Pain - neuropathic

[Midnight toker]

In MedPanel Summit, Leading Pain Experts Name Cannabinoids Among Most Promising Approaches to Treating Neuropathic Pain, Assert that Sociopolitical Climate Will Hamper Drug Approvals

PharmaLive.com

CAMBRIDGE, Mass., June 21, 2006 /PRNewswire/ -- Cannabinoids, chemical agents found in the marijuana plant and endogenous to the human body, are the most promising approach to treating a common type of pain, according to an elite group of pain specialists convened by MedPanel to discuss the challenges and future of treating neuropathic (nerve injury) pain. Despite widespread acknowledgement of the inadequacy of current therapies for this type of pain, the specialists view Food and Drug Administration (FDA) approval of a cannabinoid drug as a thorny process that will be hampered by politics, prejudice and a lack of education on the part of the FDA, Drug Enforcement Agency (DEA) and general public concerning the nature of cannabinoid agents. While it is difficult to estimate the number of people suffering from neuropathic pain, the condition is frequently seen in patients with diabetes, cancer, carpal tunnel syndrome, HIV, diseases of the central nervous system such as multiple sclerosis and Parkinson's disease, and in certain post-surgical populations.

"During the summit we asked the group to respond to data pertaining to several novel drug therapies and classes of agents under study, and at the conclusion of the meeting they told us that cannabinoids' potential for a strong analgesic affect, broad action on the central nervous system, reduced side effects and use in combination with other therapies is more exciting to them than several other investigational approaches," said Matt Fearer, Senior Vice President, Content Development for MedPanel. "It appears, however, that an unfortunate sociopolitical climate could delay or prevent the approval of potentially valuable therapies for millions of people suffering from neuropathic pain," he added.

To facilitate a cannabinoid drug approval process, some of the specialists recommended that manufacturers develop drug therapies that act selectively -- that is, on a few specific rather than on several -- cannabinoid receptors in the body. The group agreed that it would be important to involve FDA in clinical trial design, share early trial data, and engage in education with DEA and the general public to overcome the perception that cannabinoids are the same as marijuana.

The summit participants concurred that if approved for prescription use in the United States, a cannabinoid agent would likely be regulated ("scheduled") by the DEA, as are opioids and certain anti-convulsants -- two of the most commonly used types of neuropathic pain therapies.

In considering challenges to developing therapies for and treating neuropathic pain, the group frequently noted the need for more effective therapies, better animal models of pain, new diagnostic tools, and improved clinical trial design -- including selection of an appropriate study population and new methods to address bias such as the placebo effect.

MedPanel, Inc., a global organization based in Cambridge, MA, offers a powerful online research platform providing clients greater strategic direction for investment decisions, product development, and marketing. By leveraging its proprietary methodology and vast network of medical experts, MedPanel is uniquely positioned to provide fast, accurate, unbiased market data and information to clients in the biotechnology, pharmaceutical, medical device, and financial industries.

CONTACT: Janna Guinen for MedPanel, Inc., +1-781-834-7498, jpglive@adelphia.net

Web site: http://www.medpanel.com/

Terms and conditions of use apply
Copyright © 2006 PR Newswire Association LLC. All rights reserved.
A United Business Media Company

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New Study of Medical Cannabis Shows Scientific Value for Patients with Neuropathic Pain

Posted on : Mon, 12 Feb 2007 21:15:01 GMT | Author : Americans for Safe Access
News Category : PressRelease
Earth Times


WASHINGTON, Feb. 12 /PRNewswire-USNewswire/ -- National HIV/AIDS and advocacy groups including the National Association of People With AIDS (NAPWA) today called for congressional hearings in response to a new study from the University of California, San Francisco (UCSF) on medical cannabis and neuropathic pain, published in the peer reviewed journal Neurology. The study is the first of its kind in the U.S. in nearly 20 years to indicate the medical efficacy of cannabis.

"This study validates the experience people living with HIV/AIDS and their doctors have reported for years- medical cannabis provides much-needed relief from pain and suffering." said NAPWA Executive Director Frank Oldham Jr. "That is why we are joining Americans for Safe Access to call on Congress to address cannabis for its medicinal value."

An estimated 3-4 million people in the U.S. suffer from neuropathic pain and as many as 37% of people living with HIV/AIDS use cannabis to treat neuropathy and other symptoms associated with the disease.

The UCSF study was a randomized, placebo-controlled clinical trial of 50 patients who had an average of six years of neuropathic pain. The pain reduction in the group receiving the medical cannabis was twice that of the placebo group.

"I have been living with HIV/AIDS for 21 years and owe my life to the benefits of medical cannabis," said UCSF study participant Diana Dodson. "It reduces the pain and side-effects such as nausea and stomach pains that are caused by the drugs I need to take in order to stay alive. But I need the government to grant me safe access to my medicine."

The study builds on other international evidence and a 1999 Institute of Medicine (IOM) report Marijuana and Medicine, Assessing the Science Base.

"This study demonstrates the potential effectiveness of medical cannabis to treat the chronic pain of people living with HIV/AIDS," said Dr. Barbara T. Roberts, Director of Medical and Scientific Affairs for Americans for Safe Access and former Senior Policy Analyst at the White House Office of National Drug Control Policy. "In addition to people living with HIV/AIDS, there are thousands of vets returning from Iraq who will spend decades coping with neurological pain. By implementing the recommendations of the IOM report, the federal government would be exploring more options for their long-term treatment of neuropathic pain."

The groups are calling on Congress to hold hearings on the IOM report to adopt its recommendations to allow patients and researchers to have access to medical cannabis.

"It's time for Washington to stop playing politics with patients' lives and advance this important scientific discovery," said Steph Sherer, Executive Director of Americans for Safe Access. "The study is a wake-up call for Congress to hold hearings to investigate therapeutic use and encourage research."

For more information, contact: Timi Gerson, Paco Fabian, Kate Geller or Jacqueline Batambuze at Fenton Communications (202) 822-5200.

Americans for Safe Access

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Health

HIV Patients: Marijuana Eases Foot Pain

By PAUL ELIAS, The Associated Press
The San Francisco Examiner
Feb 12, 2007 4:00 PM

SAN FRANCISCO - Smoking marijuana eased HIV-related pain in some patients in a small study that nevertheless represented one of the few rigorous attempts to find out if the drug has medicinal benefits.

The Bush administration's Office of National Drug Control Policy quickly sought to shoot holes in the experiment.

The study, conducted at San Francisco General Hospital from 2003 to 2005 and published Monday in the journal Neurology, involved 50 patients suffering from HIV-related foot pain known as peripheral neuropathy. There are no drugs specifically approved to treat that kind of pain.

Three times daily for nearly a week, the patients smoked marijuana cigarettes machine-rolled at the National Institute of Drug Abuse, the only legal source for the drug recognized by the federal government.

Half the patients received marijuana, while the other 25 received placebo cigarettes that lacked the drug's active ingredient, tetrahydrocannabinol. Scientists said the study was the first one published that used a comparison group, which is generally considered the gold standard for scientific research.

Thirteen patients who received marijuana told doctors their pain eased by at least a third after smoking pot, while only six of those smoking placebos said likewise. The marijuana smokers reported an average pain reduction of 34 percent, double the drop reported by the placebo smokers as measured with a widely accepted pain scale.

"These results provide evidence that there is measurable medical benefit to smoking cannabis for these patients," said Dr. Donald Abrams, the University of California, San Francisco professor who led the study.

Many critics of smoked marijuana agree THC has promise as a painkiller, but they argue the smoke itself is harmful.

"People who smoke marijuana are subject to bacterial infections in the lungs," said David Murray, chief scientist at the Office of National Drug Control Policy. "Is this really what a physician who is treating someone with a compromised immune system wants to prescribe?"

Murray also questioned the statistical relevance of study with just 50 participants in the test.

Dr. Mark Ware, a researcher at McGill University in Montreal conducting similar tests, defended Abrams' study as sound and statistically reliable.

The study is one of the few human tests in a research field nearly devoid of federal funding.

"This is a valid medicine and I want safe access to my medication," said Diana Dodson, a 50-year-old grandmother of five who participated in the test in 2004.

California and 10 other states have passed laws legalizing marijuana for medicinal purposes, but the federal government considers it a dangerous drug, like cocaine or heroin. The U.S. Supreme Court ruled in 2005 that state laws do not protect users from the federal ban.

To conduct the test, Abrams needed authorization from eight academic and government agencies, including the Drug Enforcement Administration.

The study cost about $1 million and was paid for by the University of California Center for Medicinal Cannabis Research, which has sponsored several smoked marijuana tests.

---

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The cigarettes were made from marijuana grown on a federal marijuana farm in Mississippi, and stored in a locked freezer at San Francisco General.

Imagine what the result would have been if they'd been given some REAL bud.

Unprecedented SF study finds pot helps ease pain

Sabin Russell, Chronicle Medical Writer
The San Francisco Chronicle
Monday, February 12, 2007

(02-12) 12:59 PST SAN FRANCISCO -- Doctors at San Francisco General Hospital reported today that HIV-infected patients suffering from a painful nerve condition in their hands or feet obtained substantial relief by smoking small amounts of marijuana in a carefully constructed study funded by the State of California.

Although the study itself was small, it is the first of its kind to measure the therapeutic effects of marijuana smoking while meeting the most rigorous requirements for scientific proof -- a so-called randomized, double-blinded placebo-controlled trial.

As such, the results of the trial are being hailed by medical marijuana advocates as the most solid proof to date that smoking the herb can be beneficial to patients who might otherwise require opiates or other powerful painkillers to cope with a condition known as peripheral neuropathy.

Federal agencies oppose the use of marijuana for medical purposes on the grounds that it is harmful and that there is no scientific evidence to support medical use of marijuana for treatment in the United States.

"It's time to wake up and smell the data,'' said Bruce Mirken, spokesman for the Marijuana Policy Project, a group advocating legalization of medicinal use of the drug. "The claim that the government keeps making that marijuana is not a safe or effective medicine doesn't have a leg to stand on.''

The study found that most volunteers who were given three marijuana cigarettes a day experienced a significant drop in the searing pain of peripheral neuropathy, which patients liken to a stabbing or burning sensation, usually on the bottoms of their feet.

On average, the participants in the experiment reported at the start that their pain was roughly at midpoint on a 100 point scale, where zero was no pain at all and 100 was "the worst pain imaginable.''

At least half the volunteers who smoked the active marijuana experienced a 72 percent reduction in pain after smoking their first cigarette on the first day of the trial. Over the course of five days, the median reduction in pain reported by the marijuana smokers was 34 percent, compared to 17 percent reported by those who smoked placebo cigarettes that had the active ingredient THC removed in a process akin to decaffeinating coffee.

"This is evidence, using the gold standard for clinical research, that cannabis has some medicinal benefits for a condition that can be severely debilitating,'' said Dr. Donald Abrams, lead author of the study released today by the journal Neurology.

The trial was conducted over a two-year period during which 50 volunteers each spent a week at a secured laboratory at San Francisco General. After a two-day orientation period, during which they stopped smoking marijuana they may have been using, they were given one cigarette three times a day. Half of the volunteers received marijuana containing about 3.5 percent of THC, the active ingredient of the drug; the other half received the placebo.

Abrams said that the placebo cigarettes looked and smelled identical to the ones containing active ingredients

Because of the unusual nature of the experiment, Abrams first had to receive clearance from eight different government agencies, including the University of California, the federal Drug Enforcement Administration, and the National Institute on Drug Abuse.

The cigarettes were made from marijuana grown on a federal marijuana farm in Mississippi, and stored in a locked freezer at San Francisco General.

E-mail Sabin Russell at srussell@sfchronicle.com.

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Marijuana reduces pain in HIV patients

By Rebecca Vesely, STAFF WRITER
Article Launched: 02/12/2007 01:29:05 PM PST
The Oroville Mercury Register

HIV patients who smoked three joints of marijuana per day for five days experienced relief from chronic foot pain associated with the disease, researchers at the University of California, San Francisco reported Monday in a rare U.S. study on medical marijuana.

"These results provide evidence that there is a measurable medical benefit to smoking cannabis for these patients," said study lead author Dr. Donald Abrams, UCSF professor of clinical medicine.

The study involved 50 HIV patients with sensory neuropathy, a peripheral nerve disorder that causes intense, sharp pain, numbness and tingling in the hands and feet. The condition affects about one in three HIV patients.

Patients assigned to smoke cannabis experienced a 34 percent reduction in intense foot pain -- twice the rate experienced by patients who smoked a placebo.

The first cannabis cigarette patients smoked reduced chronic pain by a median of 72 percent compared to 15 percent for patients who smoked the placebo, according to the study, published in the journal Neurology.

Half the patients were assigned randomly to smoke cannabis while the remaining 25 patients smoked an identical-looking placebo that lacked the drug's active ingredient. They had to be off any medication to treat neuropathy, including private-use marijuana. The patients were required to have some prior experience smoking the drug but could not have substance abuse problems.

The patients were sequestered at San Francisco General Hospital for seven days, where they underwent frequent testing. Over five consecutive days, they smoked cannabis or a placebo three times per day in rolled cigarettes. The National Institute on Drug Abuse provided the identical machine-rolled marijuana cigarettes.

Diana Dodson, 50, of Santa Cruz was among the 25 patients who received cannabis. She contracted HIV after receiving tainted blood product in 1985 and has been living with AIDS for 10 years.

Dodson, who smokes marijuana on her own to control her pain and nausea associated with AIDS, said the drug has been a lifesaver. "I really attribute cannabis to why I am still alive today," she said.

Her neuropathy symptoms include an extreme burning on the soles of her feet. "It's like an electrical poker going through me," she said. "I'll scream in the kitchen. Sometimes it's like a jabbing ice-pick pain."

Just a few puffs gives her relief for two hours without the grogginess associated with taking opiates such as morphine, she said.

The UCSF study indicated that pain relief from cannabis was on par with that from morphine.

The quality of the marijuana used in the trial wasn't as good as what Dobson gets on her own, she said, but she still felt relief from pain.

"It gives me a quality of life I wouldn't otherwise have," she said.

By contrast, previous studies of marinol -- the FDA-approved drug containing a synthetic version of THC, the active ingredient in cannabis -- showed little promise in relief for HIV-associated neuropathy.

"There are other compounds in smoked marijuana besides THC," said UCSF study co-author Dr. Cheryl A. Jay, a professor of clinical neurology. "That's one of several explanations why our study had a positive result while previous marinol studies did not."

David Murray, chief scientist at the Office of National Drug Control Policy, said people who smoke marijuana are subject to bacterial infections. He added that the study, considering its small size is "not a convincing demonstration."

Treatment for HIV-related neuropathy includes antidepressants and seizure drugs, but these medications don't always work and some patients cannot tolerate them. Opiates such as morphine are also sometimes used. There are no drugs approved by the FDA specifically for the condition.

The study is the first of several clinical trials of medical cannabis being conducted through the University of California's Center for Medicinal Cannabis Research, based at UC San Diego.

Dr. Igor Grant, director of the cannabis research center at UCSD, said the findings in this study suggest that cannabis "may be useful" in treating HIV-associated neuropathy. He noted that it has been many years since clinical trials of cannabis have been conducted in the United States.

"As a result, there has been insufficient light shed on the possible therapeutic value of cannabis," Grant said.

A 1999 report by the Institute of Medicine reviewed the scientific literature on medical marijuana and found that though it is a powerful drug, it is safe and should not be excluded from some medical uses.

Studies have indicated that cannabiniod drugs could help with pain relief, control of nausea and vomiting and appetite stimulation, according to the IOM report.

Americans for Safe Access and the National Association of People with AIDS on Tuesday plan to call for congressional hearings to implement the IOM report findings, which include further scientific studies of cannabis.

"Bolstered by the preliminary findings in the Abrams (UCSF) study, we will go to Congress and familiarize them with the IOM report so we can move forward with the research," said Dr. Barbara T. Roberts, director of medical and scientific affairs at Americans for Safe Access.


The Associated Press contributed to this report.

Contact Rebecca Vesely at rvesely@angnewspapers.com or (510) 208-6408.

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HIV patients smoking marijuana eases pain, scientists report


By PAUL ELIAS | The New Mexican
February 12, 2007

SAN FRANCISCO (AP) - Smoking marijuana eased HIV-related pain in some patients in a small study that nevertheless represented one of the few rigorous attempts to find out if the drug has medicinal benefits.

The Bush administration's Office of National Drug Control Policy quickly sought to shoot holes in the study.

The study, conducted at San Francisco General Hospital from 2003 to 2005 and published Monday in the journal Neurology, involved 50 patients suffering from HIV-related foot pain known as peripheral neuropathy. There are no drugs specifically approved to treat that kind of pain.

Three times daily for nearly a week, the patients smoked marijuana cigarettes machine-rolled at the National Institute of Drug Abuse, the only legal source for the drug recognized by the federal government.

Half the patients received marijuana, while the other 25 received placebo cigarettes that lacked the drug's active ingredient, tetrahydrocannabinol. Scientists said the study was the first one published that used a comparison group, which is generally considered the gold standard for scientific research.

It's also one of the few human tests in a research field nearly devoid of federal funding, which fell off dramatically after the Reagan administration launched its "Just Say No" campaign in the 1980s.

"We live in a country that is fighting a war on drugs and marijuana is arch enemy No. 1, " said Dr. Donald Abrams, the University of California, San Francisco medical professor who led the study. "But as a physician, I have seen the benefit of medicinal marijuana."

Thirteen patients who received marijuana told doctors their pain eased by at least a third after smoking pot, while only six of those smoking placebos said likewise. The marijuana smokers reported an average pain reduction of 34 percent, double the drop reported by the placebo smokers as measured with a widely accepted pain scale.

"These results provide evidence that there is measurable medical benefit to smoking cannabis for these patients," said Abrams.

Many critics of smoked marijuana agree THC has promise as a painkiller, but they argue the smoke itself is harmful and there is no way to ensure a consistent dosing regimen.

"People who smoke marijuana are subject to bacterial infections in the lungs," said David Murray, chief scientist at the Office of National Drug Control Policy. "Is this really what a physician who is treating someone with a compromised immune system wants to prescribe?"

Murray also questioned the statistical relevance of study with just 50 participants in the test.

"You have to approach this with a grain of salt," he said. "It is not a convincing demonstration."

Dr. Mark Ware, a researcher at McGill University in Montreal conducting similar tests, defended Abrams' study as sound and statistically reliable.

The study is one of the few human tests in a research field nearly devoid of federal funding.

"This is a valid medicine and I want safe access to my medication," said Diana Dodson, a 50-year-old grandmother of five who participated in the test in 2004.

Abrams also reported the pain threshold of marijuana patients increased when researchers gently heated a small patch of skin on the arm and applied a cream containing a chemical irritant made with the active ingredient in chili peppers.

"Basically, they took a little iron and burned my arm," Dodson said. "There was a marked difference in feeling before I smoked cannabis and after."

On Tuesday, Dodson will join officials with the nonprofit medical marijuana advocates National Association of People with AIDS and Americans For Safe Access in a telephone press conference to lobby Congress to fund more research.

California and 10 other states have passed laws legalizing marijuana for medicinal purposes, but the federal government considers it a dangerous drug, like cocaine or heroin. The U.S. Supreme Court ruled in 2005 that state laws do not protect users from the federal ban.

To conduct the test, Abrams needed authorization from eight academic and government agencies, including the Drug Enforcement Administration.

The study cost about $1 million and was paid for by the University of California Center for Medicinal Cannabis Research, which has sponsored several smoked marijuana tests.

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Study: Marijuana Helps Deal With Pain

<span class=postbigbold>3-Year Study By UCSF</span>

By Lyanne Melendez

Feb. 12 - KGO - Chronic nerve pain is just one of the complications that can come with HIV. It can be so severe that the only relief for some comes from marijuana. After a three-year study, scientists at UCSF have concluded that yes, marijuana does help with the pain. It's a study that could alter the whole medical marijuana debate.

Fifty people suffering from chronic HIV-associated nerve pain were given marijuana or identical placebo cigarettes with the same taste and same smell. The study was done at San Francisco General Hospital. Patients smoked three times a day for five days.

Karin Petersen is one of the UCSF researchers who worked on the study.

Karin Petersen, clinical neuroscientist, UCSF: "So the finding was that in the group that smoked the marijuana, their average daily pain was reduced by 34-percent."

Phil Alden has known the benefits of medical marijuana for years now.

Phil Alden, HIV patient: "I started using it for my stomach, and by happy coincidence found that it removed the pain from my feet as well."

AIDS patients taking anti-HIV medication have been known to suffer from neuropathy, or pain in the hands and feet due to nerve swelling.

Phil Alden: "One of the most common descriptions that I've both used and heard from other people, is it feels like someone has taken a knife and stabbed you in the foot."

Standard pain drugs like Vicodin don't seem to work. In fact, today there is no FDA-approved drug used to treat neoropathy.

Bruce Mirken, marijuana policy project: "The debate is over scientifically, and it's time for the U.S. government to wake up and smell the data. Marijuana works for a condition that is very hard to treat, that causes suffering to many, many thousands of people."

But the study is not about to influence the Drug Enforcement Administration (DEA). On Monday, a spokesperson said agents will continue to raid pot clubs in California.

Javier Pena, Drug Enforcement Administration: "Marijuana is illegal. We are going to continue to investigate these clubs, and we are not going away."

UCSF has a few more marijuana-related studies in the pipeline. The marijuana used in all of these studies is provided by the National Institute on Drug Abuse. They have a contract to grow the marijuana on a farm operated by the University of Mississippi.

Copyright 2007, ABC7/KGO-TV/DT.

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Posted on Mon, Feb. 12, 2007

Study: Marijuana can ease HIV-related nerve pain

By Carrie Peyton Dahlberg
The State


SACRAMENTO, Calif. - Smoking marijuana can ease HIV-related nerve pain, University of California San Francisco researchers are reporting Tuesday, in a study being hailed by legalization advocates as proof that federal pot policy is deeply misguided.

The rigorous study, appearing in Tuesday's issue of the journal Neurology, was funded by a state effort to provide answers in the long debate over whether marijuana makes good medicine.

Primary investigator Dr. Donald Abrams, a professor of clinical medicine at UCSF, was not surprised that about half the people studied with burning, tingling nerve pain got relief smoking marijuana.

"It has a 5,000-year history of safety and effectiveness as a medicine that we've ignored quite grandly in the last 70 years," he said. "It's been used ... in China, in India and also in Middle Eastern cultures as a medicinal substance."

Yet the study comes on the heels of an unrelated analysis, published in Monday's Archives of Internal Medicine, that links long-term exposure to marijuana smoke with coughing, wheezing and other respiratory complaints common among tobacco smokers.

"The bottom line is, it certainly needs to be looked into further," said Dr. Jeanette Tetrault, a general internal medicine fellow at Yale University who is among those investigating possible lung cancer or respiratory disease links to marijuana smoking.

If marijuana is ultimately found to deliver better pain relief than existing medications, she said, research into the safest possible delivery mechanisms would be critical.

The UCSF study is among the first published results funded by the UC Center for Medicinal Cannabis Research, which was created by state law to improve the science on marijuana after California voters supported medical pot use.

So far, the center has spent roughly two-thirds of the $9 million it received, devoting the money to research into nerve pain, sleep difficulties, muscle spasms and other conditions.

Some studies, including ones for cancer pain and nausea, had to be discontinued for lack of volunteers, said center director Dr. Igor Grant, a UC San Diego psychiatry professor.

The center will remain active until all the money is spent, supporting about a dozen studies, which Grant acknowledges are "not a lot" but still much more than we knew just a few years ago.

"The results of these studies will provide some real information into whether cannabis is or isn't helpful," Grant said.

Federal policy has long discouraged investigations of marijuana, setting up numerous regulatory and practical hurdles, said Bruce Mirken, a spokesman for the Marijuana Policy Project, which backs legalization.

In such an environment, the state-backed study is "truly gold-standard" research, Mirken said; it's placebo-controlled and double-blinded.

About half the 55 people who initially enrolled were given placebo cigarettes, with a key active ingredient stripped out. Both they and the researchers analyzing results were "blinded" - that is, not told who got the real thing.

Such measures are used to keep subtle bias from creeping into research, and to account for the powerful way people are known to respond to dummy medications. In the UCSF study, for example, about one-fourth of the people smoking placebo cigarettes experienced significant pain relief, compared with half of those smoking marijuana.

But researchers acknowledged that their blinding effort was imperfect because smokers might have been able to recognize whether they were inhaling active cannabis or not.

"I knew immediately because I could feel the effects," said one study subject, Diana Dodson. "I did get the cannabis." Her impression was later confirmed in a letter from researchers.

Dodson, who lives near Santa Cruz, gets burning, bruising, sometimes jolting nerve pain on the bottoms of her feet, a complication of the HIV she contracted more than 20 years ago from a tainted blood product.

"It's like an ice pick stab with an electric shock," she said, and stronger painkillers leave her less aware and less alert than marijuana does. She participated in the study in hopes that "we'll be able to have safe access to this medicine."

While other options exist for many of the ills that marijuana may treat, it's important to have as many safe drugs as possible in doctors' arsenals, said UCSF medical professor Abrams.

Individuals respond differently to each drugs' benefits and side effects, and drug interactions can make it tough to find the right match for each person.

Abrams is seeking volunteers now for another marijuana study, looking into whether cancer patients taking morphine or OxyContin for pain might be able to use a lower dose or suffer fewer unpleasant side effects if they combine the treatment with marijuana.

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Smoked Cannabis Proven Effective In Treating Neuropathic Pain

Science Daily
October 25th, 2007


Smoked cannabis eased pain induced in healthy volunteers, according to a study by researchers at the University of California, San Diego (UCSD) Center for Medical Cannabis Research (CMCR.) However, the researchers found that less may be more.

In the placebo controlled study of 15 subjects, a low dose of cannabis showed no effect, a medium dose provided moderate pain relief, and a high dose increased the pain response. The results suggest a "therapeutic window" for cannabis analgesia, according to lead researcher Mark Wallace, M.D., professor of anesthesiology at UCSD School of Medicine and Program Director for the UCSD Center for Pain Medicine.

The study used capsaicin, an alkaloid derived from hot chili peppers that is an irritant to the skin, to mimic the type of neuropathic pain experienced by patients with HIV/AIDS, diabetes or shingles -- brief, intense pain following by a longer-lasting secondary pain. The subjects were healthy volunteers who inhaled either medical cannabis or a placebo after pain was induced. The marijuana cigarettes were formulated under NIH supervision to contain either zero, two, four or eight percent delta-9-tetrahydrocannabinol (THC.)

"Subjects reported a decrease in pain at the medium dose, and there was also a significant correlation between plasma levels of THC, the active ingredient in cannabis, and decreased pain," said Igor Grant, M.D., F.R.C.P.(C), professor and Executive Vice-Chair of the Department of Psychiatry, the director of the CMCR. "Interestingly, the analgesic effect wasn't immediate; it took about 45 minutes for the cannabis to have an impact on the pain," he said.

The results, showing a medium-dose (4% THC by weight) of cannabis to be an effective analgesic, converged with results from the CMCR's first published study, a paper by UCSF researcher Donald Abrams, M.D. published in the journal Neurology in February 2007. In that randomized placebo-controlled trial, patients smoking the same dose of cannabis experienced a 34% reduction in HIV-associated sensory neuropathy pain--twice the rate experienced by patients receiving a placebo.

"This study helps to build a case that cannabis does have therapeutic value at a medium-dose level," said Grant. "It also suggests that higher doses aren't necessarily better in certain situations -- something also observed with other medications, such as antidepressants."

The researchers stated that more and larger studies need to be conducted to measure the efficacy of cannabis, noting that medical marijuana could play an important role in treating patients who don't respond well to the usual pain relievers or can't tolerate drugs such as ibuprofen or opioids used for severe pain.

"The results of this study might help guide others doing clinical research into pain management," said Wallace.

The paper, to be published in the November issue of the journal Anesthesiology, is the second published study out of the CMCR. Headquartered at UCSD, the CMCR is collaboration between UCSD and UC San Francisco that was funded by a state-funded initiative in 1999 to rigorously study the safety and efficacy of medicinal cannabis in treating diseases.

Additional contributors to the study include Gery Schulteis, Ph.D., UCSD Department of Anesthesiology; J. Hampton Atkinson, M.D., professor, and Deborah Lazzaretto, M.S., UCSD HIV Neurobehavioral Research Center; Ian Abramson, Ph.D., UCSD Department of Mathematics and HIV Neurobehavioral Research Center; Tanya Wolfson, M.A., UCSD Department of Family and Preventive Medicine; and Heather Bentley and Ben Gouaux, UCSD Center for Medicinal Cannabis Research.

Adapted from materials provided by University of California - San Diego.

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Too much cannabis 'worsens pain'

BBC News
October 24th, 2007


The pain-relieving qualities of cannabis have long been hailed, and several countries have made it available for medicinal purposes.

But quantity is key, according to the study in the journal Anesthesiology.

University of California researchers found moderate use had the greatest impact on pain in 15 volunteers, while large doses actually made pain worse.

The team recruited 15 healthy volunteers, in whom pain was induced by injecting capsaicin - the "hot" chemical found in chilli peppers - under their skin.

They were then given cannabis to smoke. The strength of the dose was determined by the tetrahydrocannabinol content, which is the main active chemical in cannabis.

Some of the volunteers were given a placebo.

<span class=postbigbold>High, but in pain</span>

Five minutes after smoking the drug, none of the doses had any effect on the pain felt.

But 45 minutes later, those who had smoked the moderate dose said their pain was much better, while those who consumed high doses said it had got worse.

They did, however, feel "higher" than counterparts who had taken moderate doses.

Dr Mark Wallace, the lead researcher, said the findings could have implications for the way medicinal cannabis was offered, both in pure and drug form.

Some experts are concerned that results on healthy volunteers could not be translated into how cannabis works in the bodies of those with cancer or multiple sclerosis, for whom the drug is increasingly seen as a potential form of pain relief.

Dr Laura Bell, of the MS Society, said: "Many people with MS report benefits to symptoms such as pain from taking cannabis, however studies to date on the effects of cannabis on pain are small and difficult to draw firm conclusions from.

"We would be interested to see the results from larger scale studies focused on people with MS."

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If Sativex Works, So Does Pot

by Jacob Sullum, Reason Magazine
November 12th, 2007


A <a class=postlink target=_blank href="http://www.sciencedirect.com/science?_ob=ArticleURL&_udi=B6T0K-4R2XD04-1&_user=10&_coverDate=11%2F07%2F2007&_rdoc=1&_fmt=summary&_orig=browse&_srch=doc-info(%23toc%234865%239999%23999999999%2399999%23FLA%23display%23Articles)&_cdi=4865&_sort=d&_docanchor=&_ct=140&_acct=C000050221&_version=1&_urlVersion=0&_userid=10&md5=1c256d477009e7d3f5143cfe474843b1">new study reported in the journal Pain</a> finds that Sativex, an orally administered cannabis extract spray, is effective at treating neuropathic pain in patients for whom standard painkillers do not provide adequate relief. During the five-week study, 125 subjects with peripheral neuropathic pain continued to take previously prescribed analgesics and achieved additional relief from Sativex, averaging a reduction of about 1.5 points on a 10-point self-reported pain scale, compared to half a point for the placebo spray. The research is part of GW Pharmaceuticals' efforts to gain wider regulatory approval for Sativex, which is approved for treatment of multiple sclerosis in Europe and for treatment of both cancer pain and M.S.-related neuropathic pain in Canada.

Every study that demonstrates Sativex's medical utility also demonstrates marijuana's medical utility, belying the U.S. government's claim that it has none. At the same time, if the FDA does eventually approve Sativex for prescription use in the U.S., it will undermine the case for medical marijuana. Like smoked (or vaporized) marijuana but unlike the FDA-approved THC capsules sold under the brand name Marinol, Sativex can be taken easily by people suffering from severe nausea, and its effects are felt quickly, so patients can readily adjust their doses for optimal effect. Smoked/vaporized marijuana may be somewhat faster-acting than Sativex, which is absorbed through the mucus membranes in the mouth, and it would presumably be cheaper as well, although not for patients who have prescription drug coverage. And while Sativex contains both THC and cannabidiol, other ingredients in marijuana may contribute to its therapeutic effect in certain applications.