Every year a number of new drugs come onto the market. Some are greeted with fanfare while others just slide in. There is an assessment process to bring pharmaceuticals to market to show that they are safe, that they work and that side effects are acceptable. To get a listing on the Pharmaceutical benefits scheme (PBS) and thus attract a government subsidy, the manufacturer needs to show that the costs justify the benefits.
Last week a study showed that a medication has clinical benefit in treating childhood epilepsy and reducing seizures.
So you might think that a very old product, which is not particularity expensive, has an excellent safety profile (it is almost impossible to overdose and kill yourself with it), a reasonable side effect profile and demonstrated usefulness in a number of conditions would sail though fairly easily. You might think doctors, patients and governments would welcome such a product.
It would, except for one tiny problem, the name of the product, which is medicinal cannabis.
And at this point the scientific principals that normally apply are thrown out the window.
Recently the premier called on doctors to register to prescribe medicinal cannabis in WA as none have done so. A cursory glance at what hoops and forms doctors need to deal with to be able to prescribe might explain the apparent “reluctance”.
Lets get three things clear at the start. Medicinal cannabis is not a cure for all conditions as some of the more zealous supporters claim. It is also not a dangerous addictive drug as the zealous opponents claim. And there is scientific research to support its use. Necessarily there is still less, than with some other medications due to the difficulty of doing trials on an illegal product. Medical Cannabis Research Australia is currently supporting a number of trials.
Canada has nearly 20 years experience in its use and there is a significant amount of information online for both the public and health professionals at the health Canada website. As a historical aside, the situation in Canada came about when its courts ruled that the federal government must provide reasonable access to a legal source of cannabis for medicinal purposes.
In Australia the federal government passed legislation to allow the use of medicinal cannabis and the states have also passed supporting legislation. But there is no requirement for the government to provide reasonable access.
Realistically all the government needs to do is remove some of the barriers.
Cannabis is an old plant. Before being banned, it was prescribed legally for medicinal purposes until 1936 in the USA and 1938 in Australia. Fore runners to three of todays biggest pharmaceutical companies sold medicinal cannabis products.
Medicinal cannabis is taken orally rather than smoked. Dose (like all medications) is controlled. The ratio of cannabinoids, which are the medically active component to tetrahydrocannabinol (THC), the part that gives you the high, is minimised.
International experience shows us that used medicinally, people do not get addicted as can occur when smoked. This is in part because of the low concentration of THC and also because of the oral route of administration, which changes the speed at which it enters the bloodstream.
There are no receptors in the part of the brain, which controls breathing and circulation. Hence it is almost impossible to overdose and kill yourself with oral cannabis by suppressing the breathing centre. In contrast the opiates, which are widely prescribed for pain, can do exactly that and are responsible for more deaths each year than illicit drugs.
In simplest terms medicinal cannabis, administered orally at a known dose can provide a clinical benefit without making you “high”.
Medicinal cannabis has been shown to have benefits in chronic pain (especially neuropathic pain), nausea associated with cancer and chemotherapy, some forms of epilepsy and multiple sclerosis. Further research will likely show other uses especially in conditions of the nervous system.
The world is moving in this direction. Some 30 states in the USA (the original home of Nixon’s war on drugs) now have legal medicinal cannabis. Six states have gone even further. Other countries with legal medicinal cannabis include South Africa, Chile, Israel, Germany, Italy and Mexico.
So what do we need to do in Australia? The answer is to treat medicinal cannabis like any other therapeutic agent. It should be prescribed where there is evidence to support its use. Side effects need to be understood by its users. It needs to be regulated like any other pharmaceutical item. It should be prescribed by doctors and dispensed by pharmacists. This is the standard model and not rocket science!
Currently there are many in Australia who are self medicating, illegally, by using inhaled cannabis. They do this because they get medical benefit. Some of these people are the strongest advocates for medicinal cannabis. In fact our current situation came about due to lobbying from those who had illegally used medicinal cannabis and appealed to politicians to act.
Here is the bottom line. There is more than enough evidence to support the use of medicinal cannabis in certain people for certain conditions. Much like we don’t use a blood pressure medication for asthma we don’t use cannabis for blood pressure. Like all medications there are potential side effects but currently we use medications, which are potentially far more harmful than medicinal cannabis with far fewer hoops to jump through.
With a modicum of good will and common sense all round we can get to the proverbial level playing field where it is no harder or easier to prescribe medicinal cannabis than any other medicinal product.
At that point, those who can benefit from medicinal cannabis can have it legally prescribed in the same way as any other pharmaceutical agent.
This article first appeared here.