Latest / The Morning Edition / New study shows medicinal cannabis 'doesn't work'

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New study shows medicinal cannabis 'doesn't work' · The Morning Edition

• 0:04
  S1: Go to any family or professional gathering these days, and
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  S1: there's a good chance you'll be in a room with
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  S1: someone who's used medicinal cannabis for anxiety, physical pain, or
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  S1: hundreds of other conditions that have been treated legally with
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  S1: the product for the last ten years. I'm Samantha Selinger Morris,
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  S1: and you're listening to Morning Edition. From The Age and
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  S1: The Sydney Morning Herald today, health reporter Angus Thompson on
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  S1: the Australian researchers who have found that there is no
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  S1: evidence that medicinal cannabis is effective at treating anxiety, depression
• 0:38
  S1: and PTSD and those who are angry at the result.
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  S1: It's March the 18th. Okay, Angus, can you just start
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  S1: off by telling us how many medical conditions are people
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  S1: using cannabis to treat? And has this been increasingly popular
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  S1: over the years? You know, like how how are people
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  S1: using this?
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  S2: Yeah, well, Sam, it's a milestone year for medicinal cannabis
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  S2: in Australia. It's been ten years since it was legalized
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  S2: for medicinal and scientific use.
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  S3: It's been a long road. But from March next year,
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  S3: doctors can legally prescribe medicinal cannabis.
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  S4: This is a process and a product that we need
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  S4: to bring to the Australian people. Turnbull government is proposing
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  S4: to allow patients and their doctor access to a safe,
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  S4: legal and reliable supply of medical cannabis. Medicinal cannabis products.
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  S4: Today's legislation has been described as a landmark bill and
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  S4: the missing piece for patients and doctors around Australia.
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  S2: And since then, we've seen more and more Australians legally
• 1:50
  S2: use medicinal cannabis through these two schemes, which basically allow
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  S2: doctors to prescribe products that haven't gone through the rigorous
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  S2: testing needed to be classified as an approved medicine, and
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  S2: doctors have to record the reasons why they prescribe medicinal cannabis.
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  S2: And so we know that there are more than 250
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  S2: health conditions that people are using cannabis to treat. And
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  S2: some of the most common ones are chronic pain, anxiety, insomnia,
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  S2: and a bunch of other mental health conditions such as
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  S2: depression and PTSD.
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  S1: That is so fascinating. And do we know whether the
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  S1: majority of people who are using cannabis to treat various conditions,
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  S1: are they mostly self-prescribing, or are they actually going to
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  S1: doctors to get it?
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  S2: They're going to doctors. I mean, people self-medicating with cannabis
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  S2: to treat all sorts of conditions isn't new. It's obviously
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  S2: an ancient plant. It's been around for a very long
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  S2: time and humans have been using it for a very
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  S2: long time. The difference now is that we actually have
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  S2: numbers that show how many people are using it and
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  S2: why they're using it. The other difference is these products
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  S2: are really different from the cannabis you might get off
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  S2: the street. So these are grown products. They're grown by
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  S2: experts and backed by big companies that have millions of
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  S2: dollars to put into research and development to essentially produce
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  S2: high quality and high strength cannabis products. And there's just
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  S2: a huge range of products out there, whether it's oils
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  S2: or flowers or creams that you rub. There's so many
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  S2: ways that people can access this product.
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  S1: Okay. But you have just written about a new study.
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  S1: This was just published in Lancet Psychiatry on Tuesday, and
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  S1: it has thrown, I would say, a pretty big question
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  S1: mark over the use of cannabis to treat various ailments.
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  S1: So tell us about this study. What did it say
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  S1: this study?
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  S2: Sam was from researchers at the University of Sydney, and
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  S2: it looked at more than 50 randomized controlled trials testing
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  S2: the effectiveness of medicinal cannabis to treat mental health and
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  S2: substance use disorders specifically. Uh, these studies involved about 2500 participants.
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  S2: So quite a, quite a large group. And it looked
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  S2: at a range of conditions. So the review found no
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  S2: evidence that cannabis was effective for treating anxiety, depression and
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  S2: post-traumatic stress disorder, PTSD. There was some evidence that cannabis
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  S2: could help reduce tic severity for people with Tourette's syndrome. Uh,
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  S2: increase sleep time for people with insomnia, and help manage
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  S2: autism traits in people with cocaine use disorder. Cannabis actually
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  S2: increased cravings. But overall, the researchers cautioned that the quality
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  S2: of studies included in the review was quite low, so
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  S2: we can't exactly draw conclusive evidence from this study. But
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  S2: it does add to the evidence and the constantly updated
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  S2: evidence that we need perhaps more research into these before
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  S2: we can say whether or not they are effective. At
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  S2: a population level.
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  S1: And so I've got to ask you, Angus, is this
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  S1: finding a surprising and B going to anger anyone?
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  S2: It's not particularly surprising or new. I think these kind
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  S2: of systematic reviews of medicinal cannabis studies have been around,
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  S2: and there's been many of them for many years. This
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  S2: study was somewhat unique in the sense that it looked
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  S2: at a range of mental health and substance use conditions,
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  S2: but it again, highlights a really important point, which is
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  S2: that there is just not much research into medicinal cannabis,
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  S2: which is somewhat surprising given it has been legalised and
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  S2: regulated for decades in some countries, I think. California first
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  S2: legalized medicinal marijuana in the 90s, so it has been
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  S2: around for a while, and yet there's just not much
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  S2: research into. Especially these mental health conditions, which make up
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  S2: such a large proportion of the reasons why it's being prescribed.
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  S2: In terms of who is angry, I think this kind
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  S2: of study would really frustrate those people out there who
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  S2: have found medicinal cannabis to be useful, to treat their conditions.
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  S2: And the authors have acknowledged that people do experience benefits
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  S2: from them, but for whatever reason, we just aren't seeing
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  S2: that bearing out in population wide gold standard clinical trials.
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  S2: There was also some frustration among experts that I spoke to,
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  S2: that these types of reviews distract from what they think
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  S2: we should be doing, which is funding new clinical trials
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  S2: to understand more about how these drugs work, rather than
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  S2: looking at trials that have been around for years.
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  S1: After the break.
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  S2: Well, I think the difficulty with having a lack of research, Sam,
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  S2: is that we don't know for sure whether what the
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  S2: harms could be. There is perhaps less risk to it,
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  S2: but I don't want to say there's no harm involved,
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  S2: because there could be really serious harms that we don't
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  S2: know about because it hasn't been studied.
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  S1: And another really fascinating part of the feature that you've
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  S1: just written about this was a young father who you
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  S1: spoke to. He's living in Darwin, and he is an example,
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  S1: I guess, of what can go wrong if you become
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  S1: a habitual cannabis user. So tell us about his experience.
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  S2: That's right. So I spoke to Daniel Yakel. He's a
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  S2: young dad living in Darwin, and he was prescribed medicinal
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  S2: cannabis about two years ago to help him deal with
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  S2: anxiety and depression following a relationship breakdown. So he had
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  S2: smoked marijuana recreationally in the past, but he found himself
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  S2: going more reliant on the legal product, which was far
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  S2: more potent than what he'd dealt with before. And he said,
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  S2: you know, any time he wasn't at work, he'd be
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  S2: using it. And at the peak, he was consuming 60g
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  S2: of cannabis a month, which is quite a large amount.
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  S2: He was spending more on his cannabis prescription per week
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  S2: than his $300 rent. So the cost and the realization
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  S2: that he was slipping into dependency really was, were the
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  S2: things that he that motivated him to get off it.
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  S2: And he has been off cannabis now for four months.
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  S2: He said he's found his mental health has improved, his
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  S2: emotions are more regulated, and he's getting better quality sleep
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  S2: and actually, interestingly, dreaming vividly. Apparently, he was telling me
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  S2: that when you use cannabis regularly, you don't dream as much.
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  S2: But he's he's found that his dreams are coming back
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  S2: and more more vivid. And he said that it's probably
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  S2: one of the best decisions he's ever made. So he's
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  S2: one out of many people who use it. Obviously, there
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  S2: is a spectrum of people that use it and they
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  S2: all experience different things, but that was one case where
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  S2: he really benefited from coming off it and had noticed
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  S2: that he was getting an addiction growing dependent on this
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  S2: particular product.
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  S1: Which is so interesting, given that you said before that,
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  S1: you know, people use cannabis to treat substance abuse. Anyway,
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  S1: that's just a fascinating element to this. But I really
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  S1: want to ask you, like, how is it that there
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  S1: have been very few trials in the safety and effectiveness
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  S1: of cannabis? And yet at the same time, we've got
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  S1: more and more Australians legally using medicinal cannabis through what
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  S1: you've spoken about, which is the special access scheme, which
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  S1: is a pathway that essentially allows doctors to prescribe products
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  S1: that haven't gone through the rigorous testing needed to be
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  S1: classified as an approved medicine. Like, is this a problem?
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  S2: Well, there's a couple of things that are quite unique
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  S2: about medicinal cannabis in Australia. And so it was legalized,
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  S2: as we said in 2016. And the way that it
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  S2: has been made accessible to people is through this special
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  S2: access scheme, which basically allows doctors to prescribe unapproved products.
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  S2: So these are products that haven't been through really rigorous
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  S2: clinical trials to people who have a justification for using it.
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  S2: So through that pathway, hundreds of thousands, almost a million
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  S2: Australians have been prescribed cannabis. And so that has resulted
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  S2: in a big industry cropping up around, particularly around telehealth
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  S2: and these vertically integrated clinics where you go online, you
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  S2: speak to a doctor, they consult, you recommend medicinal cannabis.
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  S2: Then that same company distributes you the cannabis and then
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  S2: you get it mailed to you or, or such. So
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  S2: that has been a big boon for some of these companies.
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  S2: And it has also raised questions with regulators about how
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  S2: to regulate this new industry that is making cannabis so
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  S2: accessible to Australians. The other thing is that clinical trials
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  S2: are really, really expensive. I think Ian McGregor, who is
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  S2: a psychopharmacologist at the University of Sydney. He said these
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  S2: trials can cost anywhere between 3 to $10 million to do,
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  S2: and he was saying that there isn't that much incentive
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  S2: for these companies to invest in these trials because they're
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  S2: already making money and they're already got quite small margins
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  S2: on prescribing medicinal cannabis to Australians. And it's growing exponentially, almost.
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  S2: It's tripled in the last four years, so there's not
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  S2: much financial incentive for the private sector to invest in
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  S2: these kind of trials. And so that's where he and
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  S2: others have argued for other people to step in, whether
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  S2: that's the government or philanthropy. So it's a factor of
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  S2: two things. It's it's the fact that clinical trials are
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  S2: really expensive and that there is not a lot of
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  S2: motivation for people to invest in them.
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  S1: And you've written that legal cannabis sales have tripled in
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  S1: Australia in the last four years. But Ian McGregor, who
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  S1: you've just mentioned, a professor of psychopharmacology, he told you,
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  S1: you know, that research hasn't kept pace with prescribing rates.
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  S1: So I'm just wondering how is this affecting treatment outcomes
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  S1: for patients ultimately?
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  S2: Well, I think the bottom line is that it doesn't
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  S2: give people who are prescribed medicinal cannabis the overarching evidence
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  S2: or confidence that it will work for them. So a
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  S2: lot of it is their relationship with their doctor, their
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  S2: sort of process of trial and error and how it
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  S2: works for them. The good news with these kind of products,
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  S2: which I think is good to note from this study,
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  S2: the study found that medicinal cannabis products were associated with
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  S2: a greater risk of adverse events. So these are things
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  S2: like headaches and nausea. But it wasn't actually it didn't
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  S2: lead to very serious adverse events, things like hospitalizations, psychotic episodes.
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  S2: So that's comforting to know that these products aren't necessarily
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  S2: unsafe in that sense of, you know, leading to serious outcomes.
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  S2: But it does leave patients and people using these products,
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  S2: having to fend for themselves a little bit without overarching,
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  S2: really strong evidence that it is actually effective.
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  S1: And so is the upshot. Do you think, after looking
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  S1: into this area, that cannabis is unlikely to really hurt
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  S1: someone in a serious way like hospitalizing them, and therefore,
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  S1: even if it's not particularly effective to treat, say, depression
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  S1: or PTSD or anorexia or a number of the conditions
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  S1: that it's being sort of prescribed for that really, people
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  S1: are unlikely to get hurt and at best, maybe there'll
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  S1: be a placebo effect.
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  S2: Well, I think the difficulty with having a lack of research, Sam,
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  S2: is that we don't know for sure whether what the
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  S2: harms could be, especially when you look over a population level.
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  S2: Certainly there are drugs in the literature. Obviously, cannabis has
• 14:35
  S2: been legal for medicinal use for a relatively short period,
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  S2: but there has been a lot of studies of drug
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  S2: use recreationally as well. And certainly cannabis. Marijuana is much
• 14:50
  S2: lower down that scale of of drugs that harm, which
• 14:54
  S2: is a lot. By and large, alcohol and things like
• 14:58
  S2: cocaine and methamphetamine. So there is perhaps less risk to it.
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  S2: But I don't want to say. Yeah. I don't want
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  S2: to say that there's no harm involved because there could
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  S2: be really serious harms that we don't know about because
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  S2: it hasn't been studied.
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  S1: And Angus, just to wrap up, can you tell us
• 15:19
  S1: about the draft bill of the New South Wales government
• 15:22
  S1: might soon be releasing, which might really have an impact
• 15:25
  S1: in this area?
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  S2: Yeah. So, Sam, this week we're expecting the New South
• 15:30
  S2: Wales government to release a draft bill that lays out
• 15:34
  S2: their plans to amend New South Wales driving laws to
• 15:39
  S2: create an exemption for people with medicinal cannabis prescriptions who
• 15:44
  S2: aren't impaired while they're driving, obviously, in rural areas of
• 15:48
  S2: New South Wales and Australia in general. This is a
• 15:51
  S2: big issue because there's a lack of public transport and
• 15:54
  S2: people rely on their cars every day. So this is
• 15:57
  S2: a really big issue for people. It's also a big
• 16:00
  S2: issue for people who might be considering using medicinal cannabis,
• 16:04
  S2: who aren't taking that leap because they need to be
• 16:09
  S2: able to drive. And so I think all this goes
• 16:12
  S2: to the fact that we need really rigorous, evidence based
• 16:17
  S2: trials into this medication and whether it works or whether
• 16:23
  S2: it doesn't, what conditions it works for and which conditions
• 16:26
  S2: it might be less effective for.
• 16:29
  S1: Well, it's fascinating space on this ten year milestone of
• 16:32
  S1: the legalization here. So thank you so much for your time.
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  S2: Thanks for having me, Sam.
• 16:42
  S1: And in other news today with the reserve Bank hiking
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  S1: the new era of formula one racing with 50 over
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  S1: And last week, Atlassian cut 1600 jobs globally, blaming AI.
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  S1: White collar workers are watching the AI job carnage, wondering
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  S1: what jobs are on the chopping block and what jobs
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  S1: have a future. Today's episode was produced by Kai Wong.
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