By Tommy Roche
It’s time for a public dabate on decriminalising medicinal cannabis use.
Medicinal cannabis is scientifically proven to be effective in the treatment of cancer, chronic pain, epilepsy, and a number of other illnesses. For far too long, patients have been denied access to this amazing gift of Mother Nature.
This is causing unnecessary suffering among hundreds of thousands of patients who are being let down by the system.
Under current law, patients who use medicinal cannabis are classified as criminals. Medicinal cannabis use needs to be decriminalised.
But, it is now obvious that only sustained public pressure will make that happen.
Within the last two years, two opportunities to give all patients unrestricted access to medicinal cannabis were deliberately sabotaged.
Firstly, the Cannabis for Medicinal Use Regulation Bill 2016 aimed at legailising medical cannabis was killed by the Joint Oireachtas Health Committee.
Secondly, when asked by the Minister for Health to provide expert scientific advice in relation to the merits of medicinal cannabis, the Health Products Regulatory Authority (HPRA) rejected any notion of making medicinal cannabis available to the vast majority of patients that need it.
It advised that only synthetic (pharmaceutical) cannabis products be made available to select patients with multiple sclerosis, epilepsy, and intractable nausea and vomiting caused by chemotherapy. Even then, each patient will need a ministerial licence to be able to access the products. This comes nowhere near what is required; namely, unrestricted access to full extract cannabis for all patients.
In reality, both the politicians and the HPRA put political and pharmaceutical industry interests ahead of the rights and wellbeing of patients. Let’s take a closer look at how both bodies failed patients.
Hypocritical politicians and medicinal cannabis:
the kettle calling the pot black!
Oireachtas members – especially those on the Joint Health Commmittee – who opposed the introduction of medicinal cannabis say one reason they did so was because of a desire to protect the public. But how do they reconsile keeping medicinal cannabis, which is a proven treatment for chronic pain and a number of serious illnesses including cancer, illegal, while:
Approximately 6,000 deaths annually are attributable to smoking and exposure to second-hand smoke. (Report: The State of Tobacco Control in Ireland 2018). Yet, tobacco is not illegal?
Over 1,000 deaths per year are directly attributable to alcohol (around 500 of these from alcohol related cancers).
(Health Research Board). Yet, alcohol is not illegal?
161 deaths were among the 3,264 reported cases of new adverse reactions associated with the use of prescription medications in Ireland in 2016. Yet, prescription medications are not illegal.?
This is gross hypocracy.
It would be wrong, in a free country, to deprive adults of their right to consume alcohol or tobacco, even though they pose health risks. Isn’t it equally wrong to deprive them of their right to consume a medicine that is relatively risk free and improves health?
Aren’t legislators supposed to enact (and support) laws that benefit the population as a whole? Why then, are large numbers of citizens who use medicinal cannabis treated as criminals under the law?
I believe our Bill has been completely sabotaged. I was rather shocked by the shambolic nature of the pre-legislative scrutiny. I believe it was politically motivated in some ways. It was rigged… I believe the Committee on Health looked for every excuse to stymie progress of our Bill. It is as simple as that. Gino Kenny TD
“It is legal to kill a man to save your own life.
It is illegal to use a plant to do the same.”
Health Products Regulatory Authority:
whose interests does it really serve?
The Health Products Regulatory Authority (HPRA) 2017 report Cannabis for Medical Use– A ScientificReview effectively gave the two fingers to vast numbers of patients by denying them access to medicinal cannabis. In particular:
* The 40,000 people who are diagnosed with cancer every year; many of whom would benefit from the addition of medical cannabis in their treatment. There is a substantial body of scientific evidence, along with countless patient testimonies supporting the benefits of cannabis in treating cancer.
* The 800,000 people who suffer from chronic pain, of whom 40% do not get relief from existing authorised pain killers.
Unreliable and biased.
In a response published in thejournal.ie Gino Kenny TD( sponsor of the Cannabis for Medicinal Use Regulation Bill 2016 and Dr Peadar O’Grady said: “the HPRA guidance is unreliable and biased because it did not use any expert advisors with practical experience of cannabis for medicinal use and because the reasons given by the HPRA for restricting access are not applied consistently to other drugs, and do not take into account the serious risk of death and dependency caused by the existing authorised drugs such as opioids and benzodiazepines.”
We shouldn’t be surprised. According to Richard Boyd Barrett TD, the HPRA is 77% funded by the pharmaceutical industry. The recommendations in its report clearly show whose interests it serves.
Health Products Regulatory Authority
recommendations in relation to cancer.
1. Cancer treatment
The HPRA says “There is currently no evidence for a benefit in the treatment of cancer, despite anecdotal reports to the contrary”. This claim is absolutely bizarre. It is blown out of the water by both the number of scientific studies and the numerous testimonies of real people showing the benefits of cannabis.
There are hundreds of studies showing that cannabinoids are effective against many cancers, as well as reducing the side-effects of conventional cancer treatments like chemotherapy and radiation.
For example, A study published in the US National Library of Medicine outlined multiple studies proving the effectiveness of cannabis on prostate cancer.
A study published in the US National Library of Medicine, conducted by the California Pacific Medical Centre determined that cannabidiol (CBD) inhibits human breast cancer cell proliferation and invasion. They also demonstrated that CBD significantly reduces tumour mass.
Even the US National Cancer Institute says:
+ Cannabinoids may cause antitumor effects by various mechanisms, including induction of cell death, inhibition of cell growth, and inhibition of tumor angiogenesis invasion and metastasis.
+ Cannabinoids appear to kill tumor cells but do not affect their nontransformed counterparts and may even protect them from cell death.
There are thousands of patient testimonials to the life-saving benefits of cannabis oil. These include Landon Riddle who was diagnosed with leukemia and given mere days to live by doctors when he was just 3 years old. He is now a healthy 7 year-old thanks to cannabis oil treatment. Full story
7-year-old Mykayla Comstock was diagnosed with intermediate risk T-Cell acute lymphoblastic leukemia in the summer of 2012.
Just one week after beginning cannabis oil therapy, scans of Mykayla’s bone marrow and blood showed no signs of leukemia. She was in remission! Mykayla is now a healthy 13-year-old. Mykayla’s website
How can so much anecdotal evidence be dismissed out of hand?
A cautionary tale.
Cash Hyde was first diagnosed with cancer at 20 months. Along with chemotherapy and radiation – as well as brain surgery when he was 2 years old – cannabis was a key component of his cancer treatment: the medical marijuana helped him sleep and helped him eat.
Cancer-free, Cash began to get sick again and was found to have a stage IV growth. This time, the tumor progressed really fast, but a change in Montana State law led to the family being without a source of medical marijuana for 73 days.
He had beaten cancer twice, but its third appearance was too much. He died in his father’s arms at the family home in Missoula, Mont.
He was 4 years old.
The Family Says Medical Marijuana Extended His Life
The hope is that Cash’s suffering and passing will highlight the medical benefits of marijuana, and the absurdity of creating barriers to its access, a family friend said.
After all, the plant brought relief to a young child whose only memories were of being terminally ill – what, exactly, is the harm?
2. Chronic Pain
In its report, the HPRA says “The HPRA considers that current evidence does not support the use of cannabis in the treatment of chronic pain.
Chronic pain is an important issue for cancer patients. There is a lot of evidence to support the use of cannabis in the treatment of chronic pain.
The evidence is strongest for the efficacy of medicinal cannabis in the area of pain according to Professor Mike Barnes consultant neurologist, professor of neurological rehabilitation and author of the authoritative report on medicinal cannabis for the UK Parliament, and Professor David Finn, who has spent 16 years researching the area of medicinal cannabis.
Last year, a large review from the National Academies of Sciences, Engineering, and Medicine assessed more than 10,000 scientific studies on the medical benefits and adverse effects of marijuana.
One area that the report looked closely at was the use of medical marijuana to treat chronic pain. The review concluded:
There is substantial evidence that cannabis is an effective treatment for chronic pain in adults.
The HPRA report also says “ The HPRA does not consider that there is an unmet medical need as a large number of authorised medicines, and other treatments are available to treat the many factors involved in chronic pain.”
However, Professor David Finn, President of the Irish Pain Society said ” There are many other analgesic drugs for and non-pharmacological approaches to the treatment of pain, but we cannot ignore the fact that one in five people in Europe suffer from chronic pain. In Ireland, the figure is approximately the same…This is the case despite the availability of other treatments. The largest study ever carried out on this matter in Europe involved 46,000 patients. The study, Survey of chronic pain in Europe: Prevalence, impact on daily life, and treatment, by H. Breivik et al, showed that 40% of chronic pain patients said that their pain was inadequately managed by current treatments. This illustrates that there is a massive unmet clinical need here. Existing drugs are working well for some patients but they are not working well for all. That may be because of lack of efficacy or unacceptably high levels of side effects.”
3. Anti-emetic medicine
The HPRA approved access to cannabis products (but not full extract cannabis) for patients who have “Intractable nausea and vomiting associated with chemotherapy, despite the use of standard anti-emetic regimes whilst under expert medical supervision”
Why not allow natural full extract cannabis?
This study, published in Current Oncology in 2016 states:
For the cancer patient, cannabis has a number of potential benefits, especially in the management of symptoms. Cannabis is useful in combatting anorexia, chemotherapy-induced nausea and vomiting, pain, insomnia, and depression. Cannabis might be less potent than other available antiemetics, but for some patients, it is the only agent that works, and it is the only antiemetic that also increases appetite.
Cannabis proven safer than prescription medications
During 2016, the HPRA received a total of 3,264 reports of new adverse reaction associated with the use of medicines (that have HPRA approval). Of these, 161 patients were reported to have died while on treatment. Ironically, the highest number (45) involved cancer drugs.
The HPRA says that in many of these cases, significant underlying illness, disease progression and other factors contributed to the deaths.
The HPRA ignores the fact that there is no evidence that the side effects of medicinal cannabis are anywhere as serious as the effects of drugs that are toxic, that kill people and that are already authorised and sold in chemists countrywide. Professors Mike Barnes and David Finn say the side effects of medicinal cannabis products – and they acknowledge there were some – were moderate.
In terms of its adverse effects, it is worth starting with the major benefit of cannabis. Unusually for a medicine, there is no fatal toxic dose. It has never killed anyone. That is true of very few medications, particularly alternative medications for one of the biggest areas of use of cannabis medicinally, which is for pain. Opioids, benzodiazepines and valium-type drugs are commonly used and these are major causes of death. Cannabis does not cause death, which is the first important aspect to understand about it. Dr. Peadar O’Grady
In the US, where cannabis is allowed for medicinal use, the sale and use of opiate painkillers reduces as does the number of people who die from overdoses every year. That amounts to tens of thousands of people. If those figures are extrapolated for Ireland – we have asked the HSE for accurate figures but it does not seem to have them – we reckon hundreds die of opiate overdoses annually, many of whom are at the top end of the dose trying to relieve their pain, in particular. Unfortunately, as they increase the dose to try to get more pain relief, they exceed the toxic level and they die. Nobody has ever died from cannabis use. One of the answers as to who would benefit is people who are near the maximum of their pain medication and who are thinking of increasing it, thereby putting themselves at risk of overdosing. Hundreds of people probably die that way every year and, therefore, making an alternative available to reduce the toxic dose will save lives. Professor David Finn
The HPRA ignores the views of doctors and patients
About 60% of GPs, the people who do not regulate and do not sell medicine but who actually prescribe it and are medical professionals, favour the legalisation of cannabis for medicinal use. A 2018 study published in the Irish Journal of Medical Science showed that 88.54% of patients also agree that cannabis should be legalised for chronic pain medicinal purposes and that they view it as a reasonable pain management option.
Meanwhile…at least 17 countries permit the medicinal use of cannabis, while others plan to do so, soon. Here are a few:
In December 2013, Uruguay made history when it became the first country to legalise cannabis
Doctors will be able to prescribe medicinal cannabis by the autumn of 2018 according to the British Home Office.
Cannabis will be legal as of October 17, 2018. The Cannabis Act creates a strict legal framework for controlling the production, distribution, sale and possession of cannabis across Canada. The Act aims to accomplish 3 goals:
- keep cannabis out of the hands of youth
- keep profits out of the hands of criminals
- protect public health and safety by allowing adults access to safe, legal cannabis
On March 29 2017, the Argentine senate approved the use of Cannabidiol for medical reasons.
The Australian government legalised growing cannabis for medical and scientific reasons on 24 February 2016. Medical cannabis can now be prescribed in all Australian states.
As of January 1, 2018, GPs in Denmark have been able to prescribe medical cannabis to certain patients as part of a four-year trial.
The country decriminalised cannabis in 1953, and has famously allowed the sale of the plant for recreational uses in so-called “coffee shops” since 1976.
In 2016, the country legalised cannabis for medical uses.
Portugal’s parliament overwhelmingly approved a bill in 2018 to legalize marijuana-based medicines
Marijuana is legal for medical purposes in 30 states
Thailand’s Governmental Pharmaceuticall Organisation (GPO) has begun researching how to develop medicines from marijuana in acknowledgement of evidence that the outlawed substance has health-enhancing properties, according to a September, 2018 report in The Nation (Thailand). It is also seeking to initiate a legal amendment that would permit cannabis for medicinal use, possibly by May next year.
It’s the responsibility of legislators to enact laws that benefit society as a whole. It’s time they did just that for the hundreds of thousands of people who need medicinal cannabis to treat illness or relieve pain. Patients are suffering enough without being treated like criminals.
It’s time to decriminalise medicinal cannabis use.
For more information please see Cannabinoids page on this site.
– Cannabis: The Evidence for Medical Use (Prof. Michael Barnes)
– Report on Scrutiny of the Cannabis for Medicinal Use Regulation Bill 2016
– Health Research Board
– Cannabis for Medical Use – A Scientific Review (Health Products regulatory Authority)
– Attitudes of Irish patients with chronic pain towards medicinal cannabis.
Rochford, Ciaran and Edgeworth, Deidre and Hashim, Mohammad and Harmon, Dominic (2018) Attitudes of Irish patients with chronic pain towards medicinal cannabis. Irish Journal of Medical Science , Early online .