IACM-Bulletin of June 8, 2003

Science — THC reduces agitation and improves appetite in Alzheimer's patients

A pilot study suggests that THC (dronabinol) may reduce agitation and lead to weight gain in patients suffering from Alzheimer's disease. The results were presented on 15 May at the annual meeting of the American Geriatrics Society.

The study examined nine patients with a mean age of 83 years. All patients met accepted criteria for possible Alzheimer's disease and had unsatisfactory control of their agitation. The Mini Mental State Examination (MMSE), a test used to measure a person's basic cognitive skills, and an assessment of activities of daily living were used to evaluate patients at the start of the study and at one month. Patients initially received 2x2.5 mg THC daily, which was increased up to a maximum of 2x5 mg/day. In addition, all patients were treated with atypical neuroleptics and at least four medications to control behaviour.

After one month agitation was significantly reduced in six patients. Three patients experienced an average increase on the MMSE of 1.2 points (baseline: 11 points). Functional improvement was observed in three patients. Prior to the study, all patients experienced weight loss due to anorexia. After THC treatment all patients had gained weight. No adverse events, such as falls, syncope (short-term faint), seizures or exacerbation of agitation or depression were reported.

"Our trial, although preliminary, suggest dronabinol may reduce agitation and improve appetite in patients with Alzheimer's disease, when traditional therapies are not successful," said Dr. Joshua Shua-Haim, lead investigator in the study and medical director of the Meridian Institute for Aging in Central New Jersey.

In 1997 Dr. Ladislav Volicer and colleagues already conducted a study in 15 patients with Alzheimer's disease who refused food. Eleven patients completed the 12 week cross-over trial of THC and placebo (six weeks of each treatment). The THC treatment resulted in substantial weight gains. Surprisingly, THC also decreased severity of disturbed behaviour. In 1999 Unimed, the marketer of the THC preparation Marinol, estimated that about 5-10 percent of the drug's patient population consisted of Alzheimer's patients.

(Sources: PR Newswire of 15 May 2003; NORML of 29 May 2003; Volicer L, et al. Int J Geriatr Psychiatry 1997;12:913-9; Joy JE, Watson SJ, Benson JA (eds): Marijuana and Medicine: Assessing the Science Base. Institute of Medicine, National Academy Press, Washington DC 1999)

USA — Ed Rosenthal sentenced to one day in prison

A convicted cannabis grower was sentenced to one day in prison and fined $1,000 by a federal judge on 4 June, the most lenient sentence allowed under law.

Ed Rosenthal had faced a possible sentence of 100 years in prison and a potential fine of $4.5 million for his conviction in January. Federal authorities arrested Rosenthal last year for growing more than 100 cannabis plants to be sold for medicinal uses under the auspices of the medicinal marijuana ordinance of the City of Oakland (California). Rosenthal's supportes praised the sentence. One of Mr. Rosenthal's lawyers, Robert V. Eye, said the judge's handling of the sentence was a reminder that "justice can be done."

The judge, Charles R. Breyer of Federal District Court, had not allowed Rosenthal to raise the medicinal purpose of his cannabis growing as a defence, leading some jurors to later complain that they had been misled by the court. "If the jury got to hear that," another lawyer of Rosenthal, Dennis P. Riordan, said, "they could have decided Ed was acting in good faith and acquitted him." He said that he will appeal the conviction.

After convicting Mr. Rosenthal in January, several jurors requested a new trial, and when that failed, wrote to Judge Breyer urging leniency. At a hearing on 4 June, Judge Breyer said it was reasonable to conclude that Mr. Rosenthal had believed he was acting legally.

Though there was general consensus that the sentencing today did not amount to a legal breakthrough for advocates of medical marijuana, some predicted it would embolden the movement to challenge federal drug laws. And Andrea Barthwell, deputy director of the White House Office of National Drug Control Policy, said that she is "very concerned" that the sentence will "send the wrong signal."

(Sources: Associated Press of 4 June 2003, New York Times of 5 June 2003, Reuters of 5 June 2003, Berkeley Daily Planet of 6 June 2003)

News in brief

USA — Democratic candidate supports medical cannabis

One of the Democratic candidates for the presidential election in 2004 said on 29 May that if elected president, he would allow the use of cannabis for medical purposes "as an act of compassion and expression of humanity." "If a doctor makes that determination, or the patient asks for it, I think it ought to be permitted," Dennis Kucinich said. Kucinich's rival John Edwards said that as president he would not change the existing law but would set up a commission to study the medical effects of the drug. (Source: Associated Press of 29 May 2003)

Republicans and Democrats agreed on 4 June that the Federal Government should not use the money of tax payers to buy advertising to oppose state and local campaigns aimed at easing marijuana penalties. The agreement became part of legislation that would keep the White House anti-drug office in business for another five years. The Government Reform Committee of the House of Representatives approved the bill. Several other proposed expansions of the White House drug commissioner's power were also curtailed. (Sources: Associated Press of 4 June 2003, Oakland Tribune of 7 June 2003)