From 1 April, access to medical cannabis is going to get much easier for patients and prescribers, with new regulations taking effect.
The new regulations set a ‘Quality Standard’ for products in New Zealand; not only must such products be pharmaceutically prepared to give confidence to prescribers, but they have a thorough list of potential contaminants to be tested for to ensure patient safety, over and above what is required in other countries. This ‘Quality Standard’ will be the envy of other countries and could become a gold standard globally.
For products that meet the ‘Quality Standard’, any prescriber will be able to prescribe any product for any condition for any patient. This is a big improvement from the current situation, where specialists, even senior ones, would have to seek approval from the Ministry of Health for every patient in their care to access medical cannabis.
This change frees up prescribers and ensures that politicians and their delegates are no longer involved in primary healthcare decisions.
Cannabis has been used medicinally for thousands of years, with ancient Egypt having several papyrus papers describing it as far back as 1700BCE. China’s ‘Shennong Bencaojing’ a tome of medicines categorised by their side effects from approximately 250CE, refers to cannabis as a noble herb with benign side effects.
Remarkably, the symptoms treated in ancient times match up to the symptoms it is used for today, with ancient Egyptians treating ‘eye pain’ matching up to modern glaucoma, and ancient Assyrian treatment for ‘hand of the ghost’ assumed to be epilepsy, matches up to the recent approval of the first cannabis-based medicine by the American Food and Drug Administration.
Research is underway globally for various forms of medical cannabis, with trials being done successfully for severe neurological conditions such as lethal forms of epilepsy and multiple sclerosis and other conditions such as cancer, nausea, vomiting and various forms of chronic pain.
Research has been slow with chronic pain due to the complexity of the psycho activity and patients such as the various forms of arthritis, fibromyalgia and chronic back pain.
More recently, in 2017 an American organisation, the National Academy of Sciences, performed a literature review and found that there is conclusive or substantial evidence that cannabis or cannabinoids are effective for the treatment of chronic pain in adults.
Despite this, questions still remain around ideal doses and formulations, efficacy versus conventional medicines, and long-term use.
However, with no practical fatal overdose limit, medicinal cannabis could be a much safer option for those currently relying on opioids and benzodiazepine medications, both of which pose addiction and overdose risks.
What makes cannabis medicinal?
Despite being classified as illegal, many drugs are showing promise as novel therapies for hard to treat conditions, with Auckland University getting approval for trialling tiny doses of LSD, through to the fact that ‘medicinal cocaine’ is still on the books in our regulations in New Zealand.
How cannabis works has only been discovered relatively recently, with the cannabinoid receptors (drug targets) being revealed from the late 80s onwards, and the effects of the various compounds in cannabis are only now beginning to be fully understood.
The caveat for much of the effects is that they often haven’t been compared to conventional medications to compare efficacy equivalence (or indeed, superiority) or an improved safety profile. For this reason, many prescribers will consider medicinal cannabis as a medicine of last resort.
Tetrahydrocannabinol or THC is the substance we most associate with cannabis; it provides pleasurable psychoactive properties for many, and for others can trigger sensations of anxiety, even in small doses.
One of the first benefits that became understood in the modern era was that it reduced internal pressure in the eyes for glaucoma patients. This effect was invaluable in the 1970s and 1980s but has been gradually superseded by better drugs with a longer duration of effect and zero psychoactive effect.
The same can be said for other effects, such as its anti-emetic (anti-nausea and vomiting) effects, where THC is still useful but, due to its side effects, would be reserved for those getting poor results from conventional anti-emetics.
The main use, however, is pain relief, with THC being the leading illicit use of cannabis for medical reasons. Debate surrounds how much true analgesia it provides compared to its psychoactive effects helping patients cope better.
Cannabidiol or CBD is the substance that has been of much interest to researchers and the public alike. It has unique synergistic effects; it reduces the psychoactivity of THC while preserving its therapeutic effects to a degree that is still useful.
CBD first entered the public consciousness in the US based on the reports of children with intractable, and often deadly, forms of epilepsy, having exceptional reductions in seizures, both in intensity, duration and the raw number of seizures.
Other conditions show promise too, with CBD showing benefits as a novel anti-inflammatory, perhaps useful for at least some forms of chronic pain, and multiple trials show it could be useful in treating anxiety from many sources such as PTSD.
Animal studies suggest even more possibilities that need confirming, with CBD reducing rates of diabetes in mice, and reducing substance abuse and addiction across the spectrum from sugar and nicotine, through to stronger medicines such as opioids and benzodiazepines.
A remarkable feature of CBD is that it has no practical upper limit on dosing, with safety studies showing thousands of milligrams per day are safe, while typical patients are using a mere fraction of that on average.
How do I go about getting medical cannabis?
Luckily, Auckland has local cannabis clinics, with knowledgeable GPs who are already experienced with medical cannabis, and have been prescribing for years, these are:
Dr Mark Hotu at Greendoctor, www.greendoctors.co.nz and Dr Graeme Gulbransen at Cannabiscare, www.cannabiscare.co.nz
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