level and eliminate legal hazards facing many cannabis-related businesses while regulating its use like alcohol. Representative Nancy Mace of South Carolina, who is spear-heading the legislative effort, described the bill as a "compromise" with less onerous regulations than measures proposed earlier by other lawmakers including Democrats.

Reuters of 15 November 2021

Science — THC shows activity against the malaria parasite

In a study THC was shown to inhibit the growth of the malaria parasite Plasmodium falciparum. CBD was only mildly effective.

University of Cape Town, Department of Chemistry, South Africa.

de Sousa ACC, et al. Bioorg Med Chem Lett. 2021;54:128442.

Science/Animal — THC restores working memory in mice after brain injury

The administration of THC for 3 days after controlled cortical impact “promotes significant functional recovery from traumatic brain injury (TBI) in the realms of working memory and locomotor function.”

James Haley VA Medical Center and University of South Florida, Tampa, USA

Song S, et al. Cannabis Cannabinoid Res. 2021 Nov 5.

Science/Human — Cannabis users have a lower risk for an infection with Helicobacter Pylori

In a study with 4556 participants recreational cannabis use was associated with diminished risk of Helicobacter Pylori infection.

Division of Gastroenterology, Hepatology, and Nutrition, University of Pittsburgh, Pennsylvania, USA

Adejumo AC, et al. Cannabis Cannabinoid Res. 2021 Nov 8.

Science/Human — Cannabis use was not associated with suicide in adolescents

In a study with 6582 adolescents, who were asked for cannabis use at the age of 15 or 16 years, there was not an increased risk for suicide at the age of 33 but an increased risk for self-harm.

University of Turku, Faculty of Medicine, Department of Psychiatry, Turku University Hospital, Finland.

Alexander D, et al. Acta Psychiatr Scand. 2021 Nov 10.

Science/Animal — High doses of CBD reduced sperm quality

In a study with mice, which received 30 mg CBD/kg bodyweight, reduced sperm quality was observed due to deregulation of the endocannabinoid system.

Department of Pharmacology, Laboratory of Physiology and Pharmacology of Reproduction, Federal University of Goiás, Brazil

Carvalho RK, et al. Chem Biol Interact. 2021:109743.

Science/Human — Cannabis use in pregnancy does not increase the risk for autism in offspring

In a study with children aged 30 to 68 months, who either had autism (1198) or were healthy (1628) cannabis use had no influence on the risk of autism spectrum disorder.

Department of Epidemiology, Colorado School of Public Health, University of Colorado Anschutz, Aurora, USA.

DiGuiseppi C, et al. J Autism Dev Disord. 2021 Nov 12.

Science/Animal — The activation of cannabis receptors promoted metastasis in hypoxia-induced breast cancer

The activation of cannabis receptors promoted tumour growth and metastasis in chronic intermittent hypoxia induced breast cancer.

Second School of Clinical Medicine, Shanxi Medical University, Taiyuan, China.

Li LT, et al. Mol Ther Oncolytics. 2021;23:220-230.

Science/Animal — CB2 receptors and NMDA receptors may be co-localised in certain brain cells

Researchers found complexes of CB dachte 2 receptors and NMDA receptors in microglia cells and nerve cells of mice. They wrote that their negative crosstalk maybe “a tool to modulate excessive glutamate input” by the use of cannabinoids.

Centro de Investigación Biomédica en Red Enfermedades Neurodegenerativas (CiberNed), National Institute of Health Carlos iii, Madrid, Spain

Rivas-Santisteban R, et al. Alzheimers Res Ther. 2021;13(1):184.

Science/Animal — Activation of the CB2 receptor may reduce the development of morphine tolerance

Activation of the CB2 receptor reduced morphine tolerance and this was mainly due to an effect on a protein called MKP (mitogen activated protein kinase phosphatase).

Department of Anesthesiology, Harbin Medical University Cancer Hospital, Harbin, China.

Kong Q(1), et al. Neuroscience. 2021:S0306-4522(21)00558-3.

Science/Animal — CBD reduced inflammation in an animal model of multiple sclerosis

In a model of multiple sclerosis known as experimental autoimmune encephalomyelitis (EAE) the administration of CBD reduced several markers of inflammation.

Department of Pathology, Microbiology and Immunology, University of South Carolina School of Medicine, USA.

Dopkins N, et al. J Neuroimmune Pharmacol. 2021 Nov 10.