Cannabis has role to play in the fight against cancer

by Wilmot James

DAYS before Mario Ambrosini’s heart-wrenching death on August 16 2014, he called some close colleagues (among whom I had the honour of being counted) to his bed and asked them to take on the fight to find a cure for cancer and have cannabis legalised for palliative care.

I knew Ambrosini since 1995 when, on behalf of Mangosuthu Buthelezi, who was home affairs minister at the time, he oversaw my task as chairman and, with Queens University’s Jonathan Crush, co-drafter of the green paper on international migration, which gave rise to SA’s Refugees Protection Act and Immigration Act. More recently, Ambrosini and I were co-founders of the Parliamentary Institute of SA, which went — appropriately, given his Italian ancestry — by the acronym Pisa.

Ours was a fiery relationship and we had some heated debates. The temperature did not moderate even when we disagreed about what causes cancer, a puzzle of science tragically personified by the visible and unstoppable deterioration of such a lively and clever man in front of our eyes.

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AS WAS his habit, Ambrosini researched the topic extensively and came away disillusioned by the health-pharmaceutical-medical complex’s inability, billions of rand later, to find real answers to what are cancer’s unsolved science mysteries.

As public representatives, the best we can do in pushing the cancer-cure agenda is ensure that our health science community is fully supported by Parliament in its efforts to find solutions.

I recommended then, as I do now, that SA establish our equivalent of the US Mayo Clinic Cancer Centre, a specialist health facility that focuses on cancer indications that afflict our population. It is a long-term goal for which we must build traction.

We are able to tackle with immediate effect the therapeutic uses to which cannabis can be put. When Ambrosini’s Medical Innovation Bill came before the portfolio committee on health, the Medical Research Council (MRC), having done a systematic review of the medicinal uses of cannabis (published as "Cannabinoids for medical use" in the Journal of the American Medical Association in June 2015), established that there is some (moderate) evidence that patients using cannabinoids experienced less pain up to a certain threshold.

It also has some (low) evidence of diminished nausea and vomiting of patients undergoing chemotherapy; some (low) evidence that cannabinoids stimulate appetite, resulting in weight gain among HIV-positive patients; and some (moderate) evidence of improved muscle tone among patients on cannabinoids suffering from multiple sclerosis or paraplegia.

The MRC review makes a weak to moderate but still a reasonable case that cannabis extracts modulate pain. We are under a strong ethical obligation to do whatever we can to reduce pain. We know that when it becomes severe, the administration of opioids (such as morphine) often forms part of the palliative care regimen, as per clinical guidelines.

In Ambrosini’s case, as with many others, even morphine did not help in the end, leading him to take his own life. This raises the question of assisted suicide and voluntary euthanasia, steps that pose monumental and unresolved ethical difficulties for most societies the world over and must remain one of those difficult dialogues for another occasion.

But the use of cannabinoids for palliative care is, in my view, ethically clear-cut.

Much as I admired Ambrosini’s cause, the vehicle he chose to advance it, the Medical Innovation Private Members’ Bill, is an unnecessarily complex and cumbersome route to get us there. There is no need for new legislation.

Instead, what is required is to have the Medicines Control Council schedule a safe and effective cannabinoid-derived drug as a prescription medicine for particular clinical indications, such as cancer.

The problem is that there is no quality drug available locally to prescribe. Either they must be imported, or candidate drugs developed locally, but they must comply with a set of rules.

They should come in an ingestible form, as an oil or a pill to be swallowed rather than smoked, smoking being potentially carcinogenic; they should consist of compounds that can be biochemically standardised; and should be registered as a medicine, based on clinical trials or a dossier that complies with strict regulatory requirements and control council approval.

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IN SOME countries cannabinoid-containing medicines are prescribed by doctors for specific conditions, including Austria, Canada, Czech Republic, Finland, Germany, Israel, Italy, the Netherlands, Portugal, and Spain, some of which have legalised cannabis use in general.

In more than half of the US states, cannabis has been decriminalised and/or prosecutions ceased. In California and Colorado cannabis and cannabis products are distributed for medical and recreational use.

As with other medicines, there are side effects that must be eliminated or reduced to tolerable levels in the final product. The Medical Innovation Bill should be withdrawn and replaced by an effort to produce, register, and schedule a cannabinoid drug as a prescription drug for well-defined clinical indications.

In the next few months, the DA will be calling on Health Minister Aaron Motsoaledi to encourage companies to bring a suitable cannabinoid-derived drug to the Medicines Control Council for approval.

While my late friend and colleague Ambrosini might not agree precisely with our methods, I am sure he would approve that we are taking the case for medical marijuana forward.