VOLUME I EXECUTIVE SUMMARY (2000)
Introduction: The use of cannabis for medical or any other purposes is currently prohibited in all Australian States and Territories, although penalties for possession and use differ between jurisdictions.
Over the past decade, there has been considerable controversy about the possible therapeutic uses of the Cannabis sativa plant, and the chemical substances (cannabinoids) it contains, for patients with certain medical conditions.
This report on the therapeutic potential of cannabis has been prepared by a group of clinicians, lawyers and researchers, who were asked to advise the NSW Government on:
- whether the NSW government should allow patients with some medical conditions to use cannabis for medical purposes; and
- if so, how this might be achieved without legalising or decriminalising the recreational use of cannabis.
In examining these issues, the Working Party:
- consulted two major reports, published recently in the US (The US Institute of Medicine) and UK (The House of Lords Select Committee on Science and Technology), on the medical uses of cannabis;
- analysed submissions received from interested parties;
- examined the scientific literature on the safety and effectiveness of cannabis and its constituent cannabinoids for medical purposes;
- considered the legal and logistical issues that would arise if cannabis were to be used for certain medical conditions; and
- explored ways in which cannabis and cannabinoids might be made available to people with certain medical conditions without contravening existing Commonwealth and State law or the international drug control treaties to which Australia is a signatory.
Recent reports on the therapeutic value of cannabis: The Working Party consulted two recent reports the medical uses of cannabis and cannabinoids – one from by House of Lords Select Committee on Science and Technology (SCOST) in the UK, and the other from the Institute of Medicine (IOM) in the US. Both reports found that cannabinoids have potential for use with certain medical conditions and that there was a need for further research on the clinical uses of crude cannabis plant products and cannabinoid compounds.
The reports also recommended that, while awaiting the results of this research, cannabis be made available on compassionate grounds to patients with a limited range of life-threatening and chronic health conditions, where there is evidence to suggest that they may benefit from its use. The nominated medical conditions included: HIV-related wasting; nausea and vomiting caused by cancer chemotherapy; neurological conditions such as Multiple Sclerosis; and pain unrelieved by conventional analgesics.
Submissions to the Working Party: The Working Party received many submissions (both invited and volunteered) from a wide range of interested parties, including: drug and alcohol interests; pharmaceutical interests; professional health and welfare associations; and community based health and welfare bodies. These submissions covered the following issues:
- the pharmacology of cannabis
- current cannabis use by patients
- health risks (with a heavy emphasis on the risks of smoking cannabis)
- methods of administration
- value of cannabis for certain medical conditions
- legal issues (supply and availability of cannabis )
- effects of current criminal sanctions on both patients and health professionals
- community education
The following is a summary of key points.
- Cannabis is a crude plant product, which contains a complex mixture of many chemicals. This makes production of a standard cannabis product extremely difficult, as it is not clear which chemicals are responsible for particular therapeutic effects. Cannabis smoke also contains a variety of substances that are dangerous to health.
- In Australia, cannabis use for medical purposes is reported to be common among gay men who are HIV positive and people with cancer.
- The health risks of cannabis use need to be considered. These include the adverse effects of cannabis on motor skills and on the mental health of vulnerable individuals. These health risks should not rule out the use of cannabis for medical reasons, but they must be taken seriously, particularly if long-term cannabis use is being considered for the treatment of a chronic condition.
- Several submissions noted that the use of cannabis by smoking posed health risks; others noted that smoking allowed better dose titration than other routes of administration, such as eating. Many submissions recommended that other ways of taking cannabis for medical purposes, or alternative cannabinoid products, should be developed.
Submissions which advocated medical use of cannabis did so on the basis that cannabis may be appropriate as:
- an anti-nausea agent during chemotherapy when first-line treatments have failed;
- a treatment for wasting conditions and appetite loss among patients with cancer and HIV/AIDS;
- a treatment for chronic pain.
- There were conflicting ideas on the use of cannabis in multiple sclerosis and chronic conditions involving muscle spasticity.
- There was little support for the use of cannabis to treat glaucoma, because of the high doses required and the need for chronic use to control the underlying disease process.
Several submissions recommended that cannabis be supplied for medical purposes and gave the following comments/suggestions:
- obtaining an illegal substance placed an additional burden upon ill persons;
- registered growers/buyers’ co-operatives were proposed as a supply source;
- legislative changes were suggested to remove legal sanctions against medical cannabis users.
- Several groups supported the idea that cannabis should be prescribed by authorised practitioners.
- Those who were opposed to the medical uses of cannabis were concerned about the social implications, particularly the possibility that medical use may promote recreational use.
- Almost all submissions supported further research and clinical trials to obtain more information about the medical benefits of cannabis use.
The approach adopted by the Working Party: In describing its inquiries and recording its conclusions about the feasibility of using cannabis and cannabinoids for medical purposes, the Working Party divided the subject into two key areas:
- medical and therapeutic issues;
- legal and logistical (or regulatory) issues.
For clarity and consistency, the Working Party’s findings and recommendations are similarly divided, even though many of the issues are interconnected and there are inevitable areas of overlap.
The division into two key areas was logical, since the substance of the Working Party’s recommendations concerning the use of cannabis for medical purposes will determine the legal and logistical issues likely to arise and how these issues should be addressed.