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IACM-Bulletin of 11 April 2021

Science/Human: Cannabis use reduced the incidence of non-fatal opioid overdoses among patients in a methadone programme

According to a survey by researchers of the University of Washington in Seattle, USA, patients participating in methadone maintenance treatment (MMT) experienced lower rates of nonfatal opioid overdoses if they used cannabis. Investigators selected a convenient sample of individuals enrolled in four MMT clinics in Washington State and southern New England who completed a one-time survey.

Of 446 participants, 35% (n = 156) reported frequent cannabis use and 7% reported nonfatal opioid overdose in the past year. The prevalence of nonfatal opioid overdose was 3% among reporters of frequent cannabis use, and 9% among reporters of infrequent/no use. Authors concluded that “among individuals enrolled in MMT, frequent cannabis use in the past month was associated with fewer self-reported nonfatal opioid overdoses in the past year. Methodological limitations caution against causal interpretation of this relationship.”

Bryson WC, Morasco BJ, Cotton BP, Thielke SM. Cannabis Use and Nonfatal Opioid Overdose among Patients Enrolled in Methadone Maintenance Treatment. Subst Use Misuse. 2021;56(5):697-703.

Science/Human: Cannabis may be helpful in delayed gastric emptying

Patients with a diagnosis of gastroparesis (delayed gastric emptying), who use cannabis, have reduced hospital mortality compared to nonusers. Investigators of the Brigham and Women's Hospital of Harvard Medical School in Boston, USA, used a large database of 1,473,363 patients with gastroparesis, of whom 2.3% had a concomitant cannabis use disorder.

Controlling for confounders, length of hospital stay, and hospital mortality were significantly decreased for patients with gastroparesis and cannabis use. Authors concluded that “while patients with gastroparesis and cannabis use disorder were younger, with a lower socioeconomic status, and disproportionately affected by psychiatric diagnoses, these patients had better hospitalization outcomes, including decreased length of stay and improved in-hospital mortality.”

McCarty TR, Chouairi F, Hathorn KE, Chan WW, Thompson CC. Trends and Socioeconomic Health Outcomes of Cannabis Use Among Patients With Gastroparesis: A United States Nationwide Inpatient Sample Analysis. J Clin Gastroenterol. 2021 Mar 12. [in press].

USA: New York and New Mexico legalise the use of cannabis by adults, Virginia wants to follow

New York Governor Andrew Cuomo signed a bill on 31 March to legalize adult use of cannabis, making it the 15th U.S. state to allow recreational use of the drug. Cuomo said the bill, which was approved by the state Assembly late 30 March, would also wipe the slate clean for many people previously charged with cannabis crimes. “The bill creates automatic expungement of previous marijuana convictions that would now be legal,” Cuomo wrote on Twitter, announcing that he had just signed the legislation. “This is a historic day.” Cuomo added the legislation is projected to create 30,000 to 60,000 new jobs and 350 million US dollars in annual tax collection.

Earlier 31 March, Virginia Governor Ralph Northam proposed moving up the legalization of simple possession of cannabis to July rather than wait until 2024. Northam said racial disparities in prosecution of cannabis -related crimes prompted him to accelerate the timetable.

Also in New Mexico two bills to legalise the use of cannabis for adults 21 and older and expunge arrest and conviction records for some cannabis offenses have passed the legislature and await signing by Governor Michelle Lujan Grisham, who praised the bills, saying they would bolster the economy and help those who have been harmed by the "country's failed war on drugs."

Reuters of 31 March 2021
UPI of 31 March 2021
CCN of 1 April 2021

Science/Human: Long-term cannabis treatment of chronic pain resulted in better outcomes compared to conventional treatment

In an observational study by investigators from McLean Hospital in Belmont, USA, with 37 pain patients cannabis resulted in an improvement of several symptoms. Participants were evaluated before, 3 and 6 months after starting cannabis treatment. They were compared to 9 patients, who did not initiate cannabis treatment.

Relative to baseline, following 3 and 6 months of treatment, cannabis patients exhibited improvements in pain which were accompanied by improved sleep, mood, anxiety, and quality of life, and stable conventional medication use. The authors wrote that the “results generally suggest increased THC exposure was related to pain-related improvement, while increased CBD exposure was related to improved mood. (…) Pilot analyses revealed that treatment-as-usual patients do not demonstrate the same pattern of improvement.”

Gruber SA, Smith RT, Dahlgren MK, Lambros AM, Sagar KA. No pain, all gain? Interim analyses from a longitudinal, observational study examining the impact of medical cannabis treatment on chronic pain and related symptoms. Exp Clin Psychopharmacol. 2021 Mar 25. [in press].

Science/Human: Many patients with inflammatory bowel use cannabis

About half of participants in a survey among patients suffering from inflammatory bowel conducted in New Zealand reported the use of cannabis. Participants were recruited by investigators from the Dunedin School of Medicine of the University of Otago, New Zealaand, via postal mail and online resources. In total, 378 participants completed the questionnaire, of which 334 could be evaluated. Sixty-one percent of respondents had Crohn’s disease and 34% ulcerative colitis.

Overall, 51% of respondents reported having ever used cannabis. Of those, 63% reported use as recreational and 31% for reduction of their symptoms. Symptoms most reported as improved by cannabis use were abdominal pain/cramping, nausea/vomiting and loss of appetite. Fifty-four percent of participants reported that if cannabis were legal, they would request it for medicinal use to help manage their symptoms.

Appleton K, Whittaker E, Cohen Z, Rhodes HM, Dunn C, Murphy S, Gaastra M, Galletly A, Dougherty S, Haren A, Sukumaran N, Aluzaite K, Dockerty JD, Turner RM, Schultz M. Attitudes towards and use of cannabis in New Zealand patients with inflammatory bowel disease: an exploratory study. N Z Med J. 2021;134(1530):38-47.

India: Indian state Himachal Pradesh wants to legalise cannabis for medicinal and industrial use

Himachal Pradesh, a small mountain state in northern India, wants to generate incomes for the state by undertaking the controlled cultivation of cannabis. In a state budget meeting, the state’s Chief Minister Jai Ram Thakur announced that cannabis produced in the state is of high quality, and there is enormous potential to undertake its controlled cultivation.

While this announcement is a welcome move considering years of political struggle in India for cannabis legalization, the lack of comprehensive laws and the cultural taboo around cannabis might be the immediate hurdles. “Cannabis extract is used in manufacturing medicines for the treatment of cancer and Alzheimer’s,” Sunder Singh Thakur, a legislator from the state’s Kullu district, said. He has advocated the legalization of cannabis in the state for many years. “It will generate employment opportunities. The state needs it now more than ever because of the pandemic-related job loss.”

The Tennessee Tribune of 8 April 2021

News in brief

France: Launch of a 2-year study with medical cannabis
France's government has launched a two-year nationwide experiment with cannabis with a perspective of possible legalisation for medical use.
ABC News of 26 March 2021

UK: 20,000 patients have a cannabis card avoiding arrest
Nearly 20,000 people with conditions such as multiple sclerosis and arthritis are using a “cannabis card” that allows them to escape arrest if they are stopped by police. The organisers of the scheme say that 96 per cent of cardholders caught with cannabis have been allowed to keep the drug and go on their way even if they do not have a prescription.
The Times of 23 March 2021

Science/Cells: Anti-cancer effects of CBD and THC on glioblastoma cells involve the GPR55 receptor
The anti-cancer effects of CBD and THC on glioblastoma cells were abolished by blocking the GPR55 receptor. Authors concluded that this confirms “a participation of GPR55 and suggesting its involvement in modifying the cell cycle” of these brain cancer cells.
Department of Anatomy and Cell Biology, Medical Faculty of Martin-Luther University Halle-Wittenberg, Germany.
Kolbe MR, et al. Cancers (Basel). 2021;13(5):1064.

Science/Human: CBD effects on stress and anxiety are influenced by expectancy
In a placebo-controlled study with 43 healthy adults, who received CBD-free hempseed oil at two occasions expectancy-related factors were implicated in anxiolytic effects of CBD for those who believe it was helpful for such purposes. At one occasion participants were told that the oil contained CBD and in the other session that it was CBD-free. Authors wrote that “overall, there were no systematic changes in subjective stress, or anxiety, according to expectancy condition. However, participants who endorsed strong a priori beliefs that CBD has anxiolytic properties reported significantly diminished anxiety in the CBD expectancy condition.”
Dalhousie University, Life Sciences Centre, Halifax, Canada.
Spinella TC, et al. Psychopharmacology (Berl). 2021 Apr 4.[in press].

Science/Cells: CBD and cannabivarin may be helpful in post-Covid-19 neurodegeneration
Researchers found that “cannabidiol (CBD) and cannabivarin (CVN) obtained from Cannabis can bind to post-Covid symptoms related central nervous system (CNS) proteins and downregulate them which can be beneficial in post-Covid symptoms treatment strategy.”
Department of Botany, University of North Bengal, Siliguri, India.
Sarkar I, et al. J Biomol Struct Dyn. 2021:1-10.

Science/Animal: The numbers of cannabinoid receptors increase in irritable bowel syndrome after treatment with a ketogenic diet
Researchers investigated the basis of the efficacy of the ketogenic diet in irritable bowel syndrome. They found that the numbers of CB1 and CB2 receptors increase in the intestine and suggest that this supports “possible cannabinoid-mediated protection.”
National Institute of Gastroenterology, "S. de Bellis" Research Hospital, Castellana Grotte, Italy.
Gigante I, et al. Int J Mol Sci. 2021;22(6):2880.

Science: CBD powder is more stable than a CBD oily solution
In a study comparing the stability of CBD in an oily solution or as a powder under a different conditions with regard to temperature and humidity CBD was more stable as a powder.
Institute of Chemical Process Fundamentals of CAS v.v.i., Prague, Czech Republic.
Kosović E, et al. Pharmaceutics. 2021;13(3):412.

Science: Autism is associated with a dysregulated endocannabinoid system
In a review authors summarise the knowledge of the probability that acetaminophen may increase the risk for autism in children and that autism is associated with a low endocannabinoid tone as indicated by low levels of endocannabinoids.
Center for Biomedical Neuroscience, University of Texas, San Antonio, USA.
Schultz S, et al. Molecules. 2021;26(7):1845.

Science: A combination of CBD and terpenes were effective against a coronavirus strain
A combination of CBD and the terpenes beta caryophyllene, eucalyptol and citral against a coronavirus strain in human lung cells.
Eybna Technologies Ltd., Givat Hen, Israel.
Chatow L, et al. Life (Basel). 2021;11(4):290.

Science/Cells: Endocannabinoides may be effective in laryngeal cancers
The endocannabinoids anandamide and 2-AG (2-arachidonoylglycerol) showed antiproliferative effects in laryngeal cancer cells.
Department of ENT, Faculty of Medicine, Atilim University, Ankara, Turkey.
Önay Ö, et al. Cell Tissue Bank. 2021 Apr 2. [in press].

Science/Human: CBD treatment may become effective in Lennox-Gastaut syndrome after about one week
According to data from two controlled clinical trials CBD treatment in Lennox-Gastaut syndrome resulted in a reduction of seizures during the titration period in a significant manner on day 6.
University of Cincinnati Medical Center, USA.
Privitera M, et al. Epilepsia. 2021 Apr 2. [in press].

Science/Human: Cannabis use in adolescence has potential negative effects on academic functioning
According to an analysis of data from 3 longitudinal studies with 3762 twins “cannabis use in adolescence has potentially causal, deleterious effects on adolescent academic functioning and young-adult socioeconomic outcomes despite little evidence suggesting a strong, causal influence on adult mental health or cognitive ability.”
Institute of Child Development, University of Minnesota, Minneapolis, USA.
Schaefer JD, et al. Proc Natl Acad Sci U S A. 2021;118(14):e2013180118.

Science/Human: High doses of cannabis may create oceanic boundlessness similar to psilocybin
“Self-report data suggest that high doses of cannabis can create subjective effects comparable to those identified in trials of psilocybin that precede relief from cancer-related distress, treatment-resistant depression, alcohol problems, and cigarette dependence. (…) This work might also support the development of a cannabis-assisted psychotherapy comparable to psilocybin-assisted psychotherapy.”
Department of Psychology, University at Albany, USA.
Earleywine M, et al. J Psychopharmacol. 2021:269881121997099.

Science/Human: The pharmacokinetic of inhaled cannabis is influenced by the way of inhalation
With the aim of optimal THC administration investigators use different inhalation rhythms and suggest a protocol, where patients inhale 4 seconds and hold breath for 10 seconds afterwards.
School of Chemical Engineering, Oklahoma State University, USA.
Zhao J, et al. Comput Biol Med. 2021;132:104333.

Science/Animal: THC and CBD may be safely used in cats
In a study with 20 healthy adult cats researchers found that after the administration of oils containing CBD, THC or a combination of THC and CBD adverse events were mild and transient.
Canopy Animal Health, Research & Development, Canopy Growth Corporation, Smith Falls, Canada.
Kulpa JE, et al. J Feline Med Surg. 2021:1098612X211004215.

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