Medical Marijuana – a Role for Clinical Pharmacists?

Medical Marijuana may provide a role for for trained clinical pharmacists which could evolve remarkably and prove rewarding in multiple ways.
Pharmacists are not only trained to safely supply sensitive drugs, but also to educate patients in their safe use. 
Primarily it could provide a solution for many patients suffering from chronic neurological pain.

MedicalCannabisThese patient types seem to be multiplying by the day, and if access to my own local pain clinic is a guide, a three-month waiting list for an appointment is the norm.
Why is this happening?
There is no clear evidence, but because of its widespread occurrence globally, suspicion is aroused in the context of food chain contamination with many herbicides and pesticides known to be hormone disrupters or neurological toxins.
Conditions such as diabetes and sleep apnoea may also be factors.

The global epidemic in western economies of dementia and Alzheimer’s disease points to inflammatory processes within the body that lead to progressive nerve cell death or the formation of amyloid plaque.
All the above processes may be linked in some way, so there is an opportunity for pharmacist-led research programs involving these types of lifestyle illnesses.
Above all else, the controversy that surrounds the use of Marijuana needs a calm information source – and a trusted one.

i2P had internally documented Medical Marijuana as a potential activity within its clinical services program – one that seemed ideally suited for pharmacists- both supply-side and clinical.
We are pleased to note that PSA is also investigating a program for pharmacists because it requires a leadership organisation with reasonable political clout to deliver this particular program.

The first record of common hemp seeds brought to Australia was with the First Fleet at the request of Sir Joseph Banks, who marked the cargo “for commerce” in the hope that hemp would be produced commercially in the new colony. For 150 years early governments in Australia actively supported the growing of hemp with gifts of land and other grants, and the consumption of cannabis in Australia in the 19th century was believed to be widespread.

The US based National Institute of Drug Abuse makes the following comments:

“The marijuana plant contains several chemicals that may prove useful for treating a range of illnesses or symptoms, leading many people to argue that it should be made legally available for medical purposes. In fact, a growing number of states (20 as of March 2014) have legalized marijuana’s use for certain medical conditions.

The term “medical marijuana” is generally used to refer to the whole unprocessed marijuana plant or its crude extracts, which are not recognized or approved as medicine by the U.S. Food and Drug Administration (FDA). But scientific study of the active chemicals in marijuana, called cannabinoids, has led to the development of two FDA-approved medications already, and is leading to the development of new pharmaceuticals that harness the therapeutic benefits of cannabinoids while minimizing or eliminating the harmful side effects (including the “high”) produced by eating or smoking marijuana leaves.
Are “Medical” and “Street” Marijuana Different?

In principle, no. Most marijuana sold in dispensaries as medicine is the same quality and carries the same health risks as marijuana sold on the street.
However, given the therapeutic interest in cannabidiol (CBD) to treat certain conditions such as childhood epilepsy, strains with a higher than normal CBD:THC ratio have been specially bred and sold for medicinal purposes; these may be less desirable to recreational users because of their weaker psychoactive effects.

What Are Cannabinoids and How Might They Be Useful Medically?

Cannabinoids are a large family of chemicals related to delta-9-tetrahydrocannabinol (THC), marijuana’s main psychoactive (mind-altering) ingredient. Besides THC, the marijuana plant contains over 100 other cannabinoids. Scientists and manufacturers of “designer” drugs have also synthesized numerous cannabinoids in the laboratory (some of which are extremely potent and, when abused, have led to serious health consequences). The body also produces its own cannabinoid chemicals (called endocannabinoids), which play a role in regulating pleasure, memory, thinking, concentration, movement, coordination, sensory and time perception, appetite, and pain.

Currently the two main cannabinoids of interest therapeutically are THC and cannabidiol (CBD), found in varying ratios in the marijuana plant. THC stimulates appetite and reduces nausea (and there are already approved THC-based medications for these purposes), but it may also decrease pain, inflammation, and spasticity. CBD is a non-psychoactive cannabinoid that may also be useful in reducing pain and inflammation, controlling epileptic seizures, and possibly even treating psychosis and addictions.

Research funded by the NIH is actively investigating the possible therapeutic uses of THC, CBD, and other cannabinoids to treat autoimmune diseases, cancer, inflammation, pain, seizures, substance use disorders, and other psychiatric disorders.”

Like many developed nations Australia first responded to the issue of cannabis use in the 1920s, acting as a signatory to the 1925 Geneva Convention on Opium and Other Drugs that saw the use of cannabis restricted for medicinal and scientific purposes only. Cannabis was grouped with morphine, cocaine and heroin, despite cannabis’ rare use as a medicine or remedy in Australia at the time.

This prohibition model was applied with little research into cannabis use in Australia. Most drug-related laws enacted by jurisdictions of Australia during this time were related to opium but as a result of pressure from the United Kingdom, Australia began implementing local laws consistent with the Geneva Convention. In 1928 the state of Victoria enacted legislation that prohibited the use of cannabis; other states followed suit slowly over the next three decades.

As in other Western countries, cannabis use was perceived as a significant social problem in Australia; new drug control laws were enacted at the state and federal level, and penalties for drug offences were increased. In 1938, cannabis was outlawed in Australia as a result of a Reefer Madness-style shock campaign; the newspaper Smith’s Weekly carried a headline reading “New Drug that Maddens Victims”. This campaign introduced the word “marijuana” to Australia, describing it both as “an evil sex drug that causes its victims to behave like raving sex maniacs” and “the dreaded sex drug marijuana”. The campaign was only moderately successful; it instilled in a generation the negative effects of the drug and its impact on society, but did not stop an increase in demand and usage.

With new medical interest in Marijuana comes new research and Marijuana may be even safer than previously thought, some researchers are saying.
A new study indicates that we should stop fighting marijuana legalization and focus instead on alcohol and tobacco.
Compared with other recreational drugs — including alcohol — marijuana may be even safer than previously thought.
And researchers may be systematically underestimating risks associated with alcohol use.

Those are the top-line findings of recent research published in the journal Scientific Reports, a subsidiary of Nature. Researchers sought to quantify the risk of death associated with the use of a variety of commonly used substances.
They found that at the level of individual use, alcohol was the deadliest substance, followed by heroin and cocaine.

And all the way at the bottom of the list? Weed — roughly 114 times less deadly than booze, according to the authors, who ran calculations that compared lethal doses of a given substance with the amount that a typical person uses.
Marijuana is also the only drug studied that posed a low mortality risk to its users.

These findings reinforce drug-safety rankings developed 10 years ago under a slightly different methodology.
So in that respect, the study is more of a reaffirmation of previous findings than anything else.
But given the current national and international debates over the legal status of marijuana and the risks associated with its use, the study arrives at a good time.

It’s important to note here that “safer than alcohol” doesn’t mean “safe, full stop.” Indeed, one of the more troubling lines of thought I see in some quarters of the marijuana legalization movement is that because marijuana is “natural,” or because it can be used as (non-FDA approved) “medicine,” it is therefore “safe.”

But of course, rattlesnake venom is natural, too, and nobody would call that safe.
And prescription painkillers are medicinal and responsible for tens of thousands of deaths each year.

There are any number of risks associated with marijuana use. Most of these risks involve mental health issues, and most increase the earlier you start using and the more frequently you use.

That said, there are risks associated with literally anything you put in your body.
Eat too much sugar and you’re on the fast track to rotting teeth and diabetes.
Take in too much salt and you’re looking at increased odds of a stroke.
Psychoactive substances, such as marijuana and alcohol, aren’t at all unique for having risks associated with them.

What is unique is how these substances are treated under the law, and particularly the way in which alcohol and nicotine essentially get a free pass under the Controlled Substances Act, the cornerstone of the nation’s drug policy.
This study’s authors note that legislative classifications of psychoactive drugs often “lack a scientific basis,” and their findings are confirmation of this fact.

Given the relative risks associated with marijuana and alcohol, the authors recommend “risk management prioritization towards alcohol and tobacco rather than illicit drugs.”
And they say that when it comes to marijuana, the low amounts of risk associated with the drug “suggest a strict legal regulatory approach rather than the current prohibition approach.”

In other words, articulate individuals and organizations up in arms over marijuana legalization could have a greater effect on the health and well-being by shifting their attention to alcohol and cigarettes.
It takes extraordinary chutzpah to rail against the dangers of marijuana use by day and then go home to unwind with a glass of far more lethal stuff in the evening.

Marijuana is an ancient drug that was used for fabric-making, paper-making and medical use from as far back as 5000BC.
During periods of war, farmers have been legislated to allocate a percentage of their farm towards growing Marijuana.

When various versions of Marijuana, both natural and synthetic, legislators will need to look carefully at what classification within the Poison’s Schedule it will be given.
If it is to be readily, but responsibly accessible, a new section of Schedule 3 may need to be created where Marijuana may need to be over-sighted by a clinical pharmacist.
The cost of making it a prescription only substance will add unnecessary cost and reduce access.

The following statement by a prominent medical practitioner is offered in support:

“Why I changed my mind on weed” –  By Dr. Sanjay Gupta, CNN Chief Medical Correspondent
August 9, 2013

Over the last year, I have been working on a new documentary called “Weed.” The title “Weed” may sound cavalier, but the content is not.
I traveled around the world to interview medical leaders, experts, growers and patients. I spoke candidly to them, asking tough questions.

What I found was stunning.

Long before I began this project, I had steadily reviewed the scientific literature on medical marijuana from the United States and thought it was fairly unimpressive. Reading these papers five years ago, it was hard to make a case for medicinal marijuana. I even wrote about this in a TIME magazine article, back in 2009, titled “Why I would Vote No on Pot.”

Well, I am here to apologize.

I apologize because I didn’t look hard enough, until now. I didn’t look far enough. I didn’t review papers from smaller labs in other countries doing some remarkable research, and I was too dismissive of the loud chorus of legitimate patients whose symptoms improved on cannabis.

Instead, I lumped them with the high-visibility malingerers, just looking to get high. I mistakenly believed the Drug Enforcement Agency listed marijuana as a schedule 1 substance because of sound scientific proof. Surely, they must have quality reasoning as to why marijuana is in the category of the most dangerous drugs that have “no accepted medicinal use and a high potential for abuse.”

They didn’t have the science to support that claim, and I now know that when it comes to marijuana neither of those things are true. It doesn’t have a high potential for abuse, and there are very legitimate medical applications. In fact, sometimes marijuana is the only thing that works. Take the case of Charlotte Figi, who I met in Colorado. She started having seizures soon after birth. By age 3, she was having 300 a week, despite being on seven different medications. Medical marijuana has calmed her brain, limiting her seizures to 2 or 3 per month.

I have seen more patients like Charlotte first hand, spent time with them and come to the realization that it is irresponsible not to provide the best care we can as a medical community, care that could involve marijuana.

We have been terribly and systematically misled for nearly 70 years in the United States, and I apologize for my own role in that.

I hope this article and upcoming documentary will help set the record straight

Let us all hope that Medical Marijuana will take clinical pharmacists down a successful pathway and that the dual roles of pharmacists will be recognised – those in the community pharmacies managing the supply and dispensing of the substance, and those providing the education and clinical notes that provide a base for research.
It ought to be a substance that could be available on the PBS on the prescription of a pharmacist (hence a dual role is necessary to avoid conflict of interest) or privately on the prescription of a clinical pharmacist.

If PSA is genuine in developing the Medical Marijuana project, then it ought to use it as a fulcrum to introduce pharmacist prescribing.
Because it does not conflict with any other single program and because of the requirement for education and supervision, money invested in clinical pharmacists would give positive returns.
Linking clinical notes back to a University research project would ensure the evidence base to expand pharmacy services.
Anyone who wants to become enrolled in a clinical trial can enroll at this link:

Also, here is a link to a site which argues pro and con for medicalising marijuana:

Please note that the format of Medical Marijuana is standardised  hemp oil



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