Report on the "Cannabinoids in Medicine" Conference

The Swiss Working Group for Cannabinoids in Medicine (SACM) held a meeting on November 12, 2016. The topic was new trends in the medical use of active ingredients from the hemp plant. The day started early in the morning and ended late in the evening, but the trip to Bern to the SACM meeting was definitely worth it. I had the opportunity to gain many new impressions and look behind the scenes of cannabis as medicine.

But there is one thing I want to anticipate now: Cannabis without the now necessary official egg dance will not exist in the future. Even if many people pretend to be, nobody - except the affected people themselves - is really interested in a broad application of cannabis in the Swiss health care system.

The Swiss Working Group on Cannabinoids in Medicine organized the event under the title “Cannabinoids in Medicine - New Trends”. There were 17 short presentations of 20 minutes each to be heard. Speakers were scientists and representatives of authorities.

The first part consisted of contributions around basic research. Jürg Gertsch presented the endocannabinoid system as a therapeutic target and Arno Hazekamp reported how the company Bedrocan proceeds to obtain cannabis flowers that are as standardized as possible. Bedrocan is a Dutch company that produces cannabis flowers and also exports to other countries such as Germany. Accordingly, there is no interest on Bedrocan's part in home cultivation and the most diverse genetics possible. Nevertheless, to meet the demand, they plan to add “Amnesia Haze” as a strain to their catalog in the future.

Even more telling, however, is a project in which they are developing a vaporizer that works with a pre-dosed capsule - a Nespresso capsule for cannabis patients. As noble as the idea may sound, the patients are not expected to take any self-determination or responsibility.

The development of Sativex, a drug based on THC synthesized from lemon peel, was also reported on. The various stages of development up to release as a drug were presented.

Interesting was the information that a compound called Epidiolex was being worked on. Epidiolex is nothing more than a standardized concentrate of cannabidiol (CBD), as various smaller companies in Switzerland now offer. Since the cannabinoid CBD is not psychoactive, it is not (yet) illegal in Switzerland. The fact that a large pharmaceutical company is also developing a product in this area and wants to market it in the near future is not unusual in and of itself. However, one becomes suspicious when one considers that in the fall of 2016 CBD became available on prescription in Germany and the UK.

In the U.S., a study was also quickly waved through to investigate CBD in children suffering from epilepsy. CBD has a therapeutic benefit and the negative consequences of abuse are likely to be as minor as for other substances available over the counter in pharmacies. You don't have to be a conspiracy theorist to see the system. 

If cannabis in cancer therapy is considered objectively from a scientific point of view, one should still distance oneself from the concept of a cure. Initial trials in the laboratory showed potential and the mechanisms are slowly being understood, but we are still a long way from a medicine, said Guillermo Velasco. Tumors are very diverse, he said. The findings on one type of tumor cannot be transferred one-to-one to the others. Nevertheless, individual cases were reported at this conference, in which success was achieved with cannabis in sometimes adventurous self-experiments. However, there is a lack of objective data to prove that these successes are really due to cannabis.

Thousands of cancer patients are currently additionally treating themselves with cannabis in some form. However, their data is neither systematically collected nor evaluated. And that's where the dog bites the tail - as long as access is not improved, nothing can change in this data situation. 

It is repeatedly told that the use of cannabis significantly increases the risk of developing psychoses. This was also highlighted in a lecture on the role of the endo-cannabinoid system in psychoses.

However, it was also clearly communicated that this connection was strongly dependent on age. Scientifically, however, it was also important to understand the role of individual cannabinoids and their interaction. There are indications that CBD has an indirect protective effect, i.e. it protects against schizophrenia.

Here, too, the conclusion is a well-known but poor one: more data are needed.

When one thinks of a country that is a pioneer in the use of cannabis as medicine, Israel comes to mind. There, doctors can refer patients to state-licensed dispensaries, which then put together an optimal therapy for the patient. Cannabis is then grown and provided by the state. This works so far and there are officially 25,000 patients who benefit from such a therapy. Cannabis flowers are also used, which may be smoked, similar to what we already know from the USA and Germany. Even old people's homes and nursing homes are making active use of the offer.

Nevertheless, Dr. Ilya Reznik was not sparing with criticism. In his field, clinical neuropsychiatry, there are only a handful of diseases that are treated with cannabinoids. Many mental illnesses that would justify such treatment are not yet accepted.

He estimated that the potential number of patients who could benefit from cannabis is closer to 250,000. Acceptance by physicians is also still low, he said, and much more education needs to be done. But the system has another catch: many doctors lose sight of their patients after they have referred them to one of these pharmacies. 

The final speaker was Dr. Mahmoud A. ElSohly. He reported on his 40 years of experience in cannabis research. Pictures showed him together with pharmacist Rudolf Brenneisen, who had organized the meeting. This ended amicably, as Dr. Mahmoud A. ElSohly was Brenneisen's mentor. Brenneisen undoubtedly carried the know-how of cannabis research to Switzerland and set milestones, the Tages-Anzeiger even spoke of the “Cannabis Pope”. In my opinion, the event ended mainly in self-congratulation.

In the discussion that followed, an audience member expressed her displeasure to loud applause and demanded that something really be done now. The cardinal question, however, to what extent all these researchers and officials gathered in the room really intend to do justice to the patients and how the medieval conditions could be remedied, remained unanswered.

The conference was interesting and only strengthened my resolve to work towards full legalization. To really make a difference, you need the maximum demand.

More info about the conference can be found via www.hanflegal.ch/sacm2016.

Here's a quick look at the situation of medical cannabis in the Netherlands:

Medical use is common in the Netherlands, patients get cannabis cheaper than in coffee shops and the quality is usually better. The company Bedrocan produces medical cannabis there and also exports it, for example to Germany. Nevertheless, the topic of cannabis as medicine does not seem to have arrived yet, at least in the coffee shops. According to internet sources, a coffee shop was opened that wanted to focus on medical use and even carried CBD products - however, this was closed again by the authorities after a few days. As with us in Switzerland, it is not seen with pleasure if the medical benefit is propagated outside the health sector or even products are offered.