More Australians are using medicinal cannabis to treat a host of health problems as reports of its supposed healing powers flood the media. But is this the green miracle patients have been waiting for?
This week, the UK’s National Institute for Health and Care Excellence declined to approve medicinal cannabis for use in children with severe epilepsy on the NHS, saying there was not enough evidence to support its use. In 2018, however, the US Food and Drug Administration approved a cannabidiol for use in children with two types of severe epilepsy. So what is the situation in Australia, and is there evidence to support all the hype?
Can patients access medicinal cannabis in Australia?
The federal government approved medicinal cannabis to treat a limited number of conditions in 2016. While only one product, Sativex, is registered with the Therapeutic Goods Administration, the government allows medical practitioners to apply for a special patient-by-patient permit to prescribe unregistered drugs which have met quality and manufacturing standards, through a process known as the Special Access Scheme B (SASB).
Patient interest is strong. A study of GPs conducted last year found that more than two out of five had received a patient request for medicinal cannabis in the preceding three months. Following a streamlining of the SASB process, the number of medicinal cannabis permits approved has rapidly increased over the past year, from 229 in August 2018 to 2,206 in July 2019. As of the end of July, more than 11,000 SASB approvals had been made by the TGA.
Which conditions can it help?
While there is high community and media interest in medicinal cannabis, the scientific community is approaching the drug with caution, noting that while there is some evidence to back it in some cases, the strength of the research into cannabis needs improvement.
In a review of the science, the TGA found strongest evidence for its use in childhood epilepsy, and limited evidence related to palliative care, MS, chronic pain, and addressing the symptoms of chemotherapy patients.
The Australian Medical Association identifies potential use for medical cannabis in such conditions, but while the evidence base is growing, the AMA says, the drug remains “experimental”.
Assoc Prof Vicki Kotsirilos, of the Royal Australian College of General Practitioners, says: “The evidence for medicinal cannabis is limited and inconclusive, but there is some evidence that does suggest that there is a role for medicinal cannabis products in a number of health conditions,” in line with those reviewed by the TGA.
Is there evidence to support it?
In reviewing the research, the RACGP reports that studies show that for young epilepsy sufferers, who had exhausted first-line treatments, one in five patients reported an improvement in quality of life and one in eight found a 50% reduction in seizures. One review of medicinal cannabis use in those suffering chronic pain found that one in 22 patients reported a 30% reduction in pain.
Medicinal cannabis comes in different forms and potencies. The cannabis plant contains around 100 cannabinoids, but the ones of particular therapeutic interest are THC (which is the psychoactive compound, used in treatment of conditions such as nausea and muscle spasticity) and cannabidiol (CBD), which has been used in epilepsy treatment.
Can you become addicted?
In her capacity as a GP, Kotsirilos has seen medicinal cannabis alleviate symptoms and be well tolerated in patients. But there are unknowns which she is alert to. “The problem is the long term,” she says. “We don’t know if it will, in the long term, cause a dependency problem.”
Nadia Solowij, a psychology professor at the University of Wollongong who has been publishing cannabis research for decades and is co-director of ACRE, says: “Generally speaking, it is unlikely that medicinal cannabis used for specific medical conditions would be used sufficiently heavily for dependence or other adverse outcomes to develop, but we don’t yet know.”
She says there is less evidence about the risks of developing psychosis.
Who’s making money from it?
There is significant government and business interest in the growth of the medicinal cannabis industry, with the federal government last week announcing it would prioritise medicinal cannabis licences to projects which have been classed as offering a boost to jobs or exports.
The Greens, in their push for legalisation of cannabis for recreation use also, estimate the total legal cannabis market could be worth $3.6bn to the national economy. Research released in May predicted the worldwide marketfor legal marijuana to be worth US$66.3bn by 2025.
Cannabis Access Clinics, a private network of GPs specialising in medicinal cannabis, has facilitated access for around 2,000 patients since opening its doors a year ago. Last year MMJ PhytoTech paid $1m for a 16.7% stake in its parent company, Biologics Research Institute Australia.
The service includes bricks and mortar clinics as well as telehealth conferencing. The combined cost for an initial screening, consultation, securing the prescription and a single monthly follow-up consultation is $400. While patients may seek access to medicinal cannabis from any GP, Nijhawan says that a lack of expertise in medicinal cannabis products, an aversion to the amount of paperwork involved in securing access, and the risks associated with prescribing an unregistered drug mean many GPs shy away from the drug.
Source: The Guardian