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IACM-Bulletin of 22 November 2020

Argentina: The country allows people to grow cannabis at home for medicinal use

On 12 November Argentina authorized people to grow cannabis at home for medicinal use. A decree issued by President Alberto Fernández also allows pharmacies to sell cannabis-derived oils, creams and other products, and it orders public and private insurance systems to cover these medications for patients who obtain a prescription.

The president’s move significantly expanded the reach of a 2017 law that legalized medical cannabis. Supporters of medicinal cannabis say Mr. Fernández’s predecessor, Mauricio Macri, established restrictions so strict that it effectively made the drug inaccessible to patients. The measure is the latest step softening cannabis laws in Latin America. In 2017, Uruguay legalized cannabis for adults, which is sold in pharmacies, and Colombia established a licensing system to grow cannabis for medicinal use. Home growers in Argentina will need a license based on medical needs.

New York Times of 12 November 2020

Science/Human: Nearly 1 in 10 elder cancer patients use cannabis

According to an analysis by investigators of Moffitt Cancer Center in Tampa, USA 8% of 301 elder cancer patients used cannabis to treat their symptoms. Their research was published in the British Medical Journal Support Palliative Care. They conducted a retrospective review of patients with cancer refered to the centre between 2014 and 2017, who underwent routine urine drug testing for THC as part of their initial clinic visit.

Approximately 8% of patients with cancer aged 65 years and older tested positive for THC compared with 30% of young adults. Authors wrote that “older adult patients made up nearly 25% (301 patients) of the total sample and had a rate of cannabis use of 8%. (…) Findings suggest the rate of use in older adults living with cancer is higher than that among older adults in the general population.”

Rajasekhara S, Portman DG, Chang YD, Haas MF, Randich AL, Bromberg HS, Rashid S, Donovan KA. Rate of cannabis use in older adults with cancer. BMJ Support Palliat Care. 2020:bmjspcare-2020-002384.

Science/Human: The use of CBD full-spectrum extracts with low THC levels may result in positive urine drug testing for THC

In a study with 14 patients, who ingested a CBD extract with low levels of THC, half of them tested positive for the THC metabolite THC-COOH in urine after 4 weeks of daily intake. The investigators of McLean Hospital Imaging Center in Belmont and Harvard Medical School in Boston, USA, applied a full-spectrum, high-CBD extract containing 10 mg/mL of CBD (1.0%) and 0.2 mg/mL of THC (0.02%). The extract was taken 3 times daily. Patients used a mean of 3.48 mL of the study product per day, equivalent to a mean of 35 mg of CBD per day and 0.8 mg of THC per day.

The study drug was well tolerated, no serious adverse events were reported, and no patients reported psychoactivity. After 4 weeks, 7 of the 14 participants tested positive for THC-COOH, while 7 tested negative. Authors noted that the “results suggest that patients consistently using full-spectrum, hemp-derived products may have positive test results for THC-COOH on a urinary drug screen.”

Dahlgren MK, Sagar KA, Lambros AM, Smith RT, Gruber SA. Urinary Tetrahydrocannabinol After 4 Weeks of a Full-Spectrum, High-Cannabidiol Treatment in an Open-Label Clinical Trial. JAMA Psychiatry. 2020 Nov 4. [in press]

News in brief

IACM: Conjoint letter to UN Commission on Narcotic Drugs
Together with 50 other NGOs from 31 countries the IACM submitted a letter entitled "Towards science-based scheduling of Cannabis sativa and other controlled herbal medicines" to the UN Commission on Narcotic Drugs, which will process it towards inclusion in the documentation of the "reconvened 63rd session" (2-4 Dec. 2020) when the vote on the WHO cannabis scheduling recommendations has been planned. The IACM will inform its readers when the letter has been posted on the website of the 63rd CND session.

Europe: Court of Justice of the EURopean Union rules that CBD is not a narcotic
In a ruling published on 19 November 2020, the EURopean Court of Justice said that CBD is not a narcotic and that the sale of CBD-containing hemp extracts legally produced in one country of the EURopean Union cannot be prohibited for sale in another country. However, such a ban may be justified by the objective of protecting public health, but must not go beyond what is necessary to achieve that objective.
Judgment of the EURopean Court of Justice

Science: Request for submission of articles for special issue in “Complementary Therapies in Medicine”
The journal Complementary Therapies Medicine is requesting articles for a special issue on Medical Cannabis in Professional Education.
Journal website

Israel: The country may legalize cannabis use for adults within 9 months
After four months in which the inter-ministerial committee for the regulation of Israel's cannabis market had been convening every week, it published its conclusions on 12 November and handed them over to the Justice Ministry. Justice Minister Avi Nissenkorn said that a legal memo will be drafted in the coming days for government approval, and that a bill could come to the Knesset floor for an initial reading even before the end of 2020, with the entire legislative process expected to take around nine months before cannabis becomes legal and regulated in Israel.
Jerusalem Post of 12 November 2020

Mexico: The Senate approved a bill that would legalise cannabis use for adults
Mexico’s Senate approved a landmark cannabis legalization bill in a landslide vote on 19 November 2020, paving the way for the creation of the world’s largest legal marijuana market if the initiative passes the next hurdle in the lower house of Congress.
Reuters of 20 November 2020

USA: Record number of US citizens supports the legalisation of cannabis
According to a new survey 68% of US citizens support the legalisation of cannabis for adults. Last year 66% favoured legalisation.
UPI of 9 November 2020

Science: Cannabis extracts may protect LDL from oxidation and thus from the initial phase of atherosclerosis
In an analysis of 133,706 adults from the US frequent cannabis smokers had 2.3 times higher odds of heart attack or coronary artery disease, and 1.9 times higher odds of stroke. Authors also noted that “no association was observed between marijuana use in any form other than smoking and cardiovascular disease, across all age groups.”
Division of Cardiology, State University of New York Upstate Medical University, Syracuse, USA.
Shah S, et al. Am J Med. 2020:S0002-9343(20)30959-1.

Science/Human: Cannabis users undergoing surgery need more opioids and have similar recovery compared to nonusers
In a prospective study with 1335 adults undergoing elective surgery 5.9% reported cannabis use (medical or recreational). Investigators found that “cannabis users have higher clinical pain, poorer scores on quality of life indicators, and higher opioid use before and after surgery. Cannabis users reported similar surgical outcomes, suggesting that cannabis use did not impede recovery.”
Department of Anesthesiology, University of Michigan, USA.
McAfee J, et al. Reg Anesth Pain Med. 2020:rapm-2020-101812.

Science: Hemp extracts may be used as antioxidants in vegetable oils
A study demonstrates that hemp flowers can be used as a source of natural antioxidants in vegetable oils and lipid products to retard their oxidation, especially those characterized by a high degree of unsaturation.
Department of Agricultural, Forest and Food Sciences (DISAFA), University of Turin, Grugliasco, Italy.
Cantele C, et al. Antioxidants (Basel). 2020;9(11):E1131.

Science/Cells: CBD may enhance bone formation in stem cells derived from dental tissue
The effects of CBD and vitamin D3 on bone formation of dental-derived human stem cells were evaluated in terms of viability and metabolic activity. From their research authors concluded “that CBD and Vit. D3 can enhance osteogenic differentiation of these types of cells under certain conditions and doses.”
Department of Oral Health, University of Medicine and Pharmacy "Iuliu Hatieganu", Cluj-Napoca, Romania.
Petrescu NB, et al. Medicina (Kaunas). 2020;56(11):E607.

Science/Cells: Aerosols from E Cigarettes with CBD contain cytotoxic compounds
Acute effects of aerosols from electronic cigarettes with flavoured CBD refill solutions are associated with cytotoxic effects on epithelial cells of the lung. Authors wrote that “different flavors show different cytotoxic effects in CBD-containing e-cigarettes. Aerosols emitted from CBD containing e-cigarettes were more cytotoxic than those emitted from CBD-free e-cigarettes.”
Department of Health Behavior, Roswell Park Comprehensive Cancer Center, New York, USA.
Leigh NJ, et al. Front Physiol. 2020;11:592321.

Science/Human: Cannabis use increases risk of cardiovascular disease, but only if it is smoked
In an analysis of 133,706 adults from the US frequent cannabis smokers had 2.3 times higher odds of heart attack or coronary artery disease, and 1.9 times higher odds of stroke. Authors also noted that “no association was observed between marijuana use in any form other than smoking and cardiovascular disease, across all age groups.”
Division of Cardiology, State University of New York Upstate Medical University, Syracuse, USA.
Shah S, et al. Am J Med. 2020:S0002-9343(20)30959-1.

Science: Five mechanisms of CBD nerve cell protection
“CBD exerts its neuroprotective effects through three G protein coupled-receptors (adenosine receptor subtype 2A, serotonin receptor subtype 1A and G protein-coupled receptor 55), one ligand-gated ion channel (transient receptor potential vanilloid channel-1) and one nuclear factor (peroxisome proliferator-activated receptor gamma).”
Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Centro Neurolesi "Bonino-Pulejo", Messina, Italy.
Silvestro S, et al. Molecules. 2020;25(21):5186.

Science/Animal: A THC preparation, which may be used topically to reduce intraocular pressure
A special THC preparation (THC-valine-hemisuccinate nanoemulsion) reduces intraocular pressure in rabbits following topical administration. Authors wrote that this preparation showed the better “reduction profile in the test model compared to the commercial ophthalmic solutions evaluated.”
Department of Pharmaceutics and Drug Delivery, University of Mississippi, Oxford, USA.
Sweeney C, et al. Drug Deliv Transl Res. 2020 Nov 9. [in press]

Science/Human: Driving under the influence of cannabis in different US states
An analysis of 17,112 adults from different US states showed that driving after cannabis use was more prevalent in legal cannabis sales states. However, after considering “frequency of use, daily/almost daily, weekly/monthly, and past 12-month users from states with legal recreational cannabis sales had significantly lower prevalence of driving after cannabis use.”
Division of Epidemiology and Biostatistics, School of Community Health Sciences, University of Nevada, Reno, USA.
Lensch T, et al. Prev Med. 2020;141:106320.

Science/Human: About 20% of patients with rheumatologic diseases use cannabis
According to a systematic review “nearly 20% of patients suffering from rheumatologic diseases actively consume cannabis, with an improvement in pain. The issue of cannabis use in the management of these patients should be addressed during medical consultation, essentially with cannabis-based standardized pharmaceutical products.”
Rheumatology Department, Clermont-Ferrand University Hospital: France.
Guillouard M, et al. Rheumatology (Oxford). 2020:keaa534.

Science: So far, no measurable effects of cannabis use on cognitive function
A review of the effects of cannabis on cognitive function concluded that “human studies revealed largely null results, likely due to several methodological limitations.” No studies examined the effects of CBD.
Department of Psychiatry, University of California San Diego, USA.
Pocuca N, et al. Arch Clin Neuropsychol. 2020 Nov 7:acaa105.

Science/Human: Cannabis use may improve hospital outcomes in patients with liver cirrhosis
In a study with 17,520 patients with liver cirrhosis, of whom 2.1% used cannabis, cannabis use “resulted in mixed outcomes regarding hospital admissions with hepatic decompensation. A trend towards decreased hospital utilization and mortality was noted in cannabis users after legalization.”
Department of Internal Medicine, Division of Gastroenterology, Hepatology and Nutrition, The Ohio State Wexner Medical Center, USA.
Sobotka LA, et al. Ann Hepatol. 2020:S1665-2681(20)30205-2.

Science/Human: Cannabis-related deficit in working memory may be mediated by lower hippocampal volume
In a study with 234 individuals with self-reported cannabis exposure and 174 individuals unexposed to cannabis the use of cannabis was associated with lower working memory task performance. Authors wrote that participants “who reported higher frequency of cannabis use tended to have lower number of correct responses in the list-sorting working memory task and lower bilateral hippocampal volumes.” The hippocampus is a certain brain region associated with memory.
Institute of Psychiatry, Psychology & Neuroscience, King's College London, UK.
Paul S, et al. Addict Biol. 2020:e12984.

Science/Human: Cannabis use may be associated with adverse mental health outcomes
In an analysis of 410,138 people cannabis use was associated with major depressive episode, serious mental illness and suicidal ideation. This association was “consistent with causal relationships.”
Department of Psychiatry, University of Western Australia, Crawley, Australia.
Reece AS, et al. BMC Public Health. 2020;20(1):1655.

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