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IACM-Bulletin of 26 October 2003

USA: Doctors are allowed to recommend the medical use of cannabis to patients

On 14 October the U.S. Supreme Court ruled that the government cannot revoke the prescription licenses of doctors who recommend medical marijuana to their patients. Without any comment, the justices rejected an appeal of the Bush administration to a court ruling that bars the government from punishing a doctor because of a recommendation that a patient use marijuana.

An U.S. appeals court in San Francisco had ruled earlier that the federal government's policy against doctors who recommend marijuana violated constitutional free-speech rights of physicians and patients.

The case began after Californian voters in 1996 adopted Proposition 215, the law, which makes it legal for seriously ill patients to grow and possess cannabis for medical use when a doctor recommends it. In recent years eight other states – Alaska, Arizona, Colorado, Hawaii, Maine, Nevada, Oregon and Washington – have approved similar medical marijuana laws.

The appeals court in San Francisco upheld a federal judge's ruling that bars the U.S. Drug Enforcement Administration from revoking the very important doctor’s license to prescribe federally regulated narcotics. The agency also was barred from even beginning an investigation of any doctor who recommended marijuana. The Federal Justice Department appealed to the Supreme Court. The ruling of the high court is regarded as a setback for the Bush administration in its fight against the medical use of cannabis.

(Source: Reuters of 14 October 2003)

Science: Inhaled THC (dronabinol) tested in study with healthy subjects

Pulmonary administration of dronabinol (THC) appears to be safe and may provide a better therapeutic pharmacokinetic profile and advantages over the oral form, according to results of a study presented on 21 September at the 32nd Annual Meeting of the American College of Clinical Pharmacology in Palm Harbor, Florida (USA).

56 healthy men and women were recruited for a placebo-controlled study by Dr. Jodi Miller and colleagues of Solvay Pharmaceuticals, Marietta, Georgia (USA), to compare the pharmacokinetics of oral dronabinol against a nebulized formulation administered in a propylene glycol/ethanol/water solution.

Nebulized dronabinol resulted in relatively high plasma concentration. Overall, the nebulized route of administration appeared to be tolerable in healthy subjects, with cough being the most common complaint.

Inhaled dronabinol was rapidly absorbed with a maximum plasma concentration at 0.03-0.05 hours, while the oral formulation peaked at 0.75 to 2 hours. This is one of the big advantages of pulmonary delivery, Dr. Miller said. "The drug will be able to reach the systemic circulation quickly while bypassing first-pass metabolism, resulting in a rapid onset of action."

Dronabinol is the natural (-)-trans-isomer of delta-THC in the cannabis plant. Synthetic dronabinol is available in the USA as Marinol. In Germany two companies produce dronabinol by isomerization of cannabidiol from fibre hemp.

(Source: News article from Doctors Guide by Mike Fillon of 12 October 2003)

Science/Australia: Nabilone not better than codeine in pain relief

According to an Australian study the synthetic THC derivative nabilone does not provide any better pain relief than the weak opiate codeine. Nabilone is available in Australia for the treatment of nausea and vomiting due to cancer chemotherapy.

Dr. Dilip Kapur, from Flinders Medical Centre in Adelaide, studied nabilone in 80 patients with chronic pain and nerve damage in a double-blind cross-over design. Half were given a codeine-like drug and the others nabilone, which was swapped after six weeks

Dr Kapur said neither medication was particularly useful but codeine provided better pain relief than nabilone. He said the study provided strong evidence that cannabis was not beneficial for treating strong pain. However, it could be helpful in certain circumstances, he said.

(Source: West Australian of 18 October 2003)

Science: Discussion on influence of heavy cannabis use on male fertility

According to research by the University of Buffalo presented at the Annual Meeting of the American Society of Reproductive Medicine, heavy marijuana users have sperm that move too fast, too soon, and become burnt out, reducing the chance of fertilisation,

Researchers compared samples of seminal fluid from 22 men who were heavy marijuana users with that from 59 fertile men who had produced a pregnancy. "The bottom line is, the active ingredients in marijuana are doing something to sperm, and the numbers are in the direction towards infertility," said lead researcher Dr. Lani Burkman.

Dr. Anne Jequier, President of the Fertility Society of Australia, who has previously studied sperm from five heavy marijuana smokers, says she found Dr Burkman's research very interesting. "A year ago we took five heavily addicted marijuana smokers and we looked at their semen. We could find nothing wrong with the routine semen analysis. If Burkman has found there in an alteration in the hyperactivation pattern in this semen - and I haven't seen the abstracts for this meeting yet - that is very interesting."

Until now studies do not demonstrate that cannabis users get less often or less children. Every to every two years there is basic research from the University of Buffalo that cannabis may have a negative impact on sperm quality or fertility, however, with unclear practical relevance.

(Source: ABC Science Online of 14 October 2003)

News in brief

Australia: Survey on medical use
The National Drug and Alcohol Research Centre at the University of Sydney, Australia is conducting a survey of medicinal cannabis use. If you live in Australia, use cannabis for medicinal purposes, and would like to participate in this anonymous survey please visit the IACM homepage for more information at:
www.cannabis-med.org/english/australia.htm
You may also write to Peter Gates at p.gates@unsw.edu.au
(Source: Wendy Swift, University of Sydney)

USA: Medical marijuana cards in California
A statewide medical marijuana identity card system was signed into law on 11 October by out-going Governor Gray Davis, before governor elect Arnold Schwarzenegger takes office in November. The identification cards are designed to protect medical cannabis users from arrest by state and local law enforcement officers. Patients' names would not be registered, rather each patient would be assigned an identifying number by which he or she could grow or possess six mature plants, 12 immature plants or eight ounces of dried marijuana and be safe from arrest or confiscation of the marijuana. (Source: Associated Press of 13 October 2003, Ukiah Daily Journal of 14 October 2003)

Economy: Dexanabinol
Current phase III trials of dexanabinol are expected to be completed by the fourth quarter of 2004. Following positive results the drug is expected to go to market by mid-2006 and reach worldwide sales of $500 million to $600 million by 2009. The Food and Drug Administration late last month granted fast-track status to dexanabinol. The FDA typically awards the designation to drugs that treat serious and life-threatening conditions for which no other approved treatments exist. Dexanabinol is a synthetic cannabinoid without psychotropic effects. It is designed to limit brain damage when given in the first few hours after trauma. (Source: Associated Press of 13 October 2003)

USA: Oregon
Agents of the U.S. Drug Enforcement Agency (DEA) confiscated 104 cannabis plants from a patient’s home, despite his state license. They said they were simply enforcing federal laws against growing cannabis. The raid was the second in a year against cannabis cultivated in Oregon for medicinal uses. In recent years the DEA mainly raided Californian patients and cannabis clubs and confiscated their cannabis. (Source: Associated Press of 12 October 2003)

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