Medical cannabis gains momentum – Medical Forum

Medical cannabis gains momentum – Medical Forum

Topic:Cannabis Forum

Not only are more doctors prescribing medical cannabis to patients, but it’s becoming big business.


It’s still a slow burn, but every year more doctors are prescribing medical-grade cannabis as a viable treatment option for a range of conditions.

It was legalized in Australia in 2016, and although research is still ongoing with a lack of long-term clinical data, modern science is supporting the 10,000 years of anecdotal use of cannabis to treat a range of ailments.

Medical cannabis is believed to act on the body’s endocannabinoid system which regulates mood, memory, sleep and appetite. Studies show its effectiveness in relieving chronic pain, insomnia, symptoms of Parkinson’s disease, severe epilepsy and seizures in children, multiple sclerosis, fibromyalgia and anxiety, among others .

There have been more than 217,000 SAS-B approvals for medical cannabis since it was legalized in Australia, with around 12,000 approvals per month and more than 650 authorized prescribers. Most of the approvals are for chronic pain (115,000) and about 20% (42,000) are for patients using medical cannabis to treat anxiety.

Emyria, the Perth-based drug development company in which Andrew ‘Twiggy’ Forrest invested $5 million in November 2021, has been prescribing and collecting clinical data on medical cannabis since December 2018 through the its clinical arm Emerald Clinics. It has 6,000 patients in its clinical trial database and a turnover of about 400 to 500 patients per month.

Emyria Medical Director Associate Professor Alistair Vickery

Medical Director of Emiria, Associate Professor Alistair Vickerya well-known Perth GP and academic said Medical forum that medical cannabis was shown to be effective in managing chronic pain in non-cancer patients.

“One of the pain specialists who works for us summed it up very well when he said that this is the best product for chronic pain that he has used in the last 50 years of practice,” he said. “It’s safe and effective and makes people feel better.”

The body speaks

Professor Vickery said the clinical indications for medicinal cannabis were broad and could help a range of diseases because the endocannabinoid system was found in almost every system in the body, including the neurological, immune, respiratory and digestive systems.

When there is a disturbance in the endocannabinoid system, phytochemicals derived from plants, which are partial agonists, can play a role in rebalancing this disturbance.

“We believe that the endocannabinoid system is involved in the homeostasis of intracellular signaling. The fact that it is not only ubiquitous in the human body but also across the animal kingdom suggests that the endocannabinoid system is evolutionarily essential,” said Prof. Vickery.

Medical cannabis has level 1 evidence for reducing pain and spasm in multiple sclerosis, chemotherapy-induced nausea and vomiting and seizures in childhood seizure disorders, Professor Vickery said.

“The list is long, and when we look at the clinical indications for which we prescribe medicinal cannabis, there are more than 60 because of its ubiquity throughout the human body.”

A TGA-registered cannabis-based medicine, Sativex (nabiximol), an aerosol containing both tetrahydrocannabinol (THC) and cannabidiol (CBD), has been shown to be effective in improving symptoms related to muscle stiffness in multiple sclerosis multiple, and according to Prof. Vickery, more should be prescribed. The only other cannabis medicine approved by the TGA is Epidyolex (cannabidiol), an oral liquid that has been shown to be effective as an adjunctive therapy for seizures.

He added that medical cannabis can be used to treat pain in cancer patients without the same side effects as opioid medications.

“It reduces pain, improves anxiety, and improves sleep. People with a cancer diagnosis often have all of these symptoms. Medical cannabis has been shown not to cause the constipation or respiratory depression of opiates, and it does not cause headaches opiates and benzodiazepines, so it’s a superior drug in terms of reducing symptoms and making people feel better,” he explained.

Medical cannabis is generally well tolerated by patients.

Cannabis safety

“If we compare it to other recreational drugs, we know that the safety of medical cannabis exceeds the safety of more dangerous drugs, but it is also safer than paracetamol and even caffeine in terms of acute toxicity,” he said. to say.

Although caution should be used when prescribing to young children, Professor Vickery said it is safer than prescribing antipsychotics or antidepressants to people with underdeveloped brains.

“We’ve had 6,000 patients take it, so we have accurate adversity data, showing that it has minimal, mostly dose-related side effects. That doesn’t mean there aren’t long-term effects that we don’t let’s be aware of that. We have some safety data on longitudinal use that suggest this is a safe drug,” he said.

The best way to optimize results and manage adverse effects was to ensure that the dose and ratio of THC and CBD were carefully managed.

“The difference between recreational cannabis and pharmaceutical-grade cannabis is the doses we’re using. Medical cannabis has one-tenth or one-twentieth the dose of THC compared to recreational cannabis, so it’s really a different beast because it’s about management and treatment,” he said.

But Professor Vickery warned that people should not grow their own produce or get their hands on ‘green market’ products which may be harmful.

“Recreational cannabis is not only illegal, it is an unregulated and unregistered product and varies between
each dose”.

He said the batch-to-batch variability of approved products can vary by about 10%, so it’s important that patients get the right drugs and are monitored at the right doses.

“The future, I believe, is in a high-grade pharmaceutical product that allows for a known dose of CBD and THC and contains no impurities or other active ingredients,” Professor Vickery said. “Our drug development program is looking for a bioidentical synthetic with known properties that is absolutely pure.”

Business movements

Barb Fullerton, National Education Director, Little Green Pharma

In mid-2021, iron ore magnate Gina Rinehart invested $15 million in Little Green Pharma, another medical cannabis company based in Perth. Head of National Education for Little Green Pharma Barb Fullertonwho has worked for Bayer and Pfizer, now educates doctors about the benefits of medical cannabis.

she said Medical forum that medical cannabis was becoming more popular with more doctors prescribing it as they saw the range of benefits in patients.

“Approvals for the SAS-B pathway last year more than doubled from the year before, and that’s just one pathway; there’s also the authorized prescriber pathway, which is increasingly popular,” he said Fullerton.

“If people didn’t see results, they wouldn’t use it. It’s certainly a good option for patients who have used other medications that haven’t been successful.”

Although there was growing clinical evidence of the effectiveness of medicinal cannabis, Ms Fullerton said some doctors were still hesitant and continued to rely on the drugs they normally prescribe.

“Opioids and benzodiazepines have been around for years, and while there are side effects and they are addictive, they are tried and true, trusted and registered,” he said.

Some GPs were not prescribing cannabis because of the extra steps required to apply for approval, and the cost to the patient, compared to other drugs, could be a concern. However, Ms Fullerton said the process was becoming simpler and patients were willing to pay if they saw the benefits.

“The approval process used to be very complex, but now it’s simpler, even though medical cannabis is more expensive than a PBS drug,” he said, adding that there were compassionate access programs to buy the drug at the price at the doctor’s request.

“For patients who respond well, it’s life-changing and they’ll want to pay for it,” Ms Fullerton said. “What we’re finding is that once doctors start getting feedback from patients, they start prescribing it more because they realize it’s a good option if patients have tried other things that haven’t worked.”

GP lawyer

Dr Brian Walker, Chair of the Legalize Cannabis Western Australia party and a practicing doctor

Dr. Brian Walkerpresident of the Legalize Cannabis Western Australia Party and a practicing doctor, describes cannabis as “a wonderful healing herb” that should be prescribed more.

“Cannabis is much safer and healthier than other drugs, including heroin derivatives,” he said. “It can help people in desperate situations where the pain is too much to bear, and they can’t take it anymore. They’ll try it and say it’s better than anything they’ve ever tried.”

Dr. Walker strongly advises prescribing cannabis over opioids, which will help minimize side effects while providing patients with effective pain relief.

“If you’re prescribing heroin, start prescribing cannabis,” he said. “Compared to all the other medications I can prescribe, it has almost no side effects and is effective at what it does. I haven’t seen anything like the potential adverse side effects of other medications.”

It has seen good results in a range of health problems, from pain to neurological disorders and anxiety, with minimal side effects.

“I use it a lot to manage pain and neuropathic conditions. I’ve used it with great success for autism and the same can be said for ADHD. I have Parkinson’s patients who are doing great. For anxiety , it has none of the other side effects. It’s much safer than Xanax, much safer than diazepam, and it works better than temazepam,” Dr. Walker said.

Although there were more than 100 cannabis-related medicines available as prescription drugs, the stringent regulations in WA and the cost to patients were major obstacles.

“The hoops doctors have to jump through!” he said.

“They have to fill out the SAS-B application to be able to prescribe and then wait two days,” he said. “Another barrier is cost.”

Dr Walker said there was still a stigma attached to cannabis with many patients and doctors associating it with illicit drugs, but he hoped this would subsidize it.

“I hope the barriers are lowered, the price is lowered and cannabis is on the PBS because people have been devastated by having to pay huge amounts for what is actually a life-saving drug,” he said.

Dr. Walker encourages doctors to keep an open mind as more research comes out and not let barriers prevent them from prescribing it because its wide-ranging benefits could help patients.

“There’s a lot of excellent research going on. The psychoneuronal pharmacology of cannabis is being researched quite intensively and there’s a lot to learn. I’m really looking forward to seeing what new developments there are going to be.”

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