By Dr. Sud Agarwal
The introduction of medicinal cannabis to Australia has come with its fair share of myths and misconceptions. Many people associate medicinal cannabis with illicit drug users and imagine that most patients who seek out medicinal cannabis are merely looking for an easy way to obtain marijuana for recreational use.
Nothing could be further from the truth. But it’s not just the general public who are struggling to separate the myths from the facts about medicinal cannabis – these misconceptions and biases have affected the medical practitioner community as well.
Fortunately, more GPs and medical specialists are starting to learn more about the benefits of medicinal cannabis as well as how to prescribe it to patients. There has recently been a significant shift recently in how the medical profession views medicinal cannabis and its place in the health sector. Here’s why they are starting to take it more seriously.
It’s a talking point in the medical community
This time two years ago, there were less than 10 Australian doctors who were prescribing cannabis. If you were bold enough to prescribe cannabis, you quickly earned the wrath of your colleagues and were labelled a “fringe dweller.” As one of the earliest adopters in this industry and one of the highest cannabinoid prescribers, I frequently received a raised eyebrow from my colleagues. There had been numerous occasions where other doctors had challenged me by partaking in a “patient-centric cult.”
There’s more social proof amongst medical practitioners
One of the biggest reasons GPs have been reluctant to prescribe medicinal cannabis to their patients has been a simple lack of knowledge and experience around the drug. Now, two years after legalisation, every doctor knows at least one colleague who has prescribed a cannabis product to someone.
A study looking at the attitudes of GPs towards medicinal cannabis was published in mid-2018 following research by the University of Sydney’s Lambert Initiative for Cannabinoid Therapeutics. It found that while two out of three GPs had had a patient ask about medicinal cannabis, they felt that they lacked the training necessary to be confident about discussing it with their patients.
However, a quick look at the upward trajectory of medicinal cannabis prescriptions clearly shows that doctors are increasing their knowledge about the drug. In July 2018 the TGA approved 188 SAS Category B applications; in March this year, that figure had risen to 1,042. That’s a five-fold increase in just nine months. Medicinal cannabis is well on the way to joining the medical mainstream.
The scientific evidence is much stronger
Medicinal cannabis research is still in its infancy. Before the late 1990s, the legal status of the substance made it next to impossible to conduct clinical trials at the same level and quality as other drugs. However, the evidence is starting to catch up, and the results so far are auspicious.
The public interest in medicinal cannabis has been propelled by substantial, albeit anecdotal, experiences of children with severe epilepsy and the suffering of chronic pain patients. This was a major factor driving changes to the legislation; however, this was not enough for medical professionals to make evidence-based decisions for their patients.
As the volume of research supporting medicinal cannabis increases gradually, the body of supportive doctors prescribing medicinal cannabis is also increasing. Studies have shown promising results for patients with multiple sclerosis, chronic pain, cancer-related pain, palliative care symptoms, with more being added to the body of research all the time.
While internationally, comprehensive research is being conducted by several universities and research institutions, my company, Cannvalate, is partnering with Swinburne University on the Medical Cannabis Research Collaboration, linking academic research with the industry.
Medicinal cannabis products are easier to prescribe
It’s not easy to get a prescription for medicinal cannabis in Australia. There are lengthy bureaucratic processes to complete. Prescribing doctors must make an application to the Therapeutic Goods Administration (TGA) for each prescription, which can take a great deal of time and effort. The Lambert study mentioned above found that fewer than one in 10 GPs understood how to navigate the complex system.
However, the process is getting easier as more doctors increase their knowledge, and there are now a few alternatives to ease the administrative burden placed on doctors.
First of all, the number of authorised prescribers is on the rise. Authorised prescribers are doctors who have gone through a rigorous application and screening and can prescribe medicinal cannabis without making individual applications for TGA approval. They may still need approval from another specialist and the state health department, but they generally have the ability to streamline patient access to cannabis products significantly.. A Melbourne GP became the first authorised prescriber in June 2018, and as at 31 March this year there were 57 authorised prescribers.
Another way that GPs can navigate the system more efficiently is by engaging a service such as Cannvalate’s Cannvaclinics. We help by managing the entire TGA approval process as well as access to pharmaceuticals, retail pharmacies, and patient follow-up.
That said, GPs and patients alike would prefer the system to be simplified and easier to use, and the Royal Australian College of General Practitioners has called for a more user-friendly and consistent system.
The price of medicinal cannabis products has dropped
The final reason why medical practitioners are now paying more attention to the possibilities of medicinal cannabis is a straightforward one – the price of cannabis products has dropped considerably since they first arrived in 2016. A study released last year found that the cost of some products had nearly halved over the previous 12 months. The number of products available by prescription had also increased from 11 to 35. With lower prices and a wider variety of products available, doctors are now much more willing to explore these options with their patients. And as products from local licensed producers start to enter the market, those options will only improve.