IACM-Bulletin of 23 December 2007 Inbox Reply
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IACM-Bulletin of 23 December 2007
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* Science: THC reduces chronic pain in patients who do not get
sufficient pain relief from opioids
* UK: Medicines regulatory agency publishes an information
report on Sativex
* Science: Qualitative similar composition of cannabis and
tobacco smoke
1.
Science: THC reduces chronic pain in patients who do not get
sufficient pain relief from opioids
According to a study conducted by researches of Harvard
Medical School in Boston THC (dronabinol) was able to reduce
pain in 30 patients taking opioids for chronic pain. Phase I of this
2-phase study was a double-blinded trial in which subjects were
administered once on three occasions either 10 mg or 20 mg of
THC or identical placebo capsules. Phase II was an open-label
individually dosed trial of THC as add-on medication to patients
on stable doses of opioids.
Results of the Phase I study showed that patients who received
THC experienced decreased pain intensity compared with
placebo. No differences in benefit were found between the two
THC doses. In the Phase II trial, titrated THC contributed to
significant relief of pain and increased satisfaction compared with
baseline. The incidence of side effects was dose-related.
Overall, the use of THC was found to result in additional
analgesia among patients taking opioids for chronic non-cancer
pain.
(Source: Narang S, Gibson D, Wasan AD, Ross EL, Michna E,
Nedeljkovic SS, Jamison RN. Efficacy of Dronabinol as an
Adjuvant Treatment for Chronic Pain Patients on Opioid
Therapy. J Pain 2007 Dec 12 [Electronic publication ahead of
print])
2.
UK: Medicines regulatory agency publishes an information
report on Sativex
On 13 December the Medicines and Healthcare products
Regulatory Agency (MHRA) published a Public Information
Report on Sativex, a cannabis extract of the British company
GW Pharmaceuticals approved for medical use in Canada. The
MHRA has taken this unprecedented step due to its view of the
“huge public interest” in Sativex and the fact that approximately
1200 patients in the UK have so far received the medicine on
prescription on a named patient basis.
The report concludes that the safety profile of Sativex is
considered acceptable in principle for the proposed patient
population and indication, providing sufficient efficacy is
demonstrated. GW Pharmaceuticals is currently conducting a
clinical study to clarify the remaining questions on efficacy of
their extract. The report includes a consensus statement by a
panel of independent experts. They concluded: "We conclude
that Sativex meets a currently unmet medical need in patients
where there is no other conservative treatment option. It is our
view that Sativex should be licensed and become available on
prescription for patients with spasticity due to multiple sclerosis,
and we urge the MHRA to do so."
The report is available on the website of the MHRA:
http://www.mhra.gov.uk/home/idcplg?IdcService=GET_FILE&dID=38433&noSaveAs=0&Rendition=WEB
(Sources: Press release by GW Pharmaceuticals of 13
December 2007, MHRA Report on Sativex of 13 December
2007)
3.
Science: Qualitative similar composition of cannabis and tobacco
smoke
Canadian researches investigated the chemical composition of
cannabis and tobacco smoke. Smoking of cannabis and tobacco
cigarettes, which weighed about 800 mg was carried out on
smoking machines. The results showed qualitative similarities
with some quantitative differences. With a normal tobacco
smoke rhythm, the smoke of both tobacco and cannabis
cigarettes contained an average of about 40 mg tar. Following a
more intense inhalation to simulate usual cannabis smoking the
amount of tar by cigarette increased to 80-100 mg. Thus, the
amount of inhaled noxious substances is less dependent from the
smoked material than from the smoking pattern. The results are
agreement with previous research.
With the same smoking pattern, ammonia was found in cannabis
smoke at levels of about 20-fold greater than that found in
tobacco, which according to the authors may have been due to
higher nitrate levels in cannabis due to fertilization. Hydrogen
cyanide was about 2.5 times, nitric oxide (NO) about 4 times
and some aromatic amines were found in cannabis smoke at
concentrations 3-5 times those found in tobacco smoke.
Tobacco-specific nitrosamines were not found in cannabis
smoke. Concentrations of mercury, cadmium, lead and arsenic
as well as low-molecular weight carbonyl compounds
(formaldehyde, acetaldehyde, etc.) were found at considerably
lower concentrations in cannabis smoke compared to tobacco
smoke. Cannabis smoke also contained somewhat less amounts
of polycyclic aromatic hydrocarbons.
The study is available at:
http://pubs.acs.org/cgi-bin/sample.cgi/crtoec/asap/pdf/tx700275p.pdf
(Source: Moir D, Rickert WS, Levasseur G, Larose Y,
Maertens R, White P, Desjardins S. A Comparison of
Mainstream and Sidestream Marijuana and Tobacco Cigarette
Smoke Produced under Two Machine Smoking Conditions.
Chem Res Toxicol. 2007 Dec 7 [Electronic publication ahead of
print])
4.
News in brief
***Science: Cancer of the large intestine
It is well-known that THC and other cannabinoids reduce
survival of cancer cells in the large intestine. In a letter to the
International Journal of Cancer, British researchers warned that
the long-term use of cannabinoid receptor antagonists might
increase the risk of cancer of the large intestine. The cannabinoid
receptor antagonist rimonabant is in use in Europe against
obesity. The risk for the development of this cancer is already
increased in obesity and this risk may be further increased by
rimonabant. (Source: Wright KL, et al. Int J Cancer. 2007 Dec
12 [Electronic publication ahead of print])
5.
ONE YEAR AGO:
- Switzerland: Parliament adopts the possibility of certificates of
exemption for the medical use of cannabis
- Science: Nabilone improves pain and other symptoms in
cancer patients
TWO YEARS AGO:
- Spain/UK: Agreement for the marketing of Sativex in Europe
- Germany: Petition Committee of the German Bundestag
supports the meeting of costs of a treatment with THC
(dronabinol) by the health insurances
- Germany: Federal Constitutional Court decides that health
insurances have to meet the costs of a new treatment if no
therapeutic alternatives are available in life-threatening illness
(More at the IACM-Bulletin archives:
http://www.cannabis-med.org/)
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