Health up­date: med­i­cal mar­i­juana

Australian Women’s Weekly NZ - - CONTENTS -

Should we le­galise cannabis for med­i­cal use? Pro­fes­sor Ker­ryn Phelps re­ports on con­tro­ver­sial new clin­i­cal tri­als that are start­ing in Aus­tralia.

BACK IN 1996, I was work­ing as the med­i­cal re­porter for the To­day show on the Nine Net­work in Aus­tralia. I trav­elled with a pro­duc­tion crew to San Fran­cisco to in­ves­ti­gate the move in Cal­i­for­nia to le­galise cannabis for med­i­cal use. This new law en­abled le­gal ac­cess to cannabis for peo­ple with can­cer, AIDS, mul­ti­ple scle­ro­sis and some other med­i­cal con­di­tions, pro­vided that they had a doc­tor’s rec­om­men­da­tion.

Canada, Switzer­land, the Nether­lands and Is­rael have le­galised pro­grammes for med­i­cal cannabis. Con­versely, cannabis is treated as a se­ri­ous il­licit drug in other coun­tries, such as In­done­sia, with a con­vic­tion for im­port­ing large quan­ti­ties at­tract­ing the death penalty.

In New Zealand, cannabis-based prod­ucts can be pre­scribed for med­i­cal use sub­ject to min­is­te­rial ap­proval. The only pharmaceutical-grade cannabis­based prod­uct cur­rently avail­able in New Zealand is Sa­tivex, which is ap­proved for use in mul­ti­ple scle­ro­sis. It may also be pre­scribed for ‘off-la­bel’ uses for con­di­tions such as chronic pain, neu­ro­pathic pain, can­cer pain and in­tractable child­hood epilepsy.

There are no clin­i­cal tri­als of cannabis-based prod­ucts be­ing con­ducted in New Zealand at present, how­ever the first clin­i­cal tri­als in Aus­tralia have be­gun in New South Wales, with the fed­eral Par­lia­ment pass­ing laws ear­lier this year to le­galise the grow­ing of cannabis for medic­i­nal prod­ucts. The tri­als aim to de­ter­mine con­di­tions where it might be use­ful, the best method of de­liv­ery, dose to be used and side-ef­fects.

Un­der the Sin­gle Con­ven­tion on Nar­cotic Drugs 1961, the com­mer­cial cul­ti­va­tion of cannabis in New

Zealand for medic­i­nal pur­poses is not al­lowed ex­cept un­der the con­trol of a gov­ern­ment agency, which has to pur­chase the crop after har­vest. Such an agency does not cur­rently ex­ist in New Zealand.

HOW CANNABIS IS USED

The most com­mon ways for cannabis to be used are by in­hala­tion of smoke or vapour, in food, tea, cap­sules or a sub­lin­gual spray. Smok­ing it can cause dam­age to your lungs and air­ways, and cause in­flam­ma­tion in your nose, throat and si­nuses. In coun­tries with med­i­cal cannabis pro­grammes, in­hala­tion is rec­om­mended via a spe­cific type of med­i­cal va­por­iser.

IS IT EF­FEC­TIVE?

The prin­ci­pal rea­son for medic­i­nal cannabis tri­als is to es­tab­lish ef­fec­tive­ness in spe­cific med­i­cal con­di­tions where the op­tions for med­i­cal treat­ments are lim­ited, such as in­tractable child­hood epilepsy.

There is ev­i­dence for cannabis be­ing ef­fec­tive in treat­ing a num­ber of dif­fi­cult con­di­tions in­clud­ing:

Can­cer-re­lated nau­sea, loss of ap­petite, weight loss and de­bil­i­ta­tion.

Nau­sea and vom­it­ing re­lated to chemo­ther­apy.

Some forms of chronic pain, in­clud­ing nerve pain.

Mus­cle spasms of mul­ti­ple scle­ro­sis. Cannabis will not cure the un­der­ly­ing prob­lem, but may help man­age symp­toms and re­duce re­liance on other pharmaceutical med­i­ca­tion.

I ex­pect once a medic­i­nal cannabis pro­gramme is run­ning, doc­tors will only rec­om­mend it where stan­dard med­i­cal treat­ments are not giv­ing ad­e­quate re­lief or are likely to cause un­ac­cept­able side-ef­fects.

OTHER PRECAUTIONS

Dif­fer­ent types of cannabis have dif­fer­ent ef­fects and side-ef­fects. Be clear about why you are con­sid­er­ing cannabis. Could your symp­toms have a le­gal, safe and ef­fec­tive rem­edy?

The aim is to use small doses to the point of symp­tom re­lief. Higher doses will achieve a ‘high’, but this is more likely to cause un­wanted side-ef­fects.

If you have any med­i­cal con­di­tion af­fect­ing your lungs or breath­ing ca­pac­ity, smok­ing to­bacco or cannabis can make it worse.

Do not use cannabis in any form if you are preg­nant or plan­ning a preg­nancy, as it can dam­age a foe­tus and may in­crease the risk of some fu­ture child­hood can­cers. The ac­tive in­gre­di­ent also crosses into breast milk so cannabis use is con­traindi­cated while you are breast­feed­ing.

If you have a family his­tory of schizophre­nia or other psy­chotic ill­ness, cannabis is best avoided.

If you have a his­tory of heart dis­ease, you need to be cau­tious be­cause the ad­verse ef­fects of cannabis on heart dis­ease are not known.

WITH­DRAWAL EF­FECTS

Be­cause cannabis is ad­dic­tive, if you use it at high doses reg­u­larly, phys­i­cal de­pen­dence is a pos­si­bil­ity and if you stop us­ing it, you can ex­pe­ri­ence a with­drawal syn­drome in­clud­ing sev­eral days of ir­ri­tabil­ity, rest­less­ness, sleep­ing prob­lems, nau­sea and hot flushes.

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