[News] Alfie Dingley/Cannabis Oil

[Harry Wilson's tackle]

Have the Home Office made the correct decision not allowing the use of Cannabis Oil?

Alfie Dingley's mum is putting across a strong argument against their decision today on TV & Radio.

www.bbc.co.uk/programmes/p05yncmy

I heard it. Very sad. I have done a small amount of lab research on cannabis, and one of my PhD students did 3 year's in the lab working on CB1 and CB2 receptors in the cardiovascuar system. I have lots of contacts in the pharmaceutical industry who have worked on it. Sadly, despite much interest and some controlled clinical trials, it does nothing very much outside the psychopharm area. I hadn't read the evidence on its effects in epilepsy (which is related to psychopharm in as much as both are 'the brain'). There are no 'rationing' issues as there are with some monoclonal antibodies. My understanding is the refusal to allow its use here would largely be about the use of yer actual cannabis (a naughty drug compared with rather the non psychotropic derivative such as cannabidiol).

I have dug around for the original research. I use web of science regularly and know what peer reviewed research publications look like. Unfortunately it does not look very convincing. Yes there is a trial in Dravet syndrome, published in a top journal (New England Journal of Medicine). BUT it is on cannabidiol (not cannabis, the plant extract that contains the psychotropic chemical delta-9-THC). The most up to date viewpoint is published in Feb 2018 in another credible journal (see below). Note that 'cannabinoid' means a chemical derived from the plant, or a synthetic related to a cannabinoid. Here is the abstract:

"Over the past decade there has been an increasing interest in using cannabinoids to treat a range of epilepsy syndromes following reports of some remarkable responses in individual patients. The situation is complicated by the fact that these agents do not appear to work via their attachment to endogenous cannabinoid receptors. Their pharmacokinetics are complex, and bioavailability is variable, resulting in difficulty in developing a suitable formulation for oral delivery. Drug interactions also represent another complication in their everyday use. Nevertheless, recent randomized, placebo-controlled trials with cannabidiol support its efficacy in Dravet and Lennox-Gastaut syndromes. Further placebo-controlled studies are underway in adults with focal epilepsy using cannabidivarin. The many unanswered questions in the use of cannabinoids to treat epileptic seizures are briefly summarized in the conclusion."

I can't find any evidence that cannabis itself has any value in this condition. Yes of course there are individual testimonies for improvement in outcome for countless conditions and countless drugs (as appears to be the case here) but this is not evidence. Given that cannabis is a schedule 1 drug there is no way it can be approved for use in individual cases, no matter how heart-rending.

This may change if we go the way of Canda and other places and stop classing cannabis along with other schedule 1 drugs. But we are a long way away from this. Lack of evidence of benefit (as a treatment for Dravet), and well established evidence for harm kills it for now.

 

[The Rivet]

Exactly, you've only got to do a superficial search to find biotech companies working on therapies derived from cannabis (https://www.gwpharm.com/), some of which are already licensed. The therapeutic benefits are from compounds other than the THC that gets you mashed. Extraction, purification and consistency are vital. It is not pharma that keep these medicines from us but the regulatory authorities that, quite rightly, demand rigorous studies on them before they can be given to the public.

I know that it is the THC that gets you high. I didn't say pharma is keeping the oil from us. I do not think you should keep people from substances that give them relief because government are too bloody slow and very much behind the rest of the progressive countries by years and years. Desperate people will and should ignore the laws on this (in relation to CBD Oil) Bloody hell, even Queen Vic used cannabis/cannabinoids for period pains. Cannabis has been consumed for 5,000 years or more!

 

[Harry Wilson's tackle]

Not true - Epidiolex is a cannibinoid for seizure disorders and nabilone is used for severe nausea (as examples).



Nope - heroin is diamorphine which is available. As is it's many derivative opiate medications (morphine, fentanyl etc.) and weaker opioids such as tramadol and codeine. Methadone is a related opioid that does not have the same degree of brain penetration.

Looking up nabilone, I was quite intrigued by the literature. There is hardly anything in the recent literature. Also much of that is in the Canadian literature. I know that the laws are changing there, not only the proliferation of 'head shops' but also venture capital funding legitimate research on all sorts (a mate of mine is well into all this - cannabis is attracting funding). My guess is this. Cannabis has been around for ever. It is widely 'used'. If it has any undiscoverd medical value I'd be surprised. This could be an example since clearly kids with rare epilepsy won't have been exposed to cannabis 'widely' in the past (no data in other words). On the other hand, there is no actual evidence to say it would work.

Note that cannabis is a plant like tobacco. delt9THC is a psychoactive component (chemical), like nicotine from tobacco. The plant contains hundreds of other chemicals that are 'cannabinoids' like anandamine, just as tobacco contains many chemicals (including carcinogens). There are synthetic cannabinoids such as AM251, just as there are synthetic nicotine analogues or mimetics (drugs that act like nicotine) including lobeline. And there are endogenous cannabinoids (made by our body) such as anandamide, just as there are endogenous nicotinic agents such as acetylcholine. Use the wrong word or misunderstand a word's meaning then all is chaos. As another poster noted some cannabinoids have been used clinically. Any cannabis extract that may have delta9THC in it will almost certainly never be approved for clinical use until very persuasive clinical trial data (randomized and blinded) are published. We are nowhere near that.....

 

[beorhthelm]

I know that it is the THC that gets you high. I didn't say pharma is keeping the oil from us. I do not think you should keep people from substances that give them relief because government are too bloody slow and very much behind the rest of the progressive countries by years and years. Desperate people will and should ignore the laws on this (in relation to CBD Oil) Bloody hell, even Queen Vic used cannabis/cannabinoids for period pains. Cannabis has been consumed for 5,000 years or more!

yes you bloody did, saying government protects pharma industry implying they do so on their behalf. reality is we have a boat load of regulation to protect us from pharma and more importantly non-pharma snakoil salesman. im not against the use of cannabis, but recognise why we have regulation to try reduce harmful effects from improperly administered drugs. unfortunatly for every sad story like this child there would be a story of how someone was greatly harmed by side effects if we have a free for all. still happens with regulation and licencing.

and on the licencing, there is more to the story than the simple report will say. CBD oil is apparently legally available (in Holland & Barretts ffs), so they arent simply after that, they are looking for a high potentcy version, probably with THC content, to be licenced for prescription. Queen Vic would have been partaking before it was outlawed, if we want it available call for the law to be changed rather than shout about industry protectionism.

 

[Indurain's Lungs]

Looking up nabilone, I was quite intrigued by the literature. There is hardly anything in the recent literature. Also much of that is in the Canadian literature. I know that the laws are changing there, not only the proliferation of 'head shops' but also venture capital funding legitimate research on all sorts (a mate of mine is well into all this - cannabis is attracting funding). My guess is this. Cannabis has been around for ever. It is widely 'used'. If it has any undiscoverd medical value I'd be surprised. This could be an example since clearly kids with rare epilepsy won't have been exposed to cannabis 'widely' in the past (no data in other words). On the other hand, there is no actual evidence to say it would work.

Note that cannabis is a plant like tobacco. delt9THC is a psychoactive component (chemical), like nicotine from tobacco. The plant contains hundreds of other chemicals that are 'cannabinoids' like anandamine, just as tobacco contains many chemicals (including carcinogens). There are synthetic cannabinoids such as AM251, just as there are synthetic nicotine analogues or mimetics (drugs that act like nicotine) including lobeline. And there are endogenous cannabinoids (made by our body) such as anandamide, just as there are endogenous nicotinic agents such as acetylcholine. Use the wrong word or misunderstand a word's meaning then all is chaos. As another poster noted some cannabinoids have been used clinically. Any cannabis extract that may have delta9THC in it will almost certainly never be approved for clinical use until very persuasive clinical trial data (randomized and blinded) are published. We are nowhere near that.....

It's very interesting. Discovery of the therapeutic benefits of compounds derived from cannabis have certainly been hindered by the association with weed, when they simply share a common origin.

Sent from my SM-G930F using Tapatalk

 

[bhaseeer]

THC oil is so much fun - about once a year or so.......seriously different to smoking. Want to get 1000 creative ideas in one evening - while laughing - this is your tipple.

THC and CBD oil help with so many things - but they want to sell people factory made chemicals pills so they put out fear and lies.

 

[Bob'n'weave]

I lost a schoolmate to MS many years ago and his doctor told him to carry on using cannabis as it was the only thing that kept him fairly compos mentis and helped with the symptoms. If it helps they should be able to give it to him.

 

[Lyndhurst 14]

National Cancer Institute admits marijuana kills cancer

http://usahealthtimes.com/2018/04/21/cancer-institute-finally-admits-marijuana-kills-cancer/

 

[Perfidious Albion]

You can buy cannabis oil, without the narcotic propeties in Eastbourne Arndale Centre. It is blooming expensive though.

 

[Harry Wilson's tackle]

National Cancer Institute admits marijuana kills cancer

http://usahealthtimes.com/2018/04/21/cancer-institute-finally-admits-marijuana-kills-cancer/

Forgive me but this is not true. Follow the links. Eventually you get to the source. It mentions some work in mice (I can go on all day about animal models, but this isn't the time or place). When it comes to actual human beings, it says people take cannabinoids to alleviate pain (and like all pain killers apart from opiates the effect is subjective). Regarding actual human cancer it says this:

Cannabis , also known as marijuana, is a plant from Central Asia that is grown in many parts of the world today. The Cannabis plant produces a resin containing compounds called cannabinoids. Some cannabinoids are psychoactive (acting on the brain and changing mood or consciousness). In the United States, Cannabis is a controlled substance and has been classified as a Schedule I agent (a drug with a high potential for abuse and no currently accepted medical use).

So the headline is a lie. Fancy that.

 

[RandyWanger]

The biggest exporter of medical marijuana is the UK. Bit hypocritical.

 

[The Rivet]

The right decision to return it.

 

[Official Old Man]

The poor Mother was interviewed on 5Live, I think it was Wednesday, saying that Alfie will die and that someone would feel responsible. She said it was only a matter of time before he was rushed to hospital to die. In truth it was less than 48 hours.

 

[dingodan]

Forgive me but this is not true. Follow the links. Eventually you get to the source. It mentions some work in mice (I can go on all day about animal models, but this isn't the time or place). When it comes to actual human beings, it says people take cannabinoids to alleviate pain (and like all pain killers apart from opiates the effect is subjective). Regarding actual human cancer it says this:

Cannabis , also known as marijuana, is a plant from Central Asia that is grown in many parts of the world today. The Cannabis plant produces a resin containing compounds called cannabinoids. Some cannabinoids are psychoactive (acting on the brain and changing mood or consciousness). In the United States, Cannabis is a controlled substance and has been classified as a Schedule I agent (a drug with a high potential for abuse and no currently accepted medical use).

So the headline is a lie. Fancy that.

There is a paradox in there. The fact that it is a schedule I substance means that it is very very difficult to do research on. The reason that most of the research suggesting possible medical benefits of cannabis is limited to lab research and animal models is because clinical trials are almost impossible to conduct due to the legal status of the plant.

There is a lot of pretty decent information on what cannabinoids to to cancer cells on the CancerResearchUK website, it has been known for a long time that cannabinoids can have the following effects on cancer cells:

Triggering cell death, through a mechanism called apoptosis
Stopping cells from dividing
Preventing new blood vessels from growing into tumours
Reducing the chances of cancer cells spreading through the body, by stopping cells from moving or invading neighbouring tissue
Speeding up the cell’s internal ‘waste disposal machine’ – a process known as autophagy – which can lead to cell death
http://scienceblog.cancerresearchuk...-cannabinoids-and-cancer-the-evidence-so-far/

When you consider that 99% of the research conducted into cannabis over recent decades has been focused on trying to prove harm, and when you consider how little actual evidence has been found to prove harm, and when you consider the amount of evidence that, at the very least, it provides medical benefit in terms of pain relief, appetite stimilation, seizure reduction (and many other things) it makes little sense that it continues to be a schedule I substance.

It's also available in the form of Sativex (produced in the UK using Cannabis grown in the UK - under license from the Home Office ), which is a whole plant extract. I think many people wrongly believe that medicines like Sativex are different from Cannabis. Most medicines (infact basically all medicines) are single molecule substances. You would think, listening to politicians, that Sativex is only a particular component of Cannabis, carefully extracted and isolated from all the "bad stuff". It's actually whole plant extract, meaning that there is absolutely no, none, zero, pharmacological difference between Cannabis and Sativex. It contains all the cannabinoids and terpines from the plant.

So we in the UK grow Cannabis and sell a whole plant extract overseas (we are the largest exporter of medical Cannabis in the world), at the same time we have some of the toughest laws against it in the developed world, and we refuse it to patients whose doctors would prescribe it for them. (In fact we threaten doctors who have tried to prescribe it).

Crazy.

 

[carlzeiss]

The biggest exporter of medical marijuana is the UK. Bit hypocritical.

With a hush hush manufacturing facility located near a peaceful West Sussex village .

 

[Herr Tubthumper]

There is a paradox in there. The fact that it is a schedule I substance means that it is very very difficult to do research on. The reason that most of the research suggesting possible medical benefits of cannabis is limited to lab research and animal models is because clinical trials are almost impossible to conduct due to the legal status of the plant.

There is a lot of pretty decent information on what cannabinoids to to cancer cells on the CancerResearchUK website, it has been known for a long time that cannabinoids can have the following effects on cancer cells:

Triggering cell death, through a mechanism called apoptosis
Stopping cells from dividing
Preventing new blood vessels from growing into tumours
Reducing the chances of cancer cells spreading through the body, by stopping cells from moving or invading neighbouring tissue
Speeding up the cell’s internal ‘waste disposal machine’ – a process known as autophagy – which can lead to cell death
http://scienceblog.cancerresearchuk...-cannabinoids-and-cancer-the-evidence-so-far/

When you consider that 99% of the research conducted into cannabis over recent decades has been focused on trying to prove harm, and when you consider how little actual evidence has been found to prove harm, and when you consider the amount of evidence that, at the very least, it provides medical benefit in terms of pain relief, appetite stimilation, seizure reduction (and many other things) it makes little sense that it continues to be a schedule I substance.

It's also available in the form of Sativex (produced in the UK using Cannabis grown in the UK - under license from the Home Office ), which is a whole plant extract. I think many people wrongly believe that medicines like Sativex are different from Cannabis. Most medicines (infact basically all medicines) are single molecule substances. You would think, listening to politicians, that Sativex is only a particular component of Cannabis, carefully extracted and isolated from all the "bad stuff". It's actually whole plant extract, meaning that there is absolutely no, none, zero, pharmacological difference between Cannabis and Sativex. It contains all the cannabinoids and terpines from the plant.

So we in the UK grow Cannabis and sell a whole plant extract overseas (we are the largest exporter of medical Cannabis in the world), at the same time we have some of the toughest laws against it in the developed world, and we refuse it to patients whose doctors would prescribe it for them. (In fact we threaten doctors who have tried to prescribe it).

Crazy.

I agree with most of this but it’s legal status shouldn’t be an issue for trials. I’d say the greater problem is funding. Clinical trials cost a fortune and few pharma companies will fund them as they most likely won’t be able to profit from them. It will be left to charities, insurance companies and other bodies like governments but obviously they have less funds and other priorities etc.

 

[beorhthelm]

It's also available in the form of Sativex (produced in the UK using Cannabis grown in the UK - under license from the Home Office ), which is a whole plant extract. I think many people wrongly believe that medicines like Sativex are different from Cannabis. Most medicines (infact basically all medicines) are single molecule substances. You would think, listening to politicians, that Sativex is only a particular component of Cannabis, carefully extracted and isolated from all the "bad stuff". It's actually whole plant extract, meaning that there is absolutely no, none, zero, pharmacological difference between Cannabis and Sativex. It contains all the cannabinoids and terpines from the plant.

stunning contradiction in there. you're quite right with the first point, that most medicines are single molecule, but then quite wrong that Sativex is a "whole plant extract", it only contains two of hundreds of compounds found in cannabis. we should leave the pharmacological differences to the pharmacologists to determine.

the trouble with this debate is overlooking why we have drug licencing. the objective is not to simply show a drug has a positive affect on a illness, it has to show it does not have adverse affects. if something is found to be a cure for an illness but causes some side effect in 50% of patients, its probably not a good idea to licence, or keeping it restricted to acute cases. or under clear guidance, see Thalidomide. i'm all for licencing and use cannaboids through the correct process (as it is), lets not allow judgment to be made based on edge cases or anecdotal evidence.

 

[dingodan]

stunning contradiction in there. you're quite right with the first point, that most medicines are single molecule, but then quite wrong that Sativex is a "whole plant extract", it only contains two of hundreds of compounds found in cannabis. we should leave the pharmacological differences to the pharmacologists to determine.

the trouble with this debate is overlooking why we have drug licencing. the objective is not to simply show a drug has a positive affect on a illness, it has to show it does not have adverse affects. if something is found to be a cure for an illness but causes some side effect in 50% of patients, its probably not a good idea to licence, or keeping it restricted to acute cases. i'm all for licencing and use cannaboids through the correct process (as it is), lets not allow judgment to be made based on edge cases or anecdotal evidence.

Wrong, it's whole plant extract. The fact that it uniquely is not a single molecule medicine is why it can't be regulated under the existing medicines regulatory apartus which is designed to deal with single molecule medicines, and that is also why everywhere in the world where Cannabis has been made legal for medicinal use it is regulated under a specially created Cannabis specific regulatory system.

From GW's website:
Sativex® is an oromucosal spray of a formulated extract of the cannabis sativa plant that contains the principal cannabinoids delta-9-tetrahydrocannabinol (THC) and cannabidiol (CBD) in a 1:1 ratio (US approved name: nabiximols) as well as specific minor cannabinoids and other non-cannabinoid components.

From: https://www.drugdevelopment-technology.com/projects/sativex/
Developed by GW Pharmaceuticals, Sativex is a whole plant medicinal cannabis extract indicated for the relief of multiple sclerosis (MS) symptoms and the treatment of severe neuropathic-related cancer pain.

Yes licencing involves weighing a balance between risk and benefit, but we have countless medications which are positively dangerous. Opioids for example are regularly prescribed and have serious potential for abuse and can very easily be deadly. I think we can (probably) agree that Opioids are more dangerous than Cannabis.

 

[dingodan]

There is a good series of documentaries by Sanjay Gupta MD for CNN about this subject.

They deal with the potential for Cannabis use in treating catastrophic childhood epilepsy, PTSD, also brain diseases such as CTE, dementia and alzheimer's.

Episodes 1 - 3 (includes a lot on the subject of Cannabis & childhood epilepy & PTSD):


Episode 4 came out afew weeks ago and deals with the Opioid problem in the U.S. and the question of pills Vs Cannabis. Also looks at CTE.

 

[beorhthelm]

Wrong, it's whole plant extract. The fact that it uniquely is not a single molecule medicine is why it can't be regulated under the existing medicines regulatory apartus which is designed to deal with single molecule medicines, and that is also why everywhere in the world where Cannabis has been made legal for medicinal use it is regulated under a specially created Cannabis specific regulatory system.

read what your saying. multiple molecule drugs can be regulated, as proven by the fact Sativex exists and is regulated. your common or garden cold remedy will have muliple active compounds, such as paracetomol and caffine. no shure whoe or where makes this claim cannabis cant be regulated because it evidently is.

From GW's website:
Sativex® is an oromucosal spray of a formulated extract of the cannabis sativa plant that contains the principal cannabinoids delta-9-tetrahydrocannabinol (THC) and cannabidiol (CBD) in a 1:1 ratio (US approved name: nabiximols) as well as specific minor cannabinoids and other non-cannabinoid components.

funny you over looked the phrase "formulated extract". that means its not exactly the same as raw natural plant. ratio is TBC is not 1:1 with CDB, i dont know the amount and it varies greatly between different strains. i believe you will find "whole plant extract" means it only comes from the plant with no synthetic adjuncts.
it is interesting to contrast with opioids, because they have far greater risks. i expect its because the isnt alternatives as powerful so risk in controlled environments it deemed worth it, and they are much simpler, direct physiological affects to measure, while psychological impact is much more difficult to accurately assess.