How legitimate is the medical cannabis industry

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IACM information dated February 02, 2019

World: The World Health Organization accepts the medicinal benefits of cannabis and cannabinoids

In a letter dated January 24th to the Secretary General of the United Nations, Antonio Guterres, the Director General of the WHO, Dr. Tedros Adhanom Ghebreyesus, the UN on proposed changes to the international drug conventions. These proposals followed the meetings of the WHO Expert Committee on Drug Addiction (ECDD) in June and November 2018.

The WHO recognizes the therapeutic potential of cannabis and cannabinoids and changes its position from 1954 that "Efforts must be made to exclude cannabis from all legitimate medical practice." The new international classification proposed by the WHO offers countries the opportunity to provide legal and safe access to the medicinal use of cannabis and to research its medicinal value. Now 53 UN countries have to approve these recommendations of the WHO and thus change the classification in the conventions by a simple majority of the votes, i.e. 27 countries, voting in favor. Originally planned for March 2019, it is quite possible that delaying the publication of the results by 2 months will also delay the voting until March 2020.

Letter from WHO to the UN dated January 24, 2019
FAAAT press release from February 1, 2019

Science / Human: The legalization of medical cannabis in the US is related to decreased opioid use

According to an analysis of 4.8 million people in the United States, opioid use has decreased significantly among citizens living in a state with legal access to cannabis for medical purposes. Scientists at Pharmerit International in Bethesda (USA) published their results in the Journal of General Internal Medicine. A 10 percent sample of a nationally representative database of the insured population was used to collect information on opioid use, chronic opioid use and high risk opioid use for the years 2006 to 2014.

Cannabis legalization in the medical field was found to be associated with a 5% reduction in the likelihood of opioid use, 7% for regular opioid use, and 4% for high-risk opioid use. The authors concluded that, “In states where marijuana is available through medical channels, marginally lower rates of opioid prescriptions and high risk opioid prescriptions have been observed. Policy makers might consider medical marijuana legalization as a tool that can marginally reduce the use of chronic and high-risk opioids. "

Shah A, Hayes CJ, Lakkad M, Martin BC. Impact of Medical Marijuana Legalization on Opioid Use, Chronic Opioid Use, and High-risk Opioid Use. J Gen Intern Med. Jan 25. 2019 [in press]

Science / Human: Cannabis can be helpful in autism

In a study of 53 children with autism, about two-thirds benefited from treatment with a cannabis extract high in CBD and low in THC. The authors of the Department of Clinical Pharmacology and Toxicology of the Assaf Harofeh Medical Center in Tel Aviv, Israel published their results in Frontiers in Pharmacology. The mean age was 11 years (range: 4 to 22). They received a cannabis extract with a ratio of CBD to THC of 1 to 20. The mean THC dose was 7 mg (range: 4 to 11 mg) and of CBD 90 mg (45 to 143 mg). The median duration of therapy was 66 days (3 to 588 days).

Self-harm and tantrums improved in 68% and worsened in 9%. Hyperactivity symptoms improved in 68%, did not change in 29%, and worsened in 3%. In a comment, Dr. Franjo Grotenhermen, Managing Director of IACM, states that the name of the extract as CBD oil is misleading. "I've seen several autism patients in my doctor's office benefiting from THC alone, while I've never had an autism patient benefiting from CBD alone," he explained. “These children received a normal and effective dose of THC in the range of around 5 to 10 mg and only a moderate dose of CBD. So I have the impression that the study participants may have benefited mainly from THC and less from CBD. "

Barchel D, Stolar O, De-Haan T, Ziv-Baran T, Saban N, Fuchs DO, Koren G, Berkovitch M. Oral Cannabidiol Use in Children With Autism Spectrum Disorder to Treat Related Symptoms and Comorbidities. Front Pharmacol. 2019; 9: 1521.

Science / Human: According to a survey, cannabis can be very effective in treating endometriosis on your own

According to a survey of 484 women with endometriosis living in Australia, cannabis was very effective at relieving pain. The results of the study by scientists from the NICM Health Research Institute at Western Sydney University (Australia) have been published in BMC Complementary and Alternative Medicine. An online survey was disseminated through social media. Women were eligible to take the survey if they were between 18 and 45 years old, lived in Australia, and had a diagnosis of endometriosis.

The most common forms of self-management strategy used were warmth (70%), rest (68%), and meditation or breathing exercises (47%). Cannabis, heat, hemp / CBD oil, and dietary changes were rated the highest for self-reported effectiveness in pain relief. Physical exercises such as yoga / pilates, stretching, and exercise were found to be less effective. The authors wrote that "women who use cannabis have the highest self-assessment effectiveness".

Armor M, Sinclair J, Chalmers KJ, Smith CA. Self-management strategies amongst Australian women with endometriosis: a national online survey. BMC Complement Altern Med. 2019; 19 (1): 17.

Science / Human: Medical cannabis users reduce their consumption of benzodiazepines

According to an analysis of 146 medical cannabis patients who used benzodiazepines, 30% were able to stop using these drugs within 2 months. Researchers from the medical school at Dalhousie University, Canada, published their research in the IACM partner journal Cannabis and Cannabinoid Research.

The median age was 47 years, 61% of whom were women, and 54% said they had previously used cannabis. After completing an average of two months of prescribing medical cannabis, 30.1% of patients had discontinued their benzodiazepines. At a follow-up appointment after two prescriptions, a total of 65 patients (44.5%) had discontinued their benzodiazepines. In the last follow-up period after three cycles of prescribed medical cannabis, a total of 66 patients (45.2%) had stopped taking benzodiazepines, showing a stable stop rate over a period of an average of 6 months.

Purcell C, Davis A, Moolman N, Taylor SM. Reduction of Benzodiazepine Use in Patients Prescribed Medical Cannabis.
Cannabis Cannabinoid Res. Jan 24. 2019 [in press]

Science / Human: Low doses of CBD increased the psychedelic effects of THC, but high doses of CBD reduced these effects

In a placebo-controlled study with 36 healthy cannabis users, inhaling low doses of CBD together with THC increased the psychedelic effects of THC, while high doses of CBD decreased these effects. Researchers from the School of Psychology and the Illawarra Health and Medical Research Institute at the University of Wollongong (Australia) published their data in the EURopean Archives of Psychiatry and Clinical Neuroscience. Participants inhaled placebo versus CBD alone (400 mg), THC alone (8 mg) versus THC in combination with low (4 mg) or high (400 mg) doses of CBD.

The objective (blind observer ratings) and subjective (self-assessment) strength of intoxication differed. CBD showed some intoxicating properties when compared to the placebo. Low doses of CBD combined with THC were amplified, while high doses of CBD reduced the intoxicating effects of THC. The amplification of psychedelic effects from low-dose CBD was particularly strong in casual cannabis users.

Solowij N, Broyd S, Greenwood LM, van Hell H, Martelozzo D, Rueb K, Todd J, Liu Z, Galettis P, Martin J, Murray R, Jones A, Michie PT, Croft R. A randomized controlled trial of vaporized Δ9 -tetrahydrocannabinol and cannabidiol alone and in combination in frequent and infrequent cannabis users: acute intoxication effects. EUR Arch Psychiatry Clin Neurosci. 2019 Jan 19. [in press]

News in brief

Germany: The government will select producers of medicinal cannabis
The government has accepted requests for supply contracts from 79 potential cannabis producers as the country seeks to develop its own medicinal cannabis industry and reduce reliance on imports from Canada and the Netherlands. The BfArM, the authority for the regulation of medicinal products, announced on January 28th that it wanted to select producers for a total volume of 10,400 kg of cannabis over a period of four years between April and June.
Reuters of January 28, 2019

Thailand: The country has withdrawn applications for foreign patents on the use of cannabis
On January 28, Thailand revoked all foreign patent applications for the use of cannabis after fears that foreign companies would dominate the market that opened in December 2018 when the government approved the drug for medical purposes and research. Civil society groups and researchers feared that dominance by foreign companies could make Thai patients more difficult to access drugs and Thai researchers harder to gain access to cannabis extracts.
Reuters January 28, 2019

Israel: Government allows export of medical cannabis
On January 27, the Israeli government passed a law allowing the export of medicinal cannabis to boost the state's revenue and strengthen the agricultural sector. Israeli companies, benefiting from a favorable climate and expertise in medical and agricultural technologies, are among the world's largest manufacturers of medical cannabis. Eight companies grow cannabis in Israel, many of which have also opened farms abroad to enter the international market.
Reuters January 27, 2019

Philippines: House of Representatives approves draft medical cannabis
The House of Representatives reached a historic milestone after the Chamber voted for the proposed legalization of medical cannabis in the country. During the January 29 plenary session, a total of 163 legislators voted in favor of the Philippine Compassionate Medical Cannabis Act, and 5 voted against.
Politiko from January 29, 2019

Science / Human: Cannabis patients reduce the consumption of other drugs and alcohol
In a survey of 2,032 medical cannabis patients from Canada, 69% said they were substituting prescription drugs, followed by alcohol (45%), tobacco (31%) and illegal substances (27%). Of the prescription drugs, opiate medications made up 35%, followed by antidepressants (22%).
Social Dimensions of Health, University of Victoria, Canada.
Lucas P, et al. Harm Reduct J. 2019; 16 (1): 9.

Science / Human: Adult cannabis legalization has been linked to reduced opioid use in the US
The number of prescriptions and the total dose of opioids were reduced in states where adult use of cannabis had been legalized. In models comparing eight states and Washington DC, legalization was not associated with prescriptions for Class II opioids (e.g., oxycodone), but was associated with reducing prescriptions and overall dose of Class III opioids (e.g., codeine) by about 30%.
Department of Family Medicine and Public Health, University of California at San Diego, USA.
Shi Y, et al. Drug Alcohol Depend. 2019; 194: 13-19.

Science / Human: According to survey, cannabis can be an effective pain reliever and replacement for opioids
According to a US survey of 1,321 people suffering from chronic pain, 53% replaced opioids and 22% benzodiazepines with cannabis.
Department of Anaesthesiology, University of Michigan Medical School, USA.
Boehnke KF, et al. J Pain. 2019-01-25 [in press]

Science / Animal: CBD can trigger programmed cell death in malignant melanoma cells
In a study of mice with malignant melanoma, a significant decrease in tumor size was found in animals treated with CBD. Cisplatin, a standard anti-cancer drug, was more effective, but the quality of life of the animals treated with CBD was better.
Augusta University Medical Center, USA.
Simmerman E, et al. J Surg Res. 2019; 235: 210-215.

Science / Animal: How CBD Causes Cancer Cell Death
In a study of colon cancer cells, CBD caused apoptosis (a programmed cell death) by regulating many proteins relevant to apoptosis. The so-called noxa protein showed a high expression after administration of CBD, and reactive oxygen species (ROS) names too. The authors concluded that "CBD induced apoptosis in a noxa and ROS dependent manner."
Oncology Clinic, Korea University Guro Hospital, Korea University College of Medicine, Seoul, South Korea.
Jeong S, et al. Cancer Letters. 2019; 447: 12-23.

Science / Human: Cannabis can have negative effects on cancer therapy when administered together with immunotherapy
In an analysis of 140 patients in Israel, 89 of whom received only the immunotherapy drug involumab and 51 received involumab and cannabis, cannabis reduced the response rate to immunotherapy without affecting overall survival. The authors concluded that "while the data are retrospective and have not been found to be related to the composition of cannabis, this information may be relevant to cannabis users and suggest that caution should be exercised when initiating immunotherapy."
Department of Oncology, Rambam Health Care Campus, Haifa, Israel.
Taha T, et al. Oncologist. Jan 22. 2019 [in press]

Science: Significant increase in THC concentration in cannabis in the USA and in EURopa over the past 10 years
The average THC concentration of cannabis in the US nearly doubled in ten years, increasing from 9% in 2008 to 17% in 2017. There was also a significant increase in THC concentrations in hash oil. Other potency control programs in several European countries also showed increases in THC levels in cannabis products.
National Center for Natural Product Research, School of Pharmacy, University of Mississippi, USA.
Chandra S, et al. EUR Arch Psychiatry Clin Neurosci. 2019 Jan 22. [in press]

Science / Human: In driving simulator tests, there were no more significant defects 3 hours after cannabis use
In a driving simulator study with 15 regular cannabis users who received cannabis cigarettes with 0.3 mg THC per kg body weight (equivalent to 21 mg for a person weighing 70 kg), THC concentrations of more than 15 ng / ml blood serum increased the number of patient errors. Three hours after ingestion, there were no more significant increases in errors to be observed.
Institute for Forensic Medicine, University Hospital Düsseldorf, Germany.
Tank A, et al. Int J Legal Med. Jan 30. 2019 [in press]

Science / Animal: The lack of cannabinoid receptors protects mice from obesity
In a study with genetically modified mice without cannabinoid receptors, the animals were protected from diet-related obesity in comparison to wild-type mice, despite the same feed intake.
Department of Family Medicine, Michigan State University, USA.
Alshaarawy O, et al. Obesity (Silver Spring). 2019 Jan 30. [in press]

Science / Human: Many young children are admitted to hospitals for accidental ingestion of cannabis
In particular, oral products with a high concentration of THC (edibles, resins, vapors) that are ingested by young children can cause sedation, respiratory depression, and other side effects.
Emergency Medicine Department, University of Massachusetts Medical School, USA.
Blohm E, et al. Curr Opin Pediatr. Jan 28. 2019 [in press]

Science / Animal: Cannabis use during puberty can be harmful to the brain
The ingestion of THC in adolescent rats had negative effects on mental performance in adulthood. Some adverse effects disappeared over time.
Center for Addiction and Mental Health, Toronto, Canada.
Abela AR, et al. Psychopharmacology (Berl). 2019 Jan 29. [in press]

Science / Cells: A component of hemp seeds can reduce inflammation
In a study with microglial cells, cannabisin F, a lignanamide in hemp seeds, suppressed the production of inflammatory messenger substances, including interleukin 6 and tumor necrosis factor alpha. The researchers concluded that this substance has neuroprotective properties.
School of Pharmaceutical Sciences, Shandong University, Jinan, China.
Wang S, et al. Int J Mol Sci. 2019; 20 (3).

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