Australian doctor Olivia Lesslar says the medicinal cannabis industry still faces significant barriers to entry when it comes to persuading her colleagues to prescribe its products.
It’s 7.30am on a Friday morning at one of my partner’s practices. I’ve come in with him on my day off to do a one-off consult on a difficult case. I don’t know all the employees gathered, but I do know that the person looking casually confident, presiding over the massive tray of expensive bakery goods, must be the pharmaceutical rep.
Over the course of the 30-minute carb-loading session, the rep breezily talks up the benefits of some drug. There’s no obvious nerves, no need to convince, no hard sell… this clinic, this audience is a sure thing and the rep knows it. When it comes time for questions, the only one is “where did you get these croissants from?”
I am appalled.
This scenario is played out in many medical practices across the country at least once a week, if not more. It is definitely a great way to get the “latest information” out to doctors… if you don’t mind a hefty side of bias with that and allowing the session to be curated by a company that has a vested interest in supplying you with information which benefits their bottom line.
Pharmaceutical drugs play an important role in our healthcare system, but they are not our only tool, not by a long shot. When did pharmaceutical drugs take such precedence? When did leapfrogging safer alternatives to opioids and benzodiazepines become standard?
Doctors’ prescribing habits feed the general population’s attitudes to other tools in the toolbox, including natural substances like CBD (and THC). This “campaign” has been so successful, cannabis was demonised and criminalised for decades, leaving many to doubt its legitimacy even now that it is finally legal.
Despite the changing tide, and the avalanche of evidence for CBD and THC for various conditions, there is still a lot of resistance from the medical community. Many still hang on to perceptions of CBD as a hallucinogenic/addictive/unsafe street drug.
Some say: “If there was any truth to its many touted benefits, we would surely have harnessed CBD and THC much earlier.” And yet others say: “Do you know what they call a natural substance that works? A drug.” Insert palm to face emoji here.
You don’t witness the struggle of cannabis against the titans of the pharmaceutical industry and their influence on policy-makers without knowing that money, agendas and political will play a major role in deciding what gets clinical trial funding, what makes it into guidelines and what becomes the doctors’ go-to prescription.
Cannabis use and its perceived ability to drive individuals to the subsequent use of (other) illicit drugs has been studied and debated for decades. Existing statistical research and analysis show mixed results and do not clearly demonstrate scientific support for the rather old-fashioned theory of cannabis as a “gateway drug”. The 2018 report from the Federal Research Division of the US Department of Justice determined that no causal link between cannabis use and the use of other illicit drugs can be claimed.
Despite this and the fact that, according to a report from the World Health Organisation, CBD shows “no effects indicative of any abuse or dependence potential”, there are still inconvenient hoops a doctor must jump through to prescribe CBD in Australia.
Which is confusing considering that CBD is a Schedule 4 drug, the same as Temazepam, a pharmaceutical sleeping aid which does have notable abuse and dependence potential. So why is there this rigmarole with prescribing CBD if it has a relatively safe side effect profile, certainly no worse than other Schedule 4 pharmaceutical drugs already on the market?
This bureaucratic hurdle adds to the notion that CBD is something to be feared/used with more caution that its counterparts. After all, when we put a helmet on you to perform a sporting activity, the subconscious message is that what you are doing is somehow inherently dangerous. The aforementioned hoops have stopped several time-poor doctors, including yours truly, from prescribing CBD in Australia.
I am not putting cannabis on some sort of a pedestal, emphasising only its benefits and downplaying the risks – I do not come bearing metaphorical croissants. CBD is not without risks and side effects.
The latest report from Drug Trends at UNSW’s National Drug and Alcohol Research Centre (NDARC) looks in detail at all drug-induced deaths in Australia from 1997 to 2017. Opioids were found in 63% of all drug-induced deaths in 2017, with most of those related to pharmaceutical, not illicit, opioids.
However, although cannabis is less addictive than opioids and its side effect profile is more favourable, any claims that there has never been a death due to cannabis derivatives is false and dangerous.
Far from expecting special treatment, I am advocating for CBD to be afforded the same consideration as other similarly scheduled pharmaceutical interventions, in accordance with the first of the RACGP key principles of accountable prescribing, which states that any prescribed treatment should be based on “thoughtful consideration of the likely risks and benefits of any medication, as well as alternative interventions”.
- Dr Olivia Lesslar is an Australian doctor trained in Australia and the US. She has a special interest in biohacking, complex chronic conditions including cancer, chronic fatigue syndrome and mystery illnesses, Mast Cell Activation Syndrome and allergy disorders, as well as nutritional medicine.