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IACM-Bulletin of 15 September 2019

Science/Human: Cannabis use is associated with reduced infection with the most notorious hospital acquired bacterial disease

In a study with 59,824 patients cannabis use was associated with a reduced prevalence of Clostridioides difficile infections (CDI). Scientists of the Department of Medicine at the University of Massachusetts, USA, used data from the Nationwide Inpatient Sample 2014. They selected a sample and matched cannabis users to non-users in a ratio of 1 to 1 (29,912:29,912).

The risk of cannabis users for infection with Clostridioides difficile was reduced by 28% compared to non-users. The reduction for dependent cannabis users was even higher, 80%, while the risk for non-dependent users was reduced by only 20%. Authors concluded that cannabis use disorders “was associated with a decreased risk of CDI amongst hospitalized patients.”

Adejumo AC, Bukong TN. Cannabis use and risk of Clostridioides difficile infection: Analysis of 59,824 hospitalizations. Anaerobe. 2019 Sep 4:102095.

Science/Human: Capsaicin may be helpful in cannabis hyperemesis syndrome

In a study with 43 patients suffering from cannabinoid hyperemesis syndrome conducted by the Department of Pharmacy of the University of Colorado Hospital in Denver, USA, topical capsaicin was shown to be helpful. Capsaicin in different concentrations (0.025%, 0.075% and 0.1%) was applied to the abdomen or the chest.

Patients received fewer additional medications if capsaicin was utilized (4 vs. 3 doses), and 67% of visits where capsaicin was utilized required no further treatment prior to discharge. Additionally, opioid usage was less when utilizing capsaicin (167 versus 69 mg). Authors wrote that “while medication costs for capsaicin visits were minimally more expensive, the utility of capsaicin as an over-the-counter (OTC) product may empower at home therapy with OTC products, decreasing potentially unnecessary healthcare encounters and costs.” Cannabis hyperemesis syndrome is characterised by vomiting due to cannabis and may happen in a small part of cannabis users.

Wagner S, Hoppe J, Zuckerman M, Schwarz K, McLaughlin J. Efficacy and safety of topical capsaicin for cannabinoid hyperemesis syndrome in the emergency department. Clin Toxicol (Phila). 2019 Sep 4:1-5.

Science/Human: THC may be helpful in geriatric pain patients

In an open study with 40 geriatric patients over the age of 80 years treated by pain therapists in Potsdam, Germany,, bei der 3. Meldung dann, vergessen habe eine ASCII THC (dronabinol) was shown to reduce pain. Patients were treated between March 2017 and July 2018. Geriatric, nonpalliative pain patients and geriatric palliative patients were investigated.

By using THC, 21 of the 40 geriatric patients (52.5%) achieved pain relief of more than 30%, 10% of the patients of more than 50%. On average, about four symptoms or side effects related to previous treatment were positively influenced. 26% of patients reported side effects. Authors concluded: “We show that cannabis-based drugs (in this case dronabinol) are an effective, low-risk treatment option that should be considered early in therapy.”

Wendelmuth C, Wirz S, Torontali M, Gastmeier A, Gastmeier K. [Dronabinol in geriatric pain and palliative care patients : A retrospective evaluation of statutory-health-insurance-covered outpatient medical treatment]. [Article in German] Schmerz. 2019 Aug 31. [in press]

News in brief

Science/Human: Cannabis may be helpful in spasticity due to amyotrophic lateral sclerosis
A retrospective mono-centric cohort study was realised in 32 patients with amyotrophic lateral sclerosis with spasticity. They profited well from a treatment with the cannabis spray Sativex at a mean dose of 5.5 sprays (range less than 1 to 20 daily), 1 spray containing 2.7 mg THC and 2.5 mg CBD. The following mean satisfaction levels were found (maximum value 100): effectiveness 70.5, convenience 76.6 and global satisfaction 75.0. Authors concluded that “results suggest that THC:CBD may serve as a valuable addition in the spectrum of symptomatic therapy in ALS.
Centre for ALS and other motor neuron disorders, Charité - Universitätsmedizin Berlin, Germany.
Meyer T, et al. BMC Neurol. 2019;19(1):222.

Science/Animal: CBD may improve metabolic dysfunction in people with diabetes suffering from reduced blood supply to the brain
In a study with rats with diabetes submitted to chronic reduced blood supply to the brain treatment with CBD for 30 days (10 mg/kg bodyweight) improved metabolism. Authors concluded, that “CBD may be used as therapeutic tool to protect metabolism against injuries from diabetes aggravated by cerebral ischemia.”
Biochemistry Department, State University of Maringa, Brazil.
Trentin Zorzenon MR, et al. Chem Biol Interact. 2019 Sep 6:108819.

Science/Human: Cannabis may be helpful in familial Mediterranean fever
Two familial Mediterranean fever (FMF) patients were treated with medical cannabis. Under medical cannabis treatment, both patients had remarkable improvement in the severity of the attacks and also a decrease in the frequency of the attacks, from once every 2 weeks to 1 attack every month in 1 patient. Familial Mediterranean fever is a genetic disorder, which causes different forms of attacks with abdominal pain, fever and other symptoms.
Rheumatology Unit, Laniado Hospital, Netanya, Israel.
Habib G, et al. Am J Case Rep. 2019;20:1340-1342.

Science/Human: The presence of THC metabolites in urine was associated with reduced opioid concentrations in pain patients
An analysis of about 800,000 urine drug testing results collected from pain management patients the presence of THC-COOH was associated with differences in excreted opioid concentrations. For each of the opioids investigated (codeine, morphine, hydrocodone, hydromorphone, oxycodone, oxymorphone, fentanyl and buprenorphine), cannabis use was associated with statistically significant lower urinary opiate levels than in samples without cannabis use.
Goggin MM, et al. Pain Manage 2019;9(5).

Germany: 13 million EURos in sales tax for medical cannabis in 2018
According to a projection by the pharmacists' association, the state collected almost 13.3 million EURos in sales tax from medical cannabis in 2018. This number is thought to increase in 2019.
fuldainfo.de of 30 August 2019

Paraguay: Government opens licence process for the production of cannabis
The Minister of Health announced the beginning of the process for the granting of licenses for its production, industrialization and controlled commercialization of cannabis. Applications from interested companies will be received from 1 to 31 October at the National Directorate of Health Surveillance.
Health Ministry of 12 September 2019

Science/Cells: THC may be helpful in periodontal wound healing
In a study with human periodontal fibroblast cells THC improved periodontal wound healing by inducing migration of cells and other mechanisms. These effects were mainly mediated by the CB2 receptor. Authors concluded that cannabinoids “may contribute to developing new therapeutics for periodontal regeneration and wound healing.
University of Detroit Mercy, School of Dentistry, Detroit, USA.
Liu C, et al. J Clin Periodontol. 2019 Aug 28. [in press]

Science: Industrial hemp had higher CBD content on soils contaminated with heavy metals
Researchers demonstrated that 6 different varieties of industrial hemp produced higher concentrations of CBD on soils contaminated with lead, nickel, mercury and cadmium (between 2.2 and 2.6%) compared to normal soil (between 1.1and 1.6% CBD). The authors concluded that the data indicates a high tolerance to heavy metals as indicated from the physiological and metabolites analysis.
Penn State Harrisburg, Middletown, USA.
Husain R, et al. PLoS One. 2019;14(8):e0221570.

Science: CBD and THC may be helpful in the treatment of methamphetamine in neurodegeneration
Scientists presented a hypothesis that THC and CBD may play a role through its potent neuroprotective and anti-inflammatory properties in the inhibition or treatment of methamphetamine induced neurodegeneration, neuro- inflammation and mitochondrial dysfunction.
Pharmaceutical Sciences Branch, Islamic Azad University, Tehran, Iran.
Majdi F, et al. Med Hypotheses. 2019;133:109371.

Science/Animal: Activation of CB2 receptors may prevent the development of heart damage in liver disease
In a study with mice activation of the CB2 receptor with severe liver disease reduced the level of TNF-alpha, a pro-inflammatory cytokine and improved dysfunction and inflammation of the heart. Authors concluded that cannabinoids, which activate the CB2 receptor “may delay/prevent the development of cardiomyopathy in severe liver disease.”
Laboratory of Cardiovascular Physiology and Tissue Injury, National Institutes of Health, Bethesda, USA.
Matyas C, et al. Hepatology. 2019 Aug 30. [in press]

Science/Animal: CB2 receptors in the spinal cord may be involved in pain-reducing effects of exercise
Several studies have shown that exercise is a non-pharmacological therapy in muscle pain. In a study with mice researchers demonstrated that the activation of CB2 receptors in the spinal cord and reduction of activated microglia cells may be involved in this process.
Institute of Motricity Sciences, Federal University of Alfenas, Brazil.
Dos Santos RS, et al. Neuroscience. 2019 Aug 29. [in press]

Science/Human: Cannabis was associated with the risk for suicidal thoughts in military personal with post-traumatic stress disorder
In a study with 545 patients the presence of post-traumatic stress disorder and cannabis use was aswociated with an increased risk for suicidal thoughts and behaviour.
Department of Psychology, Ohio University, USA.
Allan NP, et al. Depress Anxiety. 2019 Sep 2. [in press]

Science/Human: CBD may reduce seizures in Angelman syndrome
In a mouse model of Angelman syndrome CBD reduced seizures and EEG abnormalities. Angelman syndrome is a genetic disorder, which mainly affects the nervous system.
Gu B, et al. J Clin Invest. 2019 Sep 10. [in press]

Science/Human: Cannabis use in adolescence may impair function of glia cells in the brain
in a study with 22 adolescents, who used cannabis, and 21 non-using controls researchers found signs of impaired function of glia cells in a certain brain region (hippocampus). Researchers wrote that this “may underlie cannabinoid-induced memory impairments.”
Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK.
Blest-Hopley G, et al. Addict Biol. 2019 Sep 2. [in press]

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