It was late 2020 when David determined to speak to his GP about getting a prescription for medicinal hashish.
He’d been identified with fibromyalgia — a situation characterised by widespread ache and tenderness within the physique — and had been largely self-medicating with hashish he’d purchased illegally.
“Fibromyalgia is sort of debilitating,” he mentioned.
“It causes random ache spots within the physique … my shins will likely be numb after which simply really feel like they’re on hearth on the similar time.”
The situation, which might be tough to diagnose, is commonly accompanied by fatigue and altered sleep, reminiscence and temper.
David — not his actual identify — says he was feeling continuously fatigued, struggling to handle his sickness alongside work and caring for his disabled accomplice.
“By about two o’clock within the afternoon, I simply wished to go to sleep,” he mentioned.
After getting the inexperienced mild from his GP, David started utilizing hashish oils and natural merchandise.
He discovered they helped to “masks the signs” of fibromyalgia and enhance his sleep.
“Finally my physique adjusted and I used to be in a position to simply have very small quantities [of cannabis],” he mentioned.
Prescriptions develop as entry eases
David is considered one of tens of hundreds of Australians who entry hashish legally.
Information from the Therapeutic Items Administration (TGA) reveals prescriptions for medicinal hashish doubled from 2020 to 2021, with greater than 122,000 prescriptions written final 12 months alone.
It is a vital leap from only a few years in the past. In 2018, roughly 2,500 prescriptions have been written for your complete 12 months.
Melbourne GP Vicki Kotsirilos — the primary authorised GP prescriber of medicinal hashish in Australia — mentioned prescriptions had doubtless elevated as a result of the TGA utility course of had been “streamlined” and affected person demand had grown.
“It was exceptionally exhausting at first. I used to be not in a position to get very many permits,” mentioned Dr Kotsirilos, an affiliate professor at Western Sydney College.
“For the reason that finish of 2018, the TGA launched a web-based allow system, and prolonged the length [of permits] from three to 6 months to at least one 12 months, and now even as much as two years.
“Up to now, we additionally needed to get a allow for each single product … now, it is generically prescribed.”
In different phrases, a GP can prescribe a product if it is primarily based on an authorised class of cannabinoid content material (eg. CBD-only therapy) for that affected person, moderately than having to get approval for every new product.
In Australia, there are solely two cannabis-based prescription medicines on the Australian Register of Therapeutic Items.
One is prescribed to deal with uncommon, drug-resistant types of epilepsy that start in childhood, the opposite as a muscle relaxant for folks with a number of sclerosis.
The overwhelming majority of hashish merchandise are unregistered medication, which require approval beneath the TGA’s Particular Entry Scheme (or by way of its Authorised Prescriber Scheme).
These merchandise, of which there are greater than 250, comprise CBD or THC (or each), and are available within the type of oils, capsules or dried flowers to be vaporised.
Information reveals most prescriptions are for power ache, nervousness, cancer-related signs, and insomnia.
Development in prescription displays ‘unmet well being wants’
Jennifer Martin, doctor and director of the Australian Centre for Cannabinoid Scientific and Analysis Excellence, mentioned she wasn’t stunned that medicinal hashish prescriptions had elevated considerably.
“The numbers have gone up exponentially, and taking a look at different international locations, it was anticipated that will occur right here too.”
Professor Martin mentioned the actual fact most prescriptions have been being written for power ache and nervousness mirrored massive “unmet well being wants” locally.
“Once we see folks like this in our medical observe, they’re generally on seven to 10 drugs and their signs do not go away,” she mentioned.
“They’re generally simply ready for the subsequent new chemical to reach.”
The issue, she mentioned, was that in lots of instances, power ache and anxiety-related situations weren’t “satiated by biochemicals” alone, and often required psychological remedy and environmental modifications to assist handle “underlying points”.
“It might simply be that [medicinal cannabis] is getting them by means of their present scenario,” she mentioned.
“It is not an issue within the sense that folks usually use chemical substances within the brief time period to deal with issues.
Professor Martin mentioned many individuals confronted restricted entry to psychological well being providers and ache administration assist.
“The truth is, it prices some huge cash, they usually have to attend six months for a [psychology] appointment. It is the identical with ache clinics.”
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Hashish prescribed when different remedies fail
Medicinal hashish is just not thought of a first-line remedy for any situation, and Dr Kotsirilos mentioned it was essential to first discover way of life and behavioural modifications that might alleviate signs of ache or nervousness.
“To handle nervousness, train performs a very necessary function, in addition to bettering sleep and diet, doing issues like meditation, and naturally [getting] a referral to a psychologist,” she mentioned.
“For power ache, it is the identical recommendation — way of life and behavioural administration … could make a distinction to sufferers’ ache ranges.”
She mentioned if pharmacological therapy was required, it was necessary to first strive registered medicines corresponding to analgesics or anti-anxiety medication (which have been assessed for security, high quality and consistency) earlier than contemplating medicinal hashish.
“Quite a lot of occasions, sufferers might have already tried anti-anxiety or different medicine and located it limiting — they could have had unwanted side effects, weight achieve, lack of urge for food, or they have been ineffective, and they don’t seem to be focused on pursuing that,” Dr Kotsirilos mentioned.
“In the event that they’ve explored the whole lot, together with way of life modifications and seeing a psychologist … medicinal hashish may be my final resort therapy.”
She mentioned she took an analogous method for sufferers with power ache, and if medicinal hashish was appropriate, all the time adopted a way of “begin low and go gradual”.
“It is extra symptomatic management, so not all of them will attain 100 per cent aid. It may be 50 per cent,” she mentioned.
“However what it could possibly doubtlessly do is deliver some high quality of life.
“If they’ve much less ache, they could sleep higher and due to this fact get up feeling higher, and they’re fairly glad to simply accept that.”
Proof for hashish nonetheless restricted total
Whereas the quantity of scientific literature on medicinal hashish has elevated in recent times, the proof for its use stays restricted total.
“There’s proof for some varieties of power ache, corresponding to neuropathic ache … which individuals can get with diabetes and generally after chemotherapy,” Professor Martin mentioned.
She added there was additionally some proof for its use in folks with “existential” misery or ache, which has been described as struggling with no clear connection to bodily ache.
However Professor Martin mentioned the info up to now steered that most often, medicinal hashish was “no higher” than current pharmacological remedies.
“The info reveals that [medicinal cannabis products] may be higher for some folks than placebo — so doing nothing — however they do not actually present any profit over our current medication,” she mentioned.
Dr Kotsirilos agreed that there was a scarcity of high-quality proof for the usage of hashish merchandise, however famous that “there’s a rising physique of analysis attempting to backfill that absence of proof”.
“I’ve had some actually good success with sufferers who have gotten fibromyalgia, nervousness, problem sleeping and different behavioural issues,” she mentioned.
“Regardless that the proof is just not robust, there may be some proof … when it is a final resort and the affected person has did not receive aid from the same old medicine, or they’ve had unwanted side effects.”
The function of GPs
Due to the restricted proof base, many GPs stay cautious on the subject of prescribing medicinal hashish.
“I can perceive GPs’ hesitation, particularly due to the problems that we have had relating to opioid prescribing,” Dr Kotsirilos mentioned.
“Their considerations are justified and [medicinal cannabis] does should be used cautiously.”
Dr Kotsirilos mentioned she’d wish to see extra analysis and “higher schooling” for GPs on the proof for medicinal hashish and the potential advantages and dangers related to therapy.
“What are the protection points? What are the dangers? And what different remedies are there to assist sufferers even earlier than medicinal hashish?”
However Professor Martin, who teaches pharmacology to GPs-in-training, mentioned that present medical coaching was enough.
“They cowl all the main courses of medicine — cannabinoids are simply considered one of many.”