An Update on Medical Marijuana in Iowa

You may remember the issue of medical marijuana in Iowa from a previous post. I just got an update on the issue in an e-mail message from the Iowa Medical Society (IMS) recently,

Recall the Iowa City Channel 4 presentation about it?

That was a hard-hitting message and I must say I’m a little surprised at the speed with which the Iowa legislature took up the process of legalizing medical marijuana. I did a quick PubMed search and didn’t find much promising new research about cannabidiol and epilepsy [1-3].

There is a post for a new discussion on the matter on the IMS LinkedIn site. So far there is one supporter of the initiative. I’m not sure how many Iowa neurologists would favor such a law. I’m still not sure who would produce the cannabidiol.

I like the thoughts of Sirven, the author of the 3rd reference:

In this month’s Epilepsy & Behavior, Drs. Jacobson and Porter present a report of a parental survey of cannabidiol-enriched cannabis used in pediatric treatment-resistant epilepsy. The investigators from Stanford University conducted a survey of parents belonging to a Facebook group dedicated to sharing information about the use of cannabidiol-enriched cannabis to treat their children’s seizures [2]. Nineteen responses met the inclusion criteria for the study which included a self-directed diagnosis of epilepsy and current use of cannabidiol-enriched cannabis.

The results are fascinating and heartbreaking at the same time. Multiple seizure types and epilepsy syndromes of children ranging from ages 2 to 16 years, 13 with Dravet syndrome, 4 with Doose syndrome, 1 with Lennox Gastaut syndrome, and 1 with idiopathic early onset epilepsy were managed with cannabidiol-enriched cannabis. These children had experienced treatment-resistant epilepsy for more than three years before trying cannabidiol-enriched cannabis with an average of 12 failed antiepileptic drugs before their parents began treatment with the cannabidiol. The dosages of the cannabidiol were reported to be between 0.5 mg/kg/day and 28.6 mg/kg/day. The dosages of THC within those samples were reported to range between 0.0 and 0.8 mg/kg/day…

The survey, according to the authors, showed that parents are using medical cannabis as a treatment because of the increasing number of states that allow it despite the lack of clinical trials specifically for the purified nonpsychoactive cannabidiol to determine whether it is safe, well-tolerated, and efficacious in controlling seizures in this difficult-to-treat population…

 This issue places the epilepsy community at a medical legal ground zero in resolving this situation, and this study, if anything, highlights the failure of the health-care system as a whole to grapple with better management of epilepsy as it deals with our most vulnerable citizens — our children…

It is only by the process of science guided by rational and ethical advocacy for the best interest of the patient that we will come to an answer and not leave people to their own devices. Hopefully, there will be less polarity, less politicization of this issue, and more focus on what is real and what is not. Nevertheless and whether we like it or not, it looks like the epilepsy community is in the crosswinds of change.

The Iowa medical marijuana law doesn’t sound like it will be restricted to children with epilepsy. It might be for anyone with an uncontrolled seizure disorder.

This law might be “hastily crafted,” but some would say it’s a change that’s been a long time coming.

References:

1. Gloss, D. and B. Vickrey (2014). “Cannabinoids for epilepsy.” Cochrane Database Syst Rev 3: CD009270.
BACKGROUND: Marijuana appears to have anti-epileptic effects in animals. It is not currently known if it is effective in patients with epilepsy. Some states in the United States of America have explicitly approved its use for epilepsy. OBJECTIVES: To assess the efficacy and safety of cannabinoids when used as monotherapy or add-on treatment for people with epilepsy. SEARCH METHODS: We searched the Cochrane Epilepsy Group Specialized Register (9 September 2013), Cochrane Central Register of Controlled Trials (CENTRAL) in The Cochrane Library (2013, Issue 8), MEDLINE (Ovid) (9 September 2013), ISI Web of Knowledge (9 September 2013), CINAHL (EBSCOhost) (9 September 2013), and ClinicalTrials.gov (9 September 2013). In addition, we included studies we personally knew about that were not found by the searches, as well as searched the references in the identified studies. SELECTION CRITERIA: Randomized controlled trials (RCTs) whether blinded or not. DATA COLLECTION AND ANALYSIS: Two authors independently selected trials for inclusion and extracted the data. The primary outcome investigated was seizure freedom at one year or more, or three times the longest interseizure interval. Secondary outcomes included responder rate at six months or more, objective quality of life data, and adverse events. MAIN RESULTS: We found four randomized trial reports that included a total of 48 patients, each of which used cannabidiol as the treatment agent. One report was an abstract and another was a letter to the editor. Anti-epileptic drugs were continued in all studies. Details of randomisation were not included in any study report. There was no investigation of whether the control and treatment participant groups were the same or different. All the reports were low quality.The four reports only answered the secondary outcome about adverse effects. None of the patients in the treatment groups suffered adverse effects. AUTHORS’ CONCLUSIONS: No reliable conclusions can be drawn at present regarding the efficacy of cannabinoids as a treatment for epilepsy. The dose of 200 to 300 mg daily of cannabidiol was safely administered to small numbers of patients generally for short periods of time, and so the safety of long term cannabidiol treatment cannot be reliably assessed.

2. Porter, B. E. and C. Jacobson (2013). “Report of a parent survey of cannabidiol-enriched cannabis use in pediatric treatment-resistant epilepsy.” Epilepsy Behav 29(3): 574-577.
Severe childhood epilepsies are characterized by frequent seizures, neurodevelopmental delays, and impaired quality of life. In these treatment-resistant epilepsies, families often seek alternative treatments. This survey explored the use of cannabidiol-enriched cannabis in children with treatment-resistant epilepsy. The survey was presented to parents belonging to a Facebook group dedicated to sharing information about the use of cannabidiol-enriched cannabis to treat their child’s seizures. Nineteen responses met the following inclusion criteria for the study: a diagnosis of epilepsy and current use of cannabidiol-enriched cannabis. Thirteen children had Dravet syndrome, four had Doose syndrome, and one each had Lennox-Gastaut syndrome and idiopathic epilepsy. The average number of antiepileptic drugs (AEDs) tried before using cannabidiol-enriched cannabis was 12. Sixteen (84%) of the 19 parents reported a reduction in their child’s seizure frequency while taking cannabidiol-enriched cannabis. Of these, two (11%) reported complete seizure freedom, eight (42%) reported a greater than 80% reduction in seizure frequency, and six (32%) reported a 25-60% seizure reduction. Other beneficial effects included increased alertness, better mood, and improved sleep. Side effects included drowsiness and fatigue. Our survey shows that parents are using cannabidiol-enriched cannabis as a treatment for their children with treatment-resistant epilepsy. Because of the increasing number of states that allow access to medical cannabis, its use will likely be a growing concern for the epilepsy community. Safety and tolerability data for cannabidiol-enriched cannabis use among children are not available. Objective measurements of a standardized preparation of pure cannabidiol are needed to determine whether it is safe, well tolerated, and efficacious at controlling seizures in this pediatric population with difficult-to-treat seizures.

3. Sirven, J. I. (2013). “Medical marijuana for epilepsy: winds of change.” Epilepsy Behav 29(3): 435-436.

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Comments

  1. Reblogged this on 4:20 Smokers Blog.

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  2. Governor Branstad says he likes the CBD oil bill that Utah enacted on March 20, 2014. That bill authorizes production at a state university. So, that answers the question of where the oil will come from. Utah House Bill 105 legalizes CBD, calling it hemp oil, and the production of hemp in the same bill, tying the two together. Congress authorized states to grow hemp in the federal Agriculture Act of 2014, Section 7606. http://le.utah.gov/~2014/bills/static/HB0105.html / https://agriculture.house.gov/bill/agricultural-act-2014

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