EDITORIAL – for Monday 12 November 2018

Welcome to the current edition of i2P (Information to Pharmacists) E-Magazine dated Monday 12 November 2018.
Since our last edition the world has exploded with a range of states and countries recognising cannabis as a valuable contribution to patient health.
Unfortunately, some of this recognition comes with flawed policy engineered by global drug companies and their medical “front” groups.
The UK is a perfect example where recognition comes with policy and regulation that almost guarantees that medical cannabis will not emerge for some time.
The situation is no different here in Australia where the average patient has to procure cannabis illegally to gain access to its benefits and the medical profession talks about using it only after mainstream medicine fails to achieve a result.
When doctors pontificate and criticise pharmacists for intruding on their supposed “turf” they need to turn the light on themselves to truly see how corrupt their aspirations really are and in particular, the obstruction of an orderly patient delivery of medical cannabis and their continual attacks on other health modalities (including pharmacy)

We publish an article by Clear, an online publication devoted to promoting cannabis law reform.


Clear is a publication promoting cannabis law reform.

NHS England has today published what it describes as prescribing guidance – ‘Cannabis-based products for medicinal use: Guidance to clinicians‘.

The actual guidance is buried within a mountain of bureaucratic doublespeak and requires downloading PDFs from the Royal College of Physicians (download here) and the British Paediatric Neurology Association (download here). In both cases, aside from chemotherapy-induced nausea, the guidance amounts to ‘do not prescribe’.
This is a travesty of the intention of these reforms and demonstrates how the medical establishment is more interested in protecting its self-interest than in helping patients gain the benefits of cannabis as medicine.
Cowardly and scared are the two words which best sum this up.

It’s no surprise that doctors in the UK are ignorant about the use of cannabis as medicine.
They have been subject to the same relentless torrent of reefer madness propaganda from government and media as the rest of society.
They have been prevented even from learning about the endocannabinoid system by the authoritarian policy of prohibition and any doctor in the UK who has any experience of cannabis as medicine will have been in breach of professional ethics as well as the law.

But it’s deeply disappointing that the authors of these documents have made no effort to understand the excellent work that is being done by medical professionals in other countries.
The Royal College of Physicians and the BPNA will be a laughing stock across the world in the many more enlightened and educated jurisdictions where patients are gaining great benefit. But of course, this isn’t a laughing matter. In fact, these two so-called professional bodies are making it a tragedy.

Clearly, what is in the best interests of patients is that we must bring in expertise from overseas. There are eminent doctors abroad who will be glad to step in, particularly in private practice, and pick up this baton which the NHS has fumbled and dropped in the most clumsy fashion.

This is a huge opportunity for those in private medicine who can set aside these cowardly excuses and make the most of the new regulations for patients who are fortunate enough to be able to afford it.

For the average Briton with chronic pain, Crohn’s Disease or an epileptic child this is a kick in the teeth from the profession that is supposed to care for them.

NHS Guidelines Offer People Who Need Cannabis As Medicine Two Choices. Go Private Or Carry On Being A Criminal.

This UK landmark change in the law occurred after several stories came to light of sick children suffering under prohibition, including Billy Caldwell.
The severely epileptic 12-year-old hit headlines earlier this year when the Home Office confiscated the Canadian-bought cannabis oil that made his condition manageable.
Nationwide horror at the situation prompted Home Secretary Sajid Javid to order a review of the law, after which it was decided that cannabis should be changed from a Schedule 1 drug (no medical value) to a Schedule 2 (can be prescribed).

But let’s be clear: the struggle is far from over.
The NHS released its prescription guidelines last week and they were disappointingly restrictive.
Drawn up by the Royal College of Physicians and the Royal Paediatric Neurology Association, the guidelines say cannabis products can only be used as a last resort, and that patients with MS and chronic pain are unlikely to get prescriptions.
In fact, the guidelines state baldly that: “Very few people in England are likely to get a prescription for medical cannabis.”

An MS Society statement said: “It’s likely that nothing will change in the short term for the one in ten people who get relief from pain and muscle spasms by using medical cannabis. We’re calling for the interim guidance of prescribing medical cannabis to be urgently reviewed so that access to the treatment isn’t so restricted.”

Jon Liebling, Political Director of the United Patients Alliance (UPA), said of the guidelines: “When you read them, you get the feeling they haven’t put much thought into this other than to protect themselves from having to take on the entire responsibility and accountability for introducing an entire new classification of medicines.”
Although, to be fair, he added, the organisations drawing up these guidelines were given no more than three months for this gargantuan task.

Despite the limited scope laid out in the guidelines, Health Secretary Matt Hancock seemed to imply that doctors are being given a certain level of flexibility.
He said: “Doctors need to use their clinical judgement, and having guidance in place helps. Ultimately, the need to treat an individual person and the responsibility for that falls on the shoulders of a doctor – that’s what they do.” Indeed, there will be no direct policy from government that limits the conditions for which medical cannabis can be prescribed.

The benefits of cannabis medicine are becoming widely accepted within the Australian community. However, laws around the non-profit cultivation of the plant to help the sick continue to carry the same level of criminality as the laws for those who grow it for profit.

But, it appears some magistrates and judges are beginning to make the distinction between an individual who’s making cannabis medicines and those whose suburban hydroponic setup is aimed at profiting from recreational use.

This new understanding was evident as Judge Roy Ellis handed down a sentence to Barry John “BJ” Futter in the Newcastle District Court on 24 October.
Mr Futter was before the court after pleading guilty to one count of cultivating a large commercial quantity of a prohibited plant by enhanced indoor means and one count of drug supply.

The charges arose after a raid was carried out by NSW police at Mr Futter’s Newcastle residence on 1 December 2016, which resulted in the seizure of 215 cannabis plants.
The plants were being grown to be distributed without charge to patients registered with the Church of Ubuntu.

The large commercial cultivation charge could have landed Mr Futter – who’s the president of Ubuntu – in prison for up to 20 years. However, the judge saw fit to impose a conditional release order without recording a conviction against Futter’s name, on condition the cannabis medicine advocate enters into a 12 month good behaviour bond.

“It’s nice to know the cannabis truth is finally hitting home at the level of judiciary,” said Mr Futter. “And that when presented with facts and truths people with humanity and understanding about them come up with conclusions like this one.”

According to Futter, his case reveals that politicians are putting corporate interests before the welfare of patients, as it’s illegal for him to cultivate cannabis and produce medicine, while today in Australia, it’s legal for licensed companies to produce medicine using the same plant.
And there’s also a glimmering of other global developments about his case. “South Africa is an example of where the judiciary there made cannabis legal to smoke at home,” Mr Futter told Sydney Criminal Lawyers.
“The judiciary made it legal. Not the politicians.”

In September, South Africa’s highest court upheld a lower court ruling that found the criminalisation of cannabis was unconstitutional, which effectively legalised the home use and cultivation of cannabis in that country.

In handing down the sentence, Judge Ellis said that it was clear that Mr Futter had been cultivating the plants for non-profit medicinal purposes.
And his Honour acknowledged that there is a rising awareness in the community of the “potential medicinal benefits of cannabis”.

The judge also lamented the state of NSW laws that don’t recognise a distinction between growing recreational cannabis so as to turn a profit and cultivating the plant for the benefit of those in medical need.

Judge Ellis told the court that while this distinction can’t be found in the law, there’s no reason why it shouldn’t appear there, and in the meantime, this distinction “should be found in the sentencing principles applied by a sentencing court when dealing with such offences”.

And this isn’t the first time the District Court judge has accepted that people in the community are genuinely helping others by producing cannabis oil. In October 2015,
Judge Ellis imposed a two year good behaviour bond on Malcolm Ronald Lee in a similar case involving cannabis used as medicine.

A NSW coroner has likened the effects of drug prohibition to state sanctioned racism, saying future generations would look back at current laws on illicit substances with incredulity.
Deputy State Coroner Harriet Grahame also took aim at sniffer dogs patrolling train stations as a “low-hanging” law enforcement tactic during an ongoing inquest examining government policy on prescription opiates and illegal drug use.
Ms Grahame’s comments came a day before the release of a report that claims governments have ignored evidence suggesting the majority of people who use drugs will not experience harm unless they come in contact with the justice system.
Ms Grahame said she did not doubt that “in a hundred years from now people will look back” and be “incredulous” about the law’s treatment of drug users under the current regime of prohibition.

“It will be like the way we look back at when we didn’t allow black people to vote,” she said.

While the rest of the world has been openly embracing the value of medical cannabis, the people who could provide the most accessibility, logistics and health literacy – pharmacists – have been universally silent on the matter, seemingly to prefer to be onlookers.
Pharmacists have the most to gain, both professionally and financially, by involving themselves and their patients by fully engaging with this unique substance.
The timing is right for pharmacy leaders to engage decision-makers by raising the benefits that can be provided by community pharmacists.

Where are the calls for down-regulation allowing pharmacists to fully engage in a primary role in delivering medical cannabis to patients.
It’s a natural fit, particularly the market for whole plant extracts.

Where are the pharmacy leaders becoming actively involved?
The silence is deafening.
And the Australian medical profession are “beavering away” locking up the market and isolating supply.
Pharmacy leaders – get out there and do the job you were elected to do!

Our lead article for this edition involves a continuation of the outline for a pharmacy-in-the-home presence.
Differentiating customers from patients is an essential cornerstone for establishing professional services.
Customers are offered retail and non-professional services.
Retailing has always underwritten pharmacy professional services and we propose that this should not change – only be done differently by using the customer “pool” to convert to patients.
Patient numbers are the real KPI that establishes the goodwill value of a pharmacy.
A pharmacy-in-the-Home program relies on established patients who can be communicated with through external systems.

Read: Professional Services Home Outreach – Marketing the Program and Recruiting the Patients

An integrative model is a natural fit for pharmacists.
Dark forces that sit in the Big Pharma camp constantly criticise pharmacist support for clinical nutrition practice which involves dietetics and the prescribing of nutritional supplements.
Are we letting these corrupted people interfere with our professional practice – all for the wrong reasons?
Read: Do we Play a Role in the Nutritional Interventions in Children’s Asthma?

WHO has made a statement saying that cannabis should be decriminalised world-wide because existing laws cause health discrimination.
In Australia, patients are being actively discriminated against as police are instructed to enforce existing laws and close down “illegal” supplies, leaving critically ill people with no workable solutions for their health problems.
Flawed health policy generates bad laws and lowered community respect for policy and laws.
Yet again, Pharmacy is in a position to provide solutions very simply and simultaneously create opportunity for the profession to treat chronically ill patients efficiently and economically. Pharmacy leaders need to be proactive in the regulatory area because other health professionals are actively competing to lock pharmacy out of any opportunity whatsoever.
Potential for pharmacists is found in the compounding of THC and CBD in specific ratios to match the best result for patients with chronic illness.
Further pharmacist potential also lies in using cannabinoids in harm minimisation programs involving opioid dependencies and as an adjunct for the management of pain.
Pharmacists also need to be active and have a voice in the regulation of these substances ensuring that maximum patient access can be obtained through the application of Schedule 3 of the Poison’s Act.
Read: Understanding Medical Cannabis – 1. cannabis tech: Getting Your Cannabis Grow Off To A Great Start 2. Cannabis Cheri: How did marijuana become illegal? 3. Forbes: How Tech Will Drive The Next Stage Of Cannabis Regulation

We often hear the expression “The science is settled,” however, science is a process.
The idea that “science” cannot consider new information contradicts the definition of science.
People who promote vaccination as an extreme medical ideology are involved in “scientism” – the manipulation of the science surrounding vaccines.
And it is certainly “unsettling” to hear the dishonest scientism claims that blare out in all forms of media.
“First do no harm” is the concept that underwrites all medical practice.
Australian vaccination policy is so poor and damaging, that it beggars belief that legislators can be so close to manufacturer sales objectives as to guarantee them a market through coercive legislation that involves simultaneous removal of patient choice.
The evidence supporting vaccine policy failure and its lack of safety is becoming so voluminous that it will eventually destroy the unnatural power alliance that desperately tries to hold it all together.
Read: The Safe Vaccination Debate – 1. Elizabeth Hart’s Overvaccination: Latest Challenge to Cochrane re the Cochrane HPV Vaccine Review and the CDC’s Lauri Markowitz’ Involvement in this Compromised Review.    2. Dr Judy Wileyman Report:Newsletter 213 Australia’s Health Minister, Greg Hunt, is using False Information to Mandate Vaccines  3. Robert Kennedy’s Children’s Health Defence: How the CDC Uses Fear to Increase Demand for Flu Vaccines

Falls involving patients are a serious matter.
Pharmacists experience this situation in their various practice settings, particularly hospitals and nursing homes.
It can also happen inside a community pharmacy and the subject of falls represents a consulting opportunity for a Health Literacy appointment with a patient, or their carer.
And the subject of falls is multi-factorial – not just drug-related.
So take a holistic approach.
Read: OMNS- Preventing Falls- A serious matter: One in four falls in the elderly proves fatal.

Marketing Focus is an ongoing conversation in the form of a series of essays discussing the wider business sector.
They are about thought leadership in topics of management and marketing, and the opportunity for pharmacists to adapt the messages delivered, back into their own pharmacy practice.

Achieving your potential is giving yourself permission to achieve your goals, particularly in your business and professional life.
And that is provided you have drawn up a considered list of goals.
That is also called planning and direction.
Considered risk is part of the equation and creating new systems of work becomes that part of “giving back” to the profession that has sustained you to this point.
But unless you make a beginning and not wait until you have filled in all the “thought” gaps, you will never succeed.
You are allowed to fail and start again – that is called experience, and it is priceless!
Read: Achieving Your Potential

And we complete our offering for this edition with some media releases from two pharmacy leadership organisations:

PSA – PSA Media Releases – 1. PSA calls for support to allow pharmacists to do more for public health 2. New campaign urges Victorian smokers to seek advice from Quit-trained pharmacists 3. Pharmacists to vaccinate against more diseases in NSW

NPS – NPS Media Releases – 1. NEW DRUGS:Erenumab for migraine 2. MEDICINEWISE UPDATE: caring@home – Palliative care medicine guidelines – palliMEDS app 3. World Antibiotic Awareness Week

We hope you enjoy the content for this edition and we invite you to comment on any article in the panel provided at the foot of each article.

Neil Johnston
Editor, i2P E-Magazine
Monday 12 November 2018





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