MediHuanna Blog

Responding to Mr Hunt: My Vision for Medicinal Cannabis in Australia

“However, it is important that medicines are thoroughly tested to ensure they meet rigorous standards before being placed on the market, so that doctors and patients are assured of their efficacy, quality and safety’’ – Home Office UK spokesperson regarding medicinal cannabis

That sounds about right, doesn’t it? It would be if only access to medicinal cannabis wasn’t constantly blocked and denied.

As a GP in Australia, I am unable to prescribe it without the endorsement of a specialist. One of my patients is still waiting for state approval since July last year, even though it has already been approved by the TGA. NSW Health keeps coming up with one excuse after the other to continue denying access.

 

I wrote a letter to Mr Greg Hunt recently and stated the following:

As a caring GP, a doctor who has been studying cannabis medicine through my own research I state the following. The process of prescribing medicinal cannabis continues to be difficult and impossible to sustain. I am a very busy GP, so how can I find the time to go through so much paperwork. It is so much easier for me to write another script for oxycontin. It has to change, otherwise we’ll have to wait another 10 years to practice cannabis medicine the way it should be done, patient centered, based on individual dosing, access to different strains and formulations.

As a clinician, I believe that following should happen:

  • Cannabis formulations up to 1% THC and any % CBD should be available over the counter.
  • I support home growing of cannabis up to 5 plants for personal use, allowing the raw parts of the plant to be utilised (juicing of the raw leaves provides many health benefits with no psychoactive effects because cannabinoids are in acid form).
  • Any other formulations with THC>1% available on prescription.
  • Prescribing rules kept consistent throughout Australia governed by one regulator to avoid duplicating the process between federal and state.
  • One application form only without all the excessive paperwork to justify the clinical decision.
  • All health professionals, including GPs, specialists, herbalists, naturopaths and nurse practitioners should be allowed to prescribe after completing an appropriate course and passing exams. RACGP should support ongoing cannabis education.
  • Health professionals to collect data and share with researchers to continue ongoing scientific examination as part of n=1 studies.

I would love to see the development of cannabis clinics in which doctors and allied health professionals can work together utilising an integrative approach. Each clinic would have its own dispensary with high quality medicinal cannabis formulations. Patients would receive proper assessment, management, monitoring and recommendations would be sent to their treating doctors. I strongly believe in developing a network between ethical growers, manufacturers, pharmacists and health professionals.

The government should stop controlling health professionals and focus on ensuring that high quality medicinal cannabis is consistently delivered. I believe in whole plant medicine due to the important entourage effect. This can only be possible once cannabis is legalised properly and obstacles to prescribing removed.

Unfortunately, the current situation does not support using medicinal cannabis properly. It’s very sad that over 100,000 patients are forced to resort to the black market, missing out on professional medical guidance.

 

I am hoping Mr Hunt responds to my letter so I continue to discuss these issues with him further. There’s still much work to be done Australia!

Mr Hunt’s letter to Dr Towpik

Cannabis in palliative care and the question of assisted death

cannabis and palliative care

The main focus of palliative care is to provide symptoms control, improve quality of life, minimise side effects of medications and provide holistic care, addressing many aspects of chronic, serious illness – physical, emotional, mental and spiritual. I strongly believe that cannabis has important applications in palliative care, controlling pain, nausea and vomiting while alleviating anxiety and depression. I feel that in this situation a bit of euphoria is quite appropriate.

Currently used medications don’t provide effective symptoms control, cause side effects and most importantly make patients feel like zombies unable to communicate with their loved ones. Here, I am going to share the story from one of the emails that I have received recently.

 

“My sister Sandra, was diagnosed with Multiple Myeloma in 2012. She was told at the outset that she had the ‘black’ variety which is resistant to the usual therapies. When she was diagnosed I researched and found that people were having a lot of success with keeping the Myeloma at bay using CBD. I talked to her many times about giving it a try, but she wouldn’t go outside of her haematologists treatment. I spoke to the haematologist myself about it and she basically said that it wasn’t a proven therapy and besides that, it wasn’t legal (she was cautious). I shared this research with another sister and Sandra’s sons. We were all of the opinion that it was worth a try but could not convince Sandra.

She had a stem cell transplant in 2013 and it seemed to be successful although the treatment itself nearly killed her. I nursed her through this period and what her poor little body suffered was cruel for her and for me. Watching someone you love suffer so much is one of the worst things I’ve had to endure.

Her resilience was amazing. She had lesions in her skull and her spine but was put on a course of iridium to strengthen the bones. She seemed to come good for about 3 years.

In September last year she had severe pains in her legs and in her stomach and was told that the Myeloma had come back and this time it was causing tumours. She was in so much pain she was on large doses of oxycontin and morphine shots every two hours. They gave her chemotherapy as well as radiation and she couldn’t eat due to the ulceration caused by the chemo to her digestive system – her tongue and her mouth. She weighed about 40 kg.

Her sons and I made the decision that we would give her medicinal marihuana and not tell her that we were giving it to her. At this stage we figured we would try anything, she was in so much pain. It was unbearable.

All I can say is that there was a miraculous change in her. My sister was very Christian so she attributed her sudden change to God. We sourced the crystal marihuana that was 50% CBD and 50% THC and we were giving her a small dose 3 times per day (the size of half a grain of rice). Not only was she pain free but she was also very happy. Her appetite came back. The doctors at the hospital kept quizzing me and asking if I was giving my sister cannabinoids and I always said no. They basically said that I could sign something (to alleviate them of any blame) if I was. I wasn’t prepared to do that.

Sandra was a singer and on New Year’s Eve, the doctors gave her a leave pass from the hospital so she could sing with my brother’s band. I have a lovely video of her that I now cherish. She was singing “Be my Baby” and dancing to the music, she was so happy!

The next day I was taking her to the toilet and she collapsed. She became a quadriplegic as the lesions in her spine finally cut through the cord.

I have always believed in euthanasia and I said to her “Sis, if this gets too much I can ask the doctors to increase the morphine and you can sleep more”  but she said “Why would I do that and miss out on all this lovely time with you?”. In that time, we laughed, we sang, we watched crap TV, she told me stories about all her boyfriends – she was a beautiful girl and had quite a lot of those. It got to a stage where she was refusing the oxycontin, she said she didn’t need it.

Finally, the disease took over and she died on Valentine Day. During those last few months she wasn’t anxious and she was pain free.

I firmly believe that if we hadn’t given my sister the marihuana I would never have had positive memories of those last few months. It was comforting to me to know that she wasn’t suffering and she wasn’t afraid of dying.”

 

This is such a beautiful story, sad but at the same time so full of love, care and compassion. I believe that patients should be entitled to medicine that helps them. These people and their families don’t need to feel like criminals, breaking the law.

Now, I am going to touch on the subject of euthanasia. It is concerning me very deeply. One hand I understand that people have the right to choose to terminate their life when disease is taking over and living becomes an agony. On the other hand, I feel that this situation is a reflection on our health system’s inability to offer effective symptoms control. The question begs asking, why people want to die. Apparently, one of the important reasons is the fear of becoming a burden to their family, loss of independence, loss of being in control, fear of becoming totally incapable both physically and mentally and fear of agonising, debilitating pain.

These people usually suffer from major depression, they are anxious and these mental conditions influence their decision as well. Life is simply not worth living anymore.
However, in this situation, when nothing is to lose and a lot of gain, why can’t we offer them good quality whole plant cannabis, good nutrition, supplements and spiritual counselling.

I believe that it would help these people to live their life till the end, feeling truly comfortable, being able to communicate with their loved ones and being guided to the other side with love and compassion. Somehow, it is more appealing to me than receiving synthetic drug lethal injection. As a doctor, I would be very uncomfortable playing the role of executioner.

I am expressing my personal view here. I understand, there will be many opposing opinions on the subject. I invite anyone to become a part of the debate.

HHI Expo Melbourne Recap

I attended the Hemp, Health and Innovation Expo in Melbourne last weekend. My organisation MediHuanna was one of the exhibitors.

As usual, these events inspire, energise and motivate me to continue my cannabis work. Unfortunately, the weather was quite bad. Heavy rain, flooding and rather gloomy.

The numbers were lower than expected but in spite of the rain a lot of people came. It was great to meet other presenters and exhibitors. Passionate people with an amazing wealth of knowledge, I have a lot of respect for them.

There is something special about Hemp Expo events. The passion for cannabis connects many people from different walks of life. Many aspects of cannabis were presented, medicinal, food, beauty products, industrial and textiles, I even saw a hemp wedding dress. The choices were amazing.

I really enjoyed chatting with so many people. A lot of them were really desperate to get medical advice for their health problems and frustrated about the process of obtaining cannabis legally.

Patients want to feel comfortable and supported in making their choices, they want to be guided by medical professionals. I felt very inspired listening to stories of healing and hope.

The discussion panel was wonderful, I felt very honoured and privileged to be a part of this group. Many interesting questions were asked by the public, overall a great learning experience.

I would like to give a big thanks to the organisers of this event. They put many, many hours of hard work in to make it possible. They deserve support and recognition.

I hope there will be many sponsors for future events to continue making it possible. I’m looking forward to the next Hemp Expo in Sydney during May 2018, the event of knowledge, passion, learning and awareness.

NSW Health’s Machiavellian games with Medicinal Cannabis

Medicinal Cannabis

What a day today, I woke up this morning, checked my emails and one of them really caught my attention, from a friend, sharing the following media release from NSW Health:

 “PATIENTS TO GET FASTER ACCESS TO MEDICINAL CANNABIS

The NSW Government is intent on getting more patients access to medicinal cannabis products for palliative care, under a $6 million state-wide advisory service aimed at supporting doctors.”  Read the full media release here

I thought to myself, that sounds good, but somehow my gut feeling is a bit uneasy about it.

What is this advisory service? Who are these people, what are their qualifications and expertise as well as attitudes towards cannabis? How honest are they and can I trust them?

For some reason, I feel a bit suspicious.

So, that media release from NSW Health was in the morning and later the same day I received an email from NSW Health stating that my application to use cannabis for my patient was yet again rejected.

Here is the full story, it is rather long.

This lady is in her late sixties, she has been suffering from Parkinson’s disease, Alzheimer’s dementia, chronic pain, anxiety and depression. She has been on multiple medications, however these have not been helping her. Some of them needed to be given every 2 hours. Her family has been trying to obtain medicinal cannabis through legal channels since 2015.

They approached me in July this year, even though they live about 4 hours from my surgery. Unfortunately, nobody else was willing to help them. So, we applied for Canimed 1:20 (THC:CBD) to the TGA. Our initial application was rejected straight away because we didn’t have a letter of endorsement from a specialist.

None of her specialists were willing to support us. Eventually, we found one who was prepared to go only as far as stating that he is supporting my cannabis application for this patient. He changed the diagnosis to Lewy body dementia, thankfully that was enough for the TGA to approve us.

We got really excited and shortly after applied to NSW Health for the required state approval. On the 22nd of September 2017, I was advised by a senior pharmaceutical officer from NSW Health, that the Cannabis Products Subcommittee had considered the application for my patient and requested that I would speak with the corresponding medical advisor.

This was such a horrible conversation, it felt more like an interrogation. I could sense that she held a very biased opinion and I knew in my heart that my application was going to be declined. Subsequently, on the 5th of October 2017, the delegate, Mr Bruce Battye, advised me that my application to prescribe and supply a medicinal cannabis product had been refused.

Eventually, a very prominent lawyer kindly assisted us and offered her services on pro bono basis. On the 31st of October the application for administrative review was lodged. We got the answer today.

The application was rejected yet again.

Here are some of the reasons:

“As Delegate of the Secretary, NSW Health, I have carefully assessed your application and considered the recommendations of the Subcommittee, as is required under clause 128G(2) of the Regulation. I can advise that on the assessment of the application and supporting evidence against the criteria, authority has not been granted.

As you would be aware, medicinal cannabis products, other than Sativex, have not been tested for quality, safety or efficacy in Australia. Any proposed clinical use of an unregistered medicinal cannabis product must be regarded both medico-legally and ethically as experimental.

A lack of compelling clinical evidence to support the use of this particular ratio of cannabinoids (tetrahydrocannabinol 1mg/mL and cannabidiol 20mg/mL) in the fixed-dose combination product CanniMed Oil 1:20 in this indication (i.e. anxiety, illusions and hallucinations in the clinical context of behavioural disturbance in Lewy body dementia) in this patient. The role of cannabinoids in behavioural disturbance in dementia is highly uncertain.

There is also no clinical evidence to support the use of the cannabinoids to slow down the degenerative process. The Subcommittee noted the evidence in animal models in dementia that cannabinoids may alter the course of this disease, found these studies did not provide enough information to guide clinical practice at this time.

Consideration that all suitable treatment options with non-drug or with registered medicines have been exhausted/trialled prior to a proposal to prescribe a cannabinoid. For example, the potential use of benzodiazepines (i.e. with better safety data) as an unexplored registered medicine for anxiety, or olanzapine for behavioural disturbance in dementia, if appropriate.”

It appears that NSW Health prefers benzos and antipsychotics as better and safer options to medicinal cannabis.

Can we really agree with that?

So, after almost 6 months of cannabis prescription saga, tonnes of paper work, gathering evidence, hours of hard work, engagement with the solicitor and in the end the answer is no.

Some cannabis opponents are worried that we are moving too fast but how much slower can we go?

And today the cheerful announcement:

“NSW has led the country in its approach to medicinal cannabis. However, doctors want more support about whether to prescribe medicinal cannabis, what specific product to prescribe and how best to prescribe it, Mr Hazzard said.

This landmark service will give doctors the support and confidence they need to decide if their patients, particularly palliative care patients, may benefit from this type of treatment.

The service, based at Hunter New England Health, will help doctors across the state access onshore medicinal cannabis products for their patients much faster, as well as provide expert clinical advice on prescribing for other patients.

NSW Health’s Chief Health Officer Dr Kerry Chant said.”

To me, it is the true spirit of Machiavellianism – the employment of cunning and duplicity in statecraft and general conduct.

What I would like to know is who exactly will be on this new advisory committee along with their qualifications. This information should be made public so we know for sure whether any hidden bias or intentions reside within the committee.

To me right now it seems as though NSW Health are acting like medieval rulers who seem to think they know what’s best for us better than we do and without even consulting us, it is insulting to say the least.

Bureaucracy and red tape, can we do better

I am absolutely convinced that red tape, prohibition and excessive bureaucracy is costing our society a huge amount of money. It is demoralising, uninspiring and basically clipping our wings.

I can cite many examples here. As a doctor, I see many patients with a common cold or any other type of viral illness. All they need is to take 1-2 days off, go to bed, drink plenty of fluids and so on.

Unfortunately, gone are the days when people were allowed to take up to 2 days off without a doctor’s certificate. Now, they have to obtain one, so they need to see their GP just for that, not only that, they even need to get an attendance certificate for 1 or 2 hours of absence. Of course, these consultations could be avoided and the cost to health care reduced.

I saw a retired nurse a few days ago. I asked her what she likes about her retirement the most. Her answer was, I don’t have to write all of these reports. She commented that when she started her career as a nurse about 40 years ago, the notes were kept short just as a way of communication between the staff. Now, they have to write long stories, just to cover themselves, all in fear of litigation.

Another nurse, who works in the Accident and Emergency Department told me that years ago, you would simply do what needs to be done, now it is all about following protocols, procedures and flow charts. She doesn’t find it very helpful.

Bureaucratic papers are so convoluted and complicated that most people struggle to understand what they are on about. GPs are overloaded with red tape. That time can be better spent listening to patients.

Very sadly, many of us are forced to practice defensive medicine, quite often ordering many unnecessary investigations, again, all in fear of litigation. GPs are also very undervalued as well as unappreciated and unfortunately the suicide rate among doctors is quite high.

Another problem is the war on drugs. We know that it’s not working and never will. We spend so much money on police raids, persecution, prohibition while the drug problem is only getting worse and sadly effects so many young people. We know that countries with more liberal laws, eg. Portugal, report better outcomes on drug related problems.

Why can’t we follow that model and spend a proportion of that money on education, harm minimisation, support, creating rehabilitation centres. Why can’t we give these people better medicines to help their withdrawals, eg CBD.

Why would we rather allow a child to die than give them medicine that they need?

Why do we need to push synthetic therapeutic agents and bully other medicines?

A lot of my patients who work in offices especially government ones, experience depression, anxiety and sometimes even nervous breakdowns due to the excessive demands placed on them and bullying at work. Is it really necessary?

Politicians are now debating about dual citizenship, why does it matter, who gives a damn. These people were born here anyway, it should be about their service and performance and not about their dual or whatever citizenship.

Sometimes, it appears to me that people in power focus on minor issues so they don’t have to tackle the important problems. I feel that excessive red tape can be compared to cancer, proliferating out of control, spreading and eventually killing the organism it invades.

I believe in balance and the middle ground. Good, healthy structures, common sense and compassion. Politicians should spend less time in their offices and more time talking to real people, addressing their real needs.

Chronic Pain in Older Australians, by Leah Bisiani

Medicinal Cannabis: A Therapeutic Alternative for Management of Chronic Pain in older Australians

 

Pain has been described as a fundamental and universal human experience, and thus access to effective pain relief should be regarded as an essential and universal human right.1

Chronic unremitting pain has become a grave problem in modern civilization.

The human toll associated with chronic pain is massive, and is linked to considerable economic impact, including an enormous Health Service utilisation burden. 2-3

It could be perceived as perhaps quite paradoxical that people who do not have a condition that is life restrictive, but who suffer chronic pain, receive lesser efficient and effective means to successfully manage their pain. Hence the permanent nature of their pain creates enduring suffering and debility, which may, in some cases, encompass a period of time that could feasibly be decades.

With respect to the incidence of chronic pain among the older population, there are abundant indications confirming older Australians continue to suffer considerably, and this has a drastic impact on their future and quality of life. 4-7

‘Duty of care’ is considered an area never to be compromised as per the code outlined by the Hippocratic oath that all medical professionals are supposed to uphold.

The foundation of this oath is: “DO NO HARM”.

Thus, every person has an integral right to the provision of the finest treatment possible to alleviate any form of suffering endured from chronic, relentless, excruciating pain.

Potent opioid analgesics, are widely prescribed for older Australians in chronic pain, yet these agents are associated with the highest degree of drug-related harm.

It has been surmised that up to 73% of older people on opioid regimes are NOT receiving effective pain management!!!!!

It is therefore illustrated, there is an urgent need for an alternative approach.

Given the high prevalence of chronic unrelieved pain in the aged, this should be regarded as a matter of “high priority and focus”, of which we are duty bound to honour.

The potential benefits of medicinal cannabis in treating poorly managed intractable chronic pain is considered a beneficial alternative approach to enhancing quality of life, and maximizing comfort and well-being in Australia’s older population!!!!!!!!!!!!!

Otherwise are we not condoning neglect?!?!

In supporting the concept of a compassionate and empathetic culture, it is time for us to avoid and negate the subjective views based purely on stereotypical interpretations of street cannabis.

Bureaucratic law is enabling a gross injustice to transpire against our population in need, by continuing to construct negative viewpoints related to outdated, propagated rigid regulations, intentional barriers and stigma.

This is institutionalised bias at its worst and should not be tolerated!!!!!!!!

Is it fear of the unknown stopping Australia’s Government from legalising a natural medication, that exhibits less risks than countless prescribed drugs handed out daily, or is it fear that some of the public may judge political decisions of this nature as a negative because of their own rigid views??

This topic really should not be creating such division in society due to political correctness.

The bottom line is, we ought to be analysing the product only in relation to its efficacy in alleviating suffering for specific conditions, hence basing it on the necessity of promoting a civilised and humane philosophy of care for our society.

If preferred pharmaceuticals and other methods of treatment have demonstrated persistently, to be unsuccessful in treating a person regarding their specific conditions, it seems again, neglectful not to consider and utilise a medicine that may alleviate the issue and ensure comfort and relief.

Well-being of our older population should ultimately dominate all decisions.

Thus, it is crucial we examine the genuine medicinal usefulness, (currently being ignored), and embrace the numerous and substantial benefits of medicinal cannabis as a viable alternative.

Excruciating, relentless, debilitating chronic unmanaged pain cannot be condoned!!!!!!

The frequent and significantly hazardous and destructive adverse effects associated with opioids are detrimental to living risk free, as they habitually and predominantly affect mood, conscious thought, judgement, may create hallucinations and delusions, alter cognition, and affect mobility.

Although all medications have adverse effects, medicinal cannabis is unlikely to be associated with side effects of the dangerous severity of those arising from opioid use, so cannabis may be considered to be a safer and less harmful option than heavy and extended use of opioids.

Furthermore, withdrawal symptoms may be considerably less than with heavier compounds such as opiates, may limit and prevent the probability of accidental death/fatality, and consequently should be considered a beneficial alternative.

Side effects are evident in majority of mainstream drugs in the current market, just as there are people who exhibit allergic reactions, intolerance, and/or have the predisposition of an addictive background.

These factors are managed and reviewed ongoing during the commencement of any pain management regime, and have long been a regulated method of monitoring medications, understanding hazard management and avoiding any circumstance that may pose risk of abuse or misuse to the patient.

Precise strains, developed as a medicine, in specific measured doses and reproducible formulas, are also reinforced with all medicine, as the aim is to avoid or prevent elements of high risk.

Thus, it seems quite simple to consider that when prescribing medicinal cannabis for chronic pain, the same existing frameworks and regulatory compliance methods could easily be implemented, and utilised to minimise peril.

Consequently, the argument in regard to safety and risk of medicinal cannabis is ultimately void.

It should not be this complex!!!!!!!!!

It is essential we prioritise those who require urgent management of their suffering, thus reinstate a meaningful life to those who live in chronic, unremitting, daily agony.

In accordance with the introduction of any new medicine, an educational scheme needs to be instigated for all Medical Practitioners and Specialists who shall prescribe medicinal cannabis.

Adequate knowledge is crucial in providing information regarding the most superior available cannabis medicine best used for the treatment of chronic pain in the older population, prescription methods and preferred forms of administration.

Then prescribers may easily regulate and monitor as per proper process and regulatory compliance.

Furthermore, there can be no excuses based on ignorance once people are well educated.

It seems that the law continues to complicate an issue that admittedly requires careful consideration, but is not as intricate as it seems.

The negative impact current rigid ideals have on this area, remain evident.

Australians cannot ignore the progression of other countries, since by disregarding this evidence, we postpone the capacity to assist our older population in the present, and therefore prolong their suffering if we do not act accordingly.

Surely if Australians are not bound by old archaic ideals, we can initiate a successful strategy that enables us to follow in the footsteps of other forward-thinking countries who have successfully introduced the use of medicinal cannabis as a therapeutic pharmaceutical to benefit the population who require it.

There can be no excuses in permitting the continuation of a system that disregards the needs of those who deserve the benefits of medicinal cannabis to assuage pain and misery.

Time is not always on the side of those who agonize, thus we do not have the right to ignore this potentially lifesaving treatment, disregarding the unending suffering of older Australians.

The harsh ramifications of these decisions are discriminating and negligent.

This argument is so compelling it cannot be ignored.

We must challenge why people continue to waste valuable time overthinking and demonising the healing properties of cannabis.

Let us make a stand and give a voice to and advocate for more empathetic approaches that will benefit our population, alleviate suffering and maximise dignity, value, and quality of life.

We cannot tolerate this unacceptable ongoing cruelty to humanity!!!!!!!!!!!!!!

“Consider, the present alternative, which is, we continue ignoring the significant benefits of cannabis, and refuse to contemplate the countless areas where traditional medicine is ineffectively managing critical conditions. We must provide a united front in advocating medicinal cannabis as an innovative solution and way forward within the convoluted realms of modern medicine by challenging and dispelling the myths and attitudes associated with cannabis, and reinforcing, what we have recognised as the beneficial attributes associated with this natural plant”.

© Leah Bisiani – Uplifting Dementia: Oct.2017

 

Leah Bisiani – MHlthSc/Dementia Consultant/RN.1

“Uplifting Dementia” 30.10.2017

Uplifting Dementia

 

 

References:

  1. Brennan F, Carr DB, Cousins M. Pain management: a fundamental human right. Anesth Analg. 2007; 105: 205 – 21
  2. Dworkin RH, Panarites CJ, Armstrong EP, Malone DC, Pham SV. Health care utilization in people with postherpetic neuralgia and painful diabetic peripheral neuropathy. J Am Geriatr Soc. 2011;59(5): 827–836
  3. Breivik H, Eisenberg E, O’Brien T. The individual and societal burden of chronic pain in Europe: the case for strategic prioritisation and action to improve knowledge and availability of appropriate care. BMC Public Health 2013; 13: 1229
  4. CK Tan E, Jokanovic N, PH Koponen M, Thomas D, N Hilmer S, Simon Bell J. Prevalence of analgesic use and pain in people with and without dementia or cognitive impairment in aged care facilities: a systematic review and meta-analysis. Curr Clin Pharmacol 2015; 10: 194 – 203
  5. Teno JM, Weitzen S, Wetle T, Mor V. Persistent pain in nursing home residents. JAMA 2001; 285: 2081
  6. Fox PL, Raina P, Jadad AR. Prevalence and treatment of pain in older adults in nursing homes and other long-term care institutions: a systematic review. CMAJ 1999; 160: 329 – 333
  7. Takai Y, Yamamoto-Mitani N, Okamoto Y, Koyama K, Honda A. Literature review of pain prevalence among older residents of nursing homes. Pain Manage Nurs 2010;11: 209 – 23

 

 

Be the change that you wish to see in the world

When in conflict, we tend to think us and them, we are good they are evil. That separation is an illusion. On a deep collective consciousness level, we are one, regardless of whether we believe in it or not. It is like the force of gravity, it is there and always has been even though until Newton we didn’t know about it.

We are one organism and therefore we need to start talking and communicating. We need to let go of vested interests and start working for the highest benefit of everyone involved. I know a lot of people here would comment that it sounds like utopia. I believe it is a very practical way of living.

We can see everywhere how our current way of thinking is destroying the environment, we are killing ourselves. The short sighted, vested interests that led to the prohibition of cannabis, that chose Edison over Tesla, synthetic drugs over herbal medicines, the right to choose our own medicine and the way we want to heal ourselves, continue ruling this world.

Why are we told that other members of our society, the ones in power know what’s best for us more so than ourselves? In this context, do we really live in a free, democratic society or is this just an illusion?

Why do our politicians appear to be stuck in this old narrow minded way of thinking? However, in saying that I don’t think about them from a point of hate or aggression. They are part of this amazing organism called humanity and we are all in it together.

Someone said that our society invests a lot of money to keep us asleep. It is our choice to wake up to who we really are. Waking up applies to everyone, we must evolve and grow.

I believe, we can take the best out of many approaches, we need structure and rules, after all we are not a society of enlightened beings but at the same time the structure needs to be balanced, otherwise it becomes impossible to achieve anything. Going through tonnes of paperwork can be very demoralising.

The excessive red tape is an indication that as a society, we simply don’t trust each other, everything needs to be on paper just to cover ourselves. We need to let go of that. We need to teach our children emotional intelligence, communication, education and awareness. So, they will make the right choices not out of fear of penalty but out of wisdom and connection with who they really are.

Humanity is undergoing huge changes, we are constantly observing the forces of violence, destruction and senseless exploitation of our earth, depression, anxiety, loss of community connection, we are so lonely, we are craving love, we want to be embraced and healed. Where do we go from here?

We need to make choices that serve us and those around us. It is each person’s responsibility to contribute. We need to stand up and in an assertive, peaceful way state loud and clear what we believe in.

I strongly believe in the Gandhi way:

“Be the change that you wish to see in the world.”

Cannabis and Society

What we are witnessing now is the cannabis global phenomena. It somehow divides society, there are supporters and opponents. Opponents appear mostly on the regulators and policy makers side while the community embraces this plant wholeheartedly.

There is still a lot of stigma and misunderstanding. It’s a miracle drug for some and perhaps not so helpful for others while some are unable to tolerate it at all. To me cannabis is in some way a reflection of our society. On one hand we are experiencing great technological advances and connect so much in cyberspace, on the other hand we are becoming more and more lonely, alienated and depressed and we are longing for more connection with nature.

We want to reconnect, we want a clean environment, wholesome organic food, clean air and we want to heal in a way which is congruent with what we believe in. We want to exercise our right to choose our therapies. We are becoming tired of single molecule synthetic agents, we are looking for wholistic plant medicines that interact with us on multiple levels.

Cannabis is one of these plants, it can help so many medical conditions by interacting with many cells in our bodies. We know that the list of possible therapeutic applications is long. However, like with many things this plant is to be used but not abused.

The current availability of cannabis through legal channels continues to be very difficult. It appears that bureaucracy is ruling here big time. I understand the need to have some regulating systems in our society but at the same time when these systems become excessive it leads to stagnation and stops progress.

Sometimes, I think that bureaucrats are detached from reality, they sit in their offices, create more and more policies, which are so convoluted that you need a university degree to understand. They lack compassion, these people are not talking to real people and their needs, they just keep on creating more papers.

I really hope that common sense will eventually prevail and our policy makers will become more connected with real people. In the case of cannabis I am hoping that it will become accessible and affordable to people who need it and doctors like myself will be able to prescribe it judiciously and responsibly in a proper clinical setting.

It’s time for patients to stop needing to break the law and pay tonnes of money to obtain their medicine.

Can Cannabis Help My Patient?

I met this man about 2 months ago. He is in his late forties. He is highly educated and used to be fully functional, working a full-time job, family, children, the usual stuff.

Then, things started changing, insidiously.

One morning, while he was running, he simply fell sideways, just like that, no reason.

He became wobblier, gradually his coordination and balance changed, his sleep became poor, he became more anxious and started avoiding social contacts.

His speech became more slurred and his muscles sore and stiff.

All of that getting worse and finally diagnosed with some neurological condition, possibly neurodegenerative, and there is practically no treatment available apart from symptoms control.

He approached me and ask me to look into obtaining cannabis through the TGA and here we go, the whole circus. Not only do I have to go through them but I also need to apply to the State Health Department as well, repeat the same process and because he lives in another state I need to apply to both departments. Please, tell me which busy GP is willing to do that.

I feel that until this process is simplified medicinal cannabis in Australia doesn’t have to much chance.

On top of that I need the letter of support from his specialist. Took us about 2 months to convince his specialist to do that.

Although, there is no other treatments available, his specialist doesn’t really believe that cannabis would help in spite of plenty evidence available.

I feel rather disappointed with specialist’s attitude to medicinal cannabis, they appear quite rigid and unsupportive.

In cases like this one, what do we have to lose. I believe nothing and a lot to gain.

Even if it doesn’t help, it is not going to hurt, especially a low THC and high CBD preparations.

Once again, we really need to have more compassion and let go of the dogma and biased opinions.

After all there is no reported deaths due to cannabis overdose, which really is in line with Hippocrates oath, do no harm.

Relieve The Unnecessary Suffering And Early Preventable Deaths

This week I want to introduce truly amazing person Leah Bisiani.

Leah is a dementia consultant. She is a lady of great integrity, compassion, wisdom and knowledge, she really cares for people with dementia.

This debilitating condition can effect any of us or our family members anytime.

It is our responsibility as individuals and society to ensure that this people receive proper care with love and dignity.

And that’s what Leah is all about. I feel very honoured to have met this wonderful lady.

Please, check her website Uplifting Dementia

Below is an anonymous article written in September 2017, Victoria, Australia.

Highly Restricted Access To Medicinal Cannabis

Medicinal cannabis (MC) is an extremely safe and effective Herbal Medicine. Enough is known about MC for GPs who are very open-minded and very willing to be trained in its safe and effective use to prescribe it. There is an abundance of evidence to support its use as a very safe and effective herbal medicine of first choice in many conditions. The AMA line that not enough is known about MC is not factual. It is misleading and potentially very harmful.

One of the main problems in Australia is that MC is classified as a narcotic and schedule 8 drug. There is an extremely difficult, time consuming and onerous process at both state and federal levels that the doctor has to go through to obtain permission to prescribe MC. Even the most conscientious and senior GPs are very reluctant to get involved. They claim that it makes absolutely no sense for them to have to justify to a bureaucrat in Canberra their reason for
wanting to prescribe MC when it is easier for them to reach for their prescription pads and prescribe an ineffective and addictive opiate medication.

The solution to this is for the government to classify Medicinal Cannabis as a
Complementary Medicine, where it properly belongs. A directive of such importance should come from the Minister and/or the Prime Minister. This makes common sense and its effect will be widespread compassion.

Over 3 million Australians are affected by the Chronic Pain Syndrome. The treatments available to them are opiates and antidepressants; neither of which are satisfactory for the majority of patients. MC is safe and effective in the management of chronic severe pain and its not addictive. It may allow patients to reduce their dosage of opiate medication.

Chronic pain is costing Australians and their government in terms of suffering, premature deaths and ongoing related costs, over $50 billion dollars a year.

Medicinal Cannabis Is Herbal, Complementary Medicine

Medicinal cannabis is an unregistered medicine in Australia. This makes absolutely no sense to experts in the science of herbal medicine. Medicinal Cannabis is made from the flowers and other parts of the Cannabis sativa/indica plant-just like other herbal medicines on the Australian market. The extraction of the active ingredients is the same or similar to all other herbal medicines.

Herbal medicines in Australia are classified as Complementary Medicines and are regulated by the TGA. The Australian government’s medicines policy clearly states that medicines should be of high quality, safe, effective AND available in a timely manner. Currently, these conditions cannot be assured.

There is also provision for traditional usage. Therefore, medicinal cannabis as a Complementary Medicine, qualifies as a listable medicine. It has a traditional usage going back 8,000 years. It has a history of use in Australia for pain, spasms and migraine until the late 1930’s. It also has proven scientific and clinical uses for the management of intractable epilepsy in children, neuropathic pain, anorexia , nausea and vomiting in cancer patients receiving chemotherapy, and muscle spasms in patients with MS.

It has much wider use in the communities educated in the science of MC.

As a listed medicine, it can be manufactured in Australia as a Complementary Medicine retaining the high standards Australia has of quality and safety. This will minimise the current illicit use of imported products of dubious safety and quality.

The solution is to give it a special classification as a complementary medicine, to be prescribed by qualified GPs. An “Aust C” as distinct from Aust R and Aust L needs to be considered.

Australia Is Way Behind Canada And Europe

Medicinal cannabis is going to be a multi billion dollar industry and it one of the fastest growing industries in the world.

Australia is 16 years behind Canada and a generation or two behind Israel. There is massive investment in the industry in these countries. Australia is lagging behind because of regulatory over-reach.

The Australian government has not had properly qualified and experienced advice in the matter of Medicinal Cannabis, from the plant to the patient.

There is a lot of activity here in Australia now but it is chaotic and poorly planned. A powerful yet extremely safe herbal medicine for the patients who need it is beyond their reach.

The solution is to establish a separate ministry to look after the interests of the agribusiness sector, the manufacturing sector, the specialised research and development and the medical centres specialised in its use. I doubt this will occur so I remain pessimistic about Australia even being in the race. We are certainly nowhere near the leadership.

It is cruel to maintain the status quo. It is unethical for doctors to not plead a case for significant change. It is negligent to exclude specialists with qualifications and experience in MC from governmental advisory committees.

Surely it is not difficult for a leader to draw up the legislation to

RELIEVE THE UNNECESSARY SUFFERING AND EARLY PREVENTABLE DEATHS
(It is immoral for our political system to do little or nothing)