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AUSTRALIAN experts hope legislative reform and more trials will pave the way for informed use of medicinal cannabis, despite new research showing evidence of its benefits in many conditions is at best of moderate quality and in many cases is weak.
Professor David Penington, former head of the University of Melbourne’s medical school and university vice-chancellor, said legislative change in Australia enabling state-based, regulated supply would allow open-label trials investigating the benefits and side effects in people accessing medicinal cannabis.
“Medicinal cannabis is not at the point where one can expect doctors to write prescriptions. It has not been sufficiently tested in terms of dose-response relationship and relationship of dose to side effects, or interaction with other medications for it to be formally regarded as a therapeutic substance”, Professor Penington told MJA InSight.
“Having said that, there are a lot of data … that suggest there are benefits from medicinal cannabis under certain circumstances. Many of the claims are not based on good evidence, but some are based on good evidence that provides a basis for proceeding.”
Last week JAMA published a systematic review and a clinical review outlining the evidence base, pharmacology, indications and adverse effects of the medical use of cannabinoids. (1) (2)
The systematic review analysed 79 trials (6462 participants) and found moderate-quality evidence to support the use of cannabinoids for the treatment of chronic pain and spasticity, but only low-quality evidence of benefit in chemotherapy-related nausea and vomiting, weight gain in HIV infection, sleep disorders, and Tourette syndrome.
An accompanying editorial said the US was putting “the cart before the horse” in its approach to medicinal cannabis, and advised waiting for high-quality evidence before its use was more widely adopted. (3)
In the US, medicinal cannabis can be legally used in more than 20 states, but there are inconsistencies in how patients with specific conditions qualify for medicinal cannabis use in and between the states.
Professor Penington said the JAMA reviews were useful, but were primarily based on the US experience and did not consider a sufficient number of international publications.
He said the papers did not mention the important role that cannabinoids might play in Dravet and Lennox-Gastaut syndromes — distressing forms of epilepsy in young children — now accepted by the US Food and Drug Administration as a basis for an orphan drug trial. Families with children who currently received benefit “deserve continued access to medicinal cannabis”, Professor Penington said.
Next year NSW Health will start a clinical trial investigating the benefits of medicinal cannabis for children with severe, drug-resistant epilepsy. (4)
In last week’s NSW state budget, $9 million over 4 years was earmarked to fund a trial for this indication and two others: adults with terminal illnesses and chemotherapy-induced nausea and vomiting. Queensland and Victoria have pledged their support for the three trials.
Earlier this year, Professor Penington wrote in the MJA that Australia was “behind the times” in its approach to medicinal cannabis. (5)
However, he said it was a quickly evolving area, with political and community will growing towards change.
“We ought to work with the politicians to be sure it works sensibly”, Professor Penington told MJA InSight. “I hope the medical profession will take the trouble to be part of that rather than just recoil and say ‘we don’t want to write prescriptions’.”
He said rather than prescribing medicinal cannabis, the doctors’ role should be to provide well-informed advice to patients and to government.
A Senate inquiry into the Regulator of Medicinal Cannabis Bill, to establish an independent regulator responsible for licensing the growing, manufacturing and distribution of medicinal cannabis, was expected to report its findings this month. (6)
Other states and territories are also contemplating legislative reform.
In August, the Victorian Law Reform Commission will report the findings of its inquiry into options for legislative change in relation to medicinal cannabis. (7)
Public Health Association of Australia (PHAA) spokesperson David McDonald said the JAMA systematic review provided guidance for Australian governments as they moved to establish medicinal cannabis programs and highlighted problems in the US approach. “The selection of the health conditions for which legal medical cannabis can be used is a key component of that policy work”, he said.
Mr McDonald said the PHAA, which released a position statement on medicinal cannabis last year, welcomed calls for more and better research into the therapeutic value and adverse effects associated with medicinal cannabis use. (8)
(Photo: Atomazul / shutterstock)
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My younger brother has early onset Parkinson’s disease, he’d like to use cannabis to help with the symptoms, so he can continue working as long as possible and have the energy and ability to spend quality time with his wife and 2 little boys. It’s disgraceful that someone with a serious medical issue has to go lurking around St Kilda to find a supplier. He doesn’t have a “contact” in that world and doesn’t feel comfortable lurking anywhere, so is managing without, but he’s angry and frustrated that cannabis/oil is not available in this country for those with a serious medical issue. He speaks to other PD sufferers and many now use cannabis and feel it really helps with their symptoms.
Look it was legal for a long time and then made illegal by dead old men whose reasons were never clear but probably had more to do with rascism against Mexicans and for the benefit of the cotton and plastic industries, for which hemp was a natural competitor. Why medicalise it all, why not just legalise it and take billions way from bikie gangs and Mafia groups and allow those who believe it to help them some dignity rather than scratching around trying to find an illegal dealer. Maybe I am just a dreamer..
The tone of some of the comments published above is simply hysterical. If cannabis was not a mind-bender and not a ‘forbidden fruit’ it is doubtful that there would be this degree of misplaced and frenzied enthusiasm – worthy only of a sort of cult.
Of course cannibis products may enter the pharmacological armentarium but only when the balanced evidence is there and the production, preparation and usage are controlled – as with morphine. Besides, we don’t want more people in charge of cars and other machinery under the influence of this drug or any other agent with similar or related effects.
Discussions of so-called “medical cannabis”are regularly flooded by posters who want “medical” indications to lead to routine use. The fact is, cannabis is a herbal preparation containing psychotropic cannabinoids, much like poppy extract has herbal narcotics which are purified to make morphine. Morphine is a psychotropic substance with both beneficial and adverse effects. Like THC, these substances treat symptoms, not diseases. Talking about treating cancer cells by creating specific “apoptosis” in only those cells is silly pseudoscience, as readily identified by most readers here. By all means promote the research of symptomatic use for appropriate indications, but we already know that thc is no miracle cure – for any disease.
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I use cannabis for recreation only at the moment. But in the past have used it for extreme nausea (including travel sickness). I found it to ease the symptoms almost immediately I know it works for nausea and would definitely use it if I had something more serious.
Pharmaceutical medicines are the third-leading cause of death, after cancer and heart disease. In contrast, cannabis has never caused a single confirmed fatality. Cannabis is also analgesic, antidepressant, anti-inflammatory, anti-proliferative, anti-psychotic, anti-spasmodic, anxiolytic and neuro-protective. In recent years, the discovery of the endocannabinoid system has revealed the intimate association between cannabis and human health, opening up new avenues of research for the prevention and treatment of many conditions. A particularly important property of cannabis is apoptosis – the selective targeting of cancerous cells to self-destruct, while leaving normal cells unaffected. This represents a challenge to the lucrative chemotherapy/radiation model, with its numerous adverse side effects. Since tetrahydrocannabinol [THC] was first isolated in 1964, over 90 cannabinoids, including cannabidiol [CBD], have been identified. When ingested or vaporised, THC, CBD and other cannabinoids augment or replace the body’s own endocannabinoids, damaged or depleted through exposure to environmental pollutants, synthetic food additives and other stressors. Cannabis is thus a truly restorative, ‘re-creational’ herb, a food akin to vitamins and essential minerals, in contrast to alcohol, pharmaceutical medicines and tobacco. The real reason cannabis is prohibited, is because it presents an organic, sustainable, non-toxic alternative to powerful vested interests, including alcohol, tobacco and, in particular, the pharmaceutical industry, that Prof. Peter Gotzsche exposes in his 2013 book ‘Deadly Medicines and Organised Crime: How Big Pharma has Corrupted Healthcare.’
If doctors can find ANY scientific reason why cannabis oil is bad for you, I’d like to hear about it. Because all I’m seeing are cancer, MS, autism, epilepsy and chronic pain sufferers proclaiming that it helps them. Not one person seems to be complaining that cannabis oil is making them more sick.
Mick Vagg, some physicians get large amounts of kick backs from pharmaceutical companies, this is not new news. It’s big pharma and petro chemical companies that are trying to stop people using medicinal cannabis, this is because it will cut into their HUGE profits. Some doctors are now supporting the use of medical cannabis, people are coming out of the closet in this country in droves. Cannabis is just a herb that has been used for centuries to heal a myriad of complaints, it’s time people stopped demonising it. If cannabis has no medicinal value, why are big pharma taking out hundreds of patents? Wake up Australia, this important medicine has been kept from you for way too many years.
Can they increase the trials to include people that need it for pain when nothing else helps, I have a friend who doesn’t have a day without pain and the doctors can’t help her, it’s agony for her every day, it’s so cruel to see someone in so much pain and this could help her. If the pain is under control, these people will be able to work and not be on benefits, that’s a plus.
The IASP Neuropathic Pain SIG has recommended against the use of cannabinoids for neuropathic pain, based on poor evidence of efficacy and clear evidence of low NNT. Given that specialist pain physicians are not pushing for cannabinoids, we should resist industry pressure and stick to what the evidence is telling us.
I agree with herb king…..an inquiry done in 1894 has no relevance today as apposed to the phenomenal amount of studies and trials done worldwide. Why do we not as a world nation work together and pool the resources. Why repeat what has been done over and over. The 9 million dollars can surely be better spent!
M Kennedy… you are not seriously suggesting that a report from 1894 is the high point or benchmark for Clinical research are you… Phrenology was still thought to be an accurate indicator of personality at that time… and the scientific methods, understanding and knowledge developed over the past 120 years is astronomical, and would trump such a ‘report’ – not even factoring the differences in the Cannabis plant itself nowday compared to the ‘good ol’ days’… If Cannabis had not been demonised by racists and bigots, and supressed and prohibited by corporate interests such as Big Pharma, forestry, alcohol, law enforcement etc, then a lot more research would have been done, and we would be 20-30 years ahead of where we are currently… this is the dawn of a new era, deny that is just a luddite reaction… Quite frankly, with no recorded deaths attributeable to Cannabis consumption, a regime of reporting by those who choose to self medicate will soon build a solid real-world body of evidence that will become more comprehensive and more reliable the bigger it gets over time, and with increasing patient participation… millions of people is a pretty good sample size to turn anecdote into knowledge…
The pharmacology of the endocannabinoid system is exceedingly complex and the CB1 and CB2 receptors were unknown until the late in the last century. There have been innumerable reviews and case series describing the adverse effects of cannabinoids and the largest enquiry into medical use was probably the 3,281 page Indian Hemp Drugs Commission report completed in 1894. While some interesting new syndromes and case reports will continue to appear in the literature most of the adverse effects (short term and less long term) of cannabinoids are quite well known. Serious science in relation to cannabinoid pharmacology and therapeutic use of cannabinoids should not be left to the hands of back yard gardeners who promote magical cures but obtain a lot of press coverage.The editorial in JAMA is excellent and should be read by all medical practitioners. The pharmacology of cannabinoids is complex and Clinical pharmacological input is essential to finding the correct place of cannabinoids in therapeutics after their millenia of use in attempts to cure almost every known illness.