Why it’s time to treat medicinal cannabis as an alternative therapy, not a pharmaceutical


The recent approval of two domestically produced cannabidiol oil (CBD) products – non-intoxicating cannabis compounds – may have given cannabis prescription patients new optimism. The slow progress in product approvals had meant that some patients feared they would have to turn to the black market.

Yet these new approvals come as little consolation to the majority of people who continue to self-treat with illegal cannabis, including through “green fairies”, personal networks, drug traffickers or by cultivating. their.

Many of them are the same communities that advocated for the legalization of medicinal cannabis in the first place, but currently remain outside the fragile legal system.

After years of waiting and 18 months since the inception of the Medicinal Cannabis Scheme (MCS), many who use cannabis for medical purposes are still absent.

Affordability and persistent problems accessing prescriptions are part of the problem. The same is true of the lack of clinical trials to prove the effectiveness of cannabis in treating many conditions.

But with the fairness and justice of the entire system in question, a different approach may be necessary. Concretely, should we start to think of medicinal cannabis in terms of alternative therapy rather than as a pharmaceutical drug?

Slow progress and blame

It has been four years since the government announced its “commitment to make medical cannabis more available,” and nearly three years since an amendment to the drug abuse law allowed the Department of Health to develop guidelines. regulations for the MCS.

The scheme was opened for product applications in April 2020, with local industry working on certification and product development. Extensions of the “transition period” have been adopted to continue the sale of products imported from overseas. But that ended abruptly on October 1, leaving just four Canadian products approved under the MCS available in New Zealand pharmacies.

Domestic producers blamed the slow progress on regulatory thresholds almost as tight as for pharmaceuticals. In response, the Minister of Health criticized the industry for not working hard enough to meet these standards.

In the meantime, patients and prescribing physicians are left with few legal products to choose from.

Lack of clinical evidence

Five percent of New Zealanders use cannabis for medicinal purposes in the broad sense, with pain, sleep and anxiety being the main conditions. But scientific and clinical evidence for the efficacy of cannabis for these conditions remains limited.

For decades, the ban under the international drug treaties blocked research into the potential medical properties of cannabis. But although more clinical trials are needed, the safety profile of medicinal cannabis – especially non-intoxicating CBD products – is good and well tolerated.

Read more: CBD, Marijuana, and Hemp: What’s the Difference Between These Cannabis Products, and Which Are Legal?

Nevertheless, many physicians remain understandably reluctant to recommend and prescribe cannabis products.

Our survey of more than 3,600 medical cannabis users revealed that only one in three of the patients for medical cannabis prescriptions was successful. Other researchers have found only a 20% success rate.

This is unlikely to change until benchmark, double-blind, placebo-controlled trials demonstrate the effectiveness of cannabis products for specific health problems.

A restrictive diet

The stigma and reputational risk of discussing cannabis use with medical professionals also deters patients from seeking a prescription. Studies of medical cannabis users have found that patients conceal their cannabis use to avoid moral judgments in the provider-patient relationship.

Read more: Cannabis products are sold as sleep remedies – here is the evidence that they work

Additionally, not everyone benefits in the same way from new prescription medicinal cannabis products. Our research suggests that the current system favors Pākehā and those with higher incomes.

In contrast, those with low incomes, Maori, and those who cultivated their own cannabis for therapeutic purposes were the least likely to engage in MCS.

This tends to reinforce perceptions that the new prescription regime is too restrictive, bureaucratic and costly.

Read more: Medicinal cannabis for managing chronic pain? We have no proof that it works

The path to follow

This is where reframing the political debate into a debate on alternative therapies could benefit both patients and the medical profession.

Just as we already do for a range of dietary supplements, non-intoxicating cannadiol products could be easily made available without the need for prescriptions and pharmacies. This is already happening in US and EU jurisdictions.

By classifying medicinal cannabis as an alternative therapy, patients could be more open about its use with their GPs. Allowing patients to develop themselves could also introduce more equity into the system.

Importantly, it would recognize patients’ right to therapeutic self-determination and increased access, while freeing physicians from having to prescribe “drugs” which in many cases lack clinical trial evidence.

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