“Nothing in life is to be feared; it is only to be understood. Now is the time to understand more, so that we can fear less.”
– Marie Currie 1967-1934
This quote is long removed from the present, yet its power is not diminished. Fear is the easier path because it always shortens the journey or hinders it all together? Presently, a great deal of misunderstanding, ignorance (in the true sense of the word, lack of knowledge or information,1) and fear is associated with cannabis.
It is a colossal topic; it is ubiquitous; it is controversial, and it is adversarial.
Perhaps the initial path in this complex journey must lead to the medical implications of cannabis. For the layperson, the first impression is there are not enough valid medical studies about the effects of cannabis for it to be applied in populace medicine. This is not the case as scientific research has been developed around cannabis, particularly in the areas of medicinal practice.
A resurgence of cannabis as a medical tool is evident in recent bodies of research. A new special issue of the European Journal of Internal Medicine provides a comprehensive overview of current evidence for the use of cannabis and derived products in medicine and calls for more research to improve the evidence base for its use2. The two articles in the journal focus on the use of cannabis in cancer patients and the elderly, as well as a comprehensive overview of the evidence, regulations, ethics and practical use.3
In this special issue, Prof. Donald Abrams at the University of California San Francisco Ward in the US covers the recent review conducted by the National Academies of Sciences, Engineering and Medicine, The Health Effects of Cannabis and Cannabinoids. The report, which considered 10,000 scientific abstracts,
concluded that there was conclusive or substantial evidence that Cannabis or cannabinoids are effective for the treatment of pain in adults; chemotherapy-induced nausea and vomiting and spasticity associated with multiple sclerosis. 4
Clinical studies in Israel, Canada, Europe and the US are continuing to gather evidence for the use of cannabis in the treatment of certain illnesses like cancer and medical conditions like Parkinsons. The problem of restrictive measures which make the study of cannabis difficult, particularly in the US, and the difficulty in employing existing data to educate the medical community, the public and the legislative bodies which guide pharmaceutical law are impeding the adoption of medicinal cannabis.
So, the fear associated with a lack of knowledge shapes medical perceptions and actions related to medicinal cannabis. A comprehensive treatment guideline would ease the pressure many in the medical community are under because they do not feel adequately schooled in the prescription of cannabis. Such guidelines are being researched and recommendations are being offered. Professor Novack, one of the Israeli researchers responsible for the article, Prospective analysis of safety and efficacy of medical cannabis in a large unselected population of patients with cancer, comments:
“We hope that it (the article) will provide physicians with a contemporary summary of different aspects related to the medical cannabis and guide the choice of an appropriate treatment for the indications where the evidence is sufficient to initiate the treatment. We also hope the articles will facilitate the conversation on the future of medical cannabis research and its accommodation into mainstream medicine.” 5
However, it is incumbent that the global research community identify and purge weak or flawed cannabis studies to legitimize science-based studies which are subject to rigorous review.
In Canada, with the impending legalization of cannabis, the Canadian Medical Association (CMA) which coincidentally was founded the same year Madame Currie was born, presented to the Task Force on Cannabis Legalization and Regulation, a federal body, three guidelines for the general publics health:
1) preventing drug dependence and addiction;
2) increasing the availability of assessment, counselling and treatment services for those who wish to stop using; and
3) increasing the safety for those who are using through harm reduction programs and awareness.6
Also, in June 2017, the CMA publicly supported the release of Canadas Lower-Risk Cannabis Use Guidelines, which provide 10 science-based recommendations to enable cannabis users to reduce their health risks.7
In reading much of the CMAs literature on cannabis, the consensus is that the association is waiting for more direction and is moving at a conservative pace. Time is needed to educate and to develop sound guidelines for its membership before prescribing medicinal cannabis will be the status quo. Leaders in the cannabis industry like National Health offer educational events across Canada for doctors and other medical professionals. National Health wants to foster a positive and productive relationship with the medical profession which will reduce the fear associated with medicinal cannabis.
As with any substance that can be potentially harmful, it befits governing bodies and industry producers to be involved in the development of legislation which protects citizens from harm. Once a substance is sanctioned by the government then testing, labelling and product identification come into play. These actions present several complex scenarios, for example, all medicinal cannabis products will need bin numbers for claiming medical costs for insurance policies. Germany has already begun instituting cannabis bin numbers in its medical system. Also, the labelling of products must encompass both medicinal and recreational use. Some producers like National Health have developed graphics; for example, a pinwheel identifies types of cannabis and their different potencies and usages. The emphasis of this labelling is start low, go slow. How cannabis will be presented in the public area in Canada is still being debated.
Finally, public perception of medicinal cannabis (and recreational cannabis) comes into play. A more complex quagmire would be very difficult to find. Controversy abounds. No one can legitimately argue that no harm can come from cannabis use as that is simply not true, but it is also not true of other prescribed medical drugs. But, perhaps with cannabis, we can rethink how we caution against abusing or misusing medicinal cannabis. Unfortunately, differing presentations are already being presented in the media. Although not directed at medical cannabis, the MADD commercial of an accident scene which relies on fear is not the route to take; the ad which has the teenager advising his parents of responsible behaviour is far more effective. It promotes dialogue and responsibility, and it addresses cannabis stereotypes; these aspects of the ad do relate to the inclusion of cannabis in the medical landscape.
Like every human endeavour that is worthwhile, roadblocks?, wrong turns and misplaced passion abound, and the establishment of medicinal cannabis in the medical system is no exception. The exception will be in how we navigate this journey.