IACM-Bulletin of 31 August 2008

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IACM-Bulletin of 31 August 2008
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* Science: Nabilone effective in the treatment of night sweats of
four patients with advanced cancer
* Science: Dronabinol effective against a hyperkinetic movement
disorder due to a rare cell dysfunction in a case report

1.

Science: Nabilone effective in the treatment of night sweats of
four patients with advanced cancer

A researcher at a Division of Palliative Medicine of the University
of Toronto, Canada, presented four cases of successful treatment
of night sweats in advanced cancer with nabilone, a synthetic
derivative of dronabinol. The four patients had been referred to
the hospital and identified night sweats as one of their most
significant symptomatic concerns. On an 11-point scale with 0
indicating absence of night sweats and 10 indicating worst
possible severity, mean baseline score was 7.75. Two patients
received 1 mg nabilone daily taken at bedtime and two patients,
who also suffered from severe pain, nausea and appetite loss
received 1 mg nabilone twice daily. All patients reported
improvement within 48 hours. Two days after treatment onset
night sweat scores decreased to a mean of 2.75 and after 14 days
to a mean of 2.00. No relevant side effects occurred.

Night sweats are one of many symptoms experienced by patients
with advanced cancer. Persistent night sweats tend to decrease
quality of life through interference with sleep. A recent study has
demonstrated that night sweats occur as part of a symptom
pattern, and are associated with appetite and weight loss. In
addition, night sweats represent one of the symptoms that displays
a tendency not to improve as patients with advanced cancer
approach end of life. Other available medications are often
ineffective.

(Source: Maida V. Nabilone for the treatment of paraneoplastic
night sweats: a report of four cases. J Palliat Med 2008;11(6):929-
34.)

2.

Science: Dronabinol effective against a hyperkinetic movement
disorder due to a rare cell dysfunction in a case report

A researcher at the Department of Neurology at Michigan State
University, USA, presented a case report of a 24-year-old woman
with a complex hyperkinetic movement disorder due to a rare cell
dysfunction (mitochondrial cytopathy), who responded well to a
treatment with cannabis products. Both self-medication with
smoked cannabis and a treatment with oral dronabinol (5 mg three
times a day) were effective. She presented with tremor,
generalized dystonia, and hyperkinetic movement disorder. She
had difficulty maintaining her body weight of 36 kg, most likely
due to the increased caloric demands of her hyperkinetic
movements in combination with mild appetite loss.

At the age of 26 years she became pregnant. Dronabinol (THC)
was employed as a strategy to control her hyperkinetic involuntary
movements and promote weight gain during her pregnancy. Other
drugs that can be used to control hyperkinetic movements may be
contraindicated in pregnancy. She continued to experience an
improvement of her hyperkinetic movement disorder with the
regular use of dronabinol with no signs of tolerance or
requirement for dose escalation. Dronabinol stimulated her
appetite and assisted with weight gain. She gained a total of 20 kg
weight during her pregnancy and ultimately delivered a healthy
appearing baby with no complications.

(Source: Farooq MU, Ducommun E, Goudreau J. Treatment of a
hyperkinetic movement disorder during pregnancy with
dronabinol. Parkinsonism Relat Disord. 2008 Aug 7. [Electronic
publication ahead of print]

3.

News in brief

***Science: Anti-bacterial activity
Italian researchers found out that several natural cannabinoids
(cannabidiol, cannabichromene, cannabigerol, dronabinol, and
cannabinol) show potent anti-bacterial activity against a variety of
dangerous Staphylococcus strains, which are resistant against
several antibiotics. They noted that the use of cannabinoids as
systemic antibacterial agents has to be tested in clinical trials, but
their topical application to reduce resistant Staphylococcus
bacteria on the skin "seems promising." (Source: Appendino G, et
al. J Nat Prod 2008;71(8):1427-30.)

***Australia: Support for medical use
According to the 2007 National Drug Strategy Household Survey,
in which more than 23,000 Australians over the age of 12 were
interviewed about their drug use and their attitudes toward various
drug policy positions, 68.6 per cent of respondents supported "a
change in legislation permitting the use of marijuana for medical
purposes." More at:
http://www.aihw.gov.au/publications/index.cfm/title/10579#full_pu
blication. Survey data are found in Section 4 ("Community support
for drug-related policy"). (Source: Australian 2007 National Drug
Strategy Household Survey)

***USA: California
A bill that passed through the state senate this week would make
it illegal to fire a person solely because he uses medicinal
cannabis. The bill would reverse a court decision made earlier this
year in which the court upheld the firing of a worker for failing a
drug test after telling his employers in advance that he was using
medical cannabis to treat an ailment when not at work. The bill
still has to be signed by Governor Arnold Schwarzenegger.
(Source: Ukiah Daily Journal of 25 August 2008)

***USA: California
On 25 August California Attorney General Jerry Brown issued
new guidelines on the medical use of cannabis. According to the
guidelines, qualified patients and caregivers may possess up to 8
ounces (about 230 grams) of dried marijuana, and may maintain
no more than six mature plants or 12 immature plants, unless a
doctor recommends more. Brown's 11-page recommendation tells
local law-enforcement officers not to arrest patients, who use
medical cannabis, under federal law if their conduct is legal under
state law. Furthermore, the directive states that a properly run
dispensary operating as a non-profit is legal. The guidelines
caused a controversial discussion. (Sources: Times-Standard of 26
August 2008, Inland Valley Daily Bulletin of 27 August 2008)

***Science: Neurocognitive performance
24 subjects (12 occasional cannabis users and 12 heavy cannabis
users) participated in tests on neurocognitive performance after
cannabis use. Both groups received single doses of placebo
cigarettes and 0.5 mg/kg dronabinol as cannabis cigarettes,
resulting in 22.5-47.5 mg THC depending on body weight. THC
significantly impaired performance of occasional cannabis users in
most tests, but did not affect the performance of heavy cannabis
users except in a test on reaction time. Researchers concluded
that "cannabis use history strongly determines the behavioural
response to single doses of THC." (Source: Ramaekers JG, et al.
J Psychopharmacol 2008 Aug 21. [Electronic publication ahead of
print]

4.

ONE YEAR AGO:
- USA: Fight for the acceptance of state medicinal cannabis laws
by the Bush administration

TWO YEARS AGO:
- Science: New phase III trials of GW Pharmaceuticals in Europe
and North America, including for this first time in the USA
- USA: Judge orders changes in official explanation of cannabis
measure in South Dakota

(More at the IACM-Bulletin archives: http://www.cannabis-
med.org/)

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