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Background: Interruption of supply of pharmaceutical opiates can cause major challenge to the continuity of management of opiate-dependent patients on maintenance treatment. Policy makers and practitioners need to learn lessons from the experiences of these occasional crises. Method: Through case report and clinical audit, we report on the opiate switch and dose conversion strategies with 14 patients previously receiving dextromoramide (Palfium®) as opiate addiction maintenance treatment. Results: Patients were switched to a wide range of different opiates, of which the most commonly-selected was morphine. Dose conversion ratios varied greatly between patients. Conclusion: Lessons need to be learnt from serendipitous experiments. In the absence of pre-existing guidance, great diversity of empirically derived practice occurred. Perhaps the most important lessons to be learnt are, first, that no rigid formula for conversion can be universally applied, second, that considerable between-subject variation will...

SUMMARY This Phase I, open label, four-way crossover study pertains to pharmacokinetic parameters of four cannabis based medicine extracts (CBME). Sublingual, buccal and oro-pharyngeal test treatments (GW-1000-02) consisted of 25 mg cannabidiol (CBD) + 25 mg Δ9-tetra-hydrocannabinol (THC) per ml formulated in ethanol (eth):propylene glycol (PG) (50:50), with peppermint flavouring with a 100 μl actuation volume (total dose 10 mg CBD + 10 mg THC in 4 actuations). An oral capsule contained 2.5 mg CBD + 2.5 mg THC sprayed onto granulated lactose and encapsulated in soft gelatin capsules (total dose of 10 mg CBD + 10 mg THC 4 capsules). This study was performed in healthy volunteers in an open label, 4 period, 3-way randomised crossover followed by a nonrandomised oral dose using single doses of 20 mg of CBME (10 mg CBD + 10 mg THC). In Periods 1 to 3, the test treatment was administered as a liquid spray according to the randomisation scheme (i.e., sublingually, buccally, oro-pharyngeally). In Period 4 the te...

SUMMARY Primary objectives of this study were to assess the pharmacokinetic characteristics of CBME when administered sublingually in different ratios, to determine if the pharmacokinetic profiles of THC and its metabolite 11-hydroxy-THC are different when administered sublingually in different formulations, and to characterise the pharmacokinetic profile of CBD when administered with THC in equal amounts. Secondary objectives were to determine if there was a correlation between intoxication levels and plasma concentrations of THC and/or its metabolite 11-hydroxy-THC, and to assess safety and tolerability of CBME when administered sublingually. Methodology employed a double-blind, randomised, three-way crossover study of placebo, High THC and CBD:THC administered sublingually as a liquid spray. Twenty-four subjects were planned, dosed, completed the study and were analysed. Test products were Δ9-tetrahydrocannabinol (THC, formulated as 25 mg THC per ml) with or without cannabidiol (CBD) (formulated as 25 ...

Cannabis is now emerging from a period of prohibition and being revisited as a potential source of treatments for conditions ill served by synthetic substances. Previous research focussed primarily on effects produced by synthetic cannabinoids such as THC, or cannabis of unknown cannabinoid content. Chemovars of cannabis characterized by high content of specific cannabinoids (primarily, but not only THC and CBD) have been developed. Clinical research using defined extracts from these chemovars is now underway in the UK. Many diseases are multifactorial; a variety of receptors need to be targeted to produce a therapeutic effect. A defined botanical may better achieve this than a single synthetic compound as the components can act synergistically. A new generation of cannabis based medicinal products takes advantage of increasing understanding of the mode of action of cannabinoids, evidence-based research on clinical uses and new technology for realization of products, in anti-diversionary presenta...

ABSTACT An anonymous questionnaire was sent to all the undergraduates in a single College within Oxford University in order to explore perceptions of university life, levels of stress and emotional well‐being, attitudes and beliefs about alcohol and drugs, and the pattern of use of these substances. The response rate was 76%. There was a high level of contentment with College life, but a third of students had felt rejected on grounds of social class, and a third of the women reported sexual discrimination or harassment. Average self esteem of the women equated to a control population, but that of the men was abnormally high. Promiscuous sexual behaviour was unusual. A third of the women reported at least one episode of problematic binge‐eating or dieting. Correlational analysis suggested the existence of a small minority of vulnerable, unhappy students. Drug and alcohol use among Oxford undergraduates approximates to that of a similar age group in the general population. A third of students consume more t...