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IACM-Bulletin of 05 December 2021

World: Over 180 civil society groups call for greater transparency at the INCB within its cannabis initiative

One year on from the formal recognition of the potential for cannabis as a medicine by the United Nations 181 NGOs, among them the IACM, call for greater transparency and accountability in the INCB (International Narcotics Control Board) , particularly in relation to its Cannabis Control Initiative. On 2 December 2020 the United Nations Commission on Narcotic Drugs (CND) rescheduled cannabis recognising its medical properties for the first time.

However INCB, a body of the United Nations, has launched its own ‘Cannabis Control Initiative’. In an Open Letter to the United Nations Secretary-General, António Guterres the civil society groups from 56 countries ask:
- Disclose INCB documentation like other similar UN bodies;
- Opt-in to the UN online documentation access and archival system;
- Extend the civil society consultations to all areas of work of the Board;
- Call for and collect written contributions from non-State actors;
- Allow NGOs & non-State actors to participate as observers in INCB meetings;
- Scale-up “country visits,” inspired in the human rights treaty bodies Annual Review Mechanism.

FAAAT of 2 December 2021

Switzerland: Pharmacies sell cannabis to adults

In Switzerland, the dispensing of cannabis for recreational use will be tested in several model projects in pharmacies starting 2022. Already from the beginning of next year, consumers in Zurich, Basel and other cities will be able to purchase cannabis in pharmacies and social clubs. The Commission for Social Security and Health of the Council of States - the small chamber of the Swiss parliament - had already laid the legal foundation for this in August 2020 with the so-called experimental article and enabled strictly regulated scientific studies on the use of cannabis.

Pilot trials are to be conducted to investigate the effects of regulated access to cannabis on consumption, health and purchasing behaviour. In this way, they are to provide "a factual basis for a discussion on the further development of cannabis policy and Swiss drug policy", as announced by the City of Zurich.

Apotheke Adhoc of 23 November 2021

Malta: The country is the first in EURope to legalise home growing of cannabis for personal use

Malta is to legalize cannabis. Its citizens will be able to grow cannabis at home and establish cannabis social clubs. The bill also allows growing up to four cannabis plants at home. However, plants shouldn’t be visible from other places. When cultivating cannabis plants at home, consumers can keep up to 50 grams of dried cannabis in the household. Cannabis consumption in public will be forbidden unless the person is authorized to use it for medical reasons.

The cannabis reform bill has now to pass in parliament for the third reading and final vote. It is expected to become law in mid-December 2021. The legalization process started this year, when the Ministry for equality, research and innovation of the smallest country in the EURopean Union introduced in October 2021 a bill to reform law on cannabis.

Forbes of 1 December 2021

Science/Human: The medical use of cannabis is associated with reduced opioid and benzodiazepines prescriptions in orthopaedic pain patients

In an prospective observational study by investigators at Legacy Research Institute in Portland, USA,
orthopedic pain patients profited from a treatment with cannabis. They were enrolled in Pennsylvania's medical cannabis program by their treating pain management physician, received cannabis education from their physician at the time of certification, and purchased products from state-licensed cannabis retailers.

Cannabis use was associated with clinical improvements in pain, function, and quality of life with reductions in prescription drug use. 73% either ceased or decreased opioid consumption and 31% discontinued benzodiazepines. Significant clinical benefits of cannabis occurred within 3 months of initiating cannabis therapy and plateaued at the subsequent follow-ups.

Greis A, Larsen E, Liu E, Renslo L, Radakrishnan A, Wilson-Poe AR. Perceived efficacy, reduced prescription drug use, and minimal side effects of cannabis in patients with chronic orthopedic pain. Cannabis Cannabinoid Res. 2021 Nov 12. [in press]


Science/Human: Patients with psychotic disorders may need lower doses of neuroleptics if they get an additional treatment with CBD cigarettes

According to a small placebo-controlled trial with 31 acutely psychotic patients by investigators of the University Psychiatric Clinics Basel, Switzerland, participants needed lower doses of neuroleptics if they got an additional treatment with CBD cigarettes. CBD-rich cannabis with less than 1% THC was given in addition to standard psychiatric treatment. Outcomes were assessed after 4 weeks of acute treatment and long-term follow-up after discontinuation of CBD-cigarettes after 25 weeks.

There were no significant differences between the placebo group and the CBD group with regard to symptom severity. However, patients in the placebo group needed higher doses of neuroleptics. Authors concluded that “the presented findings might suggest an antipsychotic medication sparing effect of CBD-cigarettes as adjunctive treatment of acute psychosis. However, the low number of participants did not allow for further statistical analysis.”

Köck P, Lang E, Trulley VN, Dechent F, Mercer-Chalmers-Bender K, Frei P, Huber C, Borgwardt S. Cannabidiol Cigarettes as Adjunctive Treatment for Psychotic Disorders - A Randomized, Open-Label Pilot-Study. Front Psychiatry. 2021;12:736822.

Science/Human: Cannabis may be helpful in paediatric palliative care

According to a case series of 6 children presented by investigators of the Pediatric Pain and Palliative Care Service of the Department of Women's and Children's Health at the University Hospital in Padova, Italy, a cannabis extract may improve pain and epilepsy in palliative care. Caregivers reported changes in intensity and frequency of pain and epilepsy events. The participants received a titrated plant extract of cannabis for 1 year.

Only mild and transient adverse events occurred: drowsiness, euphoria, restlessness and tachycardia; the resolution was either spontaneous or obtained by modifying the administration schedule. Treatment was never discontinued. All patients experienced seizures during the pre-treatment observation period, and obtained a reduction in seizure frequency, although with variable extent while receiving cannabis. In addition, a benefit on pain was observed, based on the caregiver's evaluation, and a reduction of analgesic use.

Divisic A, Avagnina I, De Tommasi V, Santini A, Brogelli L, Giacomelli L, Benini F. The use of medical cannabis in pediatric palliative care: a case series. Ital J Pediatr. 2021;47(1):229.

Science/Human: An inhibitor of endocannabinoid degradation improved symptoms of Tourette Syndrome in clinical study

In a placebo-controlled study with 20 adults patients with Tourette syndrome administration of Lu AG06466, a selective inhibitor of the degradation of the endocannabinoid 2-AG (2-arachidonoylglycerol), was associated with symptom improvement. Participants were on standard-of-care medications and randomized to a single fasted dose of Lu AG06466 (40 mg) or placebo in period 1, followed by the other treatment in period 2.

There was an overall trend of tic reduction, with two out of three tic scales showing a significant effect at various time points. In addition, the study medication resulted in a significant reduction in premonitory urges versus placebo. The treatment was well-tolerated, and the most common adverse events were headache, somnolence, and fatigue.

Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Germany.
Müller-Vahl KR, Fremer C, Beals C, Ivkovic J, Loft H, Schindler C. Endocannabinoid Modulation Using Monoacylglycerol Lipase Inhibition in Tourette Syndrome: A Phase 1 Randomized, Placebo-Controlled Study. Pharmacopsychiatry. 2021 Nov 30. [in press]

News in brief

France: 1000 patients already included in a trial on medical cannabis
To date, 1,000 patients have been included in the medical cannabis trial and 779 of them are currently being monitored, in order to determine the most effective and best tolerated dose. Last August, Health Minister Olivier Véran gave the green light to the medical cannabis experiment with the inclusion of a first patient at the Clermont-Ferrand University Hospital. A few months later, 1,000 patients have been included and a thousand caregivers are mobilised to monitor this experiment. 3000 patients are expected to participate.
Top Sante of 23 November 2021

United Arab Emirates: Changes in the narcotics law
The new Federal Decree Law no. 30 of 2021 on combating narcotics and psychotropic substances, to be effective from January 2, 2022, brings key changes to the Federal Law no. 14 of 1994. Some of the drug law’s major highlights include rehabilitation of first-time drug offenders, optional deportation of expats convicted in drug-related cases and tougher penalties on serial offenders.
Khaleej Times of 28 November 2021

USA: Reduction of cannabis use by adolescents
Data provided by the Substance Abuse Mental Health Services Administration’s (SAMHSA) finds that the number of cannabis users fell significantly year-over-year among those ages 12 to 17. Specifically, it reports that past-year of cannabis use by teens fell from 13.2% in 2019 to 10.1% in 2020 — a decline of some 25 percent. Past-month cannabis use declined from 7.4% to 5.9%.
SAMHSA of 25 October 2021

Israel: The number of legal cannabis patients reaches 105,000
105,000 cannabis patients or 1.3% of the population are allowed to use altogether 4 tons of cannabis per month. More specifically, as of the end of October 2021, there were 104,907 medical cannabis licensees in israel.
Cannabis of 29 November 2021

Science/Human: Cannabis during pregnancy does not influence the IQ
Exposure to THC before birth did not influence the IQ in 1197 children, who were tested at 12, 24, 36, and 48 months of age. However, cannabis exposure was associated with worse attention scores.
Departments of Obstetrics and Gynecology, University of Utah Health, Salt Lake City, USA .
Smid MC, et al. Obstet Gynecol. 2021 Dec 2. [in press]

Science/Animal: No synergy of morphine and THC in inflammatory pain
In a rat model of persistent inflammatory pain there was no synergy between morphine and THC in reducing pain.
Center on Drug and Alcohol Research, University of Kentucky, USA.
Britch SC, et al. Behav Pharmacol. 2021;32(8):630-639.

Science/Human: Cannabis users with severe post-traumatic stress disorder tend to use cannabis after presentation of trauma reminders
In a study with 51 trauma-exposed cannabis users investigators found an “uncontrollable compulsion to use cannabis in response to trauma reminders”, “particularly likely among cannabis users with more severe PTSD symptoms.”
University of Roehampton, School of Psychology, Whitelands College, London, UK.
Romero-Sanchiz P, et al. Addict Behav. 2022;125:107126.

Science/Human: Cannabis legalisation had positive effect in the clearance of violent clients
An analysis of crime reports between 2007 and 2017 in Oregon (OR) suggests “a beneficial impact of legalization on violent crime clearances, as manifested by significant increases in the clearance rate for overall violent crimes and that for aggravated assault in OR counties relative to those in the non-legalized states following legalization.”
The University of Utah, Department of Sociology, Salt Lake City, USA.
Wu G, et al. Int J Drug Policy. 2021;100:103528.

Science/Animal: CBGA shows antiepileptic effects in mouse models
Cannabigerolic acid (CBGA), cannabidivarinic acid (CBDVA) and cannabigerovarinic acid (CBGVA) showed anticonvulsant activities in mouse models. Authors wrote that these “results suggest that CBGA, CBDVA and CBGVA may contribute to the effects of cannabis-based products in childhood epilepsy.”
Lambert Initiative for Cannabinoid Therapeutics, The University of Sydney, Australia.
Anderson LL, et al. Br J Pharmacol. 2021;178(24):4826-4841.

Science/Animal: CBD shows antipsychotic -like effects in mice
In a mouse model of psychosis investigators found that “CBD induces acute antipsychotic-like effects that last for 24-h. It also modulates DNA methylation in the ventral striatum, suggesting a new potential mechanism for its antipsychotic-like effects.”
Department of Neurosciences and Behavioral Sciences, School of Medicine of Ribeirão Preto, University of São Paulo, Brazil.
Pedrazzi JFC, et al. Prog Neuropsychopharmacol Biol Psychiatry. 2021;111:110352.

Science/Human: Childhood trauma increases the likelihood of psychotic -like experiences after cannabis use
in a study with 2630 cannabis users childhood trauma (abuse and neglect) was associated with greater psychotic -like effects after cannabis use“which may be linked with an increased susceptibility to the dysphoric/paranoid subjective effects when using the drug.”
Lives Lived Well research group, School of Psychology, Faculty of Health and Behavioural Sciences, University of Queensland, Brisbane, Australia.
Carlyle M, et al. Schizophr Res. 2021;238:178-184.

Science/Animal: CBD reverses memory impairments in a model of oestrogen depletion
There is evidence that oestrogen depletion leads to memory impairments. In a rodent model of oestrogen depletion researchers demonstrated that CBD has the “potential as a treatment for estrogen decline-induced deterioration of neural functioning and maintenance.”
School of Health and Life Sciences, Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, Brazil.
Corrê MDS, et al. Behav Brain Res. 2022;417:113555.

Science/Human: The legalisation of cannabis in Canada resulted in a reduced number of cannabis associated crimes in youth
An analysis of cannabis-related crimes among youth in the age of 12 to 17 years in the years 2015 to 2018 demonstrated that there was a reduction of 55% in male adolescents and of 65% in female adolescents.
Northern Medical Program, University of Northern British Columbia, Prince George, Canada.
Callaghan RC, et al. Addiction. 2021;116(12):3454-3462.

Science/Animal: Cannabinoid receptors may be involved in the effects of some terpenes
In mouse models of pain 3 terpenes “produced a subset of effects in tests of locomotor activity, hypothermia, and acute antinociception. These findings suggest alpha-terpineol, beta-caryophyllene, and gamma-terpinene may have differential cannabinoid receptor activity and a pharmacological profile that may yield new efficacious analgesics.”
Department of Pharmacodynamics, College of Pharmacy, University of Florida, Gainesville, USA.
Bilbrey JA, et al. Psychopharmacology (Berl). 2021 Nov 30. [in press]

Science/Human: Topical administration of CBD and PEA on the skin are well tolerated
In a number of trials the effects of several products containing CBD (cannabidiol) and PEA (palmitoylethanolamide) on the skin were investigated. They were shown to be “nonirritating and nonsensitizing in healthy adults, and further encourage similar research assessing their long-term safety and efficacy in human participants with dermatological diseases.”
Department of Dermatology, Henry Ford Health System, Detroit, USA.
Maghfour J, et al. Clin Exp Dermatol. 2021;46(8):1518-1529.

Science/Cells: CBD modulates the production of certain anti-inflammatory cytokines in monocytes
CBD was shown to alter the production of interleukin-1-beta and interleukin-6 in certain white blood cells of humans, so-called monocytes.
Department of Pharmacology and Toxicology, Michigan State University, East Lansing, USA .
Sermet S, et al. Toxicology. 2021;464:153016.

Science/Human: Cannabis use by pregnant women may cause a suppression of immune responses in the placenta
According to a study with children aged 3 to 6 years cannabis use of their mothers during pregnancy may have influenced the immune responses in the placenta and increased anxiety and hyperactivity in THC exposed children.
Addiction Institute of Mount Sinai, Departments of Psychiatry and Neuroscience, Icahn School of Medicine at Mount Sinai, New York, USA.
Rompala G, et al. Proc Natl Acad Sci U S A. 2021;118(47):e2106115118.

Science/Animal: In mice without CB1 receptors there was an impaired blood vessel relaxation
Studies with genetically modified mice without CB1 receptors there was a reduced blood vessel relaxation after the administration of a synthetic cannabinoids (WIN55212-2) and the endocannabinoid 2-AG demonstrating that the CB1 receptor is necessary for the relaxation of blood vessels by cannabinoids.
MOE Key Laboratory of Modern Teaching Technology, Shaanxi Normal University, Xi'an, China.
Wang LN, et al. Microvasc Res. 2022;139:104263.

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