Medicinal cannabis evidence still lacking: RACGP

In its updated position statement, Medicinal use of cannabis products, the RACGP does not recommend medicinal cannabis broadly, calling instead for more high-quality research into the safety and effectiveness of such products given that the current evidence is ‘limited and inconclusive’.
 
‘Importantly, medicinal cannabis products should only be considered when all first-line, conventional, evidence-based treatment options have been exhausted, and after detailed discussions of the potential benefits and harms of medicinal cannabis products with the patient,’ the statement reads.
 
‘The RACGP has always been a strong advocate for evidence-based medicine, and as the evidence around the efficacy and effectiveness of medicinal cannabis products evolve, this position statement will be reviewed to reflect the emerging evidence.’
 
The 2019 position statement is an update of a 2016 document following a thorough literature review. Notably, it makes no changes to the RACGP’s central recommendations.
 
The position statement lists the quality of evidence for the use of medicinal cannabis to treat conditions such as multiple sclerosis, epilepsy, palliative care, nausea and vomiting, and chronic non-cancer pain, with unclear, very low or low to moderate evidence accounting for almost all.
 
At present, only one medicinal-grade cannabis product is registered with the Therapeutic Goods Administration (TGA). The non- Pharmaceutical Benefits Scheme (PBS) listed drug, Nabiximols, is for symptom improvement for people with moderate to severe spasticity due to multiple sclerosis and who do not respond adequately to other medications. The RACGP rates the quality of evidence for this drug as moderate to high.
 
The updated position statement suggests the possible role for medicinal cannabis is in the event conventional evidence-based treatments have failed and the treating GP feels it is a viable option.
 
In such situations, ‘[GPs] should, as other specialists can, be able to prescribe appropriate medicinal cannabis products in accordance with the current regulatory framework,’ the statement reads.
 
Doctors have been able to supply medicinal cannabis to patients for specific medical conditions since 2016. There are many manufacturers, but these products must be approved by the TGA on a case-by-case basis. More than 3000 medicinal cannabis scripts have been approved by the TGA since March 2018.
 
‘GPs are faced with the pressing need to help patients who are unable to manage chronic and debilitating conditions using conventional, evidence-based treatments. Given the significant media and political coverage on medicinal cannabis products, GPs may experience greater patient demand to prescribe these products,’ the RACGP position statement reads.
 
‘However, as with all clinical decisions, GPs need to balance patient-initiated demands for treatment and the clinician’s therapeutic responsibility, while considering federal and state or territory legislative requirements before considering the prescription of medicinal cannabis products.’
 
Medicinal cannabis products are derived from the cannabis plant, which has more than 100 cannabinoid compounds. For medicinal purposes, the two main active ingredients are tetrahydrocannabinol (THC) and cannabidiol (CBD).
 
‘THC is the psychoactive part of cannabis that produces a “high”, and has been used to treat symptoms such as nausea, pain and muscle spasticity. CBD has no psychoactive properties, and has been used to treat several inflammatory disorders and epilepsy,’ the RACGP statement reads.
 
In Australia, only pharmaceutical, non-smokeable, medicinal-grade products can be supplied lawfully, including products such as Dronabinol (a synthetic form of THC), Nabilone (another synthetic form of THC), and Nabiximols (a chemically pure 50:50 mixture of THC and CBD.)
 
The position statement now includes a checklist for GPs to run through before prescribing medicinal cannabis products.

evidence medicinal cannabis position statement