Add in the potential to cure everything from menstrual pain to anxiety and depression – as well as curing insomnia and helping with weight loss – and cannabis sounds like a therapeutic silver bullet. Could cannabis be the perfect antidote to an overwhelming tide of chronic disease sweeping across the country?
With millions of prescriptions being written, hundreds of thousands of Australians using the products, and billions of dollars at stake, medicinal cannabis must be a powerful and proven treatment, surely?
Well, not exactly. When these exuberant claims are subject to careful scientific analysis many of them dissipate like a cloud of reefer smoke. A comprehensive review, published in the British Medical Journal last year, found little to support most of the claims made about the supposed benefits of cannabis use.
The British review confirmed the value of cannabis-based medicines for treating seizures in certain rare types of epilepsy and showed it had a clear role in managing pain and stiffness in multiple sclerosis. The evidence also supported its use in palliative care and some severe chronic pain conditions.
Yet there was precious little scientific support for any other benefits of cannabis in all of the health conditions studied. To make matters worse, researchers concluded that the scientific literature about cannabis is so flimsy that it underestimates the harms of cannabis use.
The lack of evidence of cannabis’s health benefits has not stopped the blossoming of a massive industry in so-called medicinal products. After years of campaigning by enthusiasts, “medicinal” cannabis was legalised in Australia in 2016. Since then, its legal use has skyrocketed with well over a million prescriptions issued.
A multimillion-dollar medicinal cannabis industry has sprung up almost overnight, with online consultations delivering a multitude of products directly to consumers. A recent study by Monash University warned of the dangers posed by vertically integrated clinics dedicated to medicinal cannabis.
There can be glaring conflicts of interest with the clinics owned by suppliers of the cannabis products. Assessment of patients seeking cannabis can be perfunctory, to say the least, and have no ongoing follow-up or contact with the patient’s usual GP.
Most Australians who use cannabis for health conditions obtain it illicitly, not through a prescription by a doctor. But hundreds of thousands of people are now turning to legal medicinal cannabis. Interest in its supposed benefits is high, and there is a lot of money to be made by suppliers selling it to vulnerable people, despite the lack of evidence that it is any better than standard treatments for conditions such as anxiety, insomnia or chronic pain. Can we at least be sure it is safe?
The first thing to understand is that almost all of the cannabis products are unapproved and are prescribed outside the normal guardrails of safety and quality assessment. Doctors who wish to prescribe cannabis must be authorised to do so – there now are about 6000 authorised prescribers nationwide.
Incredibly, of the hundreds of cannabis products available for prescription in Australia, only two are officially registered with the Therapeutic Goods Administration. The rest bypass testing and quality control mechanisms completely, a situation described by some of my colleagues as akin to the “Wild West”.
Australia is a major producer of cannabis products. Forecasts suggest the market volume of cannabis in this country will reach well over $4bn by the end of the decade.
The deluge of cannabis products being delivered to Australians is affecting our health system, and not necessarily in a positive way. Large increases in psychotic illness in people prescribed cannabis are putting pressure on mental health units across the country.
Psychiatrists, in particular, are concerned and warn that as many as one in 10 acute presentations of psychosis now are linked to use of prescribed cannabis. As our health system grapples with a mental health crisis, adding to the strain is the last thing we need.
The explosion in use of cannabis for “medical conditions” has also become a concern for regulators such as the TGA and the Australian Health Practitioner Regulation Agency. AHPRA leaders convened a meeting of health regulators earlier this year to discuss how best to protect the public from unfettered cannabis prescribing.
“The use of unregistered medicinal cannabis products has spiralled in recent years,” a communique from the forum said, warning that the number of prescribers had risen sharply despite the fact most cannabis products had “not been evaluated by the TGA for safety, quality or efficacy”.
Worryingly, cannabis was found to trigger the onset of psychotic mental health conditions in otherwise healthy people, particularly young people. Cannabis also was a potent cause of relapses in people with serious mental health conditions who had recovered. It was estimated that about 10 per cent of all people with schizophrenia can attribute onset of the disease to the use of cannabis.
As Australia faces a crisis that has overwhelmed our mental health system, liberal use of a “medicine” with so many potentially catastrophic side-effects – especially in young people – needs very careful community consideration.
The message for Australians is clear: almost all of the available medicinal cannabis products remain unapproved, with no processes of quality testing as occurs with registered medicines. Cannabis should only be used when all other proven treatments have failed. Anything else is just smoke … and mirrors.
Dr Steve Robson is professor of obstetrics and gynaecology at the Australian National University and former president of the Australian Medical Association.
* This column is published for information purposes only. It is not intended to be used as medical advice and should not be relied on as a substitute for independent professional advice about your personal health or a medical condition from your doctor or other qualified health professional.
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