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Going green

As Australia inches closer to widespread legalisation of medical marijuana, we ask what you need to know, and does it even really work?

If you’re facing up to chronic pain on a daily basis, you may be one of the people hoping medical cannabis will offer some relief.

The interest level in medical cannabis is definitely high, as a recent study shows. The study of 640 Australian GPs published in the British Medical Journal Open found almost two-thirds (61 per cent) had been questioned about medical cannabis by one or more patients in the past three months.

It’s not necessarily a conversation they felt ready to have. Many felt their knowledge of medical cannabis was inadequate.

Despite this, more than half (56.5 per cent) of those surveyed supported its availability on prescription. Their preferred
“access model” involved trained GPs prescribing independently of specialists. Support was condition-specific, with strong support for use in cancer-related pain, palliative care, and epilepsy, and much lower support for use in depression and anxiety.

The survey was carried out by the University of Sydney’s Lambert Initiative for Cannabinoid Therapeutics at the Brain and
Mind Centre. In a statement, co-author of the report and academic director of the Lambert Initiative, Professor Iain McGregor from the School of Psychology, said GP education and training are urgently needed.

“Part of the problem is the specialist-based model that largely excludes GPs from prescribing; most Australians know how hard it is to access specialist medical care, let alone a specialist with an interest in cannabis-based medicines.”

It’s not easy being green

Medical cannabis is currently available under certain schemes through the Therapeutic Goods Administration (TGA), but to date only about 800 patients have accessed legal medical marijuana in Australia.

It can only be prescribed by a registered medical practitioner after a thorough assessment to decide if the treatment is appropriate for the patient’s condition and individual circumstances.

If a doctor decides that a medicinal cannabis product is suitable for the patient, they must apply for approval to prescribe it under the applicable state or territory laws.

Dr Tony Bartone, president of the Australian Medical Association, says: “That’s why some of these special access schemes, or other processes, are used – to try and create a safety profile around the product that hasn’t gone through the usual trials and safety testing that usually every product that comes to the Australian market has to undergo.”

The Australian Medical Association’s position on medicinal cannabis continues to be one of support for the clinical trials to establish clinical guidelines before it is more widely available.

“That’s because there’s still not the rigour, the process, and the efficient data available about the narrow therapeutic windows that some of these products have,”
Dr Bartone says.

“The evidence around the world is being reviewed and has been found to be particularly weak in parts, not robust enough, not precise enough, not clear enough. And we’re still in the process of using trials in our country to actually gather further data.”

He points to a four-year study of 15,000 patients suffering chronic pain. The study, published in The Lancet, indicated that the use
of medicinal cannabis did not improve their health.

“It doesn’t give us the surety about how, when, and why to use it with complete comfort. Even among the particular specialists involved in the particular disciplines who might use it – refractory, paediatric epilepsy, for example, where it’s probably got its best level of indication and evidence supporting it – there is still conjecture about the right form and the right type to be using,” Dr Bartone says.

“But in other things, like palliative care, some of the studies show a really poor level of evidence.”

Guidance on medicinal cannabis

  • The Therapeutic Goods Administration has published guidance for patients about medicinal cannabis.
  • Apart from one product, medicinal cannabis products are not registered medicines in Australia and none are subsidised through the Pharmaceutical Benefits Scheme.
  • That means they can only be accessed through special pathways available for unapproved medicines.
  • A variety of products are currently available through these pathways, via import from Canada or Europe. These include raw cannabis that can be vaporised for medicinal purposes, as well as oils, liquids and oral sprays. Some gel products are applied directly to the skin.
  • Local medicinal cannabis products are expected to be available this year.