The RACP emphasises the need for caution until there is sufficient quality evidence to support the use of medicinal cannabis
The pace and scale of the introduction of medicinal cannabis are unprecedented and have raised challenges for health professionals, not so much because of its known addictive and psychoactive properties but because its introduction has not followed the usual research-based safety and effectiveness processes. These processes include pharmaceutical, animal, pharmacological and clinical research, recommended under national medicines frameworks upheld by the Therapeutic Goods Administration (TGA) in Australia and the New Zealand Medicines and Medical Devices Safety Authority (Medsafe), as well as by legislation such as the Narcotic Drugs Act 1967 (Cwlth). The Royal Australasian College of Physicians (RACP) supports timely access to products with safety and effectiveness data. However, it appreciates that there is growing community demand for prescription cannabinoids on compassionate grounds. As such, effective medical leadership and guidance is required to inform public discussion and compassionate access until the necessary data become available and more specific advice can be given.
The full article is accessible to AMA members and paid subscribers. Login to read more or purchase a subscription now.
Please note: institutional and Research4Life access to the MJA is now provided through Wiley Online Library.
- 1. Devinsky O, Cross H, Laux L, et al, for the Cannabidiol in Dravet Syndrome Study Group. Trial of cannabidiol for drug-resistant seizures in the Dravet syndrome. N Engl J Med 2017; 376: 2011-2020.
- 2. Sachs J, McGlade E, Yurgelun-Todd D. Safety and toxicology of cannabinoids. Neurotherapeutics 2015; 12: 735-746.
- 3. Geffrey AL, Pollack SF, Bruno PL, Thiele EA. Drug–drug interaction between clobazam and cannabidiol in children with refractory epilepsy. Epilepsia 2015; 56: 1246-1251.
- 4. Victorian Law Reform Commission. Medicinal cannabis: report. Melbourne: VLRC, 2015. http://www.lawreform.vic.gov.au/all-projects/medicinal-cannabis (accessed Nov 2017).
- 5. Australian Institute of Health and Welfare. Australia’s Health 2016. (AIHW Cat. No. AUS 199; Australia’s Health Series No. 15). Canberra: AIHW, 2016. https://www.aihw.gov.au/reports/australias-health/australias-health-2016/contents/summary (accessed Nov 2017).
- 6. Kim HS, Monte AA. Colorado cannabis legalization and its effect on emergency care. Ann Emerg Med 2016; 68: 71-75.
- 7. Barry RA, Stanton G. A public health framework for legalized retail marijuana based on the US experience: avoiding a new tobacco industry. PLoS Med 2016; 13: e1002131.
- 8. Dobbin M. Pharmaceutical drug misuse in Australia. Aust Prescr 2014; 37: 79-81.
- 9. Whiting P, Wolff R, Deshpande S, et al. Cannabinoids for medical use: a systematic review and meta-analysis. JAMA 2015; 313: 2456-2473.
- 10. National Academies of Sciences, Engineering, and Medicine. The health effects of cannabis and cannabinoids: the current state of evidence and recommendations for research. Washington (DC): The National Academies Press, 2017.
- 11. Australian and New Zealand College of Anaesthetists Faculty of Pain Medicine. Statement on “Medicinal Cannabis” with particular reference to its use in the management of patients with chronic non-cancer pain. PM10. 2015. http://fpm.anzca.edu.au/documents/pm10-april-2015.pdf (accessed Nov 2017).
- 12. Medical Board of Australia. Good medical practice: a code of conduct for doctors in Australia. Canberra: MBA, 2014. http://www.medicalboard.gov.au/Codes-Guidelines-Policies/Code-of-conduct.aspx (accessed Nov 2017).
We thank the RACP Policy and Advocacy Committee and Medicinal Cannabis Reference Group for editing earlier versions of the article, which has been approved by the RACP President.
The National Health and Medical Research Council has provided a $2.5 million grant to the Australian Centre for Cannabinoid Clinical and Research Excellence (ACRE). NSW Health has funded an open-label study of a variety of cannabinoids in palliative care. Jennifer Martin and Yvonne Bonomo are investigators with ACRE and the NSW study. All authors are members of various state and federal committees regarding medical cannabis, and are involved in the RACP EVOLVE initiative.