Clearing the air

Want to improve Australia’s policies on medical cannabis? Give doctors the freedom to treat it like any other unregistered medicine, Rhys Cohen writes.

Dr Jennifer Martin’s recent article on medical cannabis policy provides a welcome opportunity to dispel some of the myths about medical cannabis in Australia.

To begin with, the recent interest of doctors around medical cannabis is not unusual or surprising. Most GPs in Australia have been recently asked about medical cannabis by their patients, so it would be strange if they were incurious.

Martin seems to be confused by the very term ‘medical cannabis’. The term is only confusing to those who reject the premise of its existence. Overall, Australians are demonstrably able to tell the difference when surveyed about recreational or medical cannabis. These terms and distinctions are now clearly laid out in the Standard for the Uniform Scheduling of Medicines and Poisons, and quality and consistency standards are clearly laid out in the Standard for Medicinal Cannabis. Standardised, quality assured medical cannabis products are available as unregistered medicines.

From a public health perspective, Australian GPs know that medical cannabis is less harmful than many of the drugs currently prescribed to children and the elderly, including those who are not competent. Australians expect doctors to make informed choices in collaboration with, or on the behalf of, their patients.

More on this: Yes we cannabis? | Jennifer Martin

Although some doctors may have good reason to prescribe an unregistered medical cannabis product instead of a registered medicine, that is not currently possible. Unregistered medicines are last-line therapies. The treatment opportunity cost imagined by Martin does not exist. Nor does the “failure to uphold” the normal Schedule 8 drugs regulations on storage and prescription that Martin forebodes. Healthcare professionals are no more likely to mishandle a Schedule 8 cannabis medicine than any other Schedule 8 medicine.

Vested interests, especially commercial ones, are concerning and should be managed. But believing that ‘big cannabis’ has more money and power than ‘big opioids’ is a fantasy. Any criticism of vested interests regarding medical cannabis holds at least as true for every other drug on the market. That doesn’t mean we should ignore vested interests, but it does mean this is not a problem unique to medical cannabis, and we shouldn’t fear the “soil and water” industries – as Martin suggests – any more than the pharmaceutical industry.

Many doctors do not feel confident in the current level of evidence to prescribe medical cannabis, and that is their prerogative. But plenty of doctors believe differently, and they should be allowed to do their job without being branded, in Martin’s words, as ‘drug law lobbyists’. Once again, medical cannabis and recreational cannabis are different things. It is possible to support one and not the other.

If Australia were to follow Martin’s advice and refer to outcomes of policy approaches taken overseas, we would find that places in the US with greater access to medical cannabis have experienced a significant reduction in the rates of prescription opioid use, morbidity and mortality. Martin’s ongoing refusal to acknowledge this fact is concerning.

On the subject of pharmacovigilance, unregistered medical cannabis products are regulated to the same degree as other unregistered products, so any adverse events must be reported to the Therapeutic Goods Administration (TGA).

Does Martin believe that the TGA is incapable of performing rigorous pharmacovigilance? Or that our Commonwealth government is incapable of adhering to our treaty obligations? The Single Convention explicitly allows signatories to provide cannabis for medical purposes, and nowhere does it stipulate that medical cannabis must be more difficult to obtain than medical heroin.

There are reasonable, easily implemented improvements that should be made to Australia’s medical cannabis policy framework. The most obvious one is this: let doctors do their job and start treating unregistered medical cannabis products like any other unregistered medicine. What’s wrong with that?