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IACM-Bulletin of 25 November 2001

Canada: Debate on law on medical use of cannabis

The Canadian Medical Protective Association (CMPA) has written to Health Minister Allan Rock that the regulations that allow legal access to cannabis for patients since July 2001 place an unfair responsibility on physicians.

"The CMPA believes the medical declarations required under the regulations place an unacceptable burden on physicians to inform themselves as to the effectiveness of medicinal marijuana in each patient's case, as well as the relative risks and benefits of the drug and what dosage would be appropriate," said Dr. John Gray of the association in his letter. "This information is simply not available."

Other Canadians express their opinion that the regulations are too strict. Lawyer John Conroy, who has been involved with many cases involving the medical use of marijuana, calls the criteria for the medical use of cannabis "absurd" and says the regulations make it too difficult for people who are suffering health problems to legally use the drug. Many patients would have to fight to achieve what he considers is a basic right, that is access to the medicine of their choice.

(Sources: Edmonton Sun of 11 November 2001, Saanich News of 21 November 2001)

Science: Discussion on review papers in the British Medical Journal

On 24 November the British Medical Journal published four letters to the editor discussing review articles on the efficacy of cannabinoids in pain and chemotherapy-induced nausea published in July. The review papers had been rather reserved with regard to the medical potential of cannabinoids in these two indications.

Dr. Leslie Iversen, professor of pharmacology at the University of Oxford, wrote: "Campbell et al gave themselves an impossible task with their systematic review. Anyone who has reviewed the scientific literature on the medical uses of cannabis rapidly finds that there is a dearth of well controlled clinical trials. A meta-analysis of the use of cannabis in treating pain is therefore likely to find little of substance to comment on. (...) Unfortunately, this did not deter the authors from coming to a series of emphatic but ill founded conclusions."

Dr. Ethan Russo, clinical assistant professor at the University of Washington and editor of the Journal of Cannabis, stated: "What is surprising is that the authors chose to broaden the alleged impact of their limited investigation to relegate the use of cannabis and cannabinoids to a back seat in future analgesic applications. (...) The popular media have seized the opportunity, and in the process valuable laboratory and clinical research, and their funding, in analgesia and pain control have been severely compromised."

Dr. Franjo Grotenhermen of the Cologne nova-Institut and Chairman of the International Association for Cannabis as Medicine noted: "I am unsure whether the methods applied in the systematic reviews by Campbell et al and Tramèr et al are able to answer the questions of today's interest. If you pool the data from older studies of pain you will miss most of the interesting information. (...) The question of interest is not so much whether they are potent analgesics compared with codeine but, rather, which painful conditions they are effective in."

(Sources: British Medical Journal of 7 July and 24 November 2001, www.bmj.com/)

UK: Police unsure about how to deal with cannabis cafe

Britain's first cannabis café, in Stockford, Manchester, was raided by the police for the second time on 20 November. After raiding it on 15 September, the day it opened, the police seemed to have adopted a live-and-let-smoke policy, generously acknowledging, that there is an "ongoing debate about the medical benefits, or otherwise, of cannabis."

On 20 November, as the BBC was inside filming the cafe for a program about drug policy, the police returned, threw everyone out and charged the owner, Colin Davies, and several others with various drug-related offences.

An article in the New York Times stated that "it is unclear what the Stockport police really think of the Dutch Experience." In a confidential survey, conducted among the members of DrugScope, a government-backed charity, 81 percent of the 300 groups of police forces, courts, probation officers and drug care workers said, that cannabis should be sold at licensed places such as pubs, cafes and shops.

(Sources: The Observer of 11 November 2001, New York Times of 22 November 2001)

News in brief

IACM: Bulletin
There are now more than 2,000 subscribers to one of the six IACM-Bulletins in six languages. Subscribers doubled every year since its start in 1997 as the German ACM-Bulletin.

Switzerland: Steps to legalization
The health committee of the Swiss Council of States (upper house of the Swiss Parliament) has voted 6 to 4 in favour of legalizing the use and possession of cannabis and followed the proposal of the government. The sale and cultivation of cannabis will remain a criminal offence, but will be not be prosecuted under certain circumstances. The vote was in response to a government proposal. The next step involves a debate and vote on the bill by the whole upper house. (Source: AP of 13 November 2001)

Science: Cannabidiol
Mechanisms of action of cannabidiol (CBD) were analysed. CBD was shown to interact with vanilloid receptor type 1 and to increase the level of anandamide. (Source: Bisogno et al. Br J Pharmacol 2001 Oct;134(4):845-52)

Science: Intestinal inflammation
In mice bowel inflammation increased the potency of cannabinoid agonists possibly by 'up-regulating' CB1 receptors. In addition, endocannabinoids, whose turnover is increased in intestinal inflammation, might tonically inhibit bowel motility. (Source: Izzo et al. Br J Pharmacol 2001 Oct;134(3):563-70)

Europe: Cannabis use
The Lisbon-based EURopean Monitoring Centre for Drugs and Drug Addiction said in its annual report for 2001 that the proportion of adults who had ever used cannabis ranged from 10 percent in Finland to 20-25 percent in Denmark, France, Ireland, the Netherlands, Spain and the United Kingdom. Between one and nine percent of EU adults have used cannabis in the past 12 months. (Source: Reuters of 20 November 2001)

Science: Cell proliferation
Endocannabinoids seem to inhibit cell proliferation by a mechanism involving combined activation of both vanilloid receptors and to a lesser extent cannabinoid receptors. However, at present there is no universal mechanism known whereby phytocannabinoids affect cell proliferation. (Source: Jacobsson et al. J Pharmacol Exp Ther 2001 Dec 1;299(3):951-959)

Science: Cross-sensitisation with morphine
Repeated THC application to rats induced behavioural sensitisation not only to cannabinoids but also to opiates. This cross-sensitisation was symmetrical since rats sensitised to morphine were also sensitised to cannabinoids. These observations were regarded by the authors as a neurobiological basis for a relationship between cannabis use and opiate use. (Source: Cadoni et al. Psychopharmacology (Berl) 2001 Nov;158(3):259-266)

Science: Receptors in fetal brain
In the fetal human brain, low numbers of cannabinoid receptors could be observed as early as the 14th week of gestation. Receptor density increased slowly but did not reach adult levels by the end of the 24th week. The distribution pattern in the fetal brains was markedly different from the adult pattern. The relatively low number of cannabinoid receptors in the fetal human brain may explain the relatively mild consequences of cannabis use during pregnancy. (Source: Biegon A, Kerman IA. Neuroimage 2001 Dec;14(6):1463-1468)

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