Outrage over medicinal cannabis stance

man holding 'no' sign

The RACP has been criticised over its MJA article calling for caution with prescription cannabinoids

A Sydney University academic has criticised an article published on behalf of the Royal Australasian College of Physicians (RACP), saying it underreported international evidence and exaggerated potential dangers.

In the original article, the authors wrote that while there is a growing community demand for prescription cannabinoids on compassionate grounds, the usual medical research standards have not yet been met.

“While the RACP understands the community interest in cannabinoids as a therapeutic product, it emphasises that the usual regulatory processes designed to protect patients from serious harms are incomplete for medicinal cannabinoids, and that evidence for their effectiveness for many medical conditions is at present limited,” wrote Professor Jennifer Martin, Associate Professor Yvonne Bonomo and Clinical Associate Professor Adrian Reynolds.

Professor Iain McGregor, academic director of the Lambert Initiative for Cannabinoid Therapeutics in the Brain and Mind Centre at the University of Sydney, has responded saying that the piece “stokes concerns” and “neglects facts”.

“For the vast majority of Australian patients, medicinal cannabis is little more than a pipe dream and part of the problem lies with the all-too-conservative approach that relies on specialist doctors.

“Rather than providing a coherent and balanced account of the current state of play, the [RACP] ‘perspective’ reads like a patronising and scaremongering diatribe, misrepresenting the literature to frighten off would-be prescribers,” Professor McGregor, who is also an NHMRC Principal Research Fellow and Professor of Psychopharmacology, writes in a Fairfax article.

“Most egregious of its falsehoods is the statement that medicinal cannabis is no better than placebo in treating pain,” he says.

“Oddly, when asserting this claim, the published piece cites two authoritative recent reviews from the US – reviews that in fact concluded the opposite.

“This misrepresentation is no trivial issue. Some 20% of Australians suffer chronic pain and surveys shows self-medication for back pain, arthritis and neuropathic pain are major drivers of illicit cannabis use in the Australian community.

“Those in unremitting pain are precisely the people who need their specialist doctors to have a nuanced and accurate knowledge of cannabinoid science.”

Professor McGregor says that the RACP chose to focus on reports of potential side effects of cannabidiol in children given extremely large doses of the compound to treat severe epilepsy.

“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 suggests that GPs, rather than specialists, could be the future gatekeepers of medicinal cannabis.

“Rumblings from Canberra – that regime change might indeed bring GPs into a new system where they act as medicinal cannabis gatekeepers – could be just what the doctor ordered,” says Professor McGregor.

“After all, if GPs are entrusted to prescribe opiates and benzodiazepines, why not medicinal cannabis products?”

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