GPs prescribing cannabis could be just what the doctor ordered
For the vast majority of Australian patients, medicinal cannabis is little more than a pipe dream and part of the problem lies with the all-too-conservative approach that relies on specialist doctors.
Those seeking medicinal cannabis in Australia must navigate a cumbersome application process, which requires going to a specialist physician not a GP. The result is that patients either go without or continue to use illicitly sourced products of unknown composition and safety.
Australia's cumbersome application system makes it difficult for patients to access medicinal cannabis. Photo: Supplied
Seeing a specialist generally involves long waiting times and significant expense - and should you visit one seeking a green light for cannabis, thanks to recent government announcements, you will be most likely disappointed; they tend not to have been educated in the area of cannabis medicine and may well be skeptical and uncertain how to proceed. A new "perspective piece" by the Royal Australasian College of Physicians, published in the current issue of the Medical Journal of Australia, is unlikely to improve this situation. Rather than providing a coherent and balanced account of the current state of play, the “perspective” reads like a patronising and scaremongering diatribe, misrepresenting the literature to frighten off would-be prescribers. The RACP represents 25,000 specialists across Australasia and in 2016 formed a Medicinal Cannabis Reference Group to develop a position on the issue, this “perspective” piece being the Group’s first public output. Most egregious of its falsehoods is the statement that medicinal cannabis is no better than placebo in treating pain. Oddly, when asserting this claim, the published piece cites two authoritative recent reviews from the US - reviews that in fact concluded the opposite. This misrepresentation is no trivial issue. Some 20 per cent of Australians suffer chronic pain and surveys shows self-medication for back pain, arthritis and neuropathic pain are major drivers of illicit cannabis use in the Australian community.
Deaths due to prescription opioids have declined in states where medicinal marijuana is available in the US. Photo: AP
Those in unremitting pain are precisely the people who need their specialist doctors to have a nuanced and accurate knowledge of cannabinoid science.
The perspective piece stokes concerns about increased cannabis-related hospital presentations in parts of the US that have legalised cannabis. What isn’t mentioned is that this largely reflects children consuming their parents’ cannabis recreational “edibles” like cannabis-infused chocolates.
Also neglected is the fact that in parts of the US where medicinal cannabis is available, there has been a 25 per cent reduction in deaths due to prescription opioids, as well as a reduction in use of prescription drugs such as benzodiazepines and antidepressants.
Cannabis is a drug that is used by more than 100 million people every year, none of whom die as a result. In contrast, prescription opioids alone resulted in the deaths of more than 40,000 Americans in 2016. The RACP perspective also cites the “known addictive” properties of cannabis. However, addiction specialists generally concede that cannabis is far less addictive than opioids and benzodiazepines. Even steroids and antidepressants have withdrawal effects during sudden discontinuation and these issues are routinely managed in clinical practice. Part of the complexity in the underlying science is that cannabis is actually hundreds of potential new medicines. THC is the psychoactive ingredient but there are hundreds of other bioactive molecules in the plant with potential therapeutic effects that do not intoxicate. One of these is cannabidiol (CBD), which the World Health Organisation recently concluded poses few risks to health and its use should not be restricted by governments - again, this critical development is not mentioned in the “perspective” piece. The RACP instead chooses to focus on reports of potential side effects of CBD in children given extremely large doses of CBD to treat severe epilepsy, which can be a life-threatening condition. We also know that these parents tend to turn to cannabis as a last resort, and the results can be positively transformative. The RACP perspective offers no empathy for the estimated 100,000-plus Australians self-medicating with illicit medicinal cannabis and it proposes no solution for bringing them into mainstream medicine, as has been achieved in Canada, Israel and the Netherlands. The RACP talks of a “precautionary principle” and “do no harm” - but in misrepresenting the facts of medicinal cannabis it promulgates a great deal of harm. Our own recent work with GPs suggests many would like to be able to prescribe, given sufficient training, and that they feel disenfranchised by the specialist-only system. Rumblings from Canberra - that regime change might indeed bring GPs into a new system where they act as medicinal cannabis gatekeepers - could be just what the doctor ordered. After all, if GPs are entrusted to prescribe opiates and benzodiazepines, why not medicinal cannabis products? Professor Iain McGregor is academic director of the Lambert Initiative for Cannabinoid Therapeutics in the Brain and Mind Centre at the University of Sydney. Originally published here: http://www.smh.com.au/national/gps-prescribing-cannabis-could-be-just-what-the-doctor-ordered-20180219-p4z0y0.html