October 21st 2017


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COVER STORY Reality of family unit must underlie tax system

EDITORIAL Christianity today: the challenges ahead

CANBERRA OBSERVED Xenophon: a Mr Fixit or a political yo-yo?

DRUGS POLICY Science elbowed aside in rush for latest silver bullet: 'medical marijuana'

TRANSGENDER MARRIAGE Decoys to revolutionary laws redefining sex and marriage

FOREIGN AFFAIRS What is the way out of the Catalan crisis?

NATIONAL AFFAIRS Our barmy Army: all politically correct

FAMILY AND SOCIETY The child as weapon in Family Court process

FAMILY AND SOCIETY Faiths and the global future

KOREA Hermit Kingdom versus the Land of Morning Calm

MUSIC Hi-tech lo-fi: Resistance is futile

CINEMA Blade Runner 2049: A cypher unlocking a mystery

BOOK REVIEW The rebels

BOOK REVIEW An attempt to break through the fog

POETRY

HUMOUR More excerpts from the forthcoming revision of Forget's Dictionary of Inaccurate Facts, Furphys and Falsehoods

LETTERS

EUTHANASIA Victoria's death bill: questions that need answers

TRANSGENDER MARRIAGE: George Christensen calls Parliament's attention to activists' end-game

EUTHANASIA Victoria mistakes killing for compassion

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DRUGS POLICY
Science elbowed aside in rush for latest silver bullet: 'medical marijuana'


by Chris McCormack

News Weekly, October 21, 2017

Although serious questions remain unanswered concerning the efficacy and safety of “medicinal marijuana”, the Federal Government in March granted the first licence to an Australian company to grow and harvest marijuana for medicinal purposes.[1]

In February, the Federal Government legalised the importation, storage and sale of “medicinal marijuana” for approved companies.[2] On the Federal Government’s Department of Health website, Minister for Health Greg Hunt says in a statement: “Children suffering from epilepsy and patients dealing with side effects caused by cancer treatment are most likely to benefit from these products if a doctor believes a patient has a medical need and has approval from the Therapeutic Goods Administration.”[3]

But what evidence is there that marijuana has such therapeutic benefits? And if so, do the benefits outweigh the dangers?

A team of scientists led by Dr Penny F. Whiting from University Hospitals Bristol in Britain published a report in JAMA in 2015, entitled “Cannabinoids for medical use: A systematic review and meta-analysis”. The team found that there was “moderate-quality evidence to support the use of cannabinoids for the treatment of chronic pain and spasticity” and “low-quality evidence suggesting that cannabinoids were associated with improvements in nausea and vomiting due to chemotherapy, weight gain in HIV infection, sleep disorders, and Tourette syndrome”.

Furthermore: “Cannabinoids were associated with an increased risk of short-term AEs [adverse events].”[4]

Of the 79 studies evaluated, using the Cochrane “risk of bias” tool, 5 per cent of studies were judged to have a low risk of bias, 70 per cent a high risk of bias and 25 per cent an unclear risk of bias.[5]

One of the most popular reasons given for legalising “medicinal marijuana” is that it provides a form of pain relief not found elsewhere. Of the 28 studies of the effects of “medicinal marijuana” on chronic pain, two were deemed to have a low risk of bias, nine an unclear risk and 17 a high risk of bias. The “studies generally suggested improvements in pain measures associated with cannabinoids but these did not reach statistical significance in most individual studies”, the scientists found.[6]

Insignificant results

Given that the results “did not reach statistical significance”, it seems the jury is still out as to the efficacy of cannabinoids on pain relief. There will always be a cohort of people for whom opioid-based painkillers are ineffective, just as there will similarly be those for whom (ignoring the very real side effects) cannabinoid-based drugs will be ineffective in relieving pain.

In relation to “medicinal marijuana” relieving spasticity due to multiple sclerosis or paraplegia, the scientists found that of 14 studies, two had a low risk of bias, five an unclear risk of bias and seven a high risk of bias. “Studies generally suggested that cannabinoids were associated with improvements in spasticity, but this failed to reach statistical significance in most studies,” they said.[7]

So, it seems premature to be relaxing laws around the cultivation, importation and sale of a drug that has known serious adverse side effects but only unquantifiable benefits in treating the types of conditions described by the Health Minister, such as alleviating cancer treatment side effects and epilepsy.

The scientists found: “There was an increased risk of short-term AEs [adverse events] with cannabinoid use, including serious AEs. There was no clear evidence for a difference in association (either beneficial or harmful) based on type of cannabinoids or mode of administration. Only two studies evaluated cannabis. There was no evidence that the effects of cannabis differed from other cannabinoids.”[8]

A study led by Professor Steven Laviolette at the University of Western Ontario’s Schulich School of Medicine and Dentistry found that long-term exposure to Tetrahydrocannabinol  (THC – the main mind-altering compound in marijuana) in adolescent rats led to “persistent abnormalities in adulthood resembling schizophrenia”.[9]

Researchers from the University of Tsukuba, Japan, led by Olga Malyshevskaya found that, contrary to popular opinion, the THC in high-potency marijuana and the synthetic cannabinoid JWH-018 caused seizures, rather than reduced them. Their findings, published in the journal Scientific Reports, “provide strong evidence” that plant-derived and synthetic cannabinoids have the potential to trigger seizures.

While noting that “a substantial body of literature on cannabinoids in animal models shows mostly anticonvulsive effects”, the authors added: “Few of these used EEG recordings to assess epileptic events and many of them induced seizures either electrically or pharmacologically, changing signalling pathways and brain states prior to cannabinoid application.”[10]

Open letter

The Dalgarno Institute is a long-standing grassroots public-interest community organisation that focuses on education, advocacy and resourcing in relation to alcohol and other drugs. Executive director Shane Varcoe, in an open letter to all Federal Senators and NSW and Victorian Premiers, voiced concerns over the “public consultation” in Melbourne conducted on behalf of the Victorian Government by the Victorian Law Reform Commission into “medicinal marijuana” last year.

He noted that the public consultation, rather than being a fact-finding mission, had had a “seemingly deliberately emotively charged atmosphere, in favour of getting cannabis legalised for medical purposes” and “when attempts were made to present evidence contrary to the seemingly predetermined agenda of these facilitators, they were either quickly shut down (if they dared to speak in the first place) or continually ignored; apparently, dissenting opinions were not welcome. While at the same time, proponents for ‘self-medication’ use of cannabis were given complete and unfettered access to the floor.”[11]

He also said that some “medical marijuana” treatments with the psychotropic THC may have the effect of pacifying children who are liable to fits, but the “literature reveals THC use in the developing brain is linked to the risk of psychosis”.

According to an article in Australian Doctor, none of Western Australia’s 10,679 doctors have applied to prescribe “medical cannabis” since its legalisation last November. AMA WA president Omar Khorshid said: “The AMA is calling for more research on cannabis-based drugs so that we know what’s in them, how well they work, and how safe they are, and once that’s done, we’ll be able to prescribe better drugs for patients to manage these conditions.”[12]

The American Epilepsy Society is similarly reticent: “At this time there is no evidence from controlled trials that strongly supports the use of marijuana for treatment of epilepsy.” Furthermore: “Our position is informed by the lack of available research and supported by the position statements from the American Academy of Neurology, the American Academy of Pediatrics, and the American Medical Association.”[13]

Specialist pain medicine physician in Sydney and director of Professional Affairs for ANZCA’s Faculty of Pain Medicine, Professor Milton Cohen, said that “anecdote and clamour” and “community enthusiasm” had preceded science in relation to prescribing “medicinal marijuana”. “It’s a classic example of the cart being put before the horse, with a political imperative to facilitate access to an unproven medicine,” he said. “The international data on which one could make an informed decision about the effect of medicinal cannabis on chronic non-cancer pain is in fact very poor.”[14]

Has the Government’s legalisation of marijuana for therapeutic purposes been a kneejerk reaction to a vocal minority of drug-legalisation advocates and parents of children with conditions such as MS or epilepsy, foregoing due diligence in favour of a response based on anecdotal evidence and emotion?

The same rigorous methods employed in approving other drug medications must apply to “medicinal marijuana” to ensure the public is not blindly put in harm’s way.

 

References

[1] Greg Hunt, Minister for Health, Minister for Sport, “First licence granted for commercially grown medicinal cannabis in Australia”, Media release, March 8, 2017.

[2] Debra Killalea and AAP, “Medical marijuana legal in Australia: What it means for you”, News.com.au, February 22, 2017.

[3] Greg Hunt MP, “First imports of medicinal cannabis arrive in Australia”,Media release,May 3, 2017.

[4] Penny F. Whiting, Robert F. Wolff, Sohan Deshpande, et al, “Cannabinoids for medical use: A systematic review and meta-analysis”, The JAMA Network, June 23/30, 2015.

[5] Ibid.

[6] Ibid.

[7] Ibid.

[8] Ibid.

[9] Catherine Paddock, “Marijuana: Effects of teenage use may be reversible”, Medical News Today, September 14, 2017.

[10] Honor Whiteman, “Marijuana and ‘spice’ could trigger seizures, study says”. Medical News Today, September 25, 2017.

[11] Shane Varcoe, executive director, Dalgarno Institute, “Open letter to all Australian politicians regarding ‘new’ version of medicinal cannabis”, Dalgarno Institute, 2017.

[12] Rachel Worsley, “An entire state’s doctors have shunned medical cannabis”, Australian Doctor, May 30, 2017.

[13] Michael D. Privitera, president American Epilepsy Society, “Letter to Pennsylvania Legislature”, p1, March 11, 2016.

[14] “False hope driving claims medicinal cannabis is magic pill”, Scoop Independent News, May 13, 2017.




























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