In an Australian first, the Victorian Government announced this week that it would legalise marijuana for the treatment of medical conditions including cancer, chronic pain and epilepsy.
The decision is based upon a report by the Victorian Law Reform Commission which recommended licensing cultivators and manufacturers to develop a range of products, including oils and sprays, to be sold in pharmacies.
Dr Liz Temple, a Senior Lecturer in Psychology at Federation University Australia, Victoria, commented ““From a research perspective, there is much that we still don’t know about cannabis, its medicinal properties or therapeutic efficacy. This lack of knowledge will affect many aspects of the implementation, running and effectiveness of the medicinal cannabis scheme.
In particular, the available research evidence can’t yet tell us definitively which cannabis strains, cannabinoid profiles and doses, or administration methods will work best for which medical conditions or how this may differ for individual patients.
This means that the desired quick start to the scheme will inevitably include some trial and error, as prescribing doctors and their patients learn together what works best for the specific medical condition and individual circumstances.
Building the evidence base is essential, and it will take time. As such, there is an urgent need for research funding, and not just for the clinical trials that have been discussed so far, but also for basic and applied cannabis research.”
The trial hinges on support from the Federal Government who are signatory to an international convention on narcotic drugs. Dr Michael Farrell, Director of the National Drug and Alcoholic Research Centre, said the report on which the Victorian Government’s decision was based was very well crafted and detailed presenting a balanced view of current research evidence and presents options for moving forward and for improving access to treatment.
However if medical use is likely to be long term, patients should be advised that the adverse effects of long term use are unclear.
“Patients could also be advised of the adverse effects reported in long term recreational users, such as the development of dependence,” Dr Farrell said.
“Many doctors will be faced with patients using cannabis for complex symptoms of multiple chronic disabling conditions for which there are limited treatment options. Doctors should discuss, in a dispassionate and non-judgmental and supportive manner, the advisability or otherwise of using cannabis to palliate such symptoms.
There is no clear evidence for effectiveness in treating pain, any benefits are likely to be modest, and there is no clear evidence that putative benefits outweigh possible harms. When symptoms of cannabis dependence are elicited it is appropriate to discuss the wisdom of continued use in the context of the illness and the prognosis, and, if appropriate, to offer the patient support for withdrawal. Helping patients who wish to use cannabis for symptomatic relief to live as comfortably and productively as possible is an important and valuable goal of palliative and rehabilitation treatment.”
A Psychiatry specialist, Dr Matthew Large from the University of New South Wales, also cautioned that “while the therapeutic halo around cannabis gets ever bigger and brighter, particularly in the minds of politicians, the actual evidence for therapeutic potential is weak. Meanwhile the real and very well established risks with regard to mental health seem to be forgotten. If cannabis is to be made more available it needs to be with health warnings and better public health messages.”
We will keep you posted on this latest bid to legalise cannabis for medical use in Australia.