Buzz Feed reports……
Experts on both sides of the medicinal cannabis debate are arguing over an editorial published in the Medical Journal of Australia (MJA) that has been labeled “scaremongering” and “patronising”.
The niche corner of social media devoted to medicinal cannabis was ablaze on Monday after the MJA published a story from the Royal Australasian College of Physicians (RACP) – which represents over 25,000 medical specialists and trainee specialists – that warned about the effects of the drug. The paper was reported on by multiple mainstream outlets, including the Australian, the Guardian, SBS, and the Australian Journal of Pharmacy.
The piece, Compassion and evidence in prescribing cannabinoids: a perspective from the Royal Australasian College of Physicians, declared the usual medical research standards had not been met when it came to cannabinoids and warned doctors to be wary when prescribing the drug. Currently, around 500 people have legal access to medicinal cannabis – shy of the 100,000 estimated to use it illegally.
Co-authored by University of Newcastle’s Jennifer Martin, who runs the Australian Centre for Cannabinoid Clinical and Research Excellence, the editorial inspired streams of debate online.
On Twitter, the ANU Medical School’s Dr David Caldicott said the opinion piece was “poorly referenced, misleading, and certainly does not reflect current global practice”.
However, the Australian Medical Association president, Dr Michael Gannon, called the editorial important.
“There are lessons from the way that cannabis is being so heavily promoted by industry to patients and [Australian politics] alike,” he wrote.
Then on Wednesday, the University of Sydney’s Professor Iain McGregor, the academic lead of the Lambert Initiative for Cannabinoid Therapeutics, wrote about the editorial in the Sydney Morning Herald.
McGregor said the piece from the RACP was a “patronising and scaremongering diatribe” that misrepresented research to avert GPs away from prescribing.
He said the claim that medicinal cannabis was no better than a placebo in treating pain had been cited by US reviews that concluded the opposite.
Further, he criticised the piece for negligence and not including the full spectrum of the research it was citing – one example being that the claim that cannabis-related hospital presentations had gone up did not mention that this largely reflects children consuming their parents’ cannabis edibles.
McGregor cited reducing deaths related to prescription opioids in American states where medicinal cannabis is available, as well as the World Health Organisation’s recent decision to declare cannabidiol (CBD) – the non-psychoactive component of cannabis – as having few health risks.
“The RACP talks of a ‘precautionary principle’ and ‘do no harm’ – but in misrepresenting the facts of medicinal cannabis it promulgates a great deal of harm,” he wrote.
When asked to respond to McGregor’s accusations of scaremongering, a spokeswoman for the RACP told BuzzFeed News the college was standing by the article and would continue to prioritise positive patient outcomes, “especially for vulnerable patient groups including terminally ill patients, children, and those suffering from mental health issues”.
“The article was authored by three physicians who specialise in clinical pharmacology, addiction medicine, and general and acute care medicine,” said the spokeswoman.
“Doctors want to see robust clinical trials done to ensure positive patient outcomes for medicinal cannabis and ensure it’s a safe and effective form of treatment.
“We would expect the same care to be taken with any new pharmaceutical.”
Medicinal cannabis activists and black-market users say they are now worried that the paper will be used as ammunition by those against increased accessibility of the drug.
“They’ve all seen that it works,” a user of medical cannabis who accesses it illegally told BuzzFeed News. “But now they have reason not to believe it.”
Neither the Medical Journal of Australia nor its editor in chief, Nick Talley, responded to BuzzFeed News’ requests for comment.
MJA Article Reference
Compassion and evidence in prescribing cannabinoids: a perspective from the Royal Australasian College of Physicians
Jennifer H Martin, Yvonne Bonomo and Adrian DB Reynolds
Med J Aust 2018; 208 (3): 107-109. || doi: 10.5694/mja17.01004
he RACP emphasises the need for caution until there is sufficient quality evidence to support the use of medicinal cannabis
The pace and scale of the introduction of medicinal cannabis are unprecedented and have raised challenges for health professionals, not so much because of its known addictive and psychoactive properties but because its introduction has not followed the usual research-based safety and effectiveness processes. These processes include pharmaceutical, animal, pharmacological and clinical research, recommended under national medicines frameworks upheld by the Therapeutic Goods Administration (TGA) in Australia and the New Zealand Medicines and Medical Devices Safety Authority (Medsafe), as well as by legislation such as the Narcotic Drugs Act 1967 (Cwlth). The Royal Australasian College of Physicians (RACP) supports timely access to products with safety and effectiveness data. However, it appreciates that there is growing community demand for prescription cannabinoids on compassionate grounds. As such, effective medical leadership and guidance is required to inform public discussion and compassionate access until the necessary data become available and more specific advice can be given.