IACM-Bulletin of June 6, 2010

Economy Germany — Volcano Medic launched as the first approved medical cannabinoid inhaler

The German company Vapormed launched the world’s first officially approved medical cannabinoid inhaler, the Volcano Medic Vaporizer. The Volcano Medic Vaporization System is intended to vaporize and facilitate the inhalation of dronabinol (THC) dissolved in alcohol or cannabinoids from cannabis flowers (cannabis flos). In their press release of 2 June the company notes that "the Volcano Medic Vaporization System resolves two medical-technical problems at the same time. On the one hand, for the first time the Volcano Medic Vaporization System allows for the medical inhalation therapy with liquid, in alcohol dissolved cannabinoids. On the other hand, it allows for the inhalation therapy with cannabinoids directly from dried hemp flowers. (…) In the Volcano Medic Vaporization System the cannabinoids are solved (vaporized) by heat impact only. A combustion as it takes place while smoking does not occur." This avoids the formation of noxious combustion products.

The main advantages of the inhalation of cannabinoids compared to oral administration would be the rapid onset of effects and cost reduction due to considerably higher efficiency of vaporized cannabinoids. "The systemic bioavailability of inhaled cannabinoids is approx. 29% - 40%. For comparison: The systemic bioavailability of cannabinoids administered orally is below 15%." The manufacturer of the Volcano Medic Vaporization System is the company Storz & Bickel. According to the press release the Volcano Medic will first be available in the Netherlands and in Germany. It is certified by TUEV SUED in Munich in compliance with the applicable directives and laws for medical devices. "The availability of the Volcano Medic in further countries depends on the availability of authorized and vaporizable cannabinoids or cannabis flowers in these countries," the company writes.

More information:

http://www.vapormed.com

(Source: Press release by Vapormed of 2 June)

Science — Cannabis effective in the treatment of Tourette Syndrome and attention deficit hyperactivity disorder (ADHD)

German scientists from the universities of Goettingen, Hamburg and Dresden reported of the treatment of a 15-year-old boy with treatment refractory Tourette Syndrome (TS) and attention deficit hyperactivity disorder (ADHD) leading to severe physical and psychosocial impairment. Administration of THC resulted in a considerable improvement of tics without adverse effects, allowing parallel stimulant treatment of comorbid ADHD. Along with THC treatment, intracortical inhibition, that is inhibition of signal transmission between nerve cells in the cortex of the brain, was increased.

Authors concluded that "our observation suggests that delta-9-THC might be a successful alternative in patients with severe TS refractory to classic treatment. Particularly in the case of stimulant-induced exacerbation of tics, delta-9-THC might enable successful treatment of comorbid ADHD. The enhancement of intracortical inhibition might be mediated by modulating release of several neurotransmitters including dopamine and gamma-aminobutyric acid."

(Source: Hasan A, Rothenberger A, Münchau A, Wobrock T, Falkai P, Roessner V. Oral delta9-tetrahydrocannabinol improved refractory gilles de la tourette syndrome in an adolescent by increasing intracortical inhibition: a case report. J Clin Psychopharmacol 2010;30(2):190-2.)

USA — Medical doctors in Montana who sign cannabis authorization forms at travelling clinics may be disciplined

Doctors working at mass medical cannabis clinics could be disciplined by the Montana Board of Medical Examiners under a policy the board adopted in May. Recommending a course of treatment after a brief consultation and without any follow-up does not meet the standard of care expected of Montana physicians, board members decided. They approved by unanimous vote a position paper that will allow them to sanction doctors for providing substandard care to medical cannabis users.

That could include signing medical cannabis authorization forms at travelling clinics or over the Internet. "The Board of Medical Examiners takes no position on the general suitability of marijuana in the treatment of medical disorders, but does have an obligation to protect the public by ensuring that physicians provide medical services via a bona-fide physician-patient relationship that meets the generally accepted standards of care," the paper states. Medical doctors across the state are angered by the way hundreds of citizens have secured medical cannabis cards at mass clinics staffed by out-of-state doctors. "I think it’s being corrupted," said Dr. Jim Guyer, director of a medical clinic in Billings. "The people coming through the door are exploiting it. The people who are going to get hurt are the people the law was intended for." The number of card holders for medical cannabis has considerably increased in the past 1.5 years in Montana and other states of the USA.

(Source: Billings Gazette of 24 May and 1 June 2010)

News in brief

USA — Arizona

For the fourth time, the voters of Arizona will decide in November whether people with certain ailments should be able to legally use cannabis. State officials confirmed that backers of the latest medical cannabis initiative had enough valid signatures on their petitions to be on the ballot. Arizonans have approved a similar measure twice. But that never took effect because of the way it was worded. (Source: The Sun of 1 June 2010)

USA — Washington D.C.

A tax on medical cannabis could generate some 400,000 US Dollars (about 330,000 Euros) for the city over the next five years, according to an estimate from financial officials of the city. The city council passed legislation earlier this year that permits residents with certain medical conditions to purchase cannabis. Now the budget council members are expected to vote on June 15 includes a provision that would impose the city's 6 percent sales tax on medical cannabis sold in the city. (Source: Associated Press of 1 June 2010)

Science — Amyotrophic lateral sclerosis

A clinical study with 27 patients suffering from amyotrophic lateral sclerosis (ALS) and cramps was conducted at the Kantonsspital St Gallen, Switzerland. In a double-blind, placebo-controlled crossover trial they received 5 mg THC twice daily for 2 weeks and a placebo for 2 weeks interrupted by a 2 week wash-out period. THC was well tolerated. There was "no evidence for a treatment effect on cramp intensity, number of cramps, fasciculation intensity or any of the other secondary outcome measures." (Source: Weber M, et al. J Neurol Neurosurg Psychiatry 2010 May 24. [in press])

Science — Motion sickness

According to research at the University of Munich, Germany, stress and motion sickness in humans are associated with impaired endocannabinoid activity. They concluded that enhancing endocannabinoid signalling "may represent an alternative therapeutic strategy for motion sickness in individuals who do not respond to currently available treatments." (Source: Choukèr A, et al. PLoS One 2010;5(5):e10752.)

Science — Essential fatty acids

Research at the University of Cordoba, Argentina, shows that the endocannabinoid system can be modulated by ingested polyunsaturated fatty acids since these fatty acids serve as precursors of the endocannabinoids. (Source: Dain A, et al. Front Biosci (Elite Ed) 2010;2:1432-47.)

Science — Cancer

According to research at the University of New York THC inhibits cellular respiration of human oral cancer cells. The scientists noted that their "results show that cannabinoids are potent inhibitors of Tu183 cellular respiration and are toxic to this highly malignant tumor." (Source: Whyte DA, et al. Pharmacology 2010;85(6):328-335.)

Science — Cancer

According to research of the University of Bristol, UK, the endocannabinoid anandamide induces cell death in colon cancer cells, which are resistant to apoptosis. This effect depended of cyclooxygenase-2 (COX-2). They noted that "as COX-2 is not expressed in the normal colorectal epithelium, but highly expressed in colorectal tumours (...) anandamide has the potential to be an effective therapeutic in colorectal cancer." (Source: Patsos HA, et al. Int J Oncol 2010;37(1):187-93.)

Science — Food intake

Basic research at the University of Manchester, UK, demonstrates that the peptide hemopressin decreases food intake in rats and mice. This effect was mediated by antagonism at the CB1 receptor. The scientists speculate "that hemopressin may act as an endogenous functional antagonist at CB1 receptors and modulate the activity of appetite pathways in the brain." (Source: Dodd GT, et al. J Neurosci 2010;30(21):7369-76.)

Science — Neuropathic pain

Researchers at the University of Frankfurt, Germany, investigated the mode of action of R-flurbiprofen in neuropathic pain. They found out that this substance inhibited the enzyme fatty acid amide hydrolase (FAAH) responsible for the degradation of anandamide. They concluded that R-flurbiprofen "improves the endogenous mechanisms to regain stability after axonal injury and to fend off chronic neuropathic pain by modulating the endocannabinoid system." (Source: Bishay P, et al. PLoS One 2010;5(5):e10628.)