Ireland, like many other countries, stands on the verge of easing patients' access to medicinal cannabis. Still, even as some users report dramatic health benefits, doctors are proceeding with caution. Our reporter asks why
It has become a highly-charged emotional issue, debated in the Dáil and
played out on social media with prominent campaigns attracting national
headlines.
There is a growing clamour for greater access to medicinal cannabis
for patients with debilitating conditions, and in particular children
suffering from certain types of epilepsy.
Health Minister Simon Harris has come under intense pressure to make certain cannabis treatments more widely available.
Last November, the Dáil passed a bill tabled by People before Profit TD Gino Kenny to make cannabis available in Ireland for medicinal use, after the Government said it would not oppose the legislation.
Last November, the Dáil passed a bill tabled by People before Profit TD Gino Kenny to make cannabis available in Ireland for medicinal use, after the Government said it would not oppose the legislation.
As a result, certain cannabis treatments are likely to be made more widely available under a special access programme.
But many health organisations and medical consultants urge caution when it comes to medicinal cannabis, and warn that there are dangers if the drugs are permitted here without sound scientific evidence.
But many health organisations and medical consultants urge caution when it comes to medicinal cannabis, and warn that there are dangers if the drugs are permitted here without sound scientific evidence.
Dr Brian Sweeney, consultant neurologist at Cork University Hospital,
says: "Drugs have to be produced to a standard, with evidence that they
work. We cannot just do it based on emotion. It has to be based on
science."
Doctors warn that there is a danger of a free-for-all, with patients self-medicating, using unregulated cannabis-based products for a wide variety of illnesses.
Doctors warn that there is a danger of a free-for-all, with patients self-medicating, using unregulated cannabis-based products for a wide variety of illnesses.
In a culture where recreational use is widespread and health advice
often received on the basis of anecdote and hearsay, users may even form
the belief that they can cure a wide variety of ailments by smoking
joints, without regard to the side effects.
"If you get something from a local hemp oil shop or your local drug dealer, you don't know what is in it, and how powerful it is," says Dr Sweeney, who treats patients with multiple sclerosis (MS).
"If you get something from a local hemp oil shop or your local drug dealer, you don't know what is in it, and how powerful it is," says Dr Sweeney, who treats patients with multiple sclerosis (MS).
He warns of the particular danger of some synthetic cannabis drugs
"There is a synthetic cannabinoid that has been available in recent years that can have a devastating effect."
He cites a recent medical paper reporting an incident in Brooklyn New
York, where a cannabinoid drug was taken and 40 people ended up in an
"almost coma-like state".
When analysis of the drug was done, it was found to be 85 times as potent as plant-grown marijuana.
When analysis of the drug was done, it was found to be 85 times as potent as plant-grown marijuana.
Doctors are coming under pressure to prescribe cannabis-based drugs,
such as cannabidiol (CBD), a compound from cannabis which is now being
used in medicines.
"What if the drug was found to be harmful?" asks Dr Brian Sweeney. "If a doctor prescribed the drug and a patient died two weeks later, people could turn around and say that the doctor should not have given it.
"What if the drug was found to be harmful?" asks Dr Brian Sweeney. "If a doctor prescribed the drug and a patient died two weeks later, people could turn around and say that the doctor should not have given it.
"We have to follow ethical guidelines. We have to use drugs with
proper standards, care, and safety. We have to be aware of the side
effects and interactions with other drugs."
Dr Sweeney is not against cannabis-based treatments provided that they have been fully tested, in the same ways as ordinary drugs. As a consultant, he has occasionally prescribed Sativex to MS patients.
Sativex is a drug that contains the cannibanoids tetrahydrocannabinol (THC) and cannabidiol (CBD).
Dr Sweeney is not against cannabis-based treatments provided that they have been fully tested, in the same ways as ordinary drugs. As a consultant, he has occasionally prescribed Sativex to MS patients.
Sativex is a drug that contains the cannibanoids tetrahydrocannabinol (THC) and cannabidiol (CBD).
It is
recommended for treatment of spasticity that has not responded to other
treatments. The drug has been licensed in Ireland since July 2014, but
much to the frustration of Dr Sweeney and other neurologists, it is not
yet available in Ireland because the HSE and the drug's producers cannot
agree a price.Some of Dr Sweeney's Irish patients have picked up
Sativex in Spain or in Northern Ireland.
Earlier this year, a government-commissioned report on medicinal cannabis said it could be used to treat some patients for a limited number of conditions.
The report from Health Products Regulatory Authority (HPRA) advised that it could be used for patients with:
Earlier this year, a government-commissioned report on medicinal cannabis said it could be used to treat some patients for a limited number of conditions.
The report from Health Products Regulatory Authority (HPRA) advised that it could be used for patients with:
* Spasticity associated with multiple sclerosis that
is resistant to all standard therapies and interventions whilst under
expert medical supervision.
* Intractable nausea and vomiting associated with chemotherapy despite the use of standard regimes whilst under expert medical supervision.
* Severe, treatment-resistant epilepsy that has failed to respond to standard anticonvulsant medications whilst under expert medical supervision.
* Intractable nausea and vomiting associated with chemotherapy despite the use of standard regimes whilst under expert medical supervision.
* Severe, treatment-resistant epilepsy that has failed to respond to standard anticonvulsant medications whilst under expert medical supervision.
While the report is likely to lead to certain cannabis-based
treatments being made legal, the report's authors do not give an
enthusiastic endorsement of the widespread medical use of the drug.
The report says there is only a "moderate benefit for cannabis in a small number of conditions and conflicting evidence, or no evidence at all, in a large number of other medical conditions".
The report says there is insufficient information on the safety of long-term cannabis use for medical treatment.
The report says there is only a "moderate benefit for cannabis in a small number of conditions and conflicting evidence, or no evidence at all, in a large number of other medical conditions".
The report says there is insufficient information on the safety of long-term cannabis use for medical treatment.
But the panel of experts who compiled the report signal some of the side effects of recreational use.
These include impaired short-term memory and coordination, psychiatric features of psychosis (including schizophrenia and paranoia), addiction and altered-brain development.
This week, a group of Irish neurologists led by Dr Colin Doherty, announced that it was producing guidelines on safe and beneficial use cannabis-based drugs for treatment of epilepsy.
These include impaired short-term memory and coordination, psychiatric features of psychosis (including schizophrenia and paranoia), addiction and altered-brain development.
This week, a group of Irish neurologists led by Dr Colin Doherty, announced that it was producing guidelines on safe and beneficial use cannabis-based drugs for treatment of epilepsy.
Dr Doherty said certain cannibanoids showed promise in the treatment
of severe epilepsy, but others are inadequately tested or known to be
potentially harmful.
"It is our solemn duty to ensure that all treatments are proven to beneficial and safe," said Dr Doherty. "This is particularly important when a new drug is used in a child's developing brain."
The cannabis-based drug Epidiolex is expected to be available later this year on compassionate grounds through a government-access programme.
"It is our solemn duty to ensure that all treatments are proven to beneficial and safe," said Dr Doherty. "This is particularly important when a new drug is used in a child's developing brain."
The cannabis-based drug Epidiolex is expected to be available later this year on compassionate grounds through a government-access programme.
The drug, which has not yet been fully approved by American and
European regulators, was reported in trials to have cut down seizures by
39pc for certain types of severe epilepsy.
Side effects during the Epidiolex trial included sleepiness, diarrhoea and decreased appetite but were mostly mild or moderate, according to the manufacturer's reported results.
Dr Doherty said no other cannabis derivatives or products for epilepsy have been adequately tested as safe and effective, including products with THC (the cannabis compound with potentially harmful psychoactive effects)."
One of the problems for doctors and patients is that cannabis is not like any other drug.
Side effects during the Epidiolex trial included sleepiness, diarrhoea and decreased appetite but were mostly mild or moderate, according to the manufacturer's reported results.
Dr Doherty said no other cannabis derivatives or products for epilepsy have been adequately tested as safe and effective, including products with THC (the cannabis compound with potentially harmful psychoactive effects)."
One of the problems for doctors and patients is that cannabis is not like any other drug.
There is a whole sub-culture that clings to it. Side by side with the
campaign to legalise medicinal cannabis, is a movement to have it
legalised for recreational use.
"One of the problems is that there is still massive confusion and misunderstanding over what medicinal cannabis is," says Peter Murphy, chief executive of Epilepsy Ireland.
"There is a huge distinction that has to be made about what people think of as a medical treatment. Are they talking about a drug that has been fully tested again and again in a clinical trial, and authorised?
"Or are they talking about a potion or a preparation that is not pharmaceutical that may or may not have good quality control behind it?"
He believes much of the misinformation is spread on social media."One of the problems is that there is still massive confusion and misunderstanding over what medicinal cannabis is," says Peter Murphy, chief executive of Epilepsy Ireland.
"There is a huge distinction that has to be made about what people think of as a medical treatment. Are they talking about a drug that has been fully tested again and again in a clinical trial, and authorised?
"Or are they talking about a potion or a preparation that is not pharmaceutical that may or may not have good quality control behind it?"
"Some people believe that when you are talking about medicinal cannabis, it is the same as taking the drugs recreationally.
"Some people think you can smoke joints to help epilepsy."
It is entirely understandable that patients with some conditions try some of the oils available, particularly when patients are in chronic pain and other drugs have failed.
Hemp oils with only traces of the psychoactive component THC are sold over the counter legally in shops, and ordered online.
But Murphy warns that some people have become attached to the issue of legalising the drugs as a medicine for "non-medical reasons".
"When you see imagery being used of cannabis leaves and terminology you would associate with recreational use, that is doing everybody a disservice - particularly those who may or may not get benefit from medicinal cannabis." Neurologist Dr Sweeney says there should be particular concerns about the use of cannabis among teenagers.
"There is some evidence with THC in particular that you double or treble the risk of psychosis in teenagers at the ages of 14, 15 or 16."
The recent government-commissioned report on medicinal cannabis expresses particular concern about the effects on teenagers.
The report says: "While risk factors have been difficult to determine a consistently emerging theme is that adolescents may be particularly susceptible to the psychiatric and neurocognitive effects."
According to the report, consumption of cannabis during adolescence could disrupt normal brain development.
A special programme to allow patients with specific conditions access to medicinal cannabis is likely to be put in place over the next few months.
In the meantime, patients who wish to use cannabis-based drugs have to apply to Minister Harris for a licence.
Dr Sweeney says the development of drugs can take many years, but the process has to be gone through over a long period.
"It's slow,methodical, and sometimes painful, but you have to go through that period of rigorous research to avoid a repeat of problems in the past with drugs such as Thalidomide."
No comments:
Post a Comment