Weed News: Medical use of cannabis

Nick Cooper :

27 Oct 2014 12:39:31pm

Dr. Swan,

I’m responding to your comments on RN Breakfast on 2014/10/27, and look forward to listening to tonight’s health Report.

My thoughts so far:

From my reading, most of the reported medical benefits are from cannabidiol (CBD) and possibly from cannabigerol (CBG) neither of which has any euphoric effect, and are quite often consumed orally rather than being smoked.

In fact, there is some evidence that heating CBD degrades it, and so cold-extracted CBD-rich compounds are also popular.

I’m not sure how much of that has been taken into account by NDARC.

There is much more anecdotal evidence – with all the inherent pitfalls of such – than peer-reviewed research, yet peer-reviewed research into CBD and CBG exists and grows on a steady basis.

Strains of cannabis that are high in CBD and have minimal THC have been bred for patients who dislike euphoria and for minors. It sounds as if NDARC may have excluded such research.

It’s far better to talk about ‘medical cannabinoids’ in specifics than ‘medical cannabis’ as a generic term. ‘Marijuana’ is a Mexican slang name that has no place in a scientific discussion.

The USA implementation is a virtually unregulated Wild West show, where Australian implementation should aim for TGA and FSANZ regulation of products, and ISO 9000 series quality management.

There is significant evidence that THC disrupts normal brain development, and although that doesn’t end until early 20s, the best that can be hoped for is prohibition of THC supply to or consumption by minors.

Given that tobacco and alcohol are legally regulated and taxed drugs that are addictive, the potential for cannabis to be addictive should not be a bar to its legal regulation and tax.

Disclosure – I am a member of Drug Law Reform Party but hold no office and am not authorised to speak on their behalf.

I’m happy to engage in follow-up correspondence on this matter if you wish that.

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Eva :

27 Oct 2014 12:51:13pm

I have a lot of respect for Dr Swan, so I was a little disappointed to hear his summary of the evidence around the efficacy of medical marijuana, in a discussion with Fran Kelly on RN Breakfast this morning.

Dr Swan seemed to equate cannabis with THC, as if it was the only compound within cannabis displaying pharmacological effects. This is a very narrow view of a very complex substance. His summary of the evidence did not acknowledge the many other substances present in cannabis; cannabidiol and anandamine being just the start.

He also overlooked the fact that cannabis itself and the burned by-products in its smoke (polycyclic aromatic hydrocarbons) can affect the body’s xenobiotic metabolism. That is, chemicals in cannabis or its smoke can temporarily alter the function of the body’s enzymes, changing the way they break down foreign substances (e.g. inhibition of Cytochrome P450 2C9 by THC, cannabidiol and cannabinol. See http://www.ncbi.nlm.nih.gov/pubmed/22166891). These enzymatic effects are not unique to cannabis. Dr Swan has already covered the question of dietary inhibitors on his own program (e.g. grapefruit inhibits CYP3A4). The effects of inhibition will vary widely between people, depending on their genes.

I would prefer that individual responses to cannabis are not dismissed as placebo, when we have done so little research to understand its chemical make-up and interactions with human pharmacogenomic variations. That is, some people use enzymes to metabolise certain substances very efficiently in their bodies, while others do not.

Until we do good quality research to understand cannabis’s synergistic effects and its interaction with enzymes in the gut, liver, blood-brain barrier and brain, we will not understand how certain effects occur in certain patients. While it remains a legal pariah, it is unlikely that high-quality, reliable studies of this kind can be done.

Cannabis is not harmless, nor a panacea. But its use to ease suffering, especially amongst those at the end of their lives, should not be blocked by untested assumptions.

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