#3 THC & Fibromyalgia Cannabis and the Cannabinoids

THC & Fibromyalgia Cannabis and the Cannabinoids

1. IACM-Bulletin of 11 June 2006
2. Science: Cannabidiol inhibits tumour growth 
3. Delta-9-THC based monotherapy 
4. Medical Use of Cannabis and THC in Germany 
5. Clinical Trial: THC Reduces Pain  
6. Medical Uses of Cannabis 

Cannabis preparations have been used as remedies for thousands of years. The active ingredients of the hemp plant can currently also be put to use in a multitude of severe medical conditions. However, the potential medical applications of natural cannabis products or individual pharmacologically active ingredients are restricted by existing laws

IACM-Bulletin of 11 June 2006
* Science: THC reduces pain due to fibromyalgia in pilot study
* Science: Cannabidiol inhibits tumor growth in leukemia and breast cancer in animal studies
Science: THC reduces pain due to fibromyalgia in pilot study

The effect of oral THC was investigated in nine patients with fibromyalgia in a study at the Department of Anesthesiology and Intensive Care Medicine of the University Hospital in Mannheim. Fibromyalgia is a chronic pain syndrome of unknown origin. In the four participants who completed the three-month study pain was reduced by 67 per cent on average. All four experienced a pain reduction by more than 50 per cent.

All pain medication was stopped 3 weeks prior to the investigation. In the study, patients received a daily oral dose of 2.5–15 mg THC. Starting with 2.5 mg the dosage was increased weekly by 2.5 mg THC, as long as no severe side effects were reported. Once a week, 24 hours after the last THC medication and a day before any dose increase, an electrical induced pain was caused. Moreover, the pain intensity was daily recorded by means of a numeric pain scale with the endpoints 0 (no pain) and 10 (maximum pain imaginable).

Five of the nine participants terminated the study before reaching the maximum dose of 15 mg due to severe side effects, primarily sedation, dizziness, fatigue or continuous tiredness. The experimentally induced pain was significantly reduced by THC in a dose of 10 and 15 mg. Daily recorded pain intensity was reduced from 8.1 on average at the beginning of the study to 2.8 after three months.

(Source: Schley M, Legler A, Skopp G, Schmelz M, Konrad C, Rukwied R. Delta-9-THC based monotherapy in fibromyalgia patients on experimentally induced pain, axon reflex flare, and pain relief. Curr Med Res Opin 2006;22(7):1269-1276 [electronic publication ahead of print])

Science: Cannabidiol inhibits tumour growth in leukaemia and breast cancer in animal studies

Italian researchers investigated the anti-tumour effects of five natural cannabinoids of the cannabis plant (cannabidiol, cannabigerol, cannabichromene, cannabidiol-acid and THC-acid) in breast cancer. Cannabidiol (CBD) was the most potent cannabinoid in inhibiting the growth of human breast cancer cells that had been injected under the skin of mice. CBD also reduced lung metastases deriving from human breast cancer cells that had been injected into the paws of the animals.

Researchers found that the anti-tumour effects of CBD were caused by induction of apoptosis (programmed cell death). They concluded that their data "support the further testing of cannabidiol and cannabidiol-rich extracts for the potential treatment of cancer."

These observations are supported by investigations of US scientists who found out that exposure of leukaemia cells to CBD led to a reduction in cell viability and induction of apoptosis. In living animals CBD caused a reduction in number of leukaemia cells. The scientists noted that CBD "may be a novel and highly selective treatment for leukemia."

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Delta-9-THC based monotherapy in fibromyalgia patients on experimentally induced pain, axon reflex flare, and pain relief
Authors: Schley, Marcus1; Legler, Andreas1; Skopp, Gisela2; Schmelz, Martin1; Konrad, Christoph1; Rukwied, Roman1 Source: Current Medical Research and Opinion, Volume 22, Number 7, July 2006, pp. 1269-1276(8)

Abstract: Objective:

Fibromyalgia (FM) is a chronic pain syndrome characterized by a distinct mechanical hyperalgesia and chronic pain. Recently, cannabinoids have been demonstrated as providing anti-nociceptive and anti-hyperalgesic effects in animal and human studies. Here, we explored in nine FM patients the efficacy of orally administered delta-9-tetrahydrocannabinol (THC) on electrically induced pain, axon reflex flare, and psychometric variables.

Research design and methods: Patients received a daily dose of 2.5-15 mg of delta-9-THC, with a weekly increase of 2.5 mg, as long as no side effects were reported. Psychometric variables were assessed each week by means of the West Haven-Yale Multidimensional Pain Inventory (MPI), Pittsburgh Sleep Quality Index (PSQI), Medical outcome survey-short form (MOS SF-36), the Pain Disability Index (PDI), and the Fibromyalgia Impact Questionnaire (FIQ). In addition, patients recorded daily, in a diary, their overall pain intensity on a numeric scale. Each week, pain and axon reflex flare was evoked experimentally by administration of high intensity constant current pulses (1 Hz, pulse width 0.2 ms, current increase stepwise from 2.5-12.5 mA every 3 minutes) delivered via small surface electrodes, attached to the volar forearm skin.

Main outcome measures: Daily pain recordings by the patient, experimentally induced pain, and axon reflex flare recorded by a laser Doppler scanner.

Results: Five of nine FM patients withdrew during the study due to adverse side effects. Delta-9-THC had no effect on the axon reflex flare, whereas electrically induced pain was significantly attenuated after doses of 10-15 mg delta-9-THC (p < 0.05). Daily-recorded pain of the FM patients was significantly reduced (p < 0.01).

Conclusions: This pilot study demonstrated that a generalized statement that delta-9-THC is an analgetic drug cannot be made. However, a sub-population of FM patients reported significant benefit from the delta-9-THC monotherapy. The unaffected electrically induced axon reflex flare, but decreased pain perception, suggests a central mode of action of the cannabinoid.

Document Type: Research article DOI: 10.1185/030079906X112651
Affiliations: 1: Department of Anaesthesiology and Intensive Care Medicine, Faculty of Clinical Medicine Mannheim, University of Heidelberg, Mannheim, Germany 2: Institute of Forensic Toxicology, University of Heidelberg, Heidelberg, Germany

Survey on the Medical Use of Cannabis and THC in Germany

Page Range: 17 - 40
DOI: 10.1300/J175v03n02_03
Copyright Year: 2003

Abstract:
In recent years, a number of open patient interviews and standardized surveys have been conducted to gain more information concerning subjective experiences with the use of cannabis products in a multitude of medical conditions. After a first effort in 1999 (Schnelle et al. 1999), a second anonymous survey was conducted among patients in the German speech area of Europe concerning use of natural illegal cannabis products and THC, a natural cannabinoid that may be prescribed by German doctors since 1998, and that is also manufactured synthetically. Questionnaires were distributed to the members of the Association for Cannabid as Medicine (ACM) and additional persons interested in participating. One hundred eighty-two completed questionnaires were sent to the Institute for Oncological and Immunological Research and the ACM, of whom 17 were excluded because these participants apparently did not suffer from severe diseases. Of the 165 respondents included in the final analysis, 61.2% were male and 38.8% were female. Median age was 40.3 ± 12.4 years, with a range of 16 to 87 years. Twenty-two participants did not use cannabis products for therapeutic purposes. The main reasons were fear of criminal prosecution, the assumption that their doctor will not prescribe THC or a refusal of the doctor to do so. Among the 143 participants with cannabis or THC experience, the main diagnosis groups were neurological symptoms (28%) and painful conditions (25.3%), followed by diseases with mainly gastrointestinal symptoms, such as nausea and appetite loss (14%). The most frequent single diagnoses were multiple sclerosis (17.5%), Tourette syndrome (11.9%), HIV/AIDS (10.5%), migraine/headaches (4.9%), chronic pain that was not described more precisely (4.2%), hepatitis C (3.5%), depression, sleep disorders, spinal cord injury, and back pain (2.8% each), asthma, allergy, fibromyalgia, menstraul pain, and epilepsy (2.1% each). Average daily THC doses were 14.9 ± 9.5 mg, ranging from 4 to 35 mg. Doses of natural cannabis products (marijuana, hashish) were 1.3 ± 0.9 grams on average (range: 0.02-3.5g). The drugs were inhaled by 55.9%, employed orally by 16.8%, and 23.1% use both routes of administration. The cited conditions were much improved by cannabis or THC in 74.8%. An additional 13.3% of patients noted a small improvement, and 2.1% noted no improvement. Others were unsure whether it improved their condition (7.0%), or did not answer the question (2.8%). High satisfaction was reported in 54.4%, 28.0% were satisfied, 14.0% were partly satisfied and 2.1% were not satisfied, while 1.4% did not answer. No side effects were experienced in 73.4%, while 22.4% reported moderate side effects, and 4.2% did not respond. About three-quarters made statements to the consequences of discontinuation of use with regard to withdrawal symptoms. Of these, 67.6% reported no withdrawal symptoms; in 17.6% these symptoms were mild, and in 2.8% they were more severe, while 12.0% reported that they coould not evaluate the severity of withdrawal symptoms. Fifty-three participants noted that they had asked their doctor to prescribe THC. In 54.8% the doctor was willing to do so, but in more than half of the cases (45.9%), the health insurance companies refused to pay for the treatment. There was no association between the reaction of the doctor or of the health insurance and the diagnosis.

Most of the participants who reported a refusal by their doctor or the health insurance used cannabis products in the previous month. Experience with both the medical use of THC and natural cannabis products was reported by 16 participants. There were no clear differences between both drugs with regard to side effects and medicinal efficacy. In conclusion, this survey adds to an increasing number of patient reports of successful and well-tolerated medical uses of cannabis products in a multitude of conditions. Furthermore, it reflects the division of German doctors and health insurances on the issue.

Journal Title:Journal of Cannabis Therapeutics:
Studies in Endogenous, Herbal, and Synthetic Cannabinoids
official journal of the International Association for Cannabis as Medicine
Volume: 3 Issue: 2
ISSN: 1529-9775 Pub Date: 3/1/2003
Contributors:
Franjo Grotenhermen MD, affiliated with the nova-Institut, Goldenbergstraße 2, D-50354 Hürth, Germany, franjo.grotenhermen@nova-institut.de
Martin Schnelle MD, Affiliated with the Institute for Oncological and Immunological Research , Hardenbergstrasse 19, Berlin , Germany , martin.schnelle@eifoi.de


Clinical Trial: THC Reduces Pain In Fibromyalgia Patients
June 22, 2006 - Mannheim, Germany

Mannheim, Germany: Oral administration of THC significantly reduces both chronic and experimentally induced pain in patients with fibromyalgia, according to clinical trial data to be published in the forthcoming issue of the journal Current Medical Research and Opinion. The study is the first-ever clinical trial assessing the efficacy of cannabinoids in the treatment of fibromyalgia.

Investigators at Germany's University of Heidelberg assessed the analgesic effects of oral THC in nine patients with fibromyalgia over a 3-month period. Subjects in the trial were administered daily doses of 2.5 to 15 mg of THC, but received no other pain medication during the trial. Among those participants who completed the trial, all reported a significant reduction in daily recorded pain and electronically induced pain, investigators found.

"All patients who completed the delta-9-THC therapy ... experienced pain relief of more than 50 percent," authors concluded. Investigators recommended that follow up placebo-control trials be conducted assessing the use of cannabinoids on fibromyalgia. Previous trials have shown that both naturally occurring and endogenous cannabinoids hold analgesic qualities, particularly in the treatment of cancer pain and neuropathic pain, both of which are poorly treated by conventional opiates.

Fibromyalgia is a chronic pain syndrome characterized by widespread musculoskeletal pain, fatigue, and multiple tender points in the neck, spine, shoulders, and hips. An estimated 3 to 6 million Americans are afflicted by the disease, which is often poorly controlled by standard pain medications.

For more information, please contact Paul Armentanot (202) 483-5500. Full text of the study, "Delta-9-THC based monotherapy in fibromyalgia patients on experimentally induced pain, axon reflex flare, and pain relief," will be available in the forthcoming issue of Current Medical Research and Opinion.

(www.norml.org)

The disease is characterized by widespread musculoskeletal pain, fatigue, and multiple tender points in the neck, spine, shoulders, and hips. An estimated 3 to 6 million Americans are afflicted by fibromyalgia, which is often poorly controlled by standard pain medications.
Fibromyalgia patients frequently self-report using cannabis therapeutically to treat symptoms of the disease,[1-2] and physicians – where legal to do so – often recommend the use of cannabis to treat musculoskeletal disorders.[3-4] To date however, only one clinical trial is available in the scientific literature assessing the use of cannabinoids to treat the disease.

Writing in the July 2006 issue of the journal Current Medical Research and Opinion, investigators at Germanyʹs University of Heidelberg evaluated the analgesic effects of oral THC in nine patients with fibromyalgia over a 3-month period. Subjects in the trial were administered daily doses of 2.5 to 15 mg of THC, but received no other pain medication during the trial. Among those participants who completed the trial, all reported a significant reduction in daily recorded pain and electronically induced pain.[5]

Previous clinical and preclinical trials have shown that both naturally occurring and endogenous cannabinoids hold analgesic qualities,[6-7] particularly in the treatment of cancer pain [8] and neuropathic pain, [9] both of which are poorly treated by conventional opioids. As a result, some experts have suggested that cannabinoid agonists would be applicable for the treatment of chronic pain conditions unresponsive to opioid analgesics such as fibromyalgia, and they theorize that the disease may be associated with an underlying clinical deficiency of the endocannabinoid system.[10]

REFERENCES
[1] Swift et al. 2005. Survey of Australians using cannabis for medical purposes. Harm Reduction Journal 4: 2-18. [2] Ware et al. 2005. The medicinal use of cannabis in the UK: results of a nationwide survey. International
Journal of Clinical Practice 59: 291-295. [3] Dale Gieringer. 2001. Medical use of cannabis: experience in California. In: Grotenhermen and Russo (Eds).
Cannabis and Cannabinoids: Pharmacology, Toxicology, and Therapeutic Potential. New York: Haworth Press: 153-
170. [4] Gorter et al. 2005. Medical use of cannabis in the Netherlands. Neurology 64: 917-919. [5] Schley et al. 2006. Delta-9-THC based monotherapy in fibromyalgia patients on experimentally inducedpain, axon reflex flare, and pain relief. Current Medical Research and Opinion 22: 1269-1276. [6] Burns and Ineck. 2006. Cannabinoid analgesia as a potential new therapeutic option in the treatment of chronic pain.
The Annals of Pharmacotherapy 40: 251-260. [7] David Secko. 2005. Analgesia through endogenous cannabinoids. CMAJ 173: [8] Radbruch and Elsner. 2005. Emerging analgesics in cancer pain management. Expert Opinion on Emerging Drugs 10: 151171. [9] Notcutt et al. 2004. Initial experiences with medicinal extracts of cannabis for chronic pain: Results from 34 ʹN of 1ʹ studies. Anaesthesia 59: 440. [10] Ethan Russo. 2004. Clinical Endocannabinoid deficiency (CECD): Can this concept explain therapeutic benefits of cannabis in migraine, fibromyalgia, irritable bowel syndrome, and other treatment-resistant conditions? Neuroendocrinoogy Letters 25: 31-39.
http://www.schmoo.co.uk/thclub/thcuses.htm

Medical Uses of Cannabis
Ailments for which the medical use of cannabis may be beneficial include: Addiction, Arthritis, Appetite Loss, Nausea, Cancer Chemotherapy, AIDS Wasting Syndrome, Nausea From Cancer, Chemotherapy, Glaucoma, Multiple Sclerosis, Depression, Parkinson’s Disease, Movement Disorders, Dystonia, Asthma, Brain Injury/Stroke, Crohn's Disease, Ulcerative Depression, Mental Illness, Epilepsy, Fibromyalgia, High Blood Pressure/ Hypertension, Migraine, Nail Patella Syndrome, Schizophrenia, Tourette's Syndrome.

Below are notes on some of the most common medical uses of cannabis.

Arthritis: In 1994 the ‘Times’ reported; ‘The demand for Cannabis among British pensioners has stunned doctors, police and suppliers. The old people use the drug to ease the pain of such ailments as arthritis and rheumatism. Many are running afoul of the law for the first time in their lives as they try to obtain suppliers.’ Arthritis affects the joints and surrounding areas, including muscles, membrane linings and cartilage. It causes painful inflammation, heat, swelling, pain, redness of skin and tenderness in the affected areas. Cortisone-type drugs provide dramatic pain relief for short periods but decrease in effectiveness if used over time. The side effects of these drugs include nausea, restlessness, insomnia, dizziness, headache, depression and mood swings, irregular heartbeat and menstruation problems. Several cannabinoids have both analgesic (pain-relieving) and anti-inflammatory effects, a combination particularly helpful for arthritic people. Cannabidiol (CBD), one of the main active ingredients in cannabis is a very effective anti-inflammatory agent. Cannabis can be smoked or eaten to relieve the general pain, inflammation and discomfort of arthritis. Cannabis poultices can be applied topically to troubled areas. Cannabis in alcohol or as a cream can also be rubbed on the skin.

Appetite Loss, Nausea, Cancer Chemotherapy, AIDS Wasting Syndrome: One of the most outstanding medical values of cannabis is the role it can play in restoring a person’s relationship to food. Cannabis is remarkably powerful in combating nausea and vomiting, making it possible to consume food and hold it down. It is also an extraordinary stimulant of appetite itself; a condition known by cannabis users as ‘the munchies’. Conditions characterized by nausea, vomiting, appetite problems and severe weight loss include AIDS Wasting Syndrome, kidney failure, tuberculosis, hyperemesis gravidarum (magnified form of morning sickness) and anorexia and the side effects of chemotherapy.

Nausea From Cancer Chemotherapy: Nausea and vomiting, which can last for days after a single treatment and be so violent as to threaten to break bones and rupture the aesophagus, are common side effects of the chemotherapies used in treating cancer. Many patients develop such an aversion to the site or odor of food that they stop eating altogether and lose the will to live. Up to 40% of cancer patients undergoing chemotherapy do not respond to the standard treatment for preventing vomiting. These use expensive ‘antiemetics’ drugs such as ‘Zofran’ (which must be administered by intravenous drip and cost £250+ a treatment). ‘Marinol’ which uses THC was approved after much resistance in the USA in 1986. It is effective in many cases where other drugs have failed. Smoking or eating cannabis also seems to provide relief where standard treatments fail. The effectiveness of cannabis in treating nausea and vomiting from cancer chemotherapy is dose-related. The higher the blood levels of THC, the more complete the relief of vomiting. Lester Grinspoon, M.D. has calculated that using cannabis to treat chemotherapy nausea would cost about one percent as much as treatment with Zofran.

Glaucoma: The usual treatment is eye drops containing drugs called ‘beta-blockers’. While effective they can cause depression, exacerbate asthma, decrease heart rate and increase danger of heart failure. The most common form of glaucoma, ‘open angle glaucoma’ happens when the channels that carry fluid out of the eyeball gradually become narrower causing the intra ocular pressure to increase slowly over time, damaging the optic nerve that relays signals from the eye to the brain and resulting in blindness. Fortunately, it can be treated with cannabis. Cannabis relieves symptoms by reducing intra ocular pressure, thereby slowing down the progress of the condition, sometimes bringing it to a complete halt. The pressure relieving effects achieved by using cannabis last for four to five hours.

Multiple Sclerosis: Multiple Sclerosis destroys the sheathing that protects nerve fibres, interfering with the function of the nervous system. The victim suffers painful muscle spasms, loss of coordination, tremors, paralysis, insomnia, mood swings and depression, blurred vision, impotence, loss of bladder control and more. There are three types; fairly mild and does not get worse over time; one which gets worse slowly; and one which gets rapidly worse once it appears. Many suffers end up using wheelchairs. Modern medicine has failed to find an effective treatment for the overall condition although various drugs give short-term relief of different symptoms. Valium or similar tranquilizers are used to treat muscle spasms but have there associated side effect of addiction, and doses often have to be increased sharply over time (good for profits if nothing else). MS patients who use cannabis report a soothing of the painful muscle spasms and improved muscle coordination. Some are able to walk unaided when they were previously unable to do so. It also helps blurred vision, tremors, loss of bladder control, insomnia and depression.

Depression: Depression can be a very depressing state of mind to be in, and can include pessimism, hopelessness, despair, loss of interest in life, boredom and sadness. Symptoms include insomnia or excessive sleeping, loss of appetite or over eating, decreased sex drive, constipation, listlessness, chronic tiredness, difficulty with concentration and decision making, and irritability. About 30% of patients with depression respond badly to antidepressants or find the side effects intolerable. A significant difference between the two is that the mood lifting effects of cannabis occur within a few minutes of smoking or about an hour after ingesting while pharmaceutical antidepressants usually take several days or weeks to kick in - and the same or longer to safely get off them.

Movement Disorders: Diseases characterised by impaired motor function and difficulties with muscle control. Conventional drug treatments are not very effective and can have very bad side effects. Cannabis has proved to be surprisingly helpful. Research indicates that the reason may have something to do with the presence of receptors for cannabinoids in the ‘basal ganglia’, a part of the nervous system involved in the coordination of movement.

Parkinson’s Disease: A movement disorder closely associated with the aging process, thought to be caused by abnormalities in the ‘basal ganglia’ and deterioration of the brain systems associated with the brain chemical ‘dopamine’ which is involved in movement and motor control. Levels of dopamine decline with ageing. Conventional treatments include ‘Deprenyl’, ‘Bromocriptine’ and ‘L-dopa’, all drugs which increase levels of dopamine in the nervous system. ‘L-dopa’, the most frequently used of these treatments, may actually increase damage to parts of the brain involved in dopamine production. It does not slow down the progression of the disease or increase life expectancy. Its side effects include most of the symptoms of the disease it is intended to treat! These include nausea, loss of libido, vomiting, irritability, insomnia, loss of appetite, headache, dystonias, and muscle spasms. Cannabis has demonstrated a beneficial impact on all of them. However ‘Cannabidiol’ one of the active agents of cannabis may aggravate the ‘hypokinesia’, or overall lack of movement associated with Parkinson’s.

Dystonia: Dystonias are a group of movement disorders characterized by abnormal body movements and postures. Their causes can be a side effect of medicines used to treat psychotic conditions and Parkinson’s disease. Cannabis has been shown to be helpful for dystonia in studies with both humans and animals when conventional drugs are rarely effective and have dangerous side effects. Cannabis used in conjunction with standard medications can help achieve a more effective overall treatment.

Chronic Pain: One of the most difficult problems for health practitioners to treat. Conventional medicine uses opiate-type drugs such as codeine. Opiates are highly addictive and dosages have to be increased to remain effective, increasing the addiction. Much addiction has its roots in pain being self medication conscious or not. Non-addictive painkillers are also available, but they are often not strong enough to provide adequate pain relief! The painkilling properties of Cannabis (THC) are comparable to those of codeine and other commonly used painkillers without the side effects or risk of addiction. Studies have found that the dose of THC required to kill pain was far smaller than the amount of codeine required to give the same level of relief. Amazingly the same dosage of cannabis has a consistently stronger painkilling effect for experienced users of cannabis than for inexperienced users. This is the opposite of a development of tolerance! A single dose can relieve pain for several hours. Eating is often more effective than smoking and the effects last longer. However, the use of cannabis and opiates is not necessarily an either-or issue. If cannabis is used in an ongoing regime of medication, opiates could be added or substituted during periods when pain levels rise. Conversely, if opiates are used as the basis of the ongoing regime, cannabis could be added when pain levels rise , avoiding the need to increase the dosages of opiates being used and the associated dangers.

Diabetes: Insulin is excreted from the beta islet cells of the pancreas. Insulin, a natural body chemical, floods the body after a sugar-rich meal and causes various cell types to dramatically increase their uptake of glucose, a common sugar. The effect of insulin is to reduce the levels of glucose in the bloodstream. Diabetes can result from the body’s inability to produce sufficient quantities of insulin or from an inability to respond properly to the insulin that is produced. In either case, many of the clinical effects of diabetes stem from the deleterious effects of high blood sugar. There is some anecdotal evidence that cannabis lowers blood sugar. AIDS and cancer patients, among other cannabis users, often report an increase in appetite after consuming cannabis, and a few reports indicate that smoking cannabis can lower blood sugar in diabetics. A study (Tracy Blevins phd) was undertaken to determine whether this effect can be detected using an easily available over the counter blood glucose testing kit.

A morbidly obese man had a non-healing wound on his lower leg and was experiencing confusion and sleepiness after large meals. He suspected diabetes as the culprit, and, since smoking a large cannabis cigarette after large meals seemed to alleviate some of his symptoms, his blood sugar was tested before, immediately after and multiple times during the hour following a large meal rich in protein, fats and both complex and simple carbohydrates.

The results were dramatic and raised some interesting research questions. Before and immediately after the meal, the patient’s blood sugar was in the normal range, but within a few minutes increased by 80 mg/dl and remained at this high level for almost an hour. Then he smoked a 1 gram cannabis cigarette, and his blood sugar levels fell by 40 points almost instantly. This represents a full 50% of the abnormal increase in blood sugar. The drop of blood which was taken at the exact moment when he was self reporting a ‘high’ were the lowest in blood sugar, a good indication that the blood sugar lowering was caused by the ingestion of cannabis. Curiously, after a few minutes, his blood sugar started to increase again. It might be that smoking cannabis helped to reduce his blood sugar, but only transiently. Would a longer acting cannabinoid suppress blood sugar levels more efficiently?

Further studies are necessary to confirm this effect and to determine the parameters of the effect: the amount of cannabis needed, the time course of the effect, and also whether different types of cannabis show more or less blood sugar lowering. Also, in another non-diabetic patient, blood sugar was decreased by 11%, pointing to the possibility that cannabis can lower blood sugar in a non-disease state. Could it be that we have finally discovered the biological mechanism of “the munchies”?