Many doctors would welcome ability to prescribe cannabis

A doctor writes: Drug can help patients who are suffering but evidence is unclear

Cannabis for medicinal use is legal in the Netherlands, Spain, the Czech Republic, Australia, Canada and some US states. Photograph: Matthew Staver/Bloomberg

Cannabis for medicinal use is legal in the Netherlands, Spain, the Czech Republic, Australia, Canada and some US states. Photograph: Matthew Staver/Bloomberg

 

While not exactly on the cusp of legality, the prospect of medicinal cannabis becoming a reality here has drawn considerably closer with the Government’s decision to facilitate a Bill put forward by People Before Profit TD Gino Kenny.

Minister for Health Simon Harris has confirmed he will not progress the Bill beyond this second stage until a review of the issue was completed by the Health Products Regulatory Agency (HPRA).

Cannabis for medicinal use is permitted in the Netherlands, Spain, the Czech Republic, Australia, Canada and a number of US states. In some jurisdictions, people are licensed to grow cannabis plants to meet their medical need; however legislation here is more likely to support the prescribing of a pharmaceutical version of the drug.

The Republic already licenses one cannabis-based medicine – Sativex – for the treatment of multiple sclerosis. However, a doctor may only prescribe cannabis products if granted a licence by the Minister for Health. Similar contradictions exist in the US, where despite medicinal cannabis being made legal in over 20 states, the federal government treats cannabis and its derivatives as Schedule 1 drugs, which precludes their prescription by doctors who operate under a federal medical licence.

A Limerick doctor, William Brooke O’Shaughnessy, is credited with introducing the therapeutic use of cannabis to western medicine in the 19th century for a range of complaints from anxiety to painful menstruation.

Chemotherapy

In modern medicine, a cannabis derivative, nabilone, is used to treat nausea and vomiting brought on by chemotherapy treatment in cancer patients. Cannabis has been shown to reduce the increased pressure in the eyeball that leads to glaucoma.

Patients with multiple sclerosis(MS) say medicinal cannabis reduces muscle cramps and relaxes bladder and bowel sphincters. Sativex, which contains two active cannabis derivatives, is an oral spray that has been shown to improve symptoms in MS patients with moderate to severe spasticity.

Cannabis contains two chemical compounds of medical interest: tetrahydrocannabinol (THC), the psychoactive ingredient in marijuana/cannabis that leads to the “high” sought by recreational users of the drug; and cannabidiol, or CBD, a non-psychoactive component that has been shown to have a number of therapeutic benefits.

A campaign here to make medicinal cannabis available for patients with difficult to treat seizures is based on anecdotal evidence from the US of a preparation high in CBD and low in THC. Dr Colin Doherty, an epilepsy expert at St James Hospital, has said there is growing evidence for the effectiveness of CBD and initial studies were encouraging, but not definitive. However a recent review in the New England Journal of Medicine concluded that “current data from studies in humans are extremely limited, and no conclusions can be drawn”.

Cannabis is not without side effects; however many doctors would welcome the opportunity of prescribing it for certain people with specific illnesses.

For that to happen means lining up several legislative ducks in a row so that cannabis product licensing is in line with legal prescribing by doctors while maintaining some restriction on the recreational availability of the drug.

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