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IACM-Bulletin of September 27, 2009


Science — External therapy with cannabinoids effective in reducing pain in patients with herpes zoster

Researchers at the Clinic for Skin Diseases at the University of Muenster, Germany, investigated the efficacy of an external treatment of chronic pain caused by herpes zoster with a cannabinoid that activates cannabinoid receptors. In an open-label trial, 8 patients with facial neuralgia in herpes zoster received a cream containing the endocannabinoid palmitoylethanolamine. The course of symptoms was scored with a visual analogue scale.

Five of 8 patients (62.5 per cent) experienced a mean pain reduction of 88 per cent. The therapy was well tolerated by all patients. No unpleasant sensations or adverse events occurred. The authors concluded that "topical cannabinoid receptor agonists are an effective and well-tolerated adjuvant therapy option in postherpetic neuralgia." This cream is already on the market in Germany under the trade name "Physiogel A.I. Crème" used to treat pruritus.

(Source: Phan NQ, Siepmann D, Gralow I, Ständer S. Adjuvant topical therapy with a cannabinoid receptor agonist in facial postherpetic neuralgia. J Dtsch Dermatol Ges. 2009 Sep 10. [Electronic publication ahead of print])

USA — Medical cannabis law creates confusion in the State of Washington

In one corner of the State of Washington, a 62-year-old rheumatoid arthritis patient could face more than eight years in prison for growing cannabis for himself and three others, while in the town of Seattle a co-operation of growers serves 2,000 people with little interference from police. This discrepancy is typical of the confusion that has reigned since voters passed the medical cannabis law more than a decade ago. A patient may possess up to 15 cannabis plants and 24 ounces (680 grams) of dried plant material.

Unlike some other states, Washington requires patients to grow cannabis themselves or designate a caregiver to grow it for them. But some patients are too sick to grow cannabis themselves and don't have the money to set up a growing operation. So they have established collective grows or dispensaries - methods that are making police and prosecutors increasingly uncomfortable. The American Civil Liberties Union of Washington recently began discussions with Seattle police over whether to limit the size of cooperative grows. In Spokane this month, police shut down a medical cannabis dispensary - the first such measure in the state - and arrested the two owners. They warned a half-dozen other dispensaries to close as well.

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(Source: Associated Press of 20 September 2009)

News in brief

Holland — Coffee shops

On 15 September a Dutch judge rejected an application by six coffee shops from two southern towns against their mayors' plans to stop them selling cannabis. The case had been brought before the wrong court, said the judge. The mayors of Roosendaal and Bergen-op-Zoom, both near the border with Belgium, announced last year that all eight coffee shops in their borders would be banned from selling cannabis from 16 September on to reduce the number of cannabis-smoking tourists. (Source: Traveller of 16 September 2009)

Science — Post traumatic stress disorder

In a long-term study at the University of Pittsburgh, USA, with 693 adolescents who were included in the study at the age of 10 to 12 years and followed to the age of 25 years the presence of post traumatic stress disorder increased the risk for cannabis use disorder. Participants with traumatic stress disorder had a 13-fold increase in risk for regular cannabis use. (Source: Cornelius JR, et al. Addict Behav 2009 Sep 11. [Electronic publication ahead of print])

Science — Multiple sclerosis

Research with the cannabis extract Sativex on patients with MS presented already earlier in the IACM-Bulletin was now presented at the congress of the European Committee for Treatment and Research in Multiple Sclerosis (ECTRIMS) in Dusseldorf, Germany, in September. In a phase III this trial with 572 patients "Sativex demonstrated a statistically significant and clinically relevant improvement in spasticity and was well tolerated in MS patients." (Source: Press release by GW Pharmaceuticals of 14 September 2009)

Science — Drop of blood pressure

Scientists at the Medical Faculty of the Charité in Berlin, Germany, tested the hypothesis that high endocannabinoid concentrations predispose to drop of blood pressure while standing. However, they observed the contrary. Anandamide plasma concentration at rest was directly correlated with better resistance to drop of blood pressure during medical tests that cause orthostatic stress. (Source: Schroeder C, et al. Clin Auton Res 2009 Sep 15. [Electronic publication ahead of print])

Science — Pain

Scientists of the University of Sydney explained why cannabinoids may increase acute pain while reducing chronic pain. Endocannabinoids produced in the spinal cord can enhance pain by dampening the synapses of inhibitory nerve cells. This pain-promoting action of endocannabinoids wanes during the development of chronic pain that is induced by inflammation or nerve injury. (Source: Christie MJ & Mallet C. Sci Signal 2009;2(88):pe57.)

Science — Multiple sclerosis

At the department of neuroscience of the University Tor Vergata in Rome, Italy, the effects of Sativex, a medication containing equal amounts of THC and CBD, on 20 MS patients were investigated. The cannabis extract failed to influence spasticity and the excitability of the stretch reflex. Cannabis also had no effect on the synthesis and the degradation of the endocannabinoid anandamide, as well as on the expression of both CB1 and CB2 receptors in lymphocytes, a type of white blood cells. (Source: Centonze D, et al. Neurol Sci 2009 Sep 19. [Electronic publication ahead of print])