Plea for patience as Victorians look to medicinal cannabis for chronic pain treatment

 

Dr Ian Freckleton has called for patients and medical practioners to be patient when accessing medicinal cannabis. Source: What I Did/ What I Do

 

By KAVISHA DI PIETRO 

Medical and legal experts have called for patience from chronic pain sufferers and medical practitioners as the Victorian Government moves to improve access to medicinal cannabis.

As part of a Melbourne University Health Initiative (MUHI) panel discussion held on Wednesday night, member of the Australian Advisory Council on Medicinal Cannabis Dr Ian Freckleton QC said a “little patience” was needed from the community as research projects on the effects of medicinal cannabis continued.

“I think we probably need a little patience but that is tough if you are dying of bowel cancer and those people entirely and understandably don’t have patience or time,” he said.

In situations where patients were faced with time constraints for their treatment plan, Dr Freckleton said there was room for “compassionate intervention”, but evidence-based information was needed to make informed decisions.

“In terms of a broader based scheme there is a lot to be said about accessibility on the basis of sound clinical trials which have yielded information we can all have confidence about.

“I am a great advocate for decision making that is evidenced based … I am greatly encouraged that those trials are happening now and there are some great trials here and overseas,” he said.

Under the law introduced earlier this year, patients who want access to medical cannabis are required to visit a GP who then submits the application to a regulating government body.

Patients have described the process as “complicated” and “time consuming”, with many waiting up to one month to receive treatment.

Neuropharmacologist Professor David Taylor said one of the greatest concerns regarding access to medicinal cannabis existed around ensuring the products met the strict standards of safety, quality and effectiveness enforced by the Therapeutic Goods Administration (TGA).

“If you want doctors to prescribe it (medicinal cannabis) and treat it in the TGA model then you need to have that evidence,” he said at the panel discussion.

“You need larger trials and you need not to select a narrow group of patients to be tested on … you need real life diversity of the patient cohort otherwise it is going to be riddled with failure.”

The TGA has approved a number of Special Access Scheme patients with issues that include, but are not limited to: chemotherapy-induced nausea and vomiting, paediatric epilepsy, palliative care indications, neuropathic pain, and anorexia or wasting associated with chronic illness.

Despite calling for patience, Dr Freckleton said the process of obtaining medicinal cannabis was “intimidating and confusing” for medical practitioners and patients who sat outside the SAS and it lead to a number of legal issues.

Since it’s legalisation in January, the TGA has approved over 979 SAS applications.

“It is not easy (to obtain),” he said.

“As far as patients are concerned it is really confusing … the outcome is that an awful lot of patients are continuing to access medicinal cannabis illegally.”

Jarrod* is one patient who was forced to turn to illegal access.

After years of surgery, extreme pain, ineffective medication and steroid treatments for severe Crohn’s disease and ulcerative colitis, Jarrod turned to marijuana.

“No amount of pain medications would ease my pain or stop my permanent stomach cramps so my friend suggested I tried marijuana,” he said.

“I only ever smoked it in a joint and it became the single and only way for me to get at the very least a few hours of relief from the permanent cramping and spasms in my abdominal region.

“Had I had access to the oil or other ways to take the substance without smoking I would have jumped at the opportunity … I felt truly awful smoking marijuana being that it is illegal and I am completely against taking drugs,” he said.

Dr Freckleton said that although the risks associated with medicinal cannabis are low and the major associated risks are “mental state ones” due to the psychoactive constituent of cannabis, tetrahydrocannabinol (THC), it was important to understand the side effects fully before unrestricting access.

“The TGA is really important,” he said.

“It protects us against Thalidomide type disasters … it sets up processes whereby the chances of terrible side effects are minimised.

“It is evidence-based, it is slow, it is cumbersome, it is expensive – but it keeps us safe.”

A medical practitioner, who has chosen to remain anonymous, said cannabidiol (CBD), the marijuana compound that doesn’t affect your brain, should be considered a “normal drug” and listed on the PBS to offset the hefty costs patients face.

“We should be able to prescribe that freely and that is what the model in New Zealand does – the doctor prescribes a script and then they go to the chemist and they get it and there are no dramas,” they said.

Marijuana has been used in natural medicine for many years, but is new to Western medicine.

Despite medical cannabis being used in natural medicine for centuries, it is relatively new in mainstream Western medicine.

“There will always be some problems because it is new, but it doesn’t seem to have some of the problems that the others (addictive medications) have,” they said.

“We have people on huge amounts of morphine and related addictive drugs and still in chronic pain so that is not really a solution in my mind.”

After smoking marijuana a number of times as part of his treatment, Jarrod said he experienced no side effects but rather the opposite.

“The marijuana helped me in many ways,” he said.

“Aside from relaxing my body and my muscles, I would get some of my appetite back … at that period of time I had lost 17kg at my worst and struggled to eat at all.

“After I smoked I had absolutely no pain, I could relax and actually get more than a couple hours of sleep.”

Michael* said he similarly found that medicinal cannabis eased the side effects of his chemotherapy treatment without the high and brain fog often associated with marijuana use.

“I had a sarcoma growing in my arm around my right elbow … the treatment was to have 30 days of radiation on the area and chemotherapy to stop more growth and then a tricky operation to remove it,” he said.

“Everything went very well (in the operation) and I was scheduled for heavy chemotherapy which stopped my digestive system from working.

“Picture your intestine like a jellyfish that pulses and keeps squeezing (to make sure everything is working) … it is an awful feeling when that stops and you feel nauseous all the time,” he said.

After being recommended to try cannabis by a friend, Michael said the effects “immediately” counteracted the side effects of chemotherapy.

“(It) relaxed my intestine, then the nausea went away and as long as I kept using it there were no side effects from chemotherapy,” he said.

Dr Philip Peyton, chief investigator of the ROCKet clinical trial on the use of ketamine to treat post-operative pain,  said improving access would take time but studies were being conducted around the world to ensure both “negative and positive” research.

“Getting reliable evidence is much harder than anyone wants to believe … most of the evidence out there is polluted or inflated,” he said.

“There is a lot of water to go under the bridge before we know where we are at with medicinal cannabis.”

Dr Freckleton has called for people to “wait a little bit longer” and to stop investing in “false hope”.

“My optimism is that within two to three years when this discussion happens again pronouncements will be made about medicinal efficacy and hopefully it will be really positive.”

Medical marijuana lobby groups did not respond for comment by deadline.

*Did not want to give his full name,