IACM-Bulletin of May 29, 2005

Science — THC helps to reduce delayed nausea following cancer chemotherapy

Results of a new study show that THC (dronabinol) capsules help to reduce delayed nausea and vomiting following cancer chemotherapy. The study was presented on 16 May at the American Society of Clinical Oncology's Annual Meeting in Orlando, USA. It used Marinol, synthetic THC of Solvay Pharmaceuticals and was conducted by investigators at Bethesda Memorial Hospital in Boynton Beach, Florida, Compassionate Cancer Care in Fountain Valley, California, Duke University Medical Center in Durham, North Carolina, among others.

The research also suggested that adding a small dose of THC (2.5 mg) to the standard preventive antiemetic regimen helped relieve acute nausea and vomiting on the day of chemotherapy. On days 2 through 5 following chemotherapy, the study concluded that continued treatment with THC alone, or in combination with ondansetron (a commonly used drug against nausea and vomiting), was more effective than placebo in reducing delayed nausea and vomiting and comparable to ondansetron alone. Symptoms occurring on day 1 following chemotherapy are referred to as acute nausea and vomiting. Delayed nausea occurs more than 24 hours following chemotherapy treatment and sometimes is a result of poor symptom management of acute symptoms.

64 subjects receiving moderate to high emetogenic chemotherapy were included in a placebo-controlled, double-blind, parallel group, five-day study. Subjects were randomized into four therapy groups for evaluation on days 2 through 5: (1) THC; (2) ondansetron; (3) combination THC and ondansetron and (4) placebo. All groups received a standard pre-chemotherapy antiemetic regimen of dexamethasone (a corticosteroid) and ondansetron.

On day 1 total response to antiemetic treatment was observed in 79 percent of subjects receiving 2.5 mg THC in addition to standard medication compared to 40 percent of subjects receiving only the standard antiemetic therapy. On days 2 through 5 efficacy of THC was comparable to ondansetron. Both were significantly more effective in combating nausea and vomiting than placebo.

"Despite the introduction of new chemotherapy treatments and antiemetics since the approval of Marinol in 1985, there still remains an unmet need for patients suffering from nausea and vomiting," said Dr. Harold H. Shlevin, president of Solvay Pharmaceuticals.

(Source: Medical News Today of 16 May 2005)

Science UK — Three-year study to look into therapeutic effects of THC in multiple sclerosis

The British Medical Research Council (MRC) will fund a three-year trial with THC in multiple sclerosis (MS). The MRC has awarded 2 million British Pounds (about 3 million Euros) to fund the CUPID study (Cannabinoid Use in Progressive Inflammatory Brain Disease) which will be led by Dr. John Zajicek, professor at the Peninsula Medical School and Derriford Hospital, in collaboration with Dr. Alan Thompson, professor at the National Hospital for Neurology and Neurosurgery and the Institute of Neurology, University College London.

The CUPID study, which is due to begin later this year, will recruit 500 patients with progressive MS from neurology centres across the UK. The trial will evaluate whether THC, the principal active compound found in cannabis might slow the development of disability.

The research will follow on from a previous trial carried out by the same team, called Cannabinoids in MS (CAMS), which focused on testing the symptomatic benefit from cannabinoids over a 15-week and 12-month period. Evidence was found to suggest that this compound had an effect on spasticity scores and measures of disability in patients who took THC for up to 12 months, but not those who stopped medication at 15 weeks. As CAMS was a short trial, it is hoped that, by studying patients on the CUPID trial for a longer three-year period, THC’s value in slowing the progression of MS due to its neuroprotective properties may become clearer.

Dr. Zajicek said: “Currently very few medicines are effective in treating MS and none have been shown to have any effect in the later stages of the disease. If the CUPID study demonstrates that cannabinoids do have a longer term effect on the progression of disability, there are potentially far-reaching implications, not only for the health of people with MS, but also for those with other neurodegenerative conditions.”

(Source: Press release of Peninsula Medical School of 24 May 2005)

News in brief

USA — ID cards in California

Several counties in California have chosen to pilot a new state-wide medical cannabis ID card system. In Mendocino County the ID cards are now available at 50 US-Dollars. The new system will mean medical cannabis patients can get a card that will be recognized by all law enforcement in the state. Problems may arise from different systems, since several have issued their own ID cards. (Source: Ukiah Daily Journal of 26 May 2005)

Spain — Pharmacies

According to a survey on the website of the Club of Pharmacies (Club de la Farmacia) three out of five Spanish pharmacies support the distribution of cannabis for medical uses through pharmacies. Only 11 per cent of the 200 pharmacies from all over Spain which completed the questionnaire would in no case distribute the drug. Catalonia is planning a pilot study with the intend to distribute cannabis by Catalonian pharmacies and some hospitals. (Source: Europa Press of 16 May 2005)

USA — Rhode Island

The Judiciary Committee of the Rhode Island Senate on 19 May passed a medical cannabis bill in a 9-2 vote. The bill, which now goes to the full Senate for a vote, would protect medical marijuana patients and their caregivers from the threat of arrest and imprisonment. Patients qualified to use cannabis for treatment would be issued special identification cards with their name and the name of their primary caregiver. The patients would then be allowed to possess up to 12 cannabis plants and 2,5 ounces (70 grams) of usable cannabis without facing arrest. A similar bill will be discussed in the House of Representatives. Both bills have a good chance to be passed in both Houses. (Sources: Associated Press of 18 May 2005, The Providence Journal of 20 May 2005)

Holland — Coffee-Shops

A pilot project will start soon in the southern town of Maastricht, just across the border with both Germany and Belgium, where the sale of cannabis to foreigners will be banned. The centre-right government wants to call an end to foreigners, mainly youngsters, on the streets of cities like Amsterdam prowling for a joint. "We want to end all aspects of drugs tourism, the fact that people come to the Netherlands to use soft drugs or to take them home," said Justice Ministry spokesman Wim Kok. (Source: Reuters of 23 April 2005)

Germany — Bavaria

An AIDS patient from Bavaria who used cannabis against nerve pain and loss of appetite was sentenced to a fine of 1350 Euros by the court of Wolfratshausen. He was charged with the possession of 15.5 grams of cannabis. Judge Helmut Berger stated that he could have used other medicinal drugs. However, he took into account the reason of cannabis use by the defendant and reduced the original fine by 2150 Euros. In southern states the possession of cannabis usually results in higher penalties than in northern German states, where this case would probably have ended with a warning only. (Sources: Isar-Loisachbote of 21 May 2005, personal communication)

Science — Osteoporosis

Researchers of the University of Aberdeen, UK, demonstrated that blockers of cannabinoid receptors prevent bone loss and may be useful in the treatment of osteoporosis. Dr. Stuart Ralston, who led the research assumes that on the other hand cannabinoids may have a negative effect. "We hadn't studied cannabis users, but the work we've done would suggest that if you use a lot of cannabis it could stimulate bone-absorbing cells, and that would be bad," he said. However, there are no clinical data available that would support his hypothesis. (Sources: The Independent of 23 May 2005; Idris AI, et al. Nat Med. 2005 May 22; [electronic publication ahead of print])

Science — Glaucoma

CB2 cannabinoid receptors were detected in the eye and their activation enhanced aqueous humour outflow. Thus, cannabinoids that selectively activate CB2 receptors may be useful to reduce increased intraocular pressure in glaucoma patients. (Source: Zhong L, et al. Invest Ophthalmol Vis Sci. 2005;46(6):1988-92.)

Science — Airway inflammation

Animal research shows that the synthetic cannabinoid WIN 55212-2, which exerts similar effects as THC inhibits neurogenic inflammations in airway tissues. This anti-inflammatory effect was mediated by CB2 receptors. (Source: Yoshihara S, et al. J Pharmacol Sci. 2005;98(1):77-82.)