IACM-Bulletin of March 20, 2005

UK — Survey on the medical use of cannabis

A questionnaire study of patients who use cannabis for medical reasons in Britain found 16 per cent do so on the advice of their doctors. The study was conducted between 1998 and 2002 and published in the March issue of the International Journal of Clinical Practice.

3663 questionnaires were distributed and 2969 were returned. 60.9 per cent of the participants were women, the mean age was 52.7 years. Cannabis was used by a considerable percentage of patients. 25 per cent of patients with chronic pain used it. The numbers for other diseases are: multiple sclerosis (22 per cent), depression (22 per cent), arthritis (21 per cent) and neuropathy (19 per cent). Medicinal cannabis use was associated with younger age, male gender and previous recreational use of cannabis.

More than a third (35 per cent) of the medicinal cannabis users said they used it six or seven days a week. The majority (68 per cent) said cannabis considerably eased their symptoms. "The results of our UK survey, including the extent of use and reported effects, lend support to the further development of safe and effective medicines based on cannabis," said lead author Dr. Mark Ware of McGill University of Montreal (Canada).

(Sources: United Press International of 17 March 2005, Ware MA, et al. The medicinal use of cannabis in the UK: results of a nationwide survey. IJCP 2005;59(3):291)

Holland — Comparison between cannabis from coffee shops and from the Office of Medicinal Cannabis

Researchers of the University of Leiden in cooperation with the laboratories Farmalyse (Zaandam) and Bactimm (Nijmegen) compared the quality and price of cannabis sold by coffee shops and cannabis of the Office of Medicinal Cannabis (OMC) of the Health Ministry delivered by pharmacies.

Researchers found that cannabis from coffee shops may be contaminated by bacteries and fungi, that may harm seriously ill patients. The micro-organisms found on the samples included Coli-bacteria and several Aspergillus species. Coli-bacteria are faecal bacteria, that may have found their way into the cannabis by somebody who did not wash his hands. “This may go well in healthy people, but is a hazard to people who use this as a medicine," lead researcher Dr. Rob Verpoorte said. No micro-organisms were found on the medicinal cannabis distributed to pharmacies by the OMC.

There were only small price differences between cannabis from pharmacies, patients' foundations and coffee shops, based on the amount of THC in the cannabis. The average price in coffee shops was between 6 and 7 euros per gram. The cannabis in pharmacies was 10 to 40 per cent more expensive, but coffee shops often sold more then 5 per cent too little. One coffee shop gave 7.5 gram in stead of the 10 grams that were ordered and paid.

(Source: Newsletter of the Office of Medicinal Cannabis)

News in brief

Science — Medical use in the Netherlands

A survey on the medical use of cannabis conducted before the distribution of medical cannabis by the Dutch Health Ministry was published in the journal Neurology. 300 questionnaires were distributed by Maripharm, a firm that delivered cannabis to pharmacies. 107 patients completed and returned the questionnaire. Mean duration of cannabis use was 5.4 months. The main reported diagnosis for which the cannabis was prescribed were neurological disorders such as multiple sclerosis and spinal cord injury and cancer. In 18.4 per cent no positive effects of cannabis were reported. A good or excellent effect was noted by 64.1 per cent. (Source: Gorter RW, et al. Neurology 2005;64(5):917-9)

Science — Liver cirrhosis

According to new research the cannabinoid receptor CB2 plays an antifibrogenic role in the liver and cannabinoids may help to block the development of liver fibrosis. CB2 receptors were found in liver cells of patients with active cirrhosis, but were absent in normal human liver. Activation of CB2 receptors caused potent antifibrogenic effects, namely, growth inhibition of liver fibrogenic cells and apoptosis. Authors note that their research "highlights the antifibrogenic role of CB2 receptors during chronic liver injury." (Source: Julien B, et al. Gastroenterology 2005;128(3):742-55)

Science — Prostate cancer

Researchers of the University of Wisconsin found that CB1 and CB2 receptors are present in higher concentration in cancer cells of the prostate than in normal prostate cells. Treatment with a cannabinoid (WIN55,212-2) resulted in a dose-dependent inhibition of cell growth and induction of apoptosis in cancer cells. Researchers also noted further anti-cancer effects in the cells. They note that cannabinoids "could be developed as novel therapeutic agents for the treatment of prostate cancer." (Source: Sarfaraz S, et al. Cancer Res 2005;65(5):1635-41)

Science — Bladder inflammation

According to a press release by Indevus Pharmaceuticals their synthetic cannabinoid IP 751, better known as CT3 or ajulemic acid, was effective in an animal model of interstitial cystitis. It significantly reduced the bladder over-activity associated with the disease, without affecting the normal voiding mechanism of the bladder. IP 751 was tested in a highly-standardized animal model of bladder inflammation and over-activity performed by Dr. Michael Chancellor, Professor at the University of Pittsburgh. "Currently, patients with interstitial cystitis have very few treatment options," he said. (Source: Press release of Indevus Pharmaceuticals of 7 March 2005)

Germany — Patent for production of dronabinol

THC Pharm, a pharmaceutical company in Frankfurt, which produces and delivers dronabinol (THC) to pharmacies since 1998, received a patent for the production of semi-synthetic dronabinol. The patented method allows the production of THC from fibre hemp with high purity. "In contrast to the required purity of 95 per cent we are now able to produce 99 per cent pure dronabinol, a significant plus in safety for doctors, pharmacists and patients," said Christian Steup, head of the firm's laboratory. (Source: ots of 10 March 2005)

UNO — 2004 Report of the INCB

The International Narcotics Control Board (INCB) of the UN made some remarks on the medical use of cannabis in its annual report. "Since the end of the 1990s, scientific research on the therapeutic usefulness of cannabis or cannabis extracts is in progress in several countries, including Canada, Germany, the Netherlands, Switzerland, the United Kingdom and the United States. (…) Results of such research regarding the potential therapeutic usefulness of cannabis or cannabis extracts remain limited. The Board therefore wishes to voice concern about the medical use of cannabis in Canada and the Netherlands and in some jurisdictions of the United States, in the absence of conclusive results on the effectiveness of such use. The Board confirms that it welcomes sound scientific research in this respect, as stated in previous reports (…)." (Source: Report of the INCB of 3 March 2005)

Germany — Acquittal valid

On 3 March the prosecutor in a criminal procedure against a MS patient who used cannabis against ataxia accepted the ruling of the court of Mannheim. On 19 January the court of Mannheim acquitted a multiple sclerosis patient who was accused of illegal possession of cannabis. 600 grams of cannabis had been found at the home of the 41 year old defendant. The prosecutor accepted the treatment with cannabis in this case as necessary. However, he decided to appeal since he regarded the amount of cannabis to be to high. Now he changed his mind making the acquittal valid and Michael Fischer one of the few German medical cannabis users, who achieved an acquittal in court. (Source: Personal communication)