Looking after we leap

IT MAY BE one of the world’s oldest drugs, but cannabis has caught the world unprepared.

After 80 years of draconian prohibition, the tide has suddenly turned. Medicinal cannabis is flooding in and overwhelming the medical establishment, as patients clamour for it, many convinced it is a harmless cure-all to their ills. Some 2.3 million Americans are already using it.

But its efficacy is not based on data. There are barely any clinical trials to go with the long-asa-piece-of-rope claims for its medical benefits.

As with any drug, there are benefits and risks. You would think we know them all by now. Most of us have smoked a joint or two at some stage. The harms are certainly lower than what we accept from recreational drugs such as alcohol and tobacco.

But we’re not talking about occasional recreational use by robust people. We are talking about some very sick members of the community: children with epilepsy, people in chronic pain, with cancer and conditions like Crohn’s Disease.

Is a doctor’s advice going to be: take a few tokes and call me in the morning? Hardly.

So where is the clinical evidence for the benefits of cannabis treatments? Astonishingly it doesn’t exist. Cannabis has been so demonised that it has been impossible in many places for researchers to study it. As a US Schedule 1 drug, it is held to be as dangerous as heroin and with no medical benefits.

So we find ourselves facing this absurd state of affairs. Twenty-nine states have legalised medical cannabis to be sold in dispensaries, but a federally funded researcher in California who wishes to study its effects risks being raided by the authorities.

Sorting out this mess is going to be difficult. It’s not just that we don’t have the clinical studies; we don’t even really know the therapeutic ingredient/s. Cannabis contains more than 100 unique cannabinoids – each with medicinal effects. Compelling anecdotes suggest something in cannabis helps children with autism. But is it the cannabidiol, the THC, something else, or a combination?

Cannabis medicine needs a hefty injection of good science.

Israel, with 30,000 medical cannabis users, has been forced to act. Researchers at the Technion are carrying out a reverse clinical trial, trying to match the patients’ responses, captured via questionnaires, to chemical fingerprints of the cannabis extract they received. Scientists are also pushing ahead with small clinical trials for Crohn’s Disease and autism.

Meanwhile, Australia is entering this brave new world with trepidation. Providing pharmaceutically certified cannabis extracts to patients, as Australia plans to do, is expensive – about $30,000 a year per patient.

The fact is this dive into medical cannabis is driven more by hype and hope than science. Let’s hope it’s worth it.