Pubdate: Wed, 31 Jan 2001
Source: British Medical Journal (UK)
Copyright: 2001 by the British Medical Journal.
Contact:  http://www.bmj.com/
Author: Owen Dyer, London

CANNABIS TRIAL LAUNCHED IN PATIENTS WITH MS

The world's biggest clinical trial of the cannabis plant got under 
way this week at Derriford Hospital, Plymouth; the trial is looking 
at the control of pain and tremors in multiple sclerosis. Twenty 
patients were given their first doses of capsules containing cannabis 
oil, tetra hydro cannabinol, or placebo. After three months, if all 
goes to plan, the trial will be slowly extended across the country, 
eventually taking in 660 participants in 40 centres.

The cannabis in multiple sclerosis (CAMS) study is sponsored by the 
Medical Research Council and approved by the government, which has 
arranged for the drug to be imported from Switzerland. A parallel 
study will examine the effect of the drug on lower urinary tract 
symptoms.

Patients will undergo up to five weeks of titration, followed by two 
months at a steady dose. "We're looking for a dose that can help 
relieve symptoms with minimal side effects," said research registrar 
Dr Patrick Fox. "We find that few patients want to be stoned or high 
when they have to take the drug all the time."

Patients who benefit from the treatment can opt to continue for a 
further nine months. They may legally take their medication home 
because each has been granted a licence by the Home Office to possess 
schedule 1 drugs. Participants have been advised not to drive during 
the study period.

Cannabis has been a schedule 1 drug since 1971, when the World Health 
Organization pronounced it medically useless. Two years ago a House 
of Lords select committee argued that more research was necessary in 
view of widespread anecdotal reports of the drug's efficacy in 
controlling pain and tremor, particularly in multiple sclerosis.

The government has announced its willingness to amend drug laws if 
the benefits of cannabis can be shown. This would mean giving 
cannabis a legal status similar to morphine.

The CAMS study is the fourth cannabis trial to begin in Britain in 
recent months. Three smaller phase II trials have been under way 
since the autumn--in Guernsey, Oxford, and Norfolk. The drug used in 
these trials is a sublingual spray, taken from plants grown by G W 
Pharmaceuticals in Kent. The researchers expect to extend these 
trials to 2000 patients over the next two years.

Professor William Notcutt, who heads the trial at the James Paget 
Hospital, Gorleston, Norfolk, has enrolled not only people with 
multiple sclerosis but also patients with various chronic pain 
syndromes, such as neuralgia and lower back pain. "We're looking at 
overall quality of life as well as pain relief," he said. "If a 
patient says they feel better since starting the drug, I'm not going 
to panic that some of that might be drug induced euphoria and cut 
their dose on moral grounds."
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