Patients wanted for operation cannabis
Trials will rate drug’s value as painkiller after surgery

ALISON CHIESA

Patients due to have surgery will be asked to take part in trials to discover whether cannabis is effective as a
painkiller.

The tests will be conducted in 36 hospitals in the UK in the hope of measuring the effects of cannabis plant extract
against other pain-relieving drugs given after operations.

Hospitals in Scotland signed up to the trials include Gartnavel General and the Victoria Infirmary in Glasgow, Stirling
Royal Infirmary, Falkirk & District Royal Infirmary, and St John's Hospital in Livingston.

The Medical Research Council (MRC) aims to recruit 400 surgical patients for the trials. Each volunteer, who must be
over 18, will be randomly assigned to one of four oral pain-relieving treatments containing either standardised
cannabis extract, tetrahydrocannabinol (an active ingredient in cannabis), a standard pain-relieving drug or a placebo.

The drug will be administered via a capsule containing a prescribed dose.

Pain relief and side-effects will be assessed over a six-hour period. Patients will be able to request additional pain
relief at any time during the study.

Volunteers' experiences in each of the four groups will then be compared, to determine whether the cannabis-based
treatments are effective.

Dr Anita Holdcroft, from Imperial College London, who is leading the £500,000 study, said that scientific scrutiny was
now needed of anecdotal evidence that cannabis could provide effective pain relief for a variety of debilitating
conditions, including Parkinson's disease and multiple sclerosis.

She said: "This is a proper study in a clinical setting where patients can be routinely monitored, using an oral
capsule containing a prescribed dose."

Dr Holdcroft added that, if the cannabis extract was found to be effective and without adverse side-effects, it could
provide patients with another pain relief option. The trial results are expected to be published within a year.

DrugScope, a charity which aims to advise and inform on drug-related policy, welcomed the trials. Frank Warburton, the
charity's director, said: "The therapeutic benefits of cannabis have been well-known for some time.

"We welcome this trial, which appears to be a sensible and rational exploration of these benefits, and look forward to
seeing the results of the evaluation."

The research was also backed by the British Medical Association. A spokesman said: "BMA research has shown that,
although cannabis itself is unsuitable for medical use, some cannabis-based medicines have the potential to relieve
pain. There has long been a need for more research into the effectiveness of cannabinoids for therapeutic purposes."

Although cannabis remains an illegal substance, it is licensed for medical trials.

Dr Michael Serpell, consultant in anaesthetics at Gartnavel General Hospital, said: "We have already been using
cannabis to investigate its potential to help patients with chronic pain in a research setting.

"Anecdotal evidence has shown the treatment has been helpful in some chronic pain conditions, such as abdominal and
neuropathic pain. It therefore appears a promising medication, and we are keen to test it in a clinical setting to find
out if it can provide pain relief after an operation."

A spokesman for the Victoria Infirmary expected about 20 volunteers to participate in trials at the hospital.

Last year, a trial involving 34 British patients with multiple sclerosis, spinal cord injury and other conditions
causing severe pain, found that using cannabis-based treatments reduced their pain and helped them to sleep more
soundly.

Herbal Remedy With 5000-Year History

The hemp plant, cannabis sativa, has a long history of medicinal use. It was first used as a herbal remedy in China
about 5000 years ago.

The main active ingredient in cannabis is delta-9-tetrahydrocannabinol (THC), although more than 400 active compounds,
known as cannaboids, have been isolated.

Anecdotal evidence suggests that, among them, THC is the most psychoactive in humans, producing euphoria, relaxation,
intensification of ordinary sensory experiences, percept-ual alterations, diminished pain, and difficulties with memory
and concentration.

Queen Victoria, whose doctor once described the drug as "one of the most valuable medicines we possess", is said to
have taken cannabis tincture as a pain reliever during menstruation.

Editorial Comment...

The big cannabis question

Government must act resolutely on drug trials

Delaying tactic or essential next step to prove whether cannabis is an effective pain reliever? Biz Ivol believes the
former. Her negative reaction to yesterday's announcement of an extensive government-funded trial into the medical use
of cannabis is understandable. Ms Ivol, who has been in trouble with the law since 1997 when she was first reported for
growing cannabis at her Orkney home, accused the government of sanctioning more clinical trials to avoid a difficult
decision on legalising cannabis for medical purposes. Ms Ivol, who is a wheelchair user because of multiple sclerosis,
uses cannabis to relieve her debilitating symptoms. She is in no doubt that it works, as are the many others who run
the risk of falling foul of a law that is too inflexible to take account of their predicament.

The government has sent out mixed messages about cannabis and the law. Although it has decided to reclassify cannabis
as a less dangerous drug, the maximum sentence for convicted dealers is being increased from five to 14 years. Ms Ivol
takes cannabis in chocolate form and is prepared to supply it to fellow MS sufferers for no profit or gain. In the
government's eyes that could make her a dealer (it is less than two months since she faced charges of possessing,
producing, and distributing cannabis). No-one in their right mind would believe she deserved severe punishment for what
few would regard as a crime. Clearly, the law needs to be changed, but that needs to happen on the back of scientific
evidence demonstrating the safety and effectiveness of cannabis as a pain reliever, the form in which it should be
prescribed, and to whom. That has been a tortuous process. It is more than five years since a House of Lords committee
recommended reclassifying cannabis so that it could be prescribed to named patients. There have been medical trials
since, but none as extensive as those announced yesterday.

After surgery, 400 patients in hospitals throughout Britain will receive a capsule containing cannabis extract, THC
(the main active ingredient), a standard pain killer, or a placebo. The results will be carefully monitored. Some of
the hospitals involved, including Gartnavel General in Glasgow, have conducted their own tests. If the new research
confirms the findings of earlier trials, as well as the anecdotal evidence of people like Ms Ivol, there should be no
delay in making cannabis available for medical purposes. Assuming all the hurdles are passed, that could happen next
year. That would require a political will on the part of a government that, to date, has been nervous as well as
inconsistent in its attitude towards legalising cannabis for medical use. If science makes the case, boldness must
replace prevarication. The Ms Ivols of this world deserve no less.

- Aug 21st

SOURCE: The Glasgow Herald, UK
http://www.theherald.co.uk/news/archive/21-8-19103-0-14-59.html

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