In a conference room in Melbourne last week, a course was underway teaching doctors about medicinal cannabis and how to prescribe it.
Described as an Australia first, the course aimed to fill a “vacuum” in the knowledge base of the medical profession, says its architect emergency doctor and Australian National University academic Dr David Caldicott, who hopes it will become an accredited RACGP CPD program.
The one-day course – which opened the 2017 United in Compassion Medical Cannabis Symposium at Crowne Plaza – covered everything from the history and politics to the nitty gritty of suitable indications and dosing regimens – largely based on research and experience overseas.
![The United in Compassion Symposium, photo credit to UIC.](https://thelimbic.com/wordpress/wp-content/uploads/2017/06/PanelOfPanels.jpg)
The United in Compassion Symposium, photo credit to UIC.
Attracting over 90 participants, including GPs, palliative care physicians and nurses, it received an “embarrassingly positive” response, including requests to run the course in other states, Dr Caldicott tells the limbic.
The course is open to all, but targeted to GPs, neurologists, pain specialists, paediatricians and palliative care specialists.
Dr Caldicott says he is targeting those doctors who treat patients for the range of conditions for which medicinal cannabis is indicated: pain, chemotherapy-induced nausea and vomiting, intractable paediatric seizures, and end-of-life pain and associated anxiety.
But the quality of evidence to support using medicinal cannabis to treat many of these listed conditions is called into question by the Royal Australasian College of Physicians.
There are two pathways for doctors to prescribe unregistered medicinal cannabis products outside clinical trials, and the numbers doing it are low.
Doctors can use the TGA’s special access scheme or become an authorised prescriber for a specified medical condition.
In some jurisdictions, further sign offs are needed by a state health department.
A Senate Estimates hearing in May heard Australia has just 25 authorised prescribers – 24 are paediatric neurologists and one is a palliative care physician – while 66 special access applications were approved this year.
While figures from the hearing indicate less than 150 patients have been prescribed medicinal cannabis through these channels, tens of thousands more are sourcing cannabis for therapeutic purposes through illicit means says Dr Caldicott, the figure is based on reports from community-based patient support groups.
He claims Australia is too conservative in its approach to the subject.
“There are a couple of lines of opposition (to medicinal cannabis) and one of those is that we don’t know enough about it to prescribe it. That’s patently not true because many others have been doing it, and for quite a while – just not in Australia.”
Medicinal cannabis dosing guidelines have been developed in Israel and Holland, he says.
“There is a narrative in Australia that medicinal cannabis is the same as recreational cannabis, is dangerous, and no-one should use it in its botanical form, and then there is the global narrative – which is that cannabis is interesting, has huge potential, that there may be many indications, and it’s certainly benefiting some people- right now,” he says.
In a rapidly changing landscape, where a loud patient advocacy voice is calling for access on compassionate grounds and state and federal legislation is being regularly amended, he argues that the medical community needs to be up to speed on the issue.
“The point of the course is GPs, among others, will have the knowledge to scientifically decide not to prescribe cannabis, as much as to prescribe it.”
It’s fair to say the medical profession at large in Australia is cautious about the claimed benefits of medicinal cannabis.
The Royal College of General Practitioners’ position statement from October 2016 says the evidence is “incomplete”, describing only “moderate quality evidence” to support cautious use of cannabinoids for treating symptoms for a narrow range of conditions – namely arthritis, chronic non-cancer pain and multiple sclerosis-related spasticity.
The statement also highlights increased risk of short-term adverse events, with findings of a pooled analysis suggesting a three-fold increase compared to placebo or alternative medication.
It concludes that the medical profession and the wider public do need education, and that this education should “contextualise the use of medical cannabis as a last-resort medication for specific categories of illness that can only be prescribed in rare circumstances after stringent legislative criteria are satisfied”.