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IACM-Bulletin of 15 January 2012
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* Science: Cannabis smoking does not impair lung function according large long-term study
* Science: Cannabis use was not associated with cognitive impairment in people at the age of 50 according to a large epidemiological study
* Science: Cannabis-ketamine synergy in intractable neuropathic pain in case report

1. Science: Cannabis smoking does not impair lung function according
large long-term study

Cannabis does not impair lung function - at least not in the doses
inhaled by the majority of users, according to the largest and
longest study ever to consider the issue, which was published in the
Journal of the American Medical Association. US researchers conducted
a longitudinal study collecting repeated measurements of pulmonary
function and smoking over 20 years from 1985 to 2006 in 5115 men and
women. "Occasional and low cumulative marijuana use was not
associated with adverse effects on pulmonary function," authors
summarized the results. Lifetime exposure to cannabis cigarettes was
expressed in joint-years, with 1 joint-year of exposure equivalent to
smoking 365 joints (cannabis cigarettes) or filled pipe bowls.

Researchers found that measures of lung function - forced expiratory
volume in the first second of expiration and forced vital capacity -
actually improved slightly as young people reported using more
cannabis - at least up to 7 joint-years or 2,555 joints. "There's no
doubt marijuana triggers a cough," said Dr. Stefan Kertesz, from the
University of Alabama at Birmingham, who worked on the new study. But
questions have remained about the drug's longer-term effect on lung
functioning. Not surprisingly tobacco use was associated with
decreased lung function. But at least at moderate levels of cannabis
smoking, that didn't seem to be the case - in fact, the trend was
reversed. Lung volume and air flow rates both increased with each
joint-year in moderate users. "It's a very real increase (...) but
it's so small that I don't think that a person would feel a benefit
in terms of their breathing," Kertesz said. At the highest levels of
cannabis smoking lung function seemed to decline again, but the
researchers noted that there weren't enough heavy cannabis users in
their study population to be sure of that.

It is unlikely that cannabis puts users at risk of chronic
obstructive pulmonary disease, or COPD, as smoking tobacco does, says
Dr. Donald Tashkin, professor at the University of California in Los
Angeles, who studies the effects of cannabis on the lungs for decades
but wasn't involved in the new study. When it comes to diminished
lung function, "This particular potential complication of marijuana
smoking doesn't appear to be an important risk," he told the press
agency Reuters. "Therefore, people who are using marijuana for
medicinal purposes or recreationally at least could be reassured that
they're not harming their lungs in this way."

More at:
In English
- http://www.reuters.com/article/2012/01/11/us-pot-health-
idUSTRE8092BC20120111
- http://healthland.time.com/2012/01/10/study-smoking-marijuana-not-
linked-with-lung-damage/#ixzz1jLnFDX5J
In Spanish
-
http://www.nlm.nih.gov/medlineplus/spanish/news/fullstory_120727.html
- http://www.jornada.unam.mx/ultimas/2012/01/11/111624097-consumo-
ocasional-de-marihuana-no-afecta-los-pulmones-estudio
In German
- http://www.aerzteblatt.de/nachrichten/48717
- http://www.welt.de/gesundheit/article13811166/Kiffen-ist-besser-
fuer-die-Lunge-als-Rauchen.html

(Source: Pletcher MJ, Vittinghoff E, Kalhan R, Richman J, Safford M,
Sidney S, Lin F, Kertesz S. Association between marijuana exposure
and pulmonary function over 20 years. JAMA 2012;307(2):173-81.)

2. Science: Cannabis use was not associated with cognitive impairment in
people at the age of 50 according to a large epidemiological study

Researchers at King's College in London, UK, investigated the
association between illicit drug use and cognitive functioning during
the mid-adult years. They found that "at the population level, it
does not appear that current illicit drug use is associated with
impaired cognitive functioning in early middle age." A total of 8,992
participants who were surveyed at 42 years of age in the years 1999
and 2000 were included. The authors analyzed data on 3 cognition
tests when the participants were 50 years of age in the years 2008
and 2009.

Cannabis was by far the most common used drug of the participants
with six percent saying they had used it in the past year, while one-
quarter said they had ever used it. Overall, the study found, there
was no evidence that current or past drug users had poorer mental
performance. In fact, when current and past users were analysed
together, their test scores tended to be higher. But that advantage
was small, the researchers said, and might just reflect another
finding - that people who'd ever used drugs generally had a higher
education level than non-users. "However, the authors cannot exclude
the possibility that some individuals and groups, such as those with
heavier or more prolonged use, could be harmed," they write in their
article for the American Journal of Epidemiology.

More at:
http://www.reuters.com/article/2012/01/04/us-drugs-
idUSTRE8030AE20120104

(Source: Dregan A, Gulliford MC. Is Illicit Drug Use Harmful to
Cognitive Functioning in the Midadult Years? A Cohort-based
Investigation. Am J Epidemiol. 2011 Dec 21. [in press])

3. Science: Cannabis-ketamine synergy in intractable neuropathic pain in
case report

Two doctors from the Institute for Neuropathic Pain in Soest, The
Netherlands, reported of a 56 year old woman suffering from severe
chronic neuropathic pain due to damage of the right ulnar nerve.
During her life she had had several fractures and surgeries of her
right arm. Since 1996 she suffers from pain in the innervation area
of the ulnar nerve, which is mainly the area of the fourth and fifth
finger. The pain increased in the following years with a pain
intensity of 7 on an 11-point numerical rating scale (NRS) with "0=no
pain" and "10=highest possible pain," despite the use of opiates and
other pain medication.

She stopped the medication due to severe side effects and started
using oral cannabis (0.5 grams per day in cookies) resulting in the
reduction of pain intensity from 8 to 5 on the pain scale. Adding
ketamine cream twice daily further reduced the pain (pain scale: 2 to
3). Ketamine is a medicinal drug used for general anaesthesia and
also for pain reduction. Authors concluded: "Ketamine and cannabis
may act synergistically because cross-talk exists and the cannabinoid
and the opioid receptor systems also have synergistic interactions."

(Source: Hesselink JM, Kopsky DJ. Intractable neuropathic pain due to
ulnar nerve entrapment treated with cannabis and ketamine 10% J Clin
Anesth. 2012 Jan 5. [in press])

4. News in brief

***Science: Cannabis increases creativity in people with low
creativity
According to research of the University College London, UK, with 160
cannabis users, who were investigated one day under the influence of
cannabis and one day sober, cannabis influenced psychosis-like
symptoms and verbal fluency as a measure of creativity. Subjects were
divided into four groups of creativity level. The drug increased
psychosis-like symptoms in people with the highest and lowest
creativity. In addition, acute cannabis use increased creativity in
people with low creativity. (Source: Schafer G, et al. Conscious
Cogn. 2012 Jan 7. [in press])

***Science: THC neuroprotective in model of Parkinson's disease
Researchers of the University of Plymouth, UK, demonstrated an
increase of the CB1 receptor in direct response to neuronal injury in
a cell culture model of Parkinson's disease, and a direct protective
effect of THC on the nerves. (Source: Carroll CB, et al. Neuropathol
Appl Neurobiol. 2012 Jan 11. [in press])

***Science: Pharmacokinetics of Namisol (THC)
The pharmaceutical company Echo Pharmaceuticals in Nijmegen, The
Netherlands, investigated the pharmacokinetic properties of their THC
preparation Namisol. Namisol is a new tablet containing THC designed
to improve bioavailability. Oral Namisol resulted in a maximum blood
concentration after 39-56 minutes. Authors noted that "variability
and the time of maximum value of THC plasma concentrations were
smaller for Namisol than reported for studies using oral dronabinol
and nabilone." (Source: Klumpers LE, et al. Br J Clin Pharmacol. 2011
Dec 28. [in press])

***Science: Nabilone did not reduce experimental acute pain in
clinical study
Researchers of the pharmaceutical AstraZeneca investigated the
effects of the synthetic cannabinoid nabilone on acute pain, which
was induced by a chemical (capsaicin), in a placebo-controlled cross-
over study with 30 healthy subjects. The cannabinoid had no
significant effect on acute pain. (Source: Kalliomäki J, et al. Clin
Exp Pharmacol Physiol. 2012 Jan 10. [in press])

***Science: Endocannabinoids reduce allergic reactions in the skin in
tissue experiments
Researchers from University of Lübeck, German, investigated the
effects of the stimulation of CB1 receptors on so-called mast cells
in human skin. These cells are important for allergic reactions.
Researchers found that mast cells in normal skin are controlled by
the endocannabinoid system limiting excessive activation of mast
cells. They concluded that "CB1 stimulation is a promising strategy
for the future management of allergy." (Source: Sugawara K, et al. J
Allergy Clin Immunol. 2012 Jan 6. [in press])

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