Medical marijuana gets the green light for treatment of illnesses

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In the late 1980s I spent most of my time on Ward C4 of the Prince of Wales Children’s Hospital in Randwick, Sydney. I was writing my doctorate on the psychological impact of a diagnosis and treatment of cancer on adolescents. Occasionally, some of the teenagers on the oncology ward used marijuana, often without the knowledge or permission of their treating doctors, to help with their chemotherapy-induced nausea. It was clear from discussions, that while for some it was effective – there were others for whom it seemed not to have worked as well or at all. At the time, I assumed the capricious results were due to the variable quality of street-grade cannabis.

Over the years, my benign view of cannabis began to change. Having moved away from psychosocial oncology into clinical practice as a general adolescent psychologist, it was apparent that adolescent use of cannabis was linked to a range of serious developmental and social problems.

Putting aside the health concerns – notably the carcinogens and the recent claim made by one senior US physician that one cannabis joint is the equivalent of smoking 18 cigarettes – what I observed was a clear association to further drug use, lack of motivation, depression, anxiety, paranoia and psychosis. Hundreds of families with whom I have worked over the years will testify to the fact that the smoking of cannabis can and does profoundly compromise the developmental tasks of adolescence.

The medical use of cannabis was outlawed in Australia five decades ago, in an era when scientific knowledge was still embryonic. But times have changed and once again my view has had to change. Even a cursory scan of the medical literature suggests that cannabis has genuine medicinal utility, which seems to have been disregarded, with research attention in the main being directed towards the risks I observed with recreational use – rather than the benefits of its medicinal use.

A number of prestigious bodies have reviewed the evidence and all have supported its use. The American Medical Association conducted a review in 2009 and recommended rescheduling cannabinoid-based medicines to allow their legal prescription in the United States. In May 2013, a tri-partisan NSW parliamentary committee recommended making medicinal cannabis available for selected conditions. The NSW Report stated that:

“…on the present medical evidence, cannabis based treatments will only be appropriate for a small number of people in specific circumstances, and under the supervision of medical practitioners with suitable expertise.”

A few weeks ago, New York became the 23rd US state to allow medical marijuana in some form. Governor Andrew Cuomo signed into legislation what he described as one of the safest, most tightly regulated medical marijuana programs in the US known as the Compassionate Care Act, which permits medical doctors to prescribe marijuana in a non-smokable form to patients with serious ailments that are recognised by the state of New York on a predefined but flexible list of conditions.

To appease the anxieties of mental health professionals and law enforcement agencies, the Act includes criminal penalties in case of fraud, as well as a “fail-safe” mechanism allowing the Governor to “suspend the program at any time on recommendation of either the State Police Superintendent or the Commissioner of Health if there is a risk to the public health or public safety.”

In trying to introduce something akin to the Compassionate Care Act, it seems the Victorian Premier Denis Napthine would face little opposition with almost two-thirds of Australians supporting the legalisation of cannabis for medicinal use, according to recent polls.

Last week, however, a spokesman for the state Health Minister David Davis said that for cannabis to gain approval for medical use there needed to be a strong body of scientific research that proved marijuana was more effective than other drugs. “Current evidence available strongly suggests that the balance of harms and risks does not support the use of cannabis for medicinal or recreational purposes …”

But the problem is that, even if Dr Napthine and other state premiers were inclined to follow New York’s lead, the proposal faces multiple obstacles. The risks associated with long-term medicinal use are less well understood, particularly the danger of dependence and any heightened risk of cardiovascular disease, so more research is needed.

In addition, nothing can really happen until the Commonwealth acts to license growers, as it has done with poppies in Tasmania, so that the purity and quality of medical cannabis is assured. Second, it needs to get the Therapeutic Goods Administration to fast-track the reclassification of cannabis from illegal to being highly controlled.

Anyone who has listened to Fairfax radio talkback callers must recognise that the unauthorised use of cannabis as a medicine in Australia is extensive, suggesting substantial demand, but this use is neither supervised nor regulated. The hands of the Premiers are effectively tied, the ball is in the court of the federal Health Minister who needs to pay attention to the tsunami of common sense that seems to be sweeping the US and act.

Dr Michael Carr-Gregg is the author of nine books on adolescence and a co-founder of CanTeen – The Australian Organisation for Young People Living with Cancer.

Henry Sapiecha

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