In the 1990s, a woman was admitted to St Vincent’s Hospital, Sydney, with cancer of the uterus. She was told that chemotherapy followed by a hysterectomy would give her an excellent chance of cure. Unfortunately, she developed severe nausea and vomiting after chemotherapy. As none of the conventional medications suppressed her distressing symptoms, she decided that the treatment was worse than the disease and stopped her chemotherapy. The patient’s nurses then contacted me. Cannabis was provided to the patient and stopped her vomiting. The patient then completed her chemotherapy and had a hysterectomy. Today she is alive and well and teaching.
Australians with distressing symptoms from serious conditions are still unable to legally try to alleviate their symptoms with medicinal cannabis. The conventional medicines for these conditions often work but they are sometimes ineffective or produce unacceptable side effects.
A large recent Reachtel poll showed that 66 per cent of Australians support and 14 per cent oppose medicinal cannabis. There are majorities of supporters of medicinal cannabis among voters for the major political parties (Liberal/National, ALP, Greens, PUP), men, women and the four major age groups. The ban on using medicinal cannabis does not have ‘the consent of the governed’ and hasn’t for a long time. Hence the civil disobedience supply of medicinal cannabis in many parts of the country.
Private Members Bills to allow medicinal cannabis have now been announced in three jurisdictions (NSW, House of Representatives, ACT Legislative Assembly) with a parliamentary inquiry scheduled in Tasmania and the leader of the Opposition in Western Australia declaring public support. The political battle is not over yet but politically we are somewhere between the end of the beginning and the beginning of the end.
The main problem with medicinal cannabis is that this is a medical issue being decided by politicians. It’s time to take the politics out of the issue. Experts regulate medicines like penicillin, not politicians. Experts, not politicians, should also be deciding whether and how cannabis is regulated as a medicine.
When used medicinally, studies show that cannabis is often effective in relieving distressing symptoms in a number of conditions while the side effects are minimal. It is wrong to draw conclusions about side effects of cannabis from studies of recreational cannabis just as it would be wrong to assess the safety of regulated alcohol from studies of bootleg liquor.
People with advanced cancer and parents of children with rare and intractable forms of childhood epilepsy have recently begun to brave the media to discuss how medicinal cannabis had helped them and their families. They have testified that the symptoms of these diseases and the side effects of the treatments have been much worse than any side effects of medicinal cannabis. The question should not be whether medicinal cannabis is usually more effective then conventional medications but whether patients should be able to benefit from cannabis if the conventional medications have been tried and failed.
More than two-thirds of Australians support the use of medicinal cannabis because they see this as a compassionate approach to suffering patients. Almost three-quarters of Australians believe we should be doing more research on medicinal cannabis. At present, getting funding, official approval and supplies of medicinal cannabis in order to carry out scientific research is almost impossible. Very few studies of medicinal cannabis have been carried out in Australia or the US.
All nine Australian health ministers oppose medicinal cannabis. Why? Supply has been a problem but the establishment of Tasman Health Cannabinoids, a company chaired by Dr Mal Washer, until recently a federal politician, is a very encouraging development. The states and territories would require approval from the Therapeutics Goods Administration before a new medicine can be used and that involves an expensive process. For centuries western health authorities have been trying to replace medicinal plants with extracts and for good reason.
Cannabis may be one medicine where for the time being the plant is superior to the extracts. Perhaps the main reason for the official resistance is the fear that medicinal cannabis would undermine the prohibition of recreational cannabis. Australia uses morphine, cocaine, amphetamine and ketamine medically but the recreational use of these drugs is banned. If our politicians wanted to they could allow the medicinal use of cannabis but continue to prohibit its recreational use.
Medicinal cannabis is now available in 23 of the 50 states of the US (plus Washington DC). Recreational use of cannabis in the states which allow medicinal cannabis is no different than in the states which do not allow it. About 20 countries now allow medicinal cannabis. Why not Australia?
Opponents of medicinal cannabis argue that there are already several cannabinoid medicines which are legally registered for multiple sclerosis, chemotherapy-induced nausea and vomiting, and AIDS-related weight loss patients who need them. This is simply not true. Nabiximols (Sativex) is only approved (for use for a short period) for one condition (stiffness due to multiple sclerosis). Even for patients who satisfy the stringent criteria it is more available in theory than practise. If available and approved for other indications, the likely cost ($800/month) will prevent all but the wealthiest using the drug. Older cannabinoid medicines such as Dronabinol were hardly used. They were slowly and unpredictably absorbed and therefore difficult to use.
It’s usual to start new treatments on a small scale and maybe expand later if a case can be made for expansion. But we should start with the conditions where the evidence for far greater benefit than risk is already clear.
Dr Alex Wodak AM
President, Australian Drug Law Reform Foundation