Medical Marijuana and its Positive Possibilities for Pharmacy

The case for legalising marijuana for medical purposes has been tested – and has been won (Victoria has set in motion the regulatory arrangements for this to happen in their state-others will follow).
Now it’s the turn of the regulators who have the problem of separating legal use from illegal use.
As more research is applied to the subject the question becomes more “why was it illegal in the first place?”

In Colorado, one of the first US states to legalise the use of marijuana for medical use, reports that the number of people receiving strong benefit from the use of cannabis extracts is rapidly expanding – even to the extent as to question why the recreational use of marijuana is still under prohibition.
However, three years after its legal introduction, Colorado is starting to report major economic improvement and a reduced crime rate – an unexpected public benefit.

For starters, just in recreational sales of marijuana in 2014, Colorado sold over $34 million in the month of August.
$3.4 million (10%) went straight to the government and towards building schools.
At the time, a number of sources expected Colorado to rake in at least $30 million from their recreational marijuana market – just from taxes alone.

Between January and October 2014, the tax revenue was recorded at $60.1 million.
This serious tax money being accumulated is being used to strengthen Colorado communities, provide free education, and clean up the streets.
With numbers like these being reported, it surely is no longer a question of ‘if’ all states in the US will someday legalize cannabis, but ‘when’.
The market has potential to transform the economy and inspire an awakening.

And something even bigger can occur here in Australia.

We have a natural infrastructure already in place to develop the best species of cannabis to grow, and for marijuana crops to complement and use the same land as other crops e.g. as a rotational crop for sugar cane.
Downstream products using the fibre component of the plant can be readily utilised as a more eco-friendly alternative to other crops, such as cotton.
Depending on the species, the oil from the plant can be utilised as a nutritional supplement or incorporated into food processing and manufacture.

Medical marijuana contains a range of cannabinoids  called tetrahydrocannabinol (THC) and cannabidiol (CBD)
THC is known to accelerate psychosis in people with certain genetic tendency to it, and it requires heat (smoking) to activate it.

Mounting evidence involving the second important component, cannabidiol (CBD), is that it plays a critical role by opposing the effects of THC on the brain’s endogenous cannabinoid receptor CB1.

Illicit “skunk” cannabis, currently favoured in Australia, does have a high content of THC and little or no CBD, responding to market demand from people seeking to feel “stoned” with heavy use.

“Hash” cannabis, however, has large amounts of CBD, and low amounts of THC.
Popular in London, it has been shown to have no association with psychosis.
This indicates the ready possibility of providing a “safe” product and this is where pharmacy can be involved in its compounding role.

CBD does not produce excitement of the kind experienced with high-dosage THC, but has a calming influence, relieves pain and has, in recent years, been shown to improve symptoms in people developing psychosis.

CBD is reportedly the key component in new strains of c.sativa, bred specifically to produce relief for intractable forms of juvenile epilepsy called Dravet or Lennox-Gastaut syndromes.
Clinical trials with concentrates of CBD are curently in progress.

Marijuana seed (hash variety), also contains:

* All 20 amino acids, including the 9 essential amino acids (EAAs) our bodies cannot produce.
* Nature’s highest botanical source of essential fatty acid, with more essential fatty acid than flax or any other nut or seed oil.
* A perfect 3:1 ratio of Omega-6 Linoleic Acid and Omega-3 Linolenic Acid.
* A superior vegetarian source of protein considered easily digestible.
* A rich source of antioxidant phytonutrients, with immune-protective substances that may reduce total body inflammation and provide support for most lifestyle diseases.

A brief historical overview reveals that in the second century, Galen recorded that some people enjoyed eating fried hemp seeds with their desserts.
As recently as the 1950’s in Southern Africa, mothers of the Sotho tribe served the ground seed “with bread or mealie-pap” to children during weaning. Human uses of hemp seed for food are naturally found in India where the seed is pressed to provide a table oil, and in Russia where the oil is made into a kind of hemp butter or margarine.
In Europe, it was once required of monks that three meals made of hemp seed were eaten daily, whether in soups, gruel, or porridges.
In the belief that the spirits of dead relatives visit every Christmas Eve, the Polish and Lithuanian people prepared them a soup of hemp seed which was called “semieniatka”.
The Ukrainian and Latvian people made a similar offering on the day of Three Kings.
In China, hemp seed was consumed by farmers in the north and the seeds were listed as a famine food for the starving multitudes of China near the end of World War II.
Australians also used and consumed the seed during two famines in the nineteenth century.

So while we are renewing its use as a medicinal plant, it is useful to understand how long it has been in use globally for a range of practical purposes.

Now I would like to change direction for just a moment.

Australian pharmacy leaders of the past 20 years have not been renowned for possessing one simple characteristic found in real leaders – and that is the one of having courage.

Without courage and a willingness to have a considered opinion and step out into the unknown, means that there will be no followers – and no progress.
I think that is a reasonable description of pharmacy at this moment.

Marijuana represents an opportunity for Australian pharmacy leaders to create both a renewal and a forward direction.

Our ageing population is already creating stresses on health budgets and chronic diseases are all associated with pain.
CBD on available evidence can safely and effectively treat chronic pain.

On available evidence blends of cannabis  can be successfully employed in treatment for neurological disorders that are also being featured prominently in the ageing demographic, including epilepsy and Parkinson’s Disease.
Read Israeli Research Report on the subject here:  MarijuanaResearch

So this is a real issue for the Australian Pharmacy Leader’s Forum to get on board with.
Forget about non-issues and go forward with some real opportunity.
It also represents an opportunity for un upgrade of core dispensing into the compounding of specialised mixtures of marijuana.
The exciting possibility of the medical marijuana industry is that it is possible for it to be self-funding.
Colorado has found an enormous stimulus to its public income base.
Grower’s licence fees and excise fees on the processed product could create an enormous pool of funds that could be re-invested into support systems that could include a large pharmacy component.
Planning and lobbying needs to start in earnest.

APLF could create innovative policies that could also be the stimulus for Australian research into this industry.
It just needs a rational plan.
Help to establish at universities, an undergraduate-level research and innovation fund.
Results indicate that it is from this sector that the best innovations are found.
Be also involved in aiding the formation of post-graduate research and innovation fund.
Governments seem to like this type of initiative and will often provide top-up funding on a regular basis.

Post graduate pharmacists need newer and better forms of mobile and regional education, to better equip themselves for supporting the roles expected from them in their communities.
And the education must be economical or free.
Why not encourage certificate or diploma courses to back up already acquired degrees in useful primary health care supports and practice improvement.
Why not collaborate with other institutions such as TAFE that may be able to deliver these practical knowledge additions at an economical price through an already decentralised system?

Recent marijuana research is favouring natural cannabinoid oil mixtures rather than synthetic versions.
This would favour Australia because it would avoid patents and keep prices at a more economic level and allow the PBS to fund these products within its budget.
It would also stimulate local farming initiatives and local industries that can use the fibre from the plant.

In terms of pharmacy becoming the major player in primary health care, and the incorporation of marijuana into that process –  it is a natural fit.

Australia currently has a problem where codeine containing analgesics have now been up-scheduled to schedule 4 and can only be purchased on prescription.
This is because of the major addiction problems that have risen to epidemic proportions.
Yet Panadeine Forte and its equivalents have been identified as the major problem – and this drug is already prescription only.
Colorado, as already noted at the beginning of this article, through legalising its marijuana has seen major declines in opioid addiction and crimes associated with drug abuse.
So, there is obviously a public health benefit available here and possibly a benefit for opioid prescription addicts being treated through methadone clinics with an opportunity to introduce marijuana as part of a harm-minimisation system.

A further benefit for community pharmacy is that the more involved in public health initiatives it becomes, the more strategic location rules become.
I have been an opponent of location rules for a very long time because there did not seem to be a benefit for the profession, other than to exclude newcomers to the scene.
Public health potential initiatives have changed my perspective and I do see other initiatives that can be built into this function where a community pharmacy will be able to triage patients to resources that do not include a medical component.
That is a story for another edition.

There will be a lot of politics surrounding marijuana that will have nothing to do with patient health.
It will have everything to do with global manufacturers working to skew the market towards patented synthetic versions and very high profit returns.
Pharmacy has the opportunity to virtually replace a substantial income component lost under the PBS system and open up a range of clinical services and specialist compounding around pain management and other treatment possibilities.
Pharmacy leaders need to be vigilant in their lobby on behalf of all pharmacists.

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