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22 OCTOBER 2020

This week, Painaustralia released our position paper on medicinal cannabis to mixed reactions.

We recognise that consumer interest and demand for medicinal cannabis is high, and we understand that medicinal cannabis can be an appealing option of pain relief for people who have been living with chronic pain and have tried various other methods with limited success. That is why we support its availability as a potential Schedule 3 drug available over the counter. We want to see medicinal cannabis included as another option in the pain management toolkit, but this must be backed by an independent evidence base to support the effectiveness and safety of medicinal cannabis products for chronic pain.

Many of the studies that have been conducted for medicinal cannabis were funded or led by the companies that have a financial vested interest. What we need is a quality evidence base that is unbiased and built from ethical and independent sources. There are few well-designed clinical studies that support the use of medicinal cannabis for chronic pain. Without proper evidence, making medicinal cannabis more available could see millions of Australians living with chronic pain offered ‘false hope’ of a treatment option that is expensive, has limited benefit and diverts them from seeking and accessing best practice pain management.

The strongest scientific evidence is for its effectiveness in treating childhood epilepsy syndromes, such as Dravet syndrome and Lennox-Gastaut syndrome (LGS), which typically are inadequately controlled by antiseizure medications alone. These indications are the only ones that the Pharmaceutical Benefits Advisory Committee (PBAC) is considering for potential listing of CBD on the Pharmaceutical Benefits Scheme.

The incentives for the industry to fund controlled clinical research have changed with the legalisation of marijuana, and due to the provisions in the Special Access Scheme, manufacturers of medicinal cannabis products are hesitant to involve themselves in research that can demonstrate the benefits.

This is a trend that was noted in the Senate report on current barriers to patient access to medicinal cannabis in Australia, which notes evidence that large policy changes such as legalisation of marijuana have also removed incentives for the industry to fund controlled clinical research into the safety and effectiveness of cannabis based medicines. It has also not increased researchers’ access to medicinal cannabis products for investigator-initiated clinical trials.

This is why our position paper calls for more research into the use of medicinal cannabis for chronic pain. Anecdotal evidence from consumers does indicate that medicinal cannabis could potentially play a part in a holistic pain management plan that incorporates other strategies where other options are not effective or available. We need to see this evidence replicated through rigorous scientific research as well to meet the needs of consumer expectation.

We must also remember that pain is an individual experience, and treatment and management options will work differently person to person. The one approach that has shown the best benefits for most people living with chronic pain is a biopsychosocial approach – one that incorporates a variety of strategies and is actively led by the person living with pain.

Medicinal cannabis may be effective for some people living with pain however, medicines used in isolation, whether it is medicinal cannabis, opioids, or other pharmaceutical treatments, are proven to be insufficient to manage complex chronic pain conditions in the long term. If medicinal cannabis products are used for treating chronic pain, ideally they should form just one part of a comprehensive and active pain management plan.

We are also aware of access issues in Australia. Health professionals are often not armed with the knowledge or understanding to prescribe medicinal cannabis and there is particular confusion around dosage. Moving forward, education on medicinal cannabis for health professionals will be essential for productive communication and relationships with consumers.

The current cost of accessing medicinal cannabis also remains a huge barrier for consumers. Research released by the medicinal cannabis sector in Australia indicates that people living with chronic pain, who make up an estimated 60–70 per cent of the market, are paying about $350 a month for their treatment using cannabis products. Given the high cost associated with current access to medicinal cannabis products in Australia, consumers may consider alternative options such as access to medicinal cannabis products inclusive of the pyschoactive component, tetrahydrocannabinol (THC) as well as unregulated cannabis products via the black market.

Stigma is a common problem for people living with chronic non cancer pain, and a lack of understanding and access to medicinal cannabis for health professionals could cause a greater divide between the patient and health professional. We need to improve communication and understanding of chronic pain across the board, not just in relation to medicinal cannabis.

Overall, there may be merit to adding medicinal cannabis to the ‘go-to’ pain management toolbox. However, until there is stronger evidence from established, independent and evidence-based institutions, it is unlikely to be taken seriously as a legitimate treatment for chronic pain in its own right.

Unfortunately, there are no silver bullet solutions to the complex nuances of managing chronic pain.

Carol Bennett
CEO