Medicinal cannabis still not favoured by doctors

7:27 pm on 23 September 2020

Two years after medicinal cannabis was made legal in Britain many doctors were still not prescribing it.

medicinal cannabis

File photo. Photo: Supplied

And although it was still early days, with only one medical cannabis product approved for use in New Zealand, our GPs appeared to be in the same camp.

British psychiatrist David Nutt is the author of new research on prescription trends of cannabis-based products, and said it was outrageous that people were being denied what he called life-changing medication for some.

He said up until last century, cannabis was a medicine.

"Cannabis was formally banned under the 1961 UN Convention and it was said to have no medical value, but it was a medicine and stayed as medicine in Britain until 1971."

The long-time campaigner for the use of medical cannabis said reluctance to prescribe was linked to a lack of knowledge.

"Countries like Britain and New Zealand keep it out of the pharmacopoeia because they still believe it's a dangerous drug, which it isn't, and they believe if you make it a dangerous drug people will mis-use it, which they generally don't."

Cannabis became legal medicine in New Zealand in April.

One of New Zealand's newest medical cannabis companies, Tauranga based Eqalis, said a medical diagnosis was needed in order to get the full effect of medical cannabis, for the condition being treated.

Chief medical officer Elizabeth Plant said medical cannabis was complex and in order to work properly, specific ratios of compounds were needed in the active ingredients.

"You have to make sure the dose is safe and effective and it's more about low THC and high CBD."

Tetrahydrocannabinol (THC) and cannabidiol (CBD) were the two primary cannabinoids that occur naturally in the Cannabis sativa plant.

CBD was non-psychoactive, meaning it would not get the user high, and therefore appeared more frequently than THC in dietary and natural supplements.

Plant said prescribing for medical use was a delicate balance.

Research by the New Zealand Medical Journal and published by NZ Doctor in June, showed that 79 percent of GPs in New Zealand had concerns prescribing it.

Medical director of the Royal New Zealand College of General Practitioners, Dr Bryan Betty said there was still not enough evidence of its benefits.

"So if you think about doctors or GPs, they base their prescribing on authorised medication that has quite an evidence-base to say it should be used in these circumstances for these reasons.

"We're not in that position with medicinal cannabis and I think that's one of the problems we've run into."

Dr Bryan Betty of Porirua Union and Community Health.

Dr Bryan Betty. Photo: RNZ / Karen Brown

But Dr Betty, who was also a GP, said that was not to say medical cannabis did not have a place on the pharmacy shelves.

"There is no doubt, in individual circumstance, there is benefit to patients, and patients report that - we know that, but still we need quality evidence on the best use of medicinal cannabis and where it should be used."

Nutt, who was a firm believer in its merits for treating epilepsy, said patient experience was a valid form of evidence.

"If a parent's life is transformed - if a child's life is transformed by switching from six (different) anticonvulsant drugs to medical cannabis and that child ceases to have seizures, that is powerful... that is the sort of evidence you'll never get from controlled trials."

The New Zealand Drug Foundation has been working for many years to improve patient access to medical cannabis.

Executive director Ross Bell believed patients were well ahead of doctors on the subject.

But a barrier to it becoming mainstream were the overly complicated systems that controlled its use.

"The study out of the UK shows that really clearly, but we've seen the same thing happening in Australia and right now in New Zealand we have the same problem - patients can't access the medicines that they want."

Ross Bell, Executive Director of the New Zealand Drug Foundation

Ross Bell Photo: RNZ Insight/Teresa Cowie

Bell said concern lingered that use of medical cannabis could lead to the use of recreational cannabis, when they were two separate things.

He said the lack of understanding was frustrating.

"We do expect medical professionals to research what new medicines are out there, which they do for most other pharmaceuticals, but when it comes to cannabis there is this real roadblock - almost a moral roadblock in their minds.

"The people that suffer are the patients who want to benefit from these products but find their doctor is unwilling to go down that route."

Eqalis Pharmaceuticals believed cannabis reform should be delayed because of the lack of understanding among the public of the difference between medical and recreational cannabis.

Plant, who was also a registered pharmacist, said doctors and patients needed more time to engage properly with medical cannabis.

The public also needed to be clear what they were voting on in next month's referendum.

"They're not voting for medical cannabis and I don't believe they're going to get better access to medical cannabis.

"What they're voting for is the opportunity to buy flower to smoke for recreational purposes or to grow plants for recreational purposes."

The referendum on legalising recreational cannabis would be held at the General Election on Saturday the 17 October.

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