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IACM-Bulletin of March 1, 2009


Science — Nabilone effective in the treatment of nightmares in patients with posttraumatic stress disorder

According to an article by a psychiatrist of the Health Services of the Canadian army in Ottawa the synthetic cannabinoid nabilone was effective in the treatment of symptoms of posttraumatic stress disorder (PTSD). Nabilone causes similar effects as the natural cannabinoid dronabinol (THC). Charts of 47 patients diagnosed with PTSD and having continuing nightmares in spite of conventional antidepressants and sedatives were reviewed after adjunctive treatment with nabilone was initiated. These patients had been referred to a psychiatric specialist clinic between 2004 and 2006.

The majority of patients (72 per cent) receiving nabilone experienced either cessation of nightmares or a significant reduction in nightmare intensity. Subjective improvement in sleep time, the quality of sleep, and the reduction of daytime flashbacks and night sweats were also noted by some patients. This is the first clinical report of the use of cannabinoids for the treatment of posttraumatic stress disorder.

(Source: Fraser GA. The use of a synthetic cannabinoid in the management of treatment-resistant nightmares in posttraumatic stress disorder (PTSD). CNS Neurosci Ther 2009;15(1):84-8.)

Science — The beneficial effects of Sativex in MS patients with spasticity last long-term

According to a press release by the British company GW Pharmaceuticals their cannabis extract Sativex caused long-term reduction of spasticity in patients with multiple sclerosis. A withdrawal study evaluated 36 patients who had previously been taking Sativex on prescription for a mean duration of 3.6 years. The participants were randomized to Sativex or placebo for 4 weeks in a double-blinded manner. During this period, patients were not permitted to change their dose.

The primary efficacy endpoint of the study - the time to treatment failure - was statistically significant in favour of Sativex. The difference between Sativex and placebo was also significant for the patient global impression of change and the carer functional-ability global impression of change. This means that the carer recognised that the patient’s spasticity became worse when they stopped taking Sativex - thus providing independent verification of the primary endpoint.

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(Source: Press release by GW Pharmaceuticals of 24 February 2009)

Science — Cannabis and THC effective in the treatment of cluster headache in a case report

According to a case report of researchers at the Montefiore Headache Center of the Albert Einstein College of Medicine in New York, USA, both smoked cannabis and oral dronabinol (THC) were effective in the treatment of cluster headache. A 19-year-old university student had developed a cyclical pattern of attacks occurring predictably every 1 to 2 months and lasting approximately 2 weeks. During these 2-week cluster periods, he experienced one headache attack every other day. Every attack lasted three to four hours if not treated. Numerous medications had been tried to prevent and treat his condition, but none resulted in a relevant improvement.

The patient had noted that the use of cannabis at the onset of his headaches consistently brought complete relieve within 5 minutes after inhalation for each attack. At the hospital cannabis was replaced by THC, which also provided dramatic relief. Researchers noted that the "beneficial effect may be related to the high concentration of cannabinoid receptors in the hypothalamus, which has been implicated as a site of dysfunction in neuroimaging studies of patients with cluster headache."

(Source: Robbins MS, Tarshish S, Solomon S, Grosberg BM. Cluster Attacks Responsive to Recreational Cannabis and Dronabinol. Headache. 2009 Feb 11. [Electronic publication ahead of print])

News in brief

USA — Obama and raids

Remarks made by the U.S. attorney general at a recent press conference confirmed that the new federal government will be stopping raids of medical cannabis dispensaries and working toward establishing a policy to aid patients with access to cannabis. On 25 February Attorney General Eric Holder said the administration would uphold the president's campaign promises to end such raids. (Source: Times-Standard of 27 February 2009)

Science — Bladder emptying

An animal study at the University of Munich, Germany, showed that activation of the CB2 receptor increased the interval between bladder emptyings (micturitions) and reduced the tonus of the bladder. This may explain the therapeutic effects of THC and cannabis in multiple sclerosis patients, who have an increased frequency of bladder emptying due to an increased tonus of the bladder. (Source: Gratzke C, et al. J Urol 2009 Feb 21. [Electronic publication ahead of print])

Science — Loss of teeth

According to a study at the University of Aarhus, Denmark, the use of cannabis was not associated with a loss of adherence of teeth. Data from a screening examination carried out among Chilean students were analysed. Regular users had no increased risk for diseases of the periodontium and for loosing their teeth. Since THC causes dry mouth, loss of teeth has been suggested as a possible side effect, but this was the first study to investigate this issue. (Source: López R and Baelum V. J Clin Periodontol 2009;36(3):185-9.)

Science — Narcosis

In a study with 30 regular users of cannabis and 30 non-users the requirement of propofol for the induction of general anaesthesia was investigated. The cannabis group required a significantly higher dose of this drug. (Source: Flisberg P, et al. Eur J Anaesthesiol 2009;26(3):192-195.)

Science — Colitis ulcerosa

Researches of the University of Erlangen-Nuremberg, Germany, studied effects of the endocannabinoid anandamide in experimental colitis induced by a chemical in mice. Administration of anandamide significantly reduced the inflammation. (Source: Engel MA, et al. J Physiol Pharmacol 2008;59(4):673-89.)