Yes we cannabis?

The pathway to responsible cannabis policy is hazy, with various warring agendas and interest groups complicating the politics of ‘medical’ marijuana, Jennifer Martin writes.

The Lancet recently posed the question “what is the extent of the obligation health professionals have to the society in which they live”. It’s a great question for doctors whose adoption of the Hippocratic Oath focuses on ensuring the patient receives the best care. Advocating for health reform is often undertaken by groups representing consumers or organisations working in public health, and many doctors’ employment conditions restrict their ability to speak freely on such issues.

Therefore, the recent interest of doctors around the introduction of ‘medical’ marijuana is unusual.

Rarely has the emergence of a therapeutic raised so much public interest as the ‘medical’ cannabis issue. Even the name is confusing – raising queries such as whether medical cannabis is ‘safer’ to drive with compared to ‘normal’ cannabis.

To consider why there is so much public interest over a plant that has been around for thousands of years and is grown widely across parts of Asia-Pacific, a consideration of multiple and overlapping social, political, financial and health agendas is necessary.

More on this: Medicinal cannabis should be more than pot luck

The public interest also suggests the need for clarification over definitions and terms and, in many cases, a broader understanding of the differences between the recreational and prescribed use of medical substances.

Australian State, Territory and Federal legislation has liberalised access to cannabis plant and extracts to treat specific medical conditions. Whilst many professionals are concerned about this legislation, some patients believe it does not go far enough.

This has led to much deliberation about appropriate and consistent public policy. From a health perspective, the agenda concerns individual and population mental health (particularly for adolescents and for children), safety, availability and consistency of product; concerns regarding the incidence of a ‘bad’ death due to adverse events – namely paranoia, delirium and psychosis at the end of life – and the role of a carer making decisions on an unregistered product for use in a non-competent person (child, elderly person with dementia or confusion).

Use of cannabis products can produce an opportunity cost for other treatments for which evidence is better, dosing is known and safety more described. Ethical issues are also at the fore, with ‘first do no harm’ in competition with ‘autonomy’ and ‘beneficence’.

Regulatory issues also pose concerns for healthcare workers and patients, with specific State and Federal legislation around the rules for holding and prescribing Schedule 8 drugs (which include cannabis products), in hospitals and communities. Failure to uphold these may place the doctor, pharmacist or hospital in a legislative or regulatory breach.

There are also financial agendas from agriculturalists planning to grow and export products, the support industries such as those of technologies, soil and water, and supply chain businesses. Liberalisation of cannabis legislation is high on the agenda for these groups.

Some doctors may be aligned with the drug reform lobby. Other doctors whilst not supportive of ‘drug reform’, do support the provision of a potentially safer product for ‘recreational’ users, with a ‘harm minimisation’ focus.  For doctors, a lack of the standard evidence needed to prescribe is problematic.

Public health experts and doctors, particularly those of adolescents and children, have concerns about the unknown issues – long-term health outcomes and long-term public health outcomes. For Government, there are also unknown externalities, measured outside of health statistics.

More on this: There is no harm-free cannabis policy

Public Health experts usually refer to outcomes of policy approaches and drug programs overseas before they recommend a new policy with either licit (e.g. opioids) or illicit drugs in Australia. It would seem reasonable for Australia to set up pharmacovigilance systems to help evaluate outcomes of policy changes.

Australia is a signatory of the Single Convention on Narcotic Drugs, which places the same restrictions on cannabis cultivation that it does on opium cultivation and outlines certain political commitments. Ultimately, there is a cap on how liberal an Australian cannabis policy can be.

From a public perspective, there is currently a lack of easily available information on cannabis, and conflicting voices dominate the many informal websites and user forums. Both the Therapeutic Goods Administration and local State Health websites provide resources and support in this area.

Australia needs to consider the extent of the obligation health professionals have to the society in which they live, and the role a political agenda plays in providing our healthcare system.

The liberalisation of cannabis availability inspires many strong voices, and policymakers will inevitably have to navigate strong oppositional interest groups. If we wish to ensure our political system delivers the best health outcome possible in the face of a cloud of uncertainty, ensuring our politicians have access to full knowledge and expertise is imperative.