23 January 2016

Cannabis Policies Prevent Access To Life-Saving Treatments

As a scientist working to improve the health of people living with HIV/AIDS (Human Immunodeficiency Virus/Acquired Immune Deficiency Syndrome) in Canada who use illicit drugs*, an Infectious Disease Epidemiologist is reminded every day of the impacts of government policies on drugs. What's more, he has seen how misinformation about drugs can lead to ineffective and even harmful drug policies. His own work involves researching the potential impact of Cannabis among people living with HIV/AIDS.

Patients have stated for decades that Cannabis helps them deal with the side effects of their medications. But, in a preliminary study, High-intensity Cannabis use associated with lower plasma human immunodeficiency virus-1 RNA viral load among recently infected people who use injection drugs, researchers found evidence to suggest that people who use Cannabis are more likely to have slower HIV disease progression, meaning they can live longer and healthier lives.

That finding is likely due to Cannabis' anti-inflammatory properties, which slows the replication of cells carrying the virus in a person's body. It's an outcome that helps better understand a role for Cannabis in viral infections. The study concluded; "Consistent with the findings from recent in vitro and in vivo studies ... we observed a strong association between Cannabis use and lower pVL (plasma HIV-1 RNA viral loads) following seroconversion among illicit drug-using participants. Our findings support the further investigation of the immunomodulatory or antiviral effects of cannabinoids among individuals living with HIV/AIDS".

Cannabis's therapeutic benefits stem from the way it stimulates with the body's own method of making us feel good, known as the endocannabinoid system (ECS), explains Emeritus Professor of Anaesthesia, Laurence Mather, from the Northern Clinical School at the University of Sydney. "The endocannabinoid system in the body is not a pain relieving system like the endorphin system, like for morphine-type things, it's more a general well-being system and it works by making people feel more comfortable with themselves. It doesn't ablate pain, it makes the body more accepting". Cannabis helps with a very specific type of pain that does not appear to respond well to pain relieving treatments, such as opioids or non-steroidal anti-inflammatory drugs (NSAIDS).

The appetite stimulating effects of Cannabis more commonly known as 'the munchies', have also proven useful in countering the bodily wasting associated with a range of conditions from HIV/AIDS to cancer. "That was observed back in the 1960's and 1970's, particularly by the recreational users of the time who noticed the incidence of weight gain was more favourable in those that used Cannabis than others", Mather said. "The side effects of many things that are used for treating these conditions such as heavy duty pain and things of that kind, treating them with opioids or treating with NSAIDS, are far more dire than they are from Cannabis", said Mather. "People can die from morphine, they stop breathing; people can die from paracetamol because it buggers their livers, people can die from NSAIDS because it buggers their kidneys, but Cannabis doesn't do any of these things".

In Canada, Cannabis is widely available and levels of use appear to be static. In 2012, 41% of Canadians reported ever using Cannabis, while 43% reported using it in 2002. Which means that many Canadians have first-hand experience with Cannabis and many others have an opinion on it. What is troubling, though, is that while the scientific evidence on Cannabis is growing rapidly, non-scientific claims about the impact of Cannabis on the body are continually repeated in headlines, online, and by policy-makers, to the point that, to some they begin to sound true.

Medical Cannabis presents a conundrum for some medical professionals. Its illegality in large parts of the world, including Australia, means most medical users are self-medicating and this also makes it difficult to study in clinical trials. As a consequence, a significant proportion of medical Cannabis research is based on self-reported use and outcomes, rather than large, carefully-designed, randomised trials, said Professor Ian Olver, head of the Cancer Council Australia. "Probably two decades ago I remember sitting on a panel that reviewed the evidence for medical Cannabis, and in most cases the evidence is anecdotal" said Olver. As a result, he is cautious about the idea of more widespread availability of medical Cannabis but acknowledges that there may be some patients for whom it is their only recourse to relief. "If you've got a patient who's been through conventional therapy and has not responded, you're sympathetic to them if they find something that's worked ...". he said.

Interpreting scientific evidence isn't always an easy task: it involves assessing a massive set of studies and sometimes coming up against competing findings. Take the issue of potency, for example, which was in the Canadian news with the former Canadian federal government's anti-Cannabis television advertisements which were shown across Canada, before they comprehensively lost the last federal election. The ads claimed Cannabis potency had increased on average by up to 400% from a few decades ago. The issue is just not that straightforward. Data from the United States (US) government suggests that on average, Cannabis potency has increased from about 3% in the 1980's, to 12% in 2012, a 300% increase.

Lost in this debate around potency, though, is a basic but important question. Does increased potency actually have any detrimental effect on the body? This seems to be another case where the evidence shows there is no risk of the overdose-type effects of alcohol or opioids like heroin. Scientists who have reviewed the evidence have flatly stated that concerns over potency are not supported by any science.

Even if we assume increased Cannabis potency is problematic, though, what is the best way of controlling it? Between the 1980's and the 2000's, when US Cannabis potency increased by about 300%, the US government engaged in a massive global program to reduce Cannabis supply. Clearly, it was a failure. In comparison, when a Canadian medical Cannabis supplier accidentally released a strain of cannabis with delta-9-Tetrahydrocannabinol (THC) levels of 14% in 2015 (labelled as 9% THC), Health Canada took a simple step: it recalled the product. Just like that, the higher-potency Cannabis was off the market, something the US government couldn't achieve despite investing billions of dollars and deploying the world's largest counter-narcotic force.

In 2014 the US National Institute on Drug Abuse (NIDA) increased its spending on Cannabis research by 50% and annual production soared from 18 to 600 kilograms and the harvested crop included two new strains. One with low concentrations of THC and high levels of cannabidiol and the second strain with relatively balanced levels of the two cannabinoids. In the US in March 2015 it was revealed researchers would be able to access more varieties of Cannabis for research purposes courtesy of NIDA. Under a government contract the University of Mississippi in Oxford grows Cannabis for the sole US supplier, NIDA, and research scientists must obtain Cannabis for study via NIDA alone. The Director said they want to be able to evaluate the claims that Cannabis is therapeutically beneficial and to explore treatments for addiction. In Australiathe Federal Health Minister announced in late 2015 support for a change to the Narcotics Drugs Act (1967) to create a regulatory body to oversee the cultivation and importation of medical Cannabis for state trials of a Cannabis based-pharmaceutical, NOT whole plant. This would make it easier for researchers in Victoria, Queensland and New South Wales, where clinical trials for the use of a Cannabis-based pharmaceutical have been announced, to obtain the plant locally.

We expect our political leaders to build policies based on the evidence so that they are as effective as possible. Drug policies should be no different. Unfortunately, Canada's current policies on Cannabis are based on a misreading of the science at best. Worse, they are making it harder for people to access life-saving medicine. The circumstances are even worse in countries like Australia where there is NO legal access to medicinal whole plant Cannabis which simply leads to many, otherwise law-abiding citizens, being arrested and treated like common criminals when all most of them are seeking is relief from some terribly debilitating disease or syndrome. 


*The term ‘illicit drug’ can encompass a number of broad concepts, according to the Australian government, including;
• illegal drugs - a drug that is prohibited from manufacture, sale or possession in Australia, for example, Cannabis, cocaine, heroin and ecstasy
• misuse, non-medical or extra-medical use of pharmaceuticals - drugs that are available from a pharmacy, over-the-counter or by prescription, which may be subject to misuse, for example opioid-based pain relief medications, opioid substitution therapies, benzodiazepines, over-the-counter codeine, and steroids
• other psycho-active substances - legal or illegal, potentially used in a harmful way, for example, kava, or inhalants such as petrol, paint or glue (but not including tobacco or alcohol)

*Cannabis sativa L., is an annual herbaceous plant, i.e., a herb

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