Medical Cannabis Effective but Expensive for New Zealanders

By Pat Anson, PNN Editor

Medical cannabis is very effective at relieving pain, improving sleep and reducing anxiety, according to researchers in New Zealand, who say government policies need to change to make cannabis cheaper and more accessible to Kiwis.

Researchers at the University of Otago, Victoria University and the University of Auckland surveyed and conducted interviews with 213 people who had prescriptions for cannabis under New Zealand’s medical cannabis program. Participants were asked about the quality of cannabis products they used and their effectiveness.

The study findings, published in the journal Drugs, Habits and Social Policy, show that nearly 96% reported that cannabis helped them with their medical conditions. Almost half (49%) said they were able to reduce or stop taking prescription drugs.

The most common therapeutic use of medical cannabis was pain relief and 96% of participants said it helped reduce their pain. Cannabis also helped users who had difficulty sleeping (97%) and those with mental health issues (98%).

Of the participants who took cannabis for other reasons, such as autism, attention deficit hyperactivity disorder, post-traumatic stress disorder, and difficulty eating, 98% found cannabis helpful.

"An important finding of the study was that participants either decreased or stopped their use of prescribed medicines, many of which were opioid based," said co-author Geoff Noller, PhD, a Research Fellow at Otago University's Dunedin School of Medicine. "This both reinforces that they experienced some actual effect from using cannabis in that they ceased or decreased other medications with recognized efficacy, and in the case of many of these other medications, they reduced their use of potentially more problematic medications.

"There is a place for both approaches, with the results of this study suggesting that cannabis products could have a role in treating patients with chronic pain and other conditions refractory to treatment by conventional means."

But many New Zealanders find medical cannabis difficult to obtain and rely on the black market. A recent study by the NZ Drug Foundation estimated that while over a quarter of a million Kiwis use cannabis for medical reasons, only 6% -- about 17,000 people -- obtained cannabis with a prescription.

Many doctors won’t prescribe medical cannabis and there are a limited number of products on the market, keeping prices high. The Foundation said CBD oil can cost a patient $150-350 per month, with other cannabis products costing even more.

"At present, current regulations appear to be creating problems for many New Zealanders who otherwise report positive benefits from their use of medicinal cannabis,” says Noller. "Specific barriers include cost, with currently available medicinal cannabis products being too expensive for many New Zealanders due to the compliance costs of production imposed by regulations, and also the lack of knowledge about it for physicians, leading to a reluctance to prescribe, in many cases."

To obtain medical cannabis, New Zealanders need a prescription from a doctor that spells out what cannabis products can be used and the amount. Medical cannabis can only be obtained legally from a doctor or pharmacy, although many Kiwis use a “Green Fairy” – a person who provides cannabis for a nominal fee.

Doctors Advised Not To Prescribe Cannabis for Chronic Pain

By Pat Anson, PNN Editors

Pain management experts around the world are becoming more vocal about the growing use of medical marijuana as a treatment for chronic pain, saying there is little evidence to support the use of cannabis as an analgesic.

Today the Faculty of Pain Medicine at the Australian and New Zealand College of Anaesthetists (ANZCA) released new guidance urging doctors not to prescribe medical cannabis for patients with chronic, non-cancer pain unless they are enrolled in a clinical trial.

“Until there are results from high-quality, unbiased clinical trials which establish the effectiveness and safety of medicinal cannabis in treating chronic pain, the Faculty of Pain Medicine does not believe cannabinoid products should be prescribed,” Mick Vagg, MD, Dean of the Faculty of Pain Medicine, said in a statement.  

“We want to highlight to healthcare providers that currently available medical cannabis products are not even close at this stage to showing that they deserve a place in the management of the complex patients who suffer from ongoing pain. We believe clinicians will welcome this clear guidance.”

ANZCA is a professional society for nearly 8,000 anesthesiologists and pain management specialists in Australia and New Zealand, and sets standards for pain medicine in both countries.

Australia and New Zealand have some of the highest rates of cannabis consumption in the world. But New Zealand only allows medical cannabis for terminally ill patients, while Australia requires a prescription for cannabis that is often difficult to obtain.

About one if five Australians live with chronic pain.   

“Medical cannabis products are not even close at this stage to showing that they deserve a place in the management of the complex patients who suffer from ongoing pain.”

— Dr. Mick Vagg

“By far the most common reason for the use of medicinal cannabis in this country is chronic pain − however there is a critical lack of evidence that it provides a consistent benefit for any type of chronic non-cancer pain, especially compared to the treatments we already strive to provide in pain clinics,” Vagg said.

“The research available is either unsupportive of using cannabinoid products in chronic non-cancer pain or is of such low quality that no valid scientific conclusion can be drawn. Cannabidiol-only formulations have never been the subject of a published randomised controlled trial for chronic pain treatment, yet they are the most commonly prescribed type of cannabis product.”

Vagg also said research is lacking in how cannabinoids react with pharmaceutical drugs, particularly in relation to their sedative and psychiatric side effects.

‘Hypothesis’ of Analgesia

ANZCA’s new guidance came just days after the International Association for the Study of Pain (IASP) released a position statement saying it could not endorse the use of cannabinoids to treat pain. IASP said there were preliminary studies supporting the “hypothesis of cannabinoid analgesia,” but not enough to overcome the lack of evidence on the safety and efficacy of cannabinoids.

“While IASP cannot endorse the general use of cannabinoids for treatment of pain at this time, we do not wish to dismiss the lived experiences of people with pain who have found benefit from their use,” said Andrew Rice, MD, chair of IASP’s Presidential Task Force on Cannabis and Cannabinoid Analgesia.

“This is not a door closing on the topic, but rather a call for more rigorous and robust research to better understand any potential benefits and harms related to the possible use of medical cannabis, cannabis-based medicines and synthetic cannabinoids for pain relief, and to ensure the safety of patients and the public through regulatory standards and safeguards.”

Rice said IASP was concerned that laws allowing the use of medical marijuana were being adopted without the same rigor and regulatory procedures that are followed for pharmaceutical products. Patients who self-treat their pain with cannabis are also at risk, according to Rice, because their doctors often don’t know about their cannabis use.  

“IASP is also calling for the delivery of a comprehensive research agenda. Priorities include identifying patients with pain who may receive the most benefit from cannabis or cannabinoids, and who may be at risk of the most harm,” said former IASP president Lars Arendt-Nielsen, MD, who co-chaired the Cannabis Task Force.

Supporters of medical cannabis dispute the contention that there is inadequate evidence about the use of cannabis for pain.

“These recommendations are political, not scientific. Several peer-reviewed trials have concluded that inhaled cannabis is safe and effective for treating various types of pain, in particular neuropathic pain,” Paul Armentano, Deputy Director of NORML, said in an email to PNN.

Armentano cited a 2017 study from the U.S. National Academy of Sciences, which found “conclusive or substantial evidence” that cannabis is an effective treatment for chronic pain.

“In the real world, the therapeutic use of cannabis is rising among chronic pain patients, many of whom are substituting it in place of opioids. In jurisdictions where cannabis is legally available, chronic pain is the most qualifying condition among medical cannabis patients enrolled in state-specific access programs. To willfully ignore these data is indicative that political considerations, rather than scientific considerations, influenced this group’s decision,” Armentano said.