The medicinal cannabis conundrum
The word ‘cannabis’ polarises opinions in countries around the world, and New Zealand is no exception.
A popular belief is people who take cannabis will go on to become addicted to other substances, or develop schizophrenia, become drug dealers, or drop out of school, university, work or life.
Another belief is the physical and mental health benefits for some people far outweigh the risks associated with licensed prescribed medicines, and definitely some freely-available unlicensed drugs such as tobacco and alcohol.
Professor David Nutt, a Professor of Psychopharmacology in the United Kingdom, was sacked from his Chief Advisory Role on the Independent Scientific Committee on Drugs by the British government in 2010 when he claimed it was far more dangerous to ride horses in the UK (associated with 100 deaths a year) than to take ecstasy (associated with 30 deaths a year).
In a pivotal 2010 publication in The Lancet on behalf of the Independent Scientific Committee on Drugs, Nutt and colleagues attributed scores for each ‘substance of misuse’ for its likelihood of producing harm to others and harm to self, and then ordered these in terms of most likely to cause harm.
Alcohol was the number one drug to cause harm, followed by heroin, crack cocaine, methamphetamine, cocaine, tobacco and then cannabis.
Nutt went on to state that drug experts would broadly agree individuals and society would be better off if marijuana became the most recreational intoxicant of choice instead of alcohol, citing fewer deaths by organ failure, poisoning and fatal traffic accidents. Driving under the influence of alcohol multiples the chance of a fatal traffic accident by 14 times, whereas the risk on marijuana is nearly double.
However, these arguments hold little sway if your mind is set.
So what about cannabis as a medicine? There is evidence it was used as a medicine by the Egyptians 4000 years ago, and by the Chinese 2500 years before the birth of Christ for pain and as an anaesthetic, as well as in India and many other countries around the world. In fact, it was freely available (alongside morphine and opium) in Victorian societies.
A worldwide move to classify cannabis and heroin (diamorphine) as illegal substances began in the 1930s when major pharmaceutical companies isolated the key ingredients from opium and morphine and were able to purify and standardise dose forms.
The United States took a lead in this move, viewing these substances of misuse as evil and detrimental to society. However, medicinal cannabis is now legal in most US states, with 200 million citizens having access to medical marijuana for treatment of pain, Parkinsonian dyskinesia and severe epilepsy, to name but a few. A further 100 million people are able to legally buy recreational cannabis. It is also legal in a host of European countries, including Holland, Belgium and Germany.
There has been no associated rise in drug dependence, violence or schizophrenia.
Globally, we have seen an increase in the number of people suffering from intractable pain or muscle spasm, which is not addressed by prescribed medicines such as gabapentin, morphine, diamorphine, fentanyl and alfentanyl. There has also been a dramatic increase in addiction to prescribed drugs, accidental overdoses and deaths.
Sometimes opiates are not appropriate for the condition being prescribed for, and just maybe medicinal cannabis might help. So why not in New Zealand?
Dr Denise Taylor will be co-presenting ‘Medicinal cannabis: A welcome relief?’ with Dr Fiona Hutton from Victoria University of Wellington’s Institute of Criminology, as part of the University’s free Spotlight Lecture Series, Lecture Theatre 2, Rutherford House, Pipitea Campus, Bunny Street, Wellington, 12.30pm–1.15pm, Wednesday 19 September. Register here.
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