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What is cachexia – and could cannabis be a potential treatment?

The condition affects approximately nine million people globally.

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The “wasting” condition causes muscle and fat loss, typically as a result of a chronic disease

Researchers at Imperial College London are presenting an overview of existing research on the effects of cannabis on cachexia at this year’s International Cannabinoid Research Society Conference in July. Lead researcher, Dr Simon Erridge, says there is potential but further research is needed.

Cachexia affects approximately nine million people globally.

The “wasting” condition causes muscle and fat loss, typically as a result of a chronic disease such as heart disease, AIDS and chronic obtrusive pulmonary disease (COPD).

Even those who are getting the right amount of nutrition will experience involuntary weight loss that can lead to a deterioration in the patient’s health.

Most people associate cachexia with cancer, with an estimated 80 percent of those with advanced cancer being diagnosed with the condition.

Current medications that are used to treat cachexia fall into several categories.

Some work by boosting appetite stimulation, encouraging the patient to eat more and, in turn, put on weight. Other medications aim to reduce the inflammation that is associated with the condition.

Although treatments exist, the number of options available are limited. Researchers at Imperial College London are now turning their attention to the potential of cannabis to treat the condition.

Scientists at the University’s Medical Cannabis Research Group have completed a systematic review and meta-analysis of the current research to gain a better understanding of what is known about the use of cannabis in treating cachexia.

Dr Simon Erridge

Dr Simon Erridge

Led by Dr Simon Erridge, researchers found that the quality of evidence was “relatively low”, with just five studies looking at the relationship between cannabis and cachexia.

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All five of the studies included a variant of THC (nabilone or dronabinol) as the active compound, which were compared against a placebo or a known active treatment for cachexia.

Imperial’s researchers were looking for improvement in appetite, weight and quality of life, but despite seeing very small improvements in appetite, the group were not able to find any “statistically significant” benefits.

However, Dr Erridge believes there is still potential for cannabis in the treatment of the condition.

As the existing research focuses purely on THC, the scientists concluded that further research is needed into the potential of CBD.

“The main conclusion we drew was that more research is needed,” Dr Erridge says.

“Secondly, there needs to be a better understanding of the appropriate regimens for this condition.

“A lot of the driving factors for [cachexia] are associated with a high inflammatory state. We understand how THC is affecting appetite stimulation, but we feel as a group that incorporating CBD, whether that be CBD on its own or alongside THC and other cannabinoids, may help elucidate different outcomes because of CBD’s known anti-inflammatory effects.”

The main driving factor behind the study, Dr Erridge says, was the preliminary evidence that suggested a molecular basis for cannabis’ effect in cachexia.

“There’s a lot of scope in terms of improving the availability of different management options for those with cachexia,” Dr Erridge continues.

“That was one of the main things that drew us to this field. We have an interest in both cancer and inflammation and the use of cannabis in those [areas]. As a condition, it covered all of those three bases and crosses that bridge quite nicely.”

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In addition to his work at Imperial College London, Dr Erridge is also head of research and access at Sapphire Medical Clinics, a medical cannabis clinic offering private consultations and prescriptions to patients across the UK.

Aside from this study, Dr Erridge believes there is further potential based on patient outcomes at the clinic.

“I think there is there is potential in terms of the work that we’ve done at Sapphire with our registry,” Dr Erridge says.

“We’ve seen improvements in quality of life in patients with palliative care needs, whether that is from increased appetite or increased weight gain,”

“We are yet to dig down into it but hopefully, once we do a focused analysis of our palliative care patient outcomes, that might be something that we are able to look at from a real-world evidence point of view at Sapphire.”

The study, titled The effect of cannabis-based medicine in the treatment of cachexia: a systematic review and meta-analysis, has been submitted for publication and is awaiting peer review.

It has also been accepted for this year’s International Cannabinoid Research Society Conference in July, where Dr Erridge and his team will present their findings.

As with many areas of medical cannabis research, evidence is lacking.

The five studies included in the literature review differed significantly in terms of the medication used, the dosing regimen and the types of patients included, making it difficult for researchers to draw definite conclusions.

Following the publication of the literature review, The Medical Cannabis Research Group intends to carry out further research subject to funding.

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Dr Erridge adds: “It’s been really difficult trying to get a lot of our clinical research off the ground over the past year due to Covid-19.

“Now we’ve been able to start getting them up and running, we can turn our attention to some of the other things that we want to study like cachexia.

“I think the next stages are to run randomised controlled trials studying medical cannabis regimens against both placebo and active treatment for cachexia.”

Industry

Spain approves first cannabis based medicine

The approval for Epidyolex was based on the results of four randomised controlled Phase III trials

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Spain cannabis: A Spanish flag in the air with an old building behind it

Spain has approved the first cannabis based medicine, Epidyolex for patients with severe conditions such as epilepsy.

Epidyolex, an oral cannabis-based medicine, has been approved in Spain by the Ministry of Health after a large two-year trial. The approval for Epidyolex was based on the results of four randomised controlled Phase III trials. The clinical development of the therapy was spread over 10 different hospitals.

The trial involved over 700 participants with severe forms of epilepsy.

Until recently, there was no distinction between recreational and medicinal cannabis use in Spain which made it difficult to obtain products with higher quantities of 0.02 percent THC.

The medicine will only be available in hospital pharmacies for the treatment of seizures caused by Lennox-Gastaut Syndrome (LGS) and Dravet Syndrome (DS).

Spain and medical cannabis

Speaking at a press conference, neurologist Vicente Villanueva, head of the Refractory Epilepsy Unit of the Hospital Universtiari i Politècnic La Fe de València said the trials have found a 40 percent reduction in seizures.  “As clinicians and researchers, we are satisfied to have these new options”, 

Antonio Gil-Nagel Rein, a neurologist and director of the Epilepsy Program of the Hospital Ruber Internacional de Madrid reported: “The potential improvement of the quality of life in an area where therapeutic options are very small is good news. Access to a new drug with a novel and clinically proven mechanism of action is a reason for hope for patients and satisfaction for specialists.”

Epidyolex received approval from the European Commission in September 2019. This made it the first cannabis-based prescription medicine to receive authorisation.

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Read more: Can cannabis reduce the side effects of anti-seizure medication?

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Industry

Royal Society of Medicine and Integro Clinics announce pain and cannabis medicines event

The event takes place on October 11 from 8:30 to 17:30. It will explore the potential of cannabis medicines in the field of pain medicine in the UK

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Event: The Royal Society of Medicine logo in green and red on a white background

The Royal Society of Medicine has announced a collaborative event, Pain and cannabis medicines: Everything you want to know (but were too afraid to ask) in association with Integro Medical Clinics.

The event takes place on October 11 from 8:30 to 17:30. It will explore the potential of cannabis medicines in the field of pain medicine in the UK

Since the legalisation of cannabis medicines on prescription in November 2018, patients and clinicians alike have been awaiting more data or information regarding these medicines. 

The event aims to provide those attending with a comprehensive understanding of the uses of cannabis medicines and the practicalities of using them in their own practice. It will consist of presentations on the history, regulatory environment and pharmacology of cannabis medicines including the use of different cannabis-based medical preparations in treating pain and related symptoms in a wide variety of clinical fields in the context of the current UK regulatory framework. 

Event presentations

The day will feature presentations from international leaders in cannabis medicines such as Professor Raphael Mechoulam, the chemist who discovered the endocannabinoid system and THC, Dr Anthony Ordman, Leading UK Consultant in Pain Medicine and previous President of the Pain Medicine Section of the Royal Society of Medicine and Dr Arno Hazekamp PhD, who worked as Head of Research and Education at Bedrocan, the first European company to produce EU GMP grade cannabis medicines.  

If you wish to sign up, please click here.

Event speakers
Dr Anthony Ordman, Consultant in Pain Medicine

Event: A black and white headshot of Dr Anthony Ordman Founder of the highly respected Chronic Pain Clinic at London’s Royal Free Hospital, he is one of the UK’s most experienced specialists in the treatment of pain. For his contributions to Pain Medicine, Dr Ordman was awarded a Fellowship of the Royal College of Physicians in 2005, and he is the Immediate Past President of the Pain Medicine Section of the Royal Society of Medicine. Dr Ordman is also Senior Medical Consultant and Lead Clinician at Integro Medical Clinics and has a special interest in the potential benefits of cannabis medicines in pain medicine.

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Alex Fraser, Patient Access Lead at GrowPharma

Event: A black and white headshot of guest speaker Alex FraserAlex Fraser is a leading medical cannabis patient advocate. He is a patient himself having been diagnosed with Crohn’s Disease in 2010 at 19 years old. In 2014 he founded the United Patients Alliance and has since appeared on mainstream media multiple times, including on the BBC and ITV, to highlight the urgent need for access to cannabis medicines for the many patients who may benefit from them. He has taken delegations of patients to parliament to give testimony to politicians at the highest levels and organised educational events, rallies and protests calling for law change on medical cannabis. In February 2019 Alex joined Grow Pharma, one of the leading suppliers of cannabis medicines in the UK, as their patient access lead. He utilises his extensive knowledge of medical cannabis, his understanding of patient needs and his network in the industry to ensure patient voices are heard and represented. His work includes informing top-level policymakers, educating healthcare professionals and conceiving and running projects that increase general awareness and provide practical help for patients.

Professor Raphael Mechoulam, Professor of Medicinal Chemistry at the Hebrew University of Jerusalem in Israel

Event: A black and white headshot Most well-known for the total synthesis of delta-9 tetrahydrocannabinol (THC) and the discovery of the Endocannabinoid System. Since the inception of his research in the 60s, Professor Mechoulam has been nominated for over 25 academic awards, including the Heinrich Wieland Prize (2004), an Honorary doctorate from Complutense University (2006), the Israel Prize in Exact Sciences – chemistry (2000), the Israel Chemical Society Prize for excellence in research (2009) and EMET Prize in Exact Sciences – Chemistry (2012

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Dr Sally Ghazaleh, Consultant Pain Specialist

Event: A black and white headshot of a guest speakerDr Sally Ghazaleh, is a Pain Management Consultant at the Whittington Hospital, and the National Hospital of Neurology and Neurosurgery, London. She qualified from the University of Szeged Medical School, Hungary in 2000, and then completed her specialist training in the Anaesthesia and Intensive Care Medicine at Semmelweis University in 2007. She went on a fellowship at University College Hospital, London, to gain her higher degree in Pain Medicine

During her time at the pain management Centre at University College Hospital, she gained extensive experience in dealing with and managing patients with complex multiple pain problems. She is accomplished at a variety of interventional and non-interventional treatments for this specific patient group. Sally specializes in managing patients with lower back pain, neck pain, neuropathic pain, abdominal pain, cancer pain, complex regional pain syndrome, post-stroke pain and Fibromyalgia. She has a particular interest in bladder and abdominal pain in women, and women’s health in general.

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Advocacy

Celebrities including Drake call for a general pardon for those involved in cannabis offences.

There are over 150 signatures from rappers, artists, producers, law enforcement and more.

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Celebrities: A judges gavel on a wooden table next to a green cannabis leaf

Over 150 celebrities including the rapper Drake and NBA athletes have signed an open letter to President Biden calling for a general pardon of non-violent cannabis offences.

NBA athlete Al Harrington, rapper Drake, world champion boxer Badou Jack, rapper and activist Killer Mike, NBA star John Wall along with Meek Mill and Julio Jones announced at a live-streamed event that they have co-written and signed a letter addressed to President Joe Biden. The letter requests a general pardon for ‘all persons subject to federal criminal or civil enforcement on the basis of a nonviolent marijuana offence.”

The idea for the letter to president Biden came from Weldon Angelos of the Weldon Project/ Mission Green and Academy for Justice Director Erik Luna. The Weldon Project aims to help fund social change and financial aid for those who are still serving prison time for cannabis-related offences. Angelo was an emerging musician before he was sent to prison for selling less than $1,000 worth of cannabis.  Despite it being his first offence,  Angelos went on to service 13 years of his term before eventually being released in 2016. He founded the project upon being released.

The letter includes signatures from 150 athletes, artists, law enforcement officials, academics, business leaders, producers, lawmakers, policy experts, reform advocates and other professionals.

It reads: “This resolve is witnessed today in both red and blue states, from coast to coast, as the American people call for an end to cannabis prohibition. Whatever one thinks of other drugs and other defendants, incarcerating cannabis offenders in federal prisons is a misuse of our nation’s resources and grossly hypocritical, given that a clear majority of Americans oppose cannabis prohibition and about half admit to using the drug during their lifetime.”

The live-streamed event discussed the letter to President Biden while placing an emphasis on a call for a general pardon. Speaking with Benzinga, Angelos said that the celebrities who had signed the letter had done so in support of a fellow artist, Ralo who is facing eight years for a cannabis offence. Despite several states switching to safe, regulated cannabis programs.

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“When Biden ran for president, he promised to take action and use the pardon power of the presidency to release those serving prison time for marijuana and pardon their felony convictions,” Angelos said. “At a time when dispensaries are as prevalent as liquor stores in some states, it is time for President Biden to now make good on that promise.”

In a press release, Ralo said: “I appreciate my friends and peers in the hip-hop community, such as Drake & Killer Mike, for supporting my clemency because it’s just not right that corporations are allowed to violate federal law and become millionaires while people like myself go to prison for years,”

He added: “This is hypocrisy. But I am hopeful that Joe Biden will honour his campaign promise and grant us clemency, without delay, so that we can return home to our families and communities.”

Angelos also highlighted that the long term effects for those incarcerated ‘go beyond the prison walls’ making it difficult for former prisoners to get jobs, access to affordable housing or educational loans. “They’re limited in so many ways that people don’t realize when they just want to begin again and contribute to society. Enough is enough. No one should be locked up in federal prison for marijuana.”

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