News of the 'medical miracle' that is an eight-year-old Mia Mia girl who has gone from having 200 seizures a day to zero after her parents gave her liquid cannabis has thrust the debate about using the drug for medicinal purposes back into the spotlight. The Bendigo Advertiser asked emeritus consultant at St Vincent's Hospital Alex Wodak for his opinion...
THE evidence that cannabis is effective and safe for some conditions is now compelling.
Cannabis is not used medically in Australia today because politicians worry it would undermine their case for the continuing prohibition of recreational cannabis.
Yet we use many other drugs medically (e.g. morphine, amphetamine, cocaine and ketamine) despite their recreational use being banned.
So why not cannabis?
My colleagues and I published a paper on medical cannabis in the Medical Journal of Australia last month.
We noted a recent German review which found for six different medical conditions 82 favourable controlled trials and only nine unfavourable controlled trials.
Controlled trials, where subjects are randomly allocated to receive an experimental treatment and compared to a contol group who receive the standard treatment, are considered the most effective research design for evaluating a treatment.
There have been several favourable reviews carried out by important organisations including by the prestigious US Institute of Medicine, a committee of the UK House of Lords, a high level committee established by the then Premier of NSW (Bob Carr) and a committee of the American Medical Association.
A NSW Parliamentary Committee comprising eight members from five political parties unanimously recommended medicinal cannabis in 2013 but their recommendations were rejected by the NSW Government in November.
Cannabis is a useful second line drug for relieving severe and distressing symptoms in a number of conditions where the first line drug all too often fails. These conditions include treatment refractory nausea and vomiting following cancer chemotherapy, severe weight loss in AIDS or cancer, some forms of multiple sclerosis and chronic non-cancer pain due to nerve damage.
Medicinal cannabis is now legal and available in about a dozen countries including (20 states in the) USA, Canada, the Netherlands and Israel.
There are many different ways governments could allow medicinal cannabis.
Doctors generally do not like patients smoking cannabis as a medicine but are prepared to be flexible if their patient has distressing symptoms from a terminal condition.
Derivatives of cannabis have been available in tablet form for years but are rarely used as they are erratically and unpredictably absorbed. This means that the patient cannot be sure that they will get relief.
Rather than being smoked, cannabis can also be gently heated to release a vapour (which is inhaled). Doctors prefer this approach to the smoke being inhaled. Nabiximols is a new pharmaceutical cannabis product sprayed on the inside of the mouth but is unaffordable for most people.
Legislation could also exempt approved persons from prosecution. But this would mean that often elderly and severely ill people would have to buy cannabis from the black market or “grow their own”.
Do we want Australia to be a civilized and compassionate country that values scientific evidence or are we content for our leaders to continue a policy because that’s what we have always done?
Sixty-nine per cent of Australians support the medical use of cannabis and 75 per cent support more research into the medical use of cannabis.
Ten years ago the then Prime Minister (John Howard) gave qualified support to allowing medical cannabis.
Click here to read Dr Wodak's published article on this subject in the Medical Journal of Australia in December.
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