New advice to GPs from the Australian and New Zealand College of Anaesthetists (ANZCA) on prescribing medicinal cannabis puts patients at risk and could drive them further towards the black market, according to industry leaders.
The industry has reacted with dismay to the advice not to prescribe medicinal cannabis products to treat chronic non-cancer pain (CNCP) unless they are part of a registered clinical trial.
The Faculty of Pain Medicine at ANZCA claimed a lack of clinical trials meant there is no robust evidence to prove cannabinoids are effective in alleviating suffering.
However, Medicinal Cannabis Industry Australia (MCIA) chair Peter Crock warned the advice risked pushing patients towards the black market.
“Taking the position that medicinal cannabis can only be prescribed as the ‘last resort’, or not prescribed at all because of a lack of evidence, potentially drives patients to source illicit or unknown product as they often desperately look to improve their quality of life.”
He described the Special Access Scheme as a “progressive and positive step” towards improving patient access while the evidence base is built to allow products to be taken through the registration process.
“While not a silver bullet, where products meet safety standards, and are delivered to a well-characterised quality standard, medicinal cannabis has a valuable role to play in helping patients,” Crock added.
Chair of independent body the Healthcare Practitioner/Patient Advisory Council Richard Di Natale agreed the evidence for medicinal cannabis for CNCP is still in its infancy, but said NPS Medicinewise and the TGA have developed guidelines that indicate a clear role for its use.
He added: “Given that so many patients are already being prescribed medicinal cannabis for pain and many more are using it illicitly with positive results, this is likely a case of the evidence needing to catch up with what is happening in the real world.
“While medicinal cannabis has potential side effects, it is relatively safe when compared to opioids which have resulted in tens of thousands of overdose deaths.
“The use of medicinal cannabis in CNCP provides health care practitioners with another option in the management of a condition that causes so many people to suffer and I don’t understand why anyone would want to deny people that option.”
Co-founding director of United in Compassion Lucy Haslam described the Faculty of Pain Medicine as “probably the best example of the inordinate ignorance and bias that perseveres in relation to medicinal cannabis”.
She said the reality of the situation is far different to the “lens of this specialist group”.
“Patients, in large numbers, are transitioning away from the dangerous and addictive drugs prescribed willingly by pain specialists (who are remunerated for prescribing them), despite the overly complex prescription route and high financial burdens for medicinal cannabis. The numbers continue on an upward trajectory for one very simple reason… it works for them.”
She said patients often resort to medicinal cannabis when other drugs have failed or produced such serious side effects that they cannot be continued.
“Medicinal cannabis is well tolerated with relatively few adverse effects and it gives patients a quality of life that harsher drugs like benzos and opioids have often robbed them of, so they are more functional, productive and much happier.”
She warned GPs they are likely to get left behind if they don’t keep up with patient demand.
“There is an enormous risk to doctors holding on to the view that cannabis is not a valuable therapeutic medicine. Ignorance and arrogance leads directly to irrelevance and the risk to the irrelevant doctor is fewer patients at their door.
“The risk in ignoring patients is that they are left to navigate themselves towards pain relief, often without a doctor and towards illicit supply. It is a shame that the Faculty is prepared to risk that outcome.”
Vice President of the Society of Cannabis Clinicians Australian Chapter (SCCAC) Dr Joel Wren said the move was disheartening, frustrating and “a slap in the face for patients” who could find their GPs less likely to help them as a result.
He warned: “It further limits access because interested prescribers will think ‘I was unsure before, but I’m certainly not going to risk it now’.”
Wren said it was important for the industry to work with healthcare professionals and address their concerns, with SCCAC actively engaging with the Royal Australian College of General Practitioners on the need to update their position statements on medicinal cannabis.
But he added the medical profession’s previous experience with opioids should not be used as a stick to beat cannabis with.
“I’m happy to talk to specialists, and listen to their concerns, we need to be collaborative. We have so much historical data to guide us. The opioid crisis is a stain on medicine, but we need to learn from that. Medicinal cannabis is not a panacea, but it’s certainly something that should be considered.”
Writing in Medical Forum, GP and medicinal cannabis advocate Matthew Moore said: “I get it. I was hesitant too. We work our whole lives for our reputations… I didn’t want to be known as ‘Dr Pot’.
“But the overwhelming initial anecdotal evidence is what motivated me to do what I am doing today. And believe me, my patients are better for it.”
He added: “We must continue to educate ourselves as clinicians. The body of knowledge in and around cannabis as a medicine is increasing. We need to know how to navigate this space for our patient population.”
- More reaction: Absence of evidence is not evidence of absence, by Cannaniz editor-at-large Rhys Cohen