IACM-Bulletin of November 10, 2002

USA — Doctors are allowed to recommend the use of cannabis to their patients

A federal appeals court in California ruled that the government cannot revoke the licenses of doctors who recommend marijuana to their patients. The federal government should now abandon its misguided policy of targeting doctors and sick people to fight cannabis use.

In the decision of 29 October the 9th Circuit Court of Appeals upheld a lower court ruling which protects the constitutional right of doctors to recommend medical marijuana. "An integral component of the practice of medicine is the communication between a doctor and a patient," the appeals court's three-judge panel said in its unanimous ruling. Doctors who "recommend" medical cannabis were simply exercising their free speech rights guaranteed by the First Amendment of the Constitution.

The court further rejected the government's assertion that, by recommending the medical use of marijuana, doctors were inviting their patients to break the law, noting that there are legal ways patients might seek marijuana, such as through a government-approved research project or attempting to persuade the federal government to change the cannabis laws.

The First Amendment of the U.S. Constitution says: "Congress shall make no law respecting an establishment of religion, or prohibiting the free exercise thereof; or abridging the freedom of speech, or of the press; or the right of the people peaceably to assemble, and to petition the government for a redress of grievances."

(Sources: Reuters of 29 October 2002, Associated Press of 30 October 2002, New York Times of 31 October 2002, The Constitution of the United States of America)

UK — Cannabis based medicine may be available already in 2003

GW Pharmaceuticals said on 5 November that four Phase III trials investigating the efficacy of their cannabis preparation in multiple sclerosis showed its product was significantly better than placebo in relieving disease symptoms. Phase III is the last stage of drug testing before approval.

The medicine, which is sprayed into the mouth, effectively reduced nerve damage pain, spasticity and sleep disturbance in the tests involving around 350 patients. In other trials the spray is also being studied for treating pain in cancer and spinal cord injury.

"The performance of GW's medicine has exceeded our own expectations," said Executive Chairman Geoffrey Guy. "Subject to regulatory approval, we are now on track to deliver our first prescription medicine to the UK market next year."

In two more European countries cannabis may be available in pharmacies in 2003, in the Netherlands and Germany. In the Netherlands a move to bring marijuana of licensed growers into the pharmacies is prepared by the governmental Office of Medicinal Cannabis. In Germany the Federal Association of Pharmacists on request by the Federal Health Ministry is developing a formula for a cannabis extract, so that pharmacists can prepare the medicine.

(Sources: Reuters Health of 5 November 2002, and others)

News in brief

Science — Appetite

The results of a study with rats revealed an unexpected role for peripheral CB1 receptors in the regulation of feeding. Food deprivation produced a sevenfold increase in the content of the endocannabinoid anandamide in the small intestine but not in the brain or stomach. Refeeding normalized intestinal anandamide levels. Peripheral but not central administration of cannabinoids (anandamide and WIN55,212-2) promoted reinforced eating in partially satiated rats. Similarly, peripheral but not central administration of a CB1 antagonist reduced food intake. (Source: Gomez R, et al. Neurosci 2002 Nov 1;22(21):9612-7)

USA — Mid-term elections

A measure approved by 63 percent of San Francisco voters on 5 November makes it official city policy to explore the establishment of a cannabis growing and distribution program for patients. It does not mean that San Francisco immediately will start growing marijuana, but rather that city officials will have the right to explore various possibilities. In contrast to this, other cannabis measures failed at this year's mid-term elections. Voters in Arizona and Nevada refused decriminalisation or legalisation of marijuana use. (Sources: Associated Press of 6 November 2002, Agence France-Press of 6 November 2002)

USA — Oregon and Colorado

3.5 years after the program started in 1998 the number of Oregonians with state approval to use marijuana medicinally climbed to 4,162. The number in Colorado with a similar state law is 181 within two years. (Source: Associated Press of 1 November 2002)

Science — Cannabis, alcohol, tobacco and depression

736 subjects from New York were interviewed at ages of about 14, 16, 22, and 27 years, and psychiatric disorders were assessed. Adolescent tobacco use was significantly associated with an increased risk of alcohol dependence and drug use disorders but not with depression at the age of 27 years. Early alcohol use and early marijuana use was associated with later major depressive disorder and drug use disorders. (Source: Brook DW, et al. Gen Psychiatry 2002 Nov;59(11):1039-44)