EXPERT REACTION: Victoria set to legalise medical marijuana
In an Australian first, the Victorian Government announced yesterday 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. However the trial hinges on support from the Federal Government who are signatory to an international convention on narcotic drugs.
Organisation/s: Australian Science Media Centre
These comments have been collated by the Science Media Centre to provide a variety of expert perspectives on this issue. Feel free to use these quotes in your stories. Views expressed are the personal opinions of the experts named. They do not represent the views of the SMC or any other organisation unless specifically stated.
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 Victorian Government’s decision to act decisively on medicinal cannabis, based on the Victorian Law Reform Commission’s report, is a timely and politically courageous move. The Report is a strong piece of work, and its conclusions are clear. In recent years, there have been other such reports that have preceded this one, in alternative Australian jurisdictions, all of which have reached the same conclusions. The Victorians, however, under the leadership of Daniel Andrews, have decided to act on this expert opinion instead of shelving it.
This is not a dangerous, or even novel approach, as far as a global policy is concerned, although detractors will clearly try to portray it as both. The proposals are strongly supported by the medical evidence that we have available to us, and strict enough to ensure no ‘bleed’ into the recreational market. Opponents will continue to try and confound recreational and medicinal cannabis, an approach as intellectually legitimate as confusing morphine and heroin. By allowing the state to control 100% of production, it remains in compliance with the international drug conventions. Their compassionate approach ensures the availability of medicinal cannabis for those who need it now, while allowing trials to occur in parallel. The decision to omit smoking cannabis as route of administration, while understandable from the perspective of a nervous medical community, excludes the use of the latest technology in vaporized forms, including thermal metered dose inhalers, and should be reconsidered.
The Victorians approach could, and should, be supported by federal legislation, including The Regulator of Medical Cannabis Bill. For this to happen, our federal leaders will have to show the same sort of leadership that has been shown in Victoria. The use of cannabis for medical purposes is already widespread in Australia, and whether it continues as some sort of feral experiment, or under the supervision of medical practitioners, is largely dependent on whether our political leaders choose to lead, or revert to political football. Quite apart from the benefits to patients, this field is precisely the type of ‘agile’ and ‘innovative’ one so much desired by our new Prime Minister. Australia could make a substantial global contribution to research in this developing new arena.
With significant changes to global drugs policy widely anticipated at a special session of the United General Assembly next April, we have the opportunity, very simply, to look pretty clever, or predictably dumb.
Dr Michael Farrell is Director of the National Drug and Alcoholic Research Centre
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.
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.
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 heath messages.
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