IACM-Bulletin of January 20, 2008

Israel — Patients may get an approval from the government for the medical use of cannabis

A Tel Aviv medical clinic has quietly begun giving cannabis to cancer and AIDS sufferers, legally and with Health Ministry approval. The clinic began giving the drug to patients about six months ago. By Israeli law, cannabis can legally be used as a medicine if a patient obtains a special approval from the Health Ministry. The cannabis is grown in Israel.

The drug is approved usually only for patients with cancer, AIDS or chronic inflammation of the intestine. The clinic, which the Health Ministry has refused to identify publicly, gives out the drug in small, controlled quantities when a patient presents his license. A spokesman for the Israel Cancer Association said the drug could reduce side-effects for some patients undergoing chemotherapy or other treatments, and the organization would consider adding information about this to its website.

The article is available at:

http://www.jpost.com/servlet/Satellite?cid=1198517303901&pagename=JPost%2FJPArticle%2FShowFull

(Source: Jerusalem Post of 6 January 2008, personal communication by Dr. Raphael Mechoulam)

Science — Nabilone was less analgesic than dihydrocodeine in patients with neuropathic pain

A clinical study conducted at three hospitals in the UK showed that nabilone at a maximum daily dose of 2 mg was less effective in reducing pain in 96 patients with chronic neuropathic pain than dihydrocodeine at a maximum daily dose of 240 mg. Nabilone is a synthetic derivative of THC, and 2 mg are about as effective as 15-20 mg THC. 240 mg dihydrocodeine is about equal effective as 24 mg morphine. In this crossover study patients received increasing doses of both medications for six weeks each separated by a washout period of two weeks. On a visual analogue scale for pain intensity from 0 to 100 mm the patient`s pain score had to be greater than 40 mm. Participants were allowed to continue to use their pain medications exept for dihydrocodeine and cannabinoids.

64 patients completed the whole study. Dihydrocodeine was a significantly better anlagesic than nabilone, but scientists noted that "the clinical significance of this difference is small, and neither drug was particularly effective." Three of the 64 patients had a pain reduction of more than 10 mm on nabilone and 12 patients on dihydrocodeine. No patient had a pain reduction of more than 10 mm on both drugs. Nabilone was associated with a little more side effects than dihydrocodeine, but no major adverse events occurred and both drugs were equally well tolerated.

The whole report is available at:

http://www.bmj.com/cgi/search?fulltext=nabilone

(Source: Frank B, Serpell MG, Hughes J, Matthews JN, Kapur D. Comparison of analgesic effects and patient tolerability of nabilone and dihydrocodeine for chronic neuropathic pain: randomised, crossover, double blind study. BMJ. 2008 Jan 8 [Electronic publication ahead of print])

Canada — The regulation which allows growers of cannabis to supply the drug to only one patient is unconstitutional, a federal court rules

Canadians who are prescribed cannabis to treat their illnesses will no longer be forced to rely on the federal government as a supplier following a Federal Court ruling that struck down a key restriction in the government`s medical cannabis program. The decision by Judge Barry Strayer, released on 10 January, essentially grants medical cannabis users more freedom in picking their own grower and allows growers to supply the drug to more than one patient. Currently, medical users can grow their own cannabis but growers can't supply the drug to more than one user at a time.

In his decision, Strayer called the provision unconstitutional and arbitrary, as it "caused individuals a major difficulty with access." The government must also reconsider requests made by a group of medical users who brought the matter to court to be allowed to have a single supplier as their producer, Strayer said in his 23-page decision. While the government has argued that medical users who can't grow their own cannabis can obtain it from the government, fewer than 20 per cent of patients actually use the government's supply, Strayer wrote. The government may appeal the decision.

The whole article is available at:

http://canadianpress.google.com/article/ALeqM5itrp6kt_GluGtdJ_YR5bWOGSDKPw

(Source: Canadian Press of 11 January 2008)

News in brief

Science — HIV and drug use

Researchers of the University of California at Los Angeles investigated the effects of drug use on subpopulations of T-lymphocytes in men with HIV in a longitudinal study, which started in 1996. They found no clinically meaningful associations between the use of cannabis or other drugs and CD4 and CD8 T cell counts, percentages, or rates in change of CD4 and CD8 cells. (Source: Chao C, et al. Drug Alcohol Depend. 2008 Jan 2 [Electronic publication ahead of print])

Science — Tolerance to THC effects

American scientists investigated differences between THC effects in 30 regular users of cannabis and 22 non-users. All participants received 0, 2.5 and 5 mg intravenous THC on three different days. Relative to non-users, frequent users showed tolerance to the psychotomimetic, perceptual altering, cognitive impairing, and anxiogenic effects of THC but not to its euphoric effects. (Source: D'Souza DC, et al. Neuropsychopharmacology. 2008 Jan 9 [Electronic publication ahead of print])

Science — Liver transplantion

Researches at the University of Rochester in the state of New York investigated associations between relapse after liver transplant and several variables, including drug abuse and drug dependence. The use of drugs was not associated with the risk to relapse. They concluded, that patients with abuse of drugs "should not be categorically denied access to liver transplant." (Source: Nickels M, et al. Exp Clin Transplant 2007;5(2):680-5.)