I2P has been proactive in identifying the potential of medical cannabis as a tool for clinical pharmacists and a useful treatment for chronically ill patients – particularly the elderly prone to suffering chronic conditions characterised with an underlying common factor of inflammation.
If you use the i2P search engine you can access information that i2P has been accumulating since 2012 to inform pharmacists as to the potential of this massive market.
It is appalling to see politicians here in Australia and in many other countries blocking access to medical cannabis through devious legislative mechanisms.
Yes, it has become legal for doctors to prescribe this substance, but no, they will not do it because the AMA is advising them not to, and government have added a new layer of complexity in that doctors need to register with both federal and state health departments for permission to prescribe.
And it is almost impossible, at the moment to register with the TGA any locally grown product because each strain of cannabis is able to produce high or low levels of cannabinoids and a variation in dose of active ingredients.
Unless it can be standardised and homogenised there is no local product to prescribe.
So why is it not possible to create some sort of infusion or tincture that can become a part of the APF in the same manner as many other herbal substances have found their way into community pharmacy in the past?
The dark hand of Big Pharma and Big Agriculture is in the background.
They are developing genetically modified plants that can be patented and can be engineered to produce a consistent range and quantity of cannabinoids, but at a price much higher than the local product.
There are no long term studies illustrating human safety and genome integrity for genetically modified (GM) crops.
In fact the opposite is being found in crops such as corn and soy, producing a range of adverse reactions and human genome alteration (which is permanent and may be passed along to descendants).
So do we really want to add a new level of GM insult to our genome, given the promise that has already revealed itself in the natural wild cannabis product?
And why should this non-evidence based version of GM cannabis be even considered for our Pharmaceutical Benefits Scheme (PBS)?
Big Pharma has already conducted clinical trials with a number of selected single cannabinoids.
There are approximately 80 cannabinoid molecules in a marijuana plant, in varying proportions and activity. These are found with a range of phytonutrients with substantial anti-oxidant capacity that provide extra support for a patient’s wellness.
Some pharma-sponsored clinical trials have had to be halted because in using synthesised single molecules toxicity of the manufactured molecule has caused death.
A low toxicity level for a synergistic range of cannabinoids and phytonutrients is overlooked in favour of highly toxic synthesised (but patentable and highly priced) version.
This latter version is the only version legally available in the state of NSW and it runs the danger of becoming the only version that will legally exist, unless some commonsense or political pressure is applied to the political and legislative mix.
The medical cannabis market is made for pharmacy because:
1. It provides a cheap method of treating a large number of illnesses, particularly those with the underlying problem of inflammation.
In other words, a product that will treat most lifestyle disorders of the elderly – our most rapidly increasing demographic.
2. Because medical cannabis can treat other forms of addiction it can be used as an alternative to methadone in harm minimisation programs.
It can also be used to treat cigarette smoking addiction more safely than some SSRI-based treatments and it has also had a measure of success in treating the medical addiction involving oxycodone.
3. With steps in place to remove codeine-containing products fro pharmacy shelves, the cost of pain management will now shoot through the roof as doctors are given full control.
Doctors are accused of creating oxycodone into a gateway drug to morphine and heroin.
So how are they going to achieve a better result than pharmacists?
Cannabis in the past has been accused as being a gateway to illegal drugs of addiction – but it is now proven that the opposite is the case.
4. Pharmacy leaders should be stating the case for pharmacy that the CBD variety of cannabinoid should not be Schedule 8, but instead become a Schedule 3 substance.
This would enable a fast and safe access for Australian patients and also provide an information repository that can be accessed by researchers.
This in turn would help to reinforce other initiatives (such as the PCEHR patient record), provide a better solution for patient pain management (over codeine).
Pharmacy leaders should also be turning to the APF to provide a solution for a liquid dispensary galenical that can be compounded by pharmacists.
This would also support farm investment for growers of cannabis and its impact on local employment.
It would also guarantee an alternative supply that will not quickly be manipulated and disappear for periods of time from the medicine market place – as happens with other sensitive drugs.
A locally grown natural product would also be a lower-priced product that has the potential to have a positive impact on the PBS cost.
5. One valid reason for retaining Pharmacy Location Rules exists in the community pharmacy supply of medical marijuana where the managed distribution of pharmacy outlets will ensure easy access for all patients.
After all, that was the original intent of the Location Rules.
6. Pharmacy Research into the best combinations of cannabinoids (the main ones being THC and CBD) for different medical conditions.
This could support a clinical consultation (for a fee) to advise patients and medical practitioners on the best forms and combinations.
This type of research would also underpin many education providers and clinical pharmacist trainers in their specialist roles.
Pain management protocols may have another economic benefit in being able to keep people in the workforce and out of nursing homes.
Just another area our leaders need to move on, rather than wait for some other profession to capture this territory, that should be a naturally-positioned market for community pharmacy.
7. In summary, we need proactive leaders to work on the appropriate poison schedules for cannabinoids.
The ironic thing is that if the natural plant was “juiced” from fresh leaves, stems and flowers by simply using a kitchen blender, the resultant juice would be of low toxicity and would not have any addictive or psychoactive properties.
It is only when high temperatures are applied that THC forms from the THCA component in the juice.
Smoking the dried leaf creates THC conversion as does some methods of cannabinoid extraction that use heated solvents.
So leaders, lobby for CBD and THCA to be sold as schedule 3 poisons (recordable).
Then convert the recordable exercise to evolve into an information stream that would be a useful source for researchers to document evidence supporting patient benefit and developing new pharmacist skills that can convert to new revenue streams.
Next, create a standardised galenical that can be published in the Australian Pharmaceutical Formulary, and be manufactured locally for use in compounding pharmacies.
And finally, encourage pharmacists to invest in crops through obtaining the necessary licence (a relatively cheap exercise) and incorporate this investment as part of your retirement plan.
Superannuation funds of all description could find this investment an ideal one for an eventual retiree with the added benefit of guaranteeing your own personalised supply of medical marijuana (because the demand will become very high once the ageing population demographic becomes fully aware of its benefits).
i2P has written material in this edition on the need for pharmacists to unblock their creative channels that have become blocked.
It falls under the title of design thinking and design science.
It is directed to all pharmacists, but particularly the leadership.
The concepts need to be applied to the entire range of applications needed to install medical marijuana in its natural home – the community pharmacy.
Design thinking underpins all creativity and innovation and a pharmacy design for medical cannabis must factor in any disruptive response by competitors that will inevitably occur.
Without innovation you have cultural stagnation – and that neatly sums up what community pharmacy has become.
And I don’t think that Stephen King and his review panel will come up with any sensible solutions for future community pharmacy – they can only re-arrange pieces of the jig-saw and pretend to be worldly-wise.
But they are not the experts in pharmacy nor are the academics or the bureaucrats.
We, the foot-soldiers of pharmacy are the experts.
But we are dumbed-down by all of those lobby groups that see the benefit of community pharmacy and want to control its operation and keep telling us how badly we perform.
Why else would they keep persisting in their games of mind-manipulation if they did not see us as a financial opportunity.
Think about it leaders, but please pull your fingers out and get moving!