UIC Medical Cannabis symposium

NCPIC recently attended the United in Compassion forum in Sydney to hear some fresh perspectives on medical cannabis research advancements. 

United in compassion forum Sydney

In the world of medical cannabis, it seems Dr David Caldicott is a rock star!

Well at least that’s how it appeared on the second day of this year’s United In Compassion Medical Cannabis Symposium, where “I’m just David” had the notoriously difficult middle-of-the-day timeslot. A timeslot when most people sneak out early for lunch, switch off, or feign interest while they plan their afternoon.

Not in this case.

With standing room only, the symposium was packed with at least 700 attendees, sitting edge-of-their seats as Caldicott explained, in his thick Irish accent, what United In Compassion is all about.

There is no doubt his presentation was interesting – filled with goodies and baddies, graphic novels and warnings that “there are snake oil merchants out there.”

But for all his compelling rhetoric, the real crux of the talk seemed to be conveying the future aims of United In Compassion and emphasising it is ‘people before profit’. He said the group has a focus on ‘open science’, and will start to share what they know in online independent education modules.

An ‘history of cannabis’ module will be available to everyone, while specialist modules will be made available to clinicians only. And though the wider medical cannabis community – possibly those more with an agenda for general legalisation – have made ‘cannabis cures’ claims for dozens, upon dozens of different illnesses and symptoms, the clinician modules seemed to cover only the four main areas emphasised throughout the symposium – pain, epilepsy, MS and side effects of treatments like chemotherapy. In addition, they will have a module for cannabis use disorders, Caldicott noted, emphasising there is a significant difference between medical and recreational use of cannabis, and cannabis use disorders do exist.

Overall, though bordering on the type of passion and charisma we’d all love to see from our politicians during campaign speeches, and despite the goodies verses baddies sub-plot, the presentation was refreshing in its acknowledgement of the positives and negatives of cannabis and ongoing focus on people and patients.

Caldicott’s ‘Ted Talk-style’ presentation caught most people’s attention and was followed by a mass exodus. But when it came to content, the scientists who took the podium before and after the doctor, really stole the limelight.

Dr Linder on epilepsy and cannabis

Prior to Caldicott, Dr Ilan Linder of Israel presented on perhaps one of the most pertinent issues covered at the Symposium, epilepsy. Linder covered a lot of ground in a short time, introducing a couple of studies worked on in Israel, and delved into case studies of some of his research participants.

Linder has treated more than 130 patients who suffer from intractable epilepsy with cannabis oil, many of them young children. Of those, he treated 25 with vaporised cannabis. Very open and seemingly transparent in his reporting, Dr Linder noted the improvements in each patient, but also covered some of the shortfalls of the study that would need to be addressed in future research. He also noted the need to consider possible mental health implications of use, and interactions with other medications.

Linder’s paper, ‘CBD-enriched medical cannabis for intractable paediatric epilepsy: The current Israeli experience’ was published in 2016, and like his talk, noted positives and areas for improvement in future studies. On the positive side, according to our senior researcher Steph, who dived into the paper to break it down for us, the cannabis dose was reasonably well controlled, and the patients had all suffered failures in first line treatments. In addition, the study considered side-effects and the study group was quite large.

In general, Steph says the study was informative, had a fairly large number of participants and the CBD was sourced and delivered somewhat consistently. The study wasn’t controlled enough to be able to draw specific conclusions: researchers used two different CBD oil types but didn’t examine if one was better than another, they didn’t look at the possible effects of interaction with previously or currently used epilepsy drugs; the number and severity of seizures weren’t independently measured; and they didn’t analyse any differences in response as related to the type of illness and seizure history (that is, did some patients have better outcomes than others?). This last point is particularly important, she noted, as some patients did get worse, and the researchers weren’t able to shed any light on why this was the case. These drawbacks were most likely the result of not having enough people in the study to be able to use the required statistical analysis.

These limitations can be addressed in future studies to produce more clear conclusions. To do so, researchers would require larger, multi-centre trials that are more specific (for example, one type of CBD oil with known potency and purity for one type of patient). Dr Linder’s was a good background study/’proof of concept’ study, but as he mentioned, much more work is needed in the area.

Professor Sánchez on cancer and cannabis

The next interesting presentation of the day was delivered by Professor Cristina Sánchez, from the University of Madrid in Spain – and for those who stuck around, eyes were glued firmly to the screen.

Sánchez’s talk was based on a 2006 paper undertaken with 9 patients with terminal brain cancer, ‘A pilot clinical study of Delta9-tetrahydrocannabinol in patients with recurrent glioblastoma multiform’, and ‘Cannabinoids reduce ErbB2-driven breast cancer progression through Akt inhibition.’

Taking listeners step-by-step through each study, Sánchez explained the research for this paper was based on in vivo (tested on whole living organisms, in this case a rat model of breast cancer) and in vitro work (laboratory experiments conducted on blood, cells or other tissue from animals or humans).

In terms of meeting the needs of the less scientific in the room, Sánchez was an excellent presenter – explaining everything carefully and deliberately, so those new to this type of research could keep up.

In both studies, THC (in combination with other cancer treatments) seemed to have a really positive affect on shrinking tumours. Listening to the presentation, it was easy to get caught up in the ‘cannabis cures cancer’ idea. Notably, Sánchez was quick to clarify this herself, stating several times that the research does seem promising, but is early and does have some flaws, meaning further research is absolutely necessary before any conclusions can be drawn.

Breaking down the paper for us, our senior researcher Steph was impressed with the set up for study one, which she said had controlled dosing and appropriate data analysis. What it did lack, she noted, was sufficient numbers of people participating and a control group (both highly important), and it was challenged by ethical constraints that meant only terminal patients with very aggressive tumours could participate.

In summing it up, she said, “The study has a very good foundation in pre-clinical research, has been published in good journals and was conducted by a respected research group. The first study is a pilot phase one trial which means it’s still in very early stages of testing, so it’s important people don’t jump straight from these results to ‘cannabis cures cancer’ – there’s much more work to do. This study provides a very good foundation to move forward to human studies/or later phase clinical trials, but people should be wary of jumping to conclusions just yet as the small number of patients in the study were also receiving chemotherapy and the long-term outcomes were not reported.”

Based on the murmurs in the room, many watching the presentation thought a successful in vivo and in vitro must mean the drug’s effectiveness and safety is in the bag. But, Steph said, as noted in Nature Biotechnology, only one in ten drugs succeed in being approved after passing these kinds of pilot Phase One studies. This just goes to show how much more research is required in this area before we really understand how cannabis affects cancer in humans: which component/s of the plant, for which tumours, in what dose, at what stage and for how long.

For the second paper, Steph was again impressed, saying it had good scientific modelling, using in vitro and different types of in vivo, and a good theory of the mechanism involved, and why cannabis might be beneficial as a combination therapy with Trastuzumab (Herceptin) for breast cancer. On the downside, human studies are needed and it seems none have yet been conducted.

All-in-all, despite the hemp markets outside (which were interesting but perhaps distracted from the important educational aspects of the symposium) the event included some very good presentations, like that from Linder and Sánchez, that did offer some small glimmers of hope for people suffering serious and life-threatening illnesses.

Though not all presentations had the same lack of bias or fanfare, being completely unbiased is an impossibility. It was refreshing that these presentations seemed honest and balanced, communicating information not only in a scientific way that encouraged people to think about the outcomes realistically, but hopefully ensuring attendees understand the need for ongoing research in order to bring real clarity to the many remaining questions about cannabis as a medicine.

Congratulations to Lucy Haslam and team on an interesting and enlightening event.

For more information on medical cannabis and the latest studies, check out our medicinal cannabis centre. We are working on upgrading the centre right now with a brand new research corner. Our researchers will look at all the latest studies and claims relating to medical cannabis, break them down and let you know how promising the current results are and what phase each study is in, so you can get a better idea of what we really know about medical cannabis right now. Got a study you want checked out? Send it to Steph, or one of our researchers here.