Earlier this week the Faculty of Pain Medicine at the Australian and New Zealand College of Anaesthetists (ANZCA) published guidance for health practitioners recommending against the prescription of medicinal cannabis for the treatment of chronic non-cancer pain (CNCP).

The recommendation is based on the current lack of high-quality evidence demonstrating medicinal cannabis products are effective for treating CNCP conditions.

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Rhys Cohen

As well as being editor-at-large at Cannabiz, Rhys is the director of Cannabis Consulting Australia, which provides commercial consulting services to various domestic and international cannabis companies....

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4 Comments

  1. Well-reasoned and well-written. Kudos!

    Doctors seem to have forgotten why the clinical trial system was instituted in the first place.

    Clinical trials were first required for therapeutic goods by Australian state laws (such as Victoria’s Therapeutic Goods Bill of 1966). Trials were required only for new drugs, to prevent a new-drug disaster like the then-recent Thalidomide disaster (https://is.gd/wk5ZcH). All pre-existing therapeutic goods, such as aspirin, were “grandfathered”, meaning that they were exempt from such clinical trials. (Here’s a list of grandfathered drugs in the USA: https://is.gd/kF5TTK; I can find no equivalent list online for Australia.)

    Cannabis was not grandfathered only because it was unjustly illegal in Australia (and/or its States) at the time.

    Now that the unjust nature of cannabis’ illegality has been recognised, medicinal use of the cannabis plant (and its extracts) should be retrospectively added to Australia’s list of grandfathered therapeutic goods, making cannabis exactly as exempt from clinical trials as is aspirin, and for exactly the same reason: it has been proven safe (enough) by centuries of use. Cannabis was not then, and is not now, a new drug; it does not pose the risks of new drugs; and it should not be required to be subjected to the testing that is rightly required of new drugs.

    You can read more about the history of Australia’s drug regulation here: https://www.tga.gov.au/sites/default/files/history-tg-regulation.pdf

    1. Thanks Jim for your insight. I did not know about this grandfathering system, for aspirin and other drugs like it to slip through the cracks. You make great arguments why cannabis should be viewed the same.

  2. Congratulations on these thoughtful, balanced comments. What matters most in prescribing is for benefits>harm. As harm of cannabis is modest, especially if regulated, odds are good for benefits to exceed harm. Medicine was too slow to recognise that often harm>benefit for opioids in chronic non cancer pain. Medicinal cannabis should be safe, available, affordable. We are still a long way from that.

  3. I agree with many of your comments Rhys. Unfortunately none of the RCTs conducted with cannabis in pain would meet the stringent IMMPACT requirements for clinical trials for analgesic medications because of strong placebo responses found in pain medicine. I don’t condemn patients for trying medicinal cannabis because of the relatively poor response to any analgesic medicine.