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.

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