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IACM-Bulletin of 14 November 1999

Science: THC in Tourette-Syndrome

A randomised double-blind placebo-controlled crossover trial of delta-9-THC in 12 adults suffering from Gilles de la Tourette-Syndrome (Tourette-Syndrome) was conducted at the Medical School of Hanover. This syndrome is a complex neuropsychiatric disorder of unknown aetiology characterized by sudden spasms especially in the face, the neck and the shoulders and one or more vocal tics.

Patients received single doses of 5, 7.5, or 10.0 mg THC. Using both self and examiner rating scales there was a significant improvement of motor and vocal tics after treatment with THC compared with placebo. In addition, a self rating scale demonstrated a significant improvement of obsessive compulsive behaviour.

No serious adverse reactions occurred. Five patients experienced transient mild side effects such as headache, nausea, dizziness, anxiety, cheerfulness, tremble, dry mouth, and hot flush. All these side effects did not last longer than 6 hours. There were no significant differences after treatment with THC compared with placebo in verbal and visual memory, reaction time, intelligence, sustained and divided attention, vigilance, and mood.

This study followed a successful open uncontrolled study in a 25-year-old man with 10 mg of delta-9-THC, after he had reported relief from the use of marijuana to his physicians. Detailed study results are presented in two papers submitted for publication. First results are presented in an article on "Cannabis in Movement Disorders" in a supplement of the journal Research in Complementary Medicine on Cannabis in Medicine.

(Source: Mueller-Vahl KR, Kolbe H, Schneider U, Emrich H M: Cannabis in Movement Disorders. In: Grotenhermen F, Saller R (eds): Cannabis und Cannabinoide in der Medizin [Cannabis and Cannabinoids in Medicine]. Research in Complementary Medicine 6, Supplement 3, 1999)

USA: Maine voters endorse medical use of marijuana

Maine voters said yes to the use of marijuana for medical purposes by a wide margin on 2 November. About 61 percent of voters were in favour of legalizing pot for certain medical conditions, while 39 percent were opposed.

The citizen initiative asked voters: ''Do you want to allow patients with specific illnesses to grow and use small amounts of marijuana for treatment, as long as such use is approved by a doctor?'' The law will go into effect 30 days after the vote has been officially tallied.

With approval of the referendum, the state will join Alaska, Arizona, California, Oregon and Washington - all of which legalized medical marijuana in referendums. Nevada voters approved a constitutional amendment for medical marijuana in 1998, but must approve it again in 2000 for it to go into effect.

In order to use marijuana legally, a patient will have to be diagnosed by a physician as suffering from one of the following conditions: persistent nausea, vomiting, loss of appetite from AIDS or cancer treatments, glaucoma, and seizures or muscle spasms from chronic diseases, such as epilepsy or multiple sclerosis.

The patient also must be under the continuing care of a doctor. Doctors will not actually prescribe marijuana - patients must buy or grow the drug. The law limits the amount a medical patient can legally possess to no more than 10 ounces of harvested marijuana and six marijuana plants, of which no more than three can be mature, flowering plants.

(Sources: Bangor Daily News of 3 November 1999, Associated Press of 4 November 1999, Seattle Times of 9 November 1999)

Germany: Study with cannabis in cancer cachexia

Since 1996 a clinical study is prepared at the EURopean Institute for Oncological and Immunological Research in Berlin to examine the effectiveness of cannabis in loss of appetite and severe weight loss (cachexia) in advanced cancer patients. On 2 November the first two patients were enrolled into the long awaited study.

The trial should clarify if the ingestion of a standardized cannabis extract increases appetite, body weight and well-being of cancer patients. The effect of cannabis is compared double-blind and randomised to the effect of THC (dronabinol) and placebo.

The preparation to be tested is an extract of Cannabis sativa standardized on its THC content. One capsule contains 2.5 mg THC. It is manufactured from a high-quality plant extract, produced from the whole plant of biologically cultivated cannabis and worked into soft-gelatine-capsules. For 12 weeks patients with loss of appetite and weight loss of at least 5 per cent will be treated with two capsules of the cannabis preparation, THC or placebo.

Seven centres in Germany and Switzerland are currently active (Charité Centre Berlin, Charité Virchow-Clinic Berlin, Robert-Roessle-Clinic Berlin, University Hospitals of Halle, Bonn and Bern, Clinic Darmstadt). It is intended to enrol a total of 445 patients in 20 EURopean centres within a recruitment phase of 18 months. If these expectations can be realized study results are expected from summer 2001 on.

Prof. Robert Gorter, head of the study till now, left the EURopean Institute for Oncological and Immunological Research on 1 November. The management of the study is taken over conjointly by Prof. Thomas Cerny (Kantonsspital of Saint Gallen, Switzerland), Dr. Florian Strasser (Inselspital Bern, Switzerland) and Dr. Martin Schnelle (European Institute for Oncological and Immunological Research, Berlin).

(Source: Personal communication by Dr. Martin Schnelle)

Germany: Papers of the ACM 1998 meetings published

The papers of the congresses on cannabis as a medicine in Cologne and Frankfurt in December 1998 have been published now as a supplement of the journal Research in Complementary Medicine by Karger-Verlag: Grotenhermen F, Saller R (eds): Cannabis und Cannabinoide in der Medizin [Cannabis and Cannabinoids in Medicine]. Research in Complementary Medicine 6, Supplement 3, 1999.

The 48-page supplement contains the original scientific articles in German or English, and summaries in German and English.
- Editorial (German), Grotenhermen F (Koeln), Saller R (Zurich)
- Cannabis and Marijuana as Multidrug Mixtures in Phytotherapy (German), Saller R (Zurich)
- The Effects of Cannabis and THC (German), Grotenhermen F (Huerth)
- Cannabis and Cannabinoids: Pharmacology and Rationale for Clinical Use (English), Pertwee RG (Aberdeen)
- Recent Advances in Cannabinoid Research (English), Mechoulam R (Jerusalem)
- Cancer Cachexia and Cannabinoids (English), Gorter RW (Berlin)
- Cannabis in Movement Disorders (English), Mueller-Vahl KR, Kolbe H, Schneider U, Emrich HM (Hanover)
- Results of a Standardized Survey on the Medical Use of Cannabis Products in the German Speech Area (German), Schnelle M (Berlin), Grotenhermen F (Cologne), Reif M, Gorter RW (Berlin)
- Some Praxis-Relevant Aspects of the Pharmacokinetics of THC (German), Grotenhermen F (Huerth)
- The Future of Medical Marijuana (English), Grinspoon L (Boston)

Canada/USA: Renee Boje has claimed refugee status in Canada

Rhat two medical marijuana activists cannot use necessity as a defence in their upcoming drug trial. They also cannot refer to their medical conditions, the medical uses of marijuana or California's Proposition 215, which allowed the personal use of marijuana for medical purposes, U.S. District Judge George King said on 5 November.

Todd McCormick, who suffers from bone cancer, and Peter McWilliams, who has AIDS and cancer in remission, are accused of possessing marijuana with intent to distribute, distribution of marijuana, and conspiracy to grow marijuana. They were arrested in 1997 after federal officials found more than 6,000 plants growing in a Bel-Air mansion and three other leased locations in Los Angeles County.

McWilliams, a self-help publisher, is accused of financing the operation, while McCormick and others are accused of growing the marijuana and trying to sell it to the Los Angeles Cannabis Buyer's Club, which has dispensed the drug to patients since Californians voted in 1996 to legalize it for medical use. They are scheduled to stand trial on 16 November.

In addition to McWilliams and McCormick, several associates were accused in a federal indictment of July 1998. They include David Williams of Lancaster, Kirill Dyjine of Hollywood, Andrew Scott Hass of Malibu, Christopher Carrington of Manhattan Beach, Greg Collier of Van Nuys and Aleksandra Evanguelidi and Renee Boje of Los Angeles.

Renee Boje went to Canada and has claimed refugee status, claiming she's a political pawn in the U.S. government's war on drugs. The U.S. Justice Department is seeking Boje's extradition to Los Angeles where she would face a minimum 10 years in jail if convicted.

(Sources: AP of 7 November 1999, UPI of 24 July 1998, Vancouver Sun of 1 November 1999)

News in brief

USA:
A panel of Washington's Medical Quality Assurance Commission voted on 5 November to add Crohn's Disease, a bowel disease, to the list of illnesses qualifying patients under state law to use medical marijuana, along with cancer, HIV, multiple sclerosis, epilepsy and other seizure disorders, spasticity disorders, glaucoma and other terminal or debilitating medical conditions characterized by "intractable pain" unrelieved by standard medical treatment. Bonnie King, executive director of the commission, said panel members noted the lack of research findings, and made their finding based on anecdotal evidence. King said the next petition to be considered will be for hepatitis C.
(Source: Seattle Times of 9 November 1999)

UK:
The leader of the Scottish Conservative Party backed the use of cannabis in medicine on 2 November. David McLetchie said he believed doctors should be able to prescribe the drug for patients. The Scottish Tory leader, who nursed his first wife when she was dying of cancer, said he believed the drug could be used like morphine for pain relief for those suffering terminal illnesses.
(Source: PA News of 2 November 1999)

Australia:
On 9 November Victorian Premier Steve Bracks reaffirmed his desire to decriminalize possession of small amounts of marijuana in his first four years in office. Bracks tangled with John Howard over his plan last week when the prime minister attacked it for sending the wrong message and running counter to society's growing distaste for cigarette smoking. Bracks said he would like to be a drugs prohibitionist but had come to realize the issue should be treated as a medical one.
(Source: Australian Associated Press of 9 November 1999)

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