Medicinal dagga must follow strict set of guidelines
MEDICAL marijuana is in the process of being le galised in South Africa as the Medical Innovation Bill is currently before Parliament awaiting approval.
Despite the global use of marijuana for millennia – for recreational, domestic, medicinal and spiritual purposes – it has always been, and continues to be, plagued by controversy.
Many in both the health industry and the public sector have celebrated the decision to legalise medical marijuana.
There’s been encouraging support by health professionals, especially in the anaesthesiology sector, who believe its legalisation in South Africa is an admirable and encouraging move towards innovative medicine.
Medical marijuana is of particular interest to anaesthesiologists because of the role cannabinoids (certain active components of cannabis) play in the treatment of chronic pain.
Other medical indications for its use include spasticity (as with multiple sclerosis and paraplegia) and nausea and vomiting.
Doctors are thinking about the benefits and issues that the legalisation and use of medical marijuana bring.
Despite decades spent in the pursuit of clear evidence that marijuana is medically beneficial, to date only moderate quality evidence has emerged proving such benefit, a situ- ation that exists with many other medications and medical practices.
“Part of the attraction rests in the general perception that marijuana is pleasurable and relaxing without the addictive properties of opioids and stimulants, as well as its ready availability and its wider social acceptance,” according to Dr Dean Gopalan, head of d e p a r t ment, a naes t hes i o l o g y and critical care at the Nelson R Mandela School of Medicine at the University of KwaZuluNatal, Durban.
Gopalan was speaking at the recent annual national South African Society of Anaesthesiologists (Sasa) Congress.
Referencing an article from the American Journal of Gastroenterology titled “Is the Hype of Medical Marijuana all Smoke and Mirrors?” by Koliani-Pace and Siegel, Gopalan said: “There remains much debate about the robustness of available evidence. Many studies are fraught with methodological weaknesses, selective outcome reporting and small sample sizes.
“Further, lack of standardisation of products, doses, routes and indications is commonplace. There is thus the call from some quarters for medical marijuana to be held to the same rigorous standards as any other drug coming into the market.”
The SA Medical Association has made assurances that access to legal marijuana will follow a strict set of guidelines and that its only use will be for medical purposes. This will make the drug easier to monitor. In addition, the Medical Research Council is embarking on trials in South Africa to ensure that better- quality, locally evidence is obtained.
Natalie Zimmelman, chief executive officer of Sasa, said: “All doctors will agree that their primary duty relevant is to the health and safety of their patients. As such, they have to be absolutely convinced that the treatment taken does no ill.
“That said, as doctors and med- ical professionals, it is our duty to seek out innovative and progressive treatments for our patients.”
With dagga remaining the most common drug to be abused in South Africa and internationally, the question is thus being posed whether the drive to get medical marijuana more accepted is a smokescreen for those who feel that it should be legalised for recreational use.
Gopalan referred to Blurred Boundaries: The Therapeutics and Politics of Medical Marijuana, an article written by Dr Michael J Bostwick (professor of psychiatry at Mayo Clinic), who explains that the line dividing the pros and cons of the drug is obscured with the boundaries between recreational and medical use, harm and benefit, pharmacological evidence and le gal restrictions becoming blurred in the therapeutics and politics surrounding medical marijuana.
The opponents of legalisation of medical marijuana cite adverse events of cannabinoid use, and their abuse and addiction potential, as prime reasons for their opposition. They also express concern over increased marijuana use, especially among vulnerable populations such as adolescents.
However, the effect of medical marijuana laws on the risk of marijuana use in more than a million adolescents before versus after passage of the law was not significantly different in a large US study.
Whatever your personal take on the legalisation of medical marijuana, it seems that the pros are edging out the cons when it comes to the advancement of medicine.
Gopalan pointed out that many years ago opium poppies drove the discovery of opioid receptors and a better understanding of pain physiology, and he has drawn on the similarities between that and the study of medical marijuana.
“Similarly, the study of a drug-containing plant such as cannabis has resulted in the discovery of the important endocannabinoid control system (ECS) crucial to neurobiological function,” he said.
(ECS is a group of endogenous cannabinoid receptors located in the brain and throughout the central and peripheral nervous systems in humans and animals. It regulates your tissues, digestive, endocrine, immune, nervous and reproductive systems.)
Said Gopalan: “Despite the aforementioned controversies, medical marijuana may well have major implications for the development of novel therapies for a variety of conditions.
It was (19th-century thinker) Ralph Waldo Emerson who asked and answered: ‘What is a weed? A plant whose virtues have not yet been discovered’.”
As far as many medical professionals are concerned, the overwhelming sentiment is that the legalisation of medical marijuana will allow for the discovery of the drug’s many virtues.