6 Jan 2017: Anti-weed boffins to create guidelines for healthcare practitioners
Observing what’s happened thus far and what continues to happen in the whacky world of Australian medical cannabis it seems rude not to ask just what the Government thinks it is doing.
Not only has it created regulations so labyrinthine that plant cultivation and manufacture of product are all but impossible it’s tweaked patient access pathways as well, making the stuff harder to obtain than before legislation was changed. One advocacy group is up in arms as its petition page on the Change.org website reveals: ‘Give Dying Patients Back Their Right to Access Cannabis’ the group is demanding, thus far to apparently deaf ears.
On top of all this, as if things could get any worse, the Commonwealth Department of Health has asked some of Australia’s most prominent anti-cannabis researchers and medical cannabis sceptics to ‘review’ the plant’s medical benefits and draw up guidelines for healthcare professionals that may in the future wish to prescribe it.
The project, called ‘Cannabis and cannabinoids for medicinal purposes: Reviewing the evidence‘ is being run at the National Drug and Alcohol Centre (NDARC), the NSW University-based drug policy think-tank and was commissioned by the Health Products Regulation Group within the CDoH. The Group runs the Therapeutic Goods Administration / Office of Drug Control tasked with regulating the medicinal herb – a body already under fire for creating those horrid, unworkable rules.
The venture involves first compiling a ‘Review of Reviews’ of cannabis use in epilepsy, palliative care, pain, AIDS and cancer-related nausea & vomiting and multiple sclerosis. Once completed a ‘draft clinical guidance document’ will be created for each of the conditions explored.
All of which might sound like a useful initiative – laudable even – until one takes a look at the team undertaking the work.
The group of five main project members and seven outside ‘investigators’ and ‘collaborators’ includes, for example, Queensland University’s Professor Wayne Hall and Professors Jan Copeland and Michael Farrell, both of NDARC.
In case the names are unfamiliar, Professor Hall, Director & Inaugural Chair at Queensland University’s Centre for Youth Substance Abuse was himself an NDARC former head and has long been an important voice in the medical cannabis debate. He caused a media flurry in 2014 after publishing a 20-year review of studies co-written with Professor Louisa Degenhardt (see below) ‘The Adverse Health Effects of Chronic Cannabis Use‘ – which supposedly showed the drug caused mental health problems, and gave the Daily Mail conniptions – admittedly no great achievement. An advisor both to the World Health Organisation on drug matters and the International Narcotics Control Board (which implements the UN Single Convention on Drugs) Professor Hall has frequently questioned the herb’s medical benefits telling the Federal Inquiry into the matter in 2015 ‘Medical use of cannabinoids requires much better evidence than we currently have.’ His Submission to the Inquiry, rubbishing claims made about the plant’s benefits, can be found here, and a jolly good read it is too.
Professor Copeland was, until its doors closed at the end of 2016, Director of the National Cannabis Prevention and Information Centre, which NDARC used to house. She too has published widely on the plant’s ills – but having spent years as the Government’s main anti-weed propagandist perhaps that’s what one might expect.
NCPIC and NDARC themselves incidentally, have long enjoyed the largesse of Big Pharm outfit GW Pharmaceuticals, makers of Sativex (the only approved cannabinoid medicine in Australia) and more recently Epidiolex, a THC-free Cannabidiol extract trialled (with limited success) for use in the treatment of epilepsy. This has, unsurprisingly, led to frequent suggestions the Centre and its staff are more than a little conflicted, but GW have an extremely large vested interest in keeping the lid, so to speak, on the pot. If they fail, it would probably cost them a fortune and quite possibly the boffins their cushy positions. So NCPIC staff have now been redeployed – to the medicinal cannabis job: think of asking a dingo to babysit and you’ll get some idea of what the Government has done in commissioning such folk to create what could easily end up as its defining position on a matter fraught with confusion and discord.
Leading the team is Professor Louisa Degenhardt, mentioned earlier – a specialist in drug-induced mental health problems and long-time collaborator of the aforementioned Professor Wayne Hall. Together the pair were responsible for such belletristic confections as ‘What are the policy implications of the evidence on cannabis and psychosis?’, ‘Cannabis use and psychotic disorders: an update‘ and of course the aforementioned classic ‘The adverse health effects of chronic cannabis use’ – the one that caused all the strife. From these it is clear, Prof. Degenhardt is far from a cannabis fan.
Next up, Professor Michael Farrell, head of NDARC itself and a successor to Professor Hall. It was Professor Farrell who, in 2014 (again with the singularly prolific Hall) wrote the infamous BMJ article ‘Should Doctors Prescribe Cannabinoids?‘ (answer ‘no’) to which Sydney University’s Emeritus Professor of Anaesthetics Laurie Mather and others would later respond – a skirmish cited by the Federal Government when discussing a change in the law.
Professor Farrell said recently of cannabis: ‘actually it being a clearly defined therapeutic agent needs far closer scrutiny before those claims can be made‘, so is not exactly gung-ho about the medical use of the plant.
Also on the team is one Peter Gates, another NCPIC alumnus, albeit of lower standing. Whilst he did deliver a talk at the 2016 Australasian Pharmaceutical Science Association conference, ‘Psychosocial Interventions for Cannabis Use Disorder’ about his paper of the same name co-written by Professor Jan Copeland, anything of a more positive nature from him toward the herb is a little less easy to find. Curious, one might think, for an individual supposedly there to effect the drug’s rehabilitation back into the clinical world.
Alongside such venerable credentials as these are to be found various other equally distinguished group members, including Dr Suzanne Nielsen, a specialist in drug dependence, especially of prescription and over-the-counter medicines and Dr Megan Weier, a senior research assistant working at Queensland University under the supervision of none other than Professor Wayne Hall. Dr Bridin Murnion is a addiction specialist at the University of Sydney and author of a widely-cited article in Australian Prescriber about a then-being-proposed Regulator of Medicinal Cannabis Bill.
Alongside him Professor John Pollard, esteemed neurologist, hailing from that same seat of learning. From there too comes toxicologist Professor Nicholas Buckley, an expert in pesticides and, apparently, snake venom and who moonlights as member of the Therapeutic Goods Administration’s Advisory Committee on the Safety of Medicines (ACSOM). Which is not to knock toxicologists, but to point out merely that cannabis is supremely non-toxic.
Two pain / palliative care specialists complete the line-up: Associate Professor Melanie Lovell again of the University of Sydney and Professor Meera Agar currently at the helm of one of the NSW clinical cannabis trials.
Australian Medical Cannabis Signpost is not, unfortunately, a betting site; if it were, and based on at least some of the above, we would certainly not be offering attractive odds on the appearance later this year of anything other than a complete trouncing of whatever good could be said about medical weed. The the appearance of some highly unfavourable ‘official’ guidelines to deter healthcare practitioners from prescribing it are probably on the horizon too. What else to expect from a group including those so strongly opposed?
The Department of Health has at its disposal a battalion of vastly experienced, extremely enthusiastic medics and other highly trained experts in the use of cannabis as well as research into it. A few are here, most are overseas, but still it could have called on their help with a project like this. Instead individuals were chosen whose illustrious careers and reputations have been built demonising all use of the drug and trashing its medical use.
Enterprising medical cannabis enthusiasts therefore could perhaps do worse than contacting the project to ask whether it will take into account fact that every obstruction that could have been placed in the way of raising funding, getting ethics research approval and obtaining the agent required for evaluation of cannabis was instead used to frustrate medicinal research.
They might also enquire how the team plans to deal with the fact that a large number of people – possibly hundreds of thousands a year – are using unregulated cannabis for medicinal purposes and will continue to do exactly that. And they might especially demand to know how the researchers will deal with the possibility – many would say probability – that the entourage effect of cannabis is actually real and important.
The project’s responses (if any) would be very interesting. But there is certainly little chance some of those profiled above will take the view that denying a 24 year old man dying of cancer something that he values greatly and which relives his suffering is even worth thinking about.