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Bulletin .

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IACM-Bulletin of February 18, 2018

Authors
Franjo Grotenhermen M.D.

Science/Human — The medical use of cannabis improves cognitive performance

The medical use of cannabis improves performance of tasks testing cognition. This is the result of research by scientists of the McLean Hospital in Belmont, USA. Participants were tested before starting the intake of cannabis and 3 months later. Patients completed the Multi-Source Interference Test (MSIT) while undergoing functional magnetic resonance imaging (fMRI). The MSIT was designed to study normal human cognition and psychiatric pathophysiology.

Following 3 months of treatment, cannabis patients demonstrated improved task performance accompanied by changes in brain activation patterns within certain brain regions (cingulate cortex and frontal regions). Authors wrote that after cannabis treatment, “brain activation patterns appeared more similar to those exhibited by healthy controls from previous studies than at pre-treatment, suggestive of a potential normalization of brain function relative to baseline.” They concluded that their findings suggest that the medical use of cannabis “may result in different effects relative to recreational marijuana (MJ) use, as recreational consumers have been shown to exhibit decrements in task performance accompanied by altered brain activation.” Patients also reported improvements in clinical state and health-related measures.

Gruber SA, Sagar KA, Dahlgren MK, Gonenc A, Smith RT, Lambros AM, Cabrera KB, Lukas SE. The Grass Might Be Greener: Medical Marijuana Patients Exhibit Altered Brain Activity and Improved Executive Function after 3 Months of Treatment. Front Pharmacol. 2018;8:983.

Science/Human — The medical use of cannabis is safe in elder people

The therapeutic use of cannabis is safe and efficacious in the elderly population, a study by researchers of the Ben-Gurion University of the Negev in Be'er-Sheva, Israel, found in a group of 2736 patients above 65 years of age, who participated in a questionnaire. The mean age was 74.5 years. The most common indications for cannabis treatment were pain (66.6%) and cancer (60.8%).

After six months of treatment, 93.7% of the respondents reported improvement in their condition and the reported pain level was reduced from a median of 8 on a scale of 0-10 to a median of 4. Most common adverse events were: dizziness (9.7%) and dry mouth (7.1%). After six months, 18.1% stopped using opioid analgesics or reduced their dose. Authors concluded that their “study finds that the therapeutic use of cannabis is safe and efficacious in the elderly population. Cannabis use may decrease the use of other prescription medicines, including opioids.”

Abuhasira R, Schleider LB, Mechoulam R, Novack V. Epidemiological characteristics, safety and efficacy of medical cannabis in the elderly. . Eur J Intern Med. 2018 Feb 1. [in press]

Science/Human — CBD is effective against seizures in Lennox-Gastaut syndrome

CBD may be helpful in the treatment of epileptic seizures due to Lennox-Gastaut syndrome. This is the result of a placebo controlled study with 171 participants led by researchers of the Pediatric Epilepsy Program at the Massachusetts General Hospital in Boston done at 24 clinical sites in the USA, the Netherlands, and Poland. Patients were aged 2-55 years and received 20 mg/kg oral CBD daily or placebo for 14 weeks in addition to their usual medication.

The median percentage reduction in monthly seizure frequency from baseline was 43.9% in the CBD group and 21.8% in the placebo group. Adverse events occurred in 86% of patients in the CBD group and 69% in the placebo group; most were mild or moderate. Authors concluded that “add-on cannabidiol is efficacious for the treatment of patients with drop seizures associated with Lennox-Gastaut syndrome and is generally well tolerated.”

Thiele EA, Marsh ED, French JA, Mazurkiewicz-Beldzinska M, Benbadis SR, Joshi C, Lyons PD, Taylor A, Roberts C, Sommerville K; GWPCARE4 Study Group. Cannabidiol in patients with seizures associated with Lennox-Gastaut syndrome (GWPCARE4): a randomised, double-blind, placebo-controlled phase 3 trial.Lancet. 2018 Jan 25. [in press]