IACM-Bulletin of February 17, 2008

The Ministry of Social Affairs and Health wants to publish guidelines on the medical use of cannabis. Just over a year ago the National Agency for Medicines granted its first special permission for medical cannabis to a man suffering from chronic pain stemming from a back injury. The Agency had initially rejected the application for the use of cannabis prescribed by a Dutch doctor. The patient appealed the case to his regional Administrative Court, which overturned the decision.

The court decision also forced the Ministry for Social Affairs and Health to clarify legislation. It is expected, that in a few months changes will be enacted that allow the prescription of cannabis. Under the plan, even after the changes, cannabis prescriptions for medicinal purposes will require the permission of the National Agency for Medicines.

The report is available at: http://yle.fi/news/id77759.html

(Source: YLE News of 17 December 2007)

USA — The largest American association of physicians calls for reclassification of cannabis and protection of patients who use the drug according to state laws

The largest association of physicians, the American College of Physicians (ACP), is calling on the federal government to ease its strict ban on cannabis as medicine and hasten research into the drug's therapeutic uses. In a 13-page position paper the organization, which has 124,000 members, calls on the government to drop cannabis from Schedule I of narcotic drugs, a classification it shares with illegal drugs such as heroin and LSD. Narcotics of Schedule have no medicinal value and a high potential of abuse.

In their paper the ACP expresses the following five positions:

"Position 1: ACP supports programs and funding for rigorous scientific evaluation of the potential therapeutic benefits of medical marijuana and the publication of such findings. (…)

Position 2: ACP encourages the use of nonsmoked forms of THC that have proven therapeutic value.

Position 3: ACP supports the current process for obtaining federal research-grade cannabis.

Position 4: ACP urges review of marijuana’s status as a schedule I controlled substance and its reclassification into a more appropriate schedule, given the scientific evidence regarding marijuana’s safety and efficacy in some clinical conditions.

Position 5: ACP strongly supports exemption from federal criminal prosecution; civil liability; or professional sanctioning, such as loss of licensure or credentialing, for physicians who prescribe or dispense medical marijuana in accordance with state law. Similarly, ACP strongly urges protection from criminal or civil penalties for patients who use medical marijuana as permitted under state laws."

The paper is available on the website of the American College of Physicians at:

http://www.acponline.org/acp_news/medmarinews.htm

(Sources: Los Angeles Times of 14 February 2008, website of the ACP)

News in brief

USA — Oregon and Nevada

According to newspaper reports there are currently about 16.000 patients in Oregon and 900 in Nevada, who are allowed to use cannabis for medicinal purposes according to the state laws. (Sources: Oregonian of 4 February 2008, Nevada Appeal of 4 February 2008)

UK — Symposium

A joint symposium of the Academy of Pharmaceutical Sciences and the Royal Pharmaceutical Society of Great Britain entitled "Cannabinoid Medicines" will be held on 10 March 2008 in London. More information at: http://www.rpsgb.org/worldofpharmacy/events. (Source: Personal communication)

Science — Cognition

Researchers of the University of Toronto, Canada, investigated cognitive functioning in a group of 140 patients with multiple sclerosis, of whom 10 were current cannabis users. Cannabis users performed significantly worse on a test of information processing speed, working memory and sustained attention, the so-called Symbol Digit Modalities Test (SDMT). Researchers suggest to conduct more studies to clarify if cannabis use is responsible for the worse performance. (Source: Ghaffar O, et al. Neurology 2008, Feb 13 [electronic publication ahead of print])

Science — Course of cannabis use

German scientists investigated the natural course of cannabis use, abuse and dependence over a period of 10 years in 3021 subjects aged 14-24 years at baseline. In their research which will be published in March, about one third of the sample (34.2 per cent) had used cannabis at least once. 46.3 per cent of those who had used cannabis more than five times at baseline reported to have used cannabis also ten years later. (Source: Perkonigg A, et al. Addiction 2008;103(3):439-449)

Science — Allergy

Spanish scientists investigated allergies to cannabis leaves. They found out that subjects with an allergy against tomato have a high risk to also have an allergy to cannabis leaves. (Source: de Larramendi CH, et al. Int Arch Allergy Immunol 2008;146(3):195-202)

Science — Allergy

Researchers of the university of Florence, Italy, investigated the effects of a synthetic cannabinoid (CP55,940), which such as THC binds to both the CB1 and the CB2 receptor, on allergic asthma in animals. Asthmatic symptoms of Guinea pigs which were allergic against a certain protein (ovalbumin) improved considerably if they were given the cannabinoid before exposure to the allergen. (Source: Giannini L, et al. J Cell Mol Med. 2008 Feb 4 [Electronic publication ahead of print])

Science — Periodontosis

Scientists of New Zealand investigated whether cannabis smoking is a risk factor for periodontosis as is known for tobacco smoking. Data of a prospective study with 1015 participants who were followed from their birth in the 1972 and 1973 into adulthood were used (the so-called Dunedin birth cohort). The highest exposure cannabis group had an about doubled risk to present with signs of periodontosis. (Source: Thomson WM, et al. JAMA 2008;299(5):525-31.)

Researchers of New Zealand investigated the association between adult attention deficit/hyperactivity disorder (ADHD) and cannabis use in a prospective study of 1265 children who now were 25 years old (the so-called Christchurch birth cohort). Cannabis use by age 25 was significantly associated with increasing self-reported adult ADHD symptoms at the same age. (Source: Fergusson DM and Boden JM. Drug Alcohol Depend. 2008 Jan 31 [Electronic publication ahead of print])

Science — Fatty liver

According to French researchers daily cannabis use was associated with an increased risk of fatty liver in patients with hepatitis C. A total of 315 patients with untreated hepatitis C, who underwent liver biopsy were included in the study. Daily cannabis use was an independent risk factor, which doubled the frequency of fatty liver compared to occasional users and non users. (Source: Hézode C, et al. Gastroenterology 2008;134(2):432-9.)

Science — Lung cancer

In a study with 79 lung cancer patients of scientists of the Medical Research Institute of New Zealand heavy cannabis smoking was associated with a six-fold increase of lung cancer. This is one of the smallest study of this kind and the largest study conducted so far in the USA did not find an increased risk for lung cancer in cannabis smokers. (Source: Aldington S, et al. Eur Respir J 2008;31(2):280-6.)

Science — Pregnancy

In a prospective study with 648 children researchers of the University of Pittsburgh found a decreased performance in an intelligence test (Stanford-Binet Intelligence Scale) at age 6 if their mothers had used cannabis daily during pregnancy. (Source: Goldschmidt L, et al. J Am Acad Child Adolesc Psychiatry. 2008 Jan 22 [Electronic publication ahead of print])