Cannabis queries to GPs, pharmacies

WELLINGTON: New Zealanders haven’t been shy about asking their doctors and pharmacists about medicinal cannabis, a new survey shows.

A snapshot of almost 1100 medical professionals revealed twothirds of GPs — and 77% of head pharmacists — had fielded requests for the products over the past year.

Regulations, licensing rules and quality standards around medicinal cannabis are to be set later this year, after Parliament recently cleared the way by passing amendments to the Misuse of Drugs Act.

The country’s biggest licensed medicinal cannabis company, Helius Therapeutics, commissioned Horizon Research to carry out what was the first independent poll of medical professionals on the issue.

Eightynine percent said they would prescribe the products for one or more of 20 medical conditions, if they had enough information.

All pharmacy owners polled said they’d be willing to stock the products, while 70% of head pharmacists said they believed the country would benefit overall from greater availability.

However, a minority of the health professionals surveyed (6%) reported being ‘‘very well informed’’ about the products.

Rates were higher among those who were ‘‘well enough informed’’ (18%) and ‘‘somewhat informed’’ (42%).

The remainder were ‘‘somewhat uninformed’’ (13%) ‘‘poorly informed’’ (14%) and ‘‘very poorly informed’’ (7%).

Elsewhere, the survey found 61% of those polled would prescribe the products for chronic pain, 59% for cancer, 47% for multiple sclerosis, 42% for radiation or chemotherapy side effects and 40% for epilepsy.

In contrast, far fewer appeared willing to prescribe them for dementia (18%), glaucoma (13%), osteoporosis (9%) or diabetes (7%).

Helius Therapeutics executive director Paul Manning said the demand shown by the survey reinforced how important it was to have an effective scheme that addressed patients’ needs and expectations around access.

Nonetheless, he believed the results would be encouraging for patients and New Zealand’s emerging cannabis industry.

‘‘The survey also reinforces to us that doctors will prescribe only the highest quality cannabis products, supported by thorough information,’’ Mr Manning said.

‘‘Understandably, many New Zealand medical professionals just haven’t had the exposure to cannabinoid medicines, so information and education for doctors, in particular, will be critical to patient accessibility.’’

The New Zealand Medical Association said rules around the products should be consistent with that for other medicines, and that they should be kept separate from debate about the legal status of cannabis for recreational use.

The association did not support smoked cannabis as a medicine and said caution was needed before recommending the products for ‘‘loosely identified medical reasons’’, due to known harms and weak evidence around their efficacy as a medicine.

Its chairwoman, Warkworth GP Kate Baddock, said some products such as the cannabisbased Sativex were already available and doctors were aware of the requirements around prescribing them.

She was not surprised that such a high number of GPs reported getting questions.

‘‘It’s not necessarily that people are saying ‘I want it’. It’s generally been more of an inquiry than a request,’’ Dr Baddock said.

There was likely also some misunderstanding among the public as to what medicinal cannabis actually was, Royal New Zealand College of General Practitioners medical director Richard Medlicott said.

‘‘If cannabis is to be used and regarded as a medicine it would need to meet the same standards as other pharmacological medicines,’’ he said.

‘‘This includes having robust clinical evidence of the efficacy and safety of the treatment, control over dosages, clear understanding of sideeffects and how the treatment interacts with other medication.’’

Dr Medlicott similarly wasn’t surprised at the survey results, given the amount of recent media coverage over the issue.

‘‘GPs encourage patients to ask questions and discuss their treatment plans, so it’s good to be able to have these conversations,’’ he said.

‘‘However, this doesn’t necessarily mean that the GP would be supportive of this type of treatment.’’

Auckland GP Mark Hotu said there had been a paucity of evidence suggesting that medicinal cannabis was superior to conventional treatments.

‘‘But one thing that many studies have shown is a much lower sideeffect profile,’’ he said.

‘‘In other words, it hasn’t been shown to be better than a lot of the meds we currently use but it has been shown to have a lot less side effects.’’

Medicinal cannabis had a broad range of clinical applications, he said, and was widely used around for the world for [treating] everything from chronic pain to chemotherapyinduced nausea.

‘‘In my practice I see a lot of people who are palliative and many who are either bedbound or homebound due to their chronic pain,’’ Dr Hotu said.

‘‘I have had numerous requests and in most of those occasions I would have liked to have prescribed it if it was more readily available and cheaper.’’

Patients using up to — and sometimes more than 100mg a day for chronic pain could be currently having to pay between $20 and $30 a day.

‘‘Once these products are being cultivated and grown in New Zealand it will certainly drive prices down and ultimately be better for my patients.’’

‘‘I have a fairly comprehensive understanding of the use of medicinal cannabis, including its contraindications, interactions and adverse effects,’’ he said.

‘‘Like any new medication though, as a GP you need to have a clear and thorough understanding of it before putting your name as the bottom of a script that you give to a patient.’’ — NZME

❛ If cannabis is to be used and regarded as a medicine it would need to meet the same standards as other pharmacological medicines