Saturday, 16 August 2014

Vive le Cannabis or it it Hir oes i'r canabis

Prescrire Int. 2014 Jun;23(150):145-8.Delta-9-tetrahydrocannabinol + cannabidiol. A reasonable option for some patients with multiple sclerosis.

Conventional drugs have only a limited impact on spasticity associated with multiple sclerosis and are rarely satisfactory. A solution for oral transmucosal delivery (spray) containing a mixture of cannabis extracts (2.7 mg of delta-9-tetrahydrocannabinol + 2.5 mg of cannabidiol per spray) has been granted marketing authorisation in France for patients who are inadequately relieved by standard treatments. Three double-blind, placebo-controlled trials in a total of about 300 patients tested this combination, in addition to ongoing treatment, for periods of 6 to 14 weeks. Individually, none of these trials showed any tangible anti-spastic efficacy, but two combined analyses showed "response rates" of about 35% with the mixture versus about 25% with placebo. In a trial with 572 patients, the 241 patients who "responded" after 4 weeks of treatment were randomised to either continue using the cannabis extract or receive placebo. Twelve weeks later, 75% of patients using the extract were still "responders", versus 51% of patients switched to placebo. The principal adverse effects of the cannabis extracts consist of neuropsychiatric disorders that resolve on treatment withdrawal. The potential for abuse increases with the dose and is tangible from 16 sprays per day. Pharmacokinetic interactions due to P-glycoprotein inhibition are likely. Treatment during pregnancy may lead to neonatal withdrawal symptoms. In practice, about 10% of patients in whom standard anti-spastic medications are unsatisfactory benefit from a specific effect of the cannabis extracts contained in this oral spray.

So this article is published as France grants the marketing rights of sativex. However perhaps its Hir oes i'r canabis (blame Google tranlate if its wrong) as NHS wales approves funding for Sativex.

For some it does nothing, for others it seems to offer some benefit above existing treatment the only way to know is to try it. To try it you have to get your hands on it. Will GW pharma offer a months free trial like other companies to see if it works?

Sativex has yet to be approved in the America. 

One of my relatives in the US, who has MS, was given a cannabis sweet to try to see if it was any good. They had never taken cannabis before and not knowing what to expect, they had a bite of the sweet and nothing. However, it made them go to sleep, they then woke, up a bit dopey, with the "munchies" (a well known side effect of cannabis that stimulates the desire to eat). What did they find first? Yep a bag of sweets/candies, which we all rapidly eaten...Ooops...now essentially paralysed and unable to move because of way too much cannabis, the children find my relative on the floor and thinking its a serious relapse or something serious, it's off to A & E (ER in American) leading to an eventual embarrassing talk with the physician. That ended their cannabis experimentation.


This episode does show that cannabis overdose does not tend to kill you..which is a good thing but it does lead to the question why are so called "medical cannabis producers" making very high content THC sweets (candies), that largely serve the function of getting people taking them very high. Packaging as candy/sweets make you wonder who are the target buyers and the responsibility of some cannabis producers out to make a buck. 

In the US they are letting a genie out of a bottle with legalisation for recreational use along with medical marijuana, so the experiment begins. 

Having met a number of PotDocs who are prescribing marijuana who go off to "Medicate"........I think the sooner that the pharmaceutical side can dissociate the medical and recreational sides the better. I suspect it is because of this type of image that no big pharmaceutical company has ventured into the cannabinoid world. 

Most of the big pharma have had cannabinoid programmes. I wonder if Sanofi (the makers of Lemtraa) who took the plunge with cannabinoid drugs and was burned (cannabinoid receptor antagonist used to suppress appetite, the opposite of the munchies, which unfortunately appeared to make some people so depressed they killed themselves), will develop any of their cannabinoid-related drugs (just check out there patent portfolio) for MS? 

COI: We are developing alternative symptomatic medicines

4 comments:

  1. "I think the sooner that the pharmaceutical side can dissociate the medical and recreational sides the better" I think pharma is best suited to study and tweak the THC/CBD ratios in cannabinoid therapies. I agree that there needs to be a well defined separation between medical and recreational marijuana. Why can't the cannabinoids be treated in a similar fashion as the opioids? By combining recreational and medical marijuana the patient is left with a hit or miss depending on the cannabis strain that is used.

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    1. For the opioids there is a clear distinction between street heroin and the pharmaceutical morphine etc. However the heroin users are not pushing legalisation on the grounds of medicinal use and the medical use does nothing to promote the street drug.

      In contrast the medical marijuana campaign gets highjacked by the recreational marijuana brigade and it has become blurred e.g. the PotDocs or at least some of them are "stoners" who delude themselves that they are medicating, whilst getting high. Not many "real" doctors who give morphine for pain and take it personally for medication.

      The problem is that street cannabis is the medicine and the drug. The US are making this blurry line more blurry by continuing to deny a licence to Sativex, whilst legalising medical marijuana. About 23 states have medical marijuana now two states also have recreational marijuana which were medical marijuana states. Having met a number of medical marijuana growers I am pretty convinced they like to sample what they grow.

      There is a move for the medical marijuana to have content of THC shown and as you say with street drugs there is no clear labelling as to quality control and with heroin this can have very disastrous consequences when some one gets pure heroin when they are used to less pure drug and so inject too much. Heroin can kill.

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    2. As to ratios it needs to be done empirically but who is going to do it.

      At a recent Cannabis meeting the mean THC to CBD ratio in medical cannabis in a sample of californian medical marijuana is 12:1,

      I went on a so called Canadian medical marijuana site

      Cannatonic 2:1 ratio however it is 12.5% THC,

      Green Cush for "Daytime use" 21.2%THC <1% CBD etc,etc most of it very high THC content can you use this to avoid the high and get medical benefit..who are we kidding
      Whilst I fully accept that the high may be part, if not the benefit.

      There are loads of claims that this stuff is good for this and that stuff is good for that...where is the published proof.. "I know because I take it myself" is not an acceptable answer but this is what I heard when I spoke to one of the medical marijuana growers.

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  2. AnonymousSunday, August 17, 2014 10:36:00 am
    said What about Canbex?

    The compounds being developed by Canbex are not Cannabinoids however the origins are indeed trying to avoid using cannabis

    ReplyDelete

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