Inhaling cannabis is associated with the remission of refractory idiopathic angioedema, according to a clinical report published in the journal Case Reports in Immunology. Angioedema is a condition characterized by rapid swelling under the skin in regions around the face and throat, which may result in airway obstruction or suffocation.
Investigators from the Soroka University Medical Center in Israel reported on the progress of a 27-year-old male patient with life-threatening, recurrent angioedema of unknown origin. Doctors placed the patient on a regiment of 20 grams of inhaled cannabis monthly after he failed to respond favorably to prescribed steroids and antihistamines.
Authors reported: “The use of inhaled cannabis resulted in a complete response, and he has been free of symptoms for 2 years. An attempt to withhold the inhaled cannabis led to a recurrent attack within a week, and resuming cannabis maintained the remission, suggesting a cause and effect relationship.”
They concluded: “This is the first report in which a cannabis product for the treatment of refractory idiopathic angioedema was associated with an excellent clinical response. … More research into the exact mechanism of action of cannabis products in cases of idiopathic angioedema and on the modulation of the immune response in general is indicated.”
The Israeli government has authorized the limited production and distribution of marijuana as a medical treatment since 2011, and preparations of the plant are expected to be available in pharmacies imminently.
Full text of the report, “Life threatening idiopathic recurrent angioedema responding to cannabis,” appears online here.
A history of cannabis use is associated with a lower likelihood of obesity and diabetes, according to population-based data published in the journal Obesity.
Investigators from the Conference of Quebec University Health Centers assessed cannabis use patterns and body mass index (BMI) in a cohort of 786 Inuit (Arctic aboriginal) adults ages 18 to 74. Researchers reported that subjects who consumed cannabis in the past year were more likely to possess a lower BMI, lower fasting insulin, and lower HOMA-IR (insulin resistance) as compared to those who did not use the substance.
Specifically, researchers reported that cannabis users possessed an average BMI of 26.8 compared to an index of 28.6 for non-users, after controlling for age, gender and other factors. Those subjects who reported using cannabis but never having used tobacco, or who were former users of tobacco, possessed on average the lowest BMI.
Authors concluded: “In this large cross-sectional adult survey with high prevalence of both substance use and obesity, cannabis use in the past year was associated with lower BMI, lower percentage fat mass, lower fasting insulin, and HOMA-IR. … The inverse association observed in our work supports evidence from a larger proportion of previous cross-sectional and follow-up investigations. … As a result, cannabinoids from cannabis may be viewed as an interesting avenue for research on obesity and associated conditions.”
Observational trial data published in 2013 in the American Journal of Medicine reported that subjects who consumed cannabis possessed favorable indices related to diabetic control compared to those without a history of recent marijuana use. Separate observational trial data published in 2012 in the British Medical Journal reported that marijuana users had a lower prevalence of type 2 diabetes and possessed a lower risk of contracting the disease than did those with no history of cannabis consumption, even after researchers adjusted for social variables such as subjects’ ethnicity, family history, and levels of physical activity.
Cross-sectional data published in 2011 in the American Journal of Epidemiology similarly reported that the prevalence of obesity in the general population is sharply lower among marijuana consumers than it is among nonusers.
We read with interest the recent review of medical use of cannabinoids (1). As the authors attempt to emphasize, they focus on a heterogeneous collection of experiments that employed a range of treatments, including synthetic THC, CBD, and THC-mimicking drugs.
Lay readers might inappropriately generalize these results specifically to whole plant medical cannabis But few (only two) of these experiments were conducted using medical cannabis; most of the studies reviewed focused on outcome measures that do not address the plant’s potential advantages over a single, compound agent in pill form.
For example, the authors conclude that evidence of individual, synthetic cannabinoids to help nausea and vomiting due to chemotherapy was low in quality. Within hours of the publication of the paper, mainstream media coverage applied these conclusions to medical cannabis per se, not just medical cannabinoids (2). In fact, as the authors emphasize, only 6 of the 28 studies assessing nausea and vomiting used THC, and none of these actually employed vaporized or inhaled botanical cannabis. The dependent measures were also not sensitive to the key advantage of medical cannabis for nausea: speed of onset. (Inhaled medicines can work within seconds. Sprayed extracts require at least a half hour while cannabinoids in pill form can take multiple hours.) The authors were generally careful about these caveats, but the disparate and inaccurate media coverage suggests that flagship journals in all fields now have to be even more diligent when cautioning readers about the inappropriate generalization of results. Despite increasing popularity, medical cannabis remains controversial and, apparently, newsworthy. As reviews of the effects of cannabinoids proliferate, authors, editors, journal staff, and journalists might welcome a reminder that cautions about interpretation need to be spelled out in more effusive, detailed, and thorough ways.
Mitch Earleywine, Ph.D.
University at Albany
Department of Psychology
Chair, NORML Board of Directors
National Organization for the Reform of Marijuana Laws (NORML)
Amanda Reiman, Ph.D.
Drug Policy Alliance
1) Whiting PF, Wolff RF, et al. Cannabinoids for Medical Use: A Systematic Review and Meta-analysis. JAMA, 2015: 313(24):2456-2473
2) Seaman, AM. Medical marijuana: good evidence for some diseases, weak for others. Reuters. June 24, 2015. http://www.reuters.com/article/2015/06/23/us-marijuana-medical-evidence-idUSKBN0P31WT20150623
The director of the US National Institute on Drug Abuse (NIDA), Nora Volkow, believes that cannabidiol (CBD) – a nonpsychotropic cannabinoid – is “a safe drug with no addictive effects.” Volkow made the comments in an op-ed published by The Huffington Post.
Volkow further acknowledged, “[P]reliminary data suggest that it may have therapeutic value for a number of medical conditions.”
Preclinical studies have documented CBD to possess a variety of therapeutic activities, including anti-cancer properties, anti-diabetic properties, and bone-stimulating activity. Clinical and observational trials have documented the substance to possess anxiolytic, anti-psychotic, and anti-seizure activity in humans. Safety trials have further concluded the substance to be “safe and well tolerated” when administered to healthy subjects.
To date, 15 states have enacted laws specifically permitting the possession of high-CBD formulated extracts for therapeutic purposes, primarily for the treatment of pediatric epilepsy.
In a recent Time Magazine op-ed, Democrat Sen. Diane Feinstein (CA) and Republican Sen. Charles Grassley (IA) encouraged the Obama administration to “definitively determine if CBD has scientific and medical benefits,” and to “look at expanding compassionate access programs where possible, to benefit as many children as possible.”
Under federal law, CBD — like cannabis — is defined as a Schedule I controlled substance with “a high potential for abuse … no currently accepted medical use, … [and] a lack of accepted safety for the use of the drug … under medical supervision.”
Massachusetts Senator Elizabeth Warren, along with seven other Senators, has directed a letter to the Obama administration demanding regulators answer questions specific to the facilitation of research into the medical benefits of marijuana.
Senators acknowledged the need for unbiased research. They wrote, “While the federal government has emphasized research on the potential harms associated with the use of marijuana, there is still very limited research on the potential health benefits of marijuana — despite the fact that millions of Americans are now eligible
by state law to use the drug for medical purposes.”
The Senators applauded a recent decision by the Department of Health and Human Services to eliminate the HHS Public Health Service review process. But they also acknowledged the drawbacks of NIDA’s monopoly on supply of marijuana for research purposes and the need for alternative providers.
Senators also questioned marijuana’s current classification as a Schedule 1 drug under federal law and its classification under international treaties and if the FDA is prepared to call for the reclassification of cannabidiol.
Addressed to the heads of the Department of Health and Human Services (HHS), the Drug Enforcement Administration (DEA), and the Office of National Drug Control Policy, the letter signals to many that medical marijuana is becoming an even more important issue in the political sphere not only to voters but also to their elected officials.
Co-signing the letter with Senator Warren were Senators Barbara Mikulski (D-Md.), Barbara Boxer (D-Calif.), Ron Wyden (D-Ore.), Jeff Merkley (D-Ore.), Kirsten Gillibrand (D-N.Y.), Edward J. Markey (D-Mass.), and Cory Booker (D-N.J.). The Senators are seeking a reply to their questions from the administration by August 31.