IACM-Bulletin of February 15, 2004

Canada — Patients may be kept away from cannabis due to its illegal drug image

The stigma attached to cannabis use keeps seriously ill patients from taking advantage of the medicinal benefits of the drug, according to a study by palliative care specialist Dr. Romayne Gallagher, a professor at the University of British Columbia.

She conducted a survey of dying patients in palliative care units in Kelowna and Vancouver, which showed these patients worried that smoking marijuana could damage their lungs, be illegal or cause addiction. They were also worried about the impact cannabis smoke might have on family members.

Morphine also has an enduring stigma, said Dr. Gallagher. Even though many patients are dying in a lot of pain, they are concerned about the issues surrounding drug use. Often, their fears reflect the views of the physicians prescribing it, she said. "What's frustrating for patients is that the physician's apprehension makes them feel they have to justify that they are in pain all the time. A general practitioner might not be comfortable prescribing an opioid, and the patient is humiliated because he had to keep justifying that he really was in pain."

Public education would help to decrease the stigma associated with cannabis use for medicinal purposes, she said. "What this study taught me is that we still need to do lots of public education about the stuff we have, which works quite well. People who get the best benefit from cannabis say it's wonderful, that they're getting good pain relief and that they're not stoned. I have used it in patients, most with non-cancer illnesses in non-palliative situations, like multiple sclerosis."

(Source: Haley L. Your bias may be keeping pot from pain patients. Medical Post of 3 February 2004, Vol. 40(5))

Germany — Federal government breaks its word on medical cannabis

In a letter of 29 January 2004 the Federal Health Ministry told the German Association for Cannabis as Medicine (ACM), that "for the present" the ministry does not want to make a cannabis extract available on prescription. The scientific knowledge on the medical effects of cannabis would not suffice to justify such a move.

In spring 1999 the health ministry asked the responsible institution of the German Pharmacists Associations to develop a formula for a cannabis extract, so that pharmacists were able to produce such extracts. At that time representatives of the ACM were told that the federal government intends to change the law to allow doctors to prescribe this extract. A cannabis extract could be available as early as autumn 2001.

In a conjoint article of a representative of the German Medical Association and the Federal Health Ministry for the Journal of the German Medical Association, the Journal of the German Pharmacists Association and the German Pharmaceutical Journal of April 2001 the stance of the health ministry was made known to health care professionals, according to which "the rescheduling of a cannabis extract into schedule 3 of the narcotics law was prepared." In a letter of the Federal Health Ministry to the petition committee of the German Bundestag of 28 September 2001 this intention was repeated.

After some delays the German Pharmacists Associations submitted their draft of a cannabis extract formula in summer 2003. The federal health ministry now writes, this formula was "passed on" to the ministry, ignoring that it had asked for its preparation. Instead of preparing the necessary law change the "federal government continues to carefully watch the scientific efforts to demonstrate the therapeutic efficacy of cannabis extract."

The chairman of the ACM, Dr. Franjo Grotenhermen, called this behaviour "a deception of the public and rude breaking of the word". The reason provided in the letter would be weak, questionable and characterized by a "heartless bureaucracy language." "The federal government is in political trouble and apparently tries to avoid another possible target of attack, on the back of patients."

Science — The effect of cannabis on driving capability is dose-dependent

Accident causes were analysed in an Australian study with 3398 fatally-injured drivers. While drivers with low THC concentrations in their blood had a lower probability of causing a traffic accident than drug free drivers, higher THC concentrations were associated with a considerable higher culpability ratio.

For all drivers with only THC in their blood the odds ratio (OR) for causing an accident compared to drug free drivers was 2.7 (which means 2.7-fold). For drivers with more than 5 ng/ml THC in the blood the OR increased to 6.6. However, the culpability ratio for drivers with 5 ng/ml THC or less in their blood was lower than drug free drivers. Drug free means that no legal (alcohol, medical drugs) or illegal drugs were found.

The culpability ratio of drivers with a blood alcohol concentration above 0.05 per cent was about three times higher than that for the THC only group. The OR for drivers with THC and alcohol compared to the THC only group was 2.9, suggesting an additive effect of THC and alcohol on impairment of driver performance.

Drivers above the age of 60 and below the age of 25 had a higher culpability risk than drivers 30-59 years of age, the first probably due to a decreased psychomotor performance, the latter probably due to unexperience and higher risk-taking. The OR of drivers 18-25 years of age compared to drivers of 30-39 years of age was 1.7, the OR of drivers above the age of 60 compared to drivers of 30-39 years of age was 2.2.

(Sources: Drummer O, et al. The involvement of drugs in drivers of motor vehicles killed in Australian road traffic crashes. Accid Anal Prev 2004;36(2):239-48; personal communication by Olaf Drummer)

News in brief

Spain — Survey on medical use of cannabis

The public health service of Andalusia is conducting a survey on the medical use of cannabis and cannabinoids in Spain. The questionnaire is available on the IACM web site at

www.cannabis-med.org/spanish/nav/home-patients.htm

Switzerland — Acquittal of doctors

A court in Neuenburg acquitted five physicians who had prescribed cannabis to their patients for pain relief. According to the court's opinion the doctors did not have the intention to break the law, but wanted to alleviate the pain of their patients. The state of emergency in which the defendants acted alone would justify an acquittal, the court said. (Source: Tagesanzeiger of 3 February 2004)

UK — Doctor bought cannabis for patient

A Medical committee was told on 2 February that a doctor bought cannabis from a patient to help another who was dying of cancer. The doctor admitted twice supplying the drug to a 56-year-old woman with lymphoma. She had been receiving chemotherapy and radiotherapy treatment but stopped them when she was told she could not be cured. (Source: Daily Telegraph of 3 February 2004)

Science — Pain in HIV

The press agency Reuters reported of a study on smoked cannabis in neuropathic pain of 16 HIV patients, which was presented at the 11th Annual Retrovirus Conference, held in San Francisco on 8-11 February. Twelve of the 16 participants reached more than 30 per cent reduction in pain. The abstract of the study by Donald Abrams and his colleagues ("The effects of smoked cannabis in painful peripheral neuropathy and cancer pain refractory to opioids") was already presented at the IACM Conference in Cologne in September 2003 and is available online at

http://www.cannabis-med.org/studies/study.php

(Source: Reuters of 12 February 2004)

USA — Oakland

The city of Oakland in California will issue business licenses to four medical marijuana vendors and force eight others to close. Effective 1 June Oakland medical marijuana clubs operating under the state medical cannabis law (Proposition 215) must apply for business licenses. The city will select four vendors from among the applicants. (Source: San Francisco Chronicle of 5 February 2004)

Science — Psychosis

An analysis of the literature on the association between cannabis and psychosis was done by British scientists. Five studies were included. Cannabis use was found to be associated with an overall twofold increase in the relative risk for later schizophrenia. Scientists assume that elimination of cannabis use would reduce schizophrenia by approximately 8 per cent, "assuming a causal relationship." Cannabis use "appears to be neither a sufficient nor a necessary cause for psychosis." (Source: Arseneault L, et al. Br J Psychiatry. 2004 Feb;184(2):110-117.)

USA — Hemp foods

On 6 February the federal drug agency DEA (Drug Enforcement Administration) lost its battle to ban foods from hemp seeds such as hemp oil, which contain only minor THC concentrations. A court of appeals in San Francisco ruled that the DEA is not responsible for the regulation of these foods since they are not drugs. The DEA had claimed that all substances that contain THC are illegal drugs. (Source: Press release of the Hemp Industries Association of 6 February 2004)

IACM — Correction IACM-Bulletin

In the IACM Bulletin of 18 January 2004 we wrote that the number of people holding medical marijuana identity cards in Oregon is 7,584 now, which is not 2 per cent as we wrote but 0.2 per cent of the Oregonian population of 3.4 million.