People are justifiably excited over the groundbreaking legalization of adult-use recreational cannabis in Canada and several American states. But it's important not to overlook the crucial role that medical cannabis plays every day in the lives of millions. So what does medical cannabis mean in a legalizing world? And how can patients best get access to medicine they need? At the 2019 World Cannabis Congress in Saint John, New Brunswick, four panelists discussed these questions and more at a session on 'Advocating for the Medical Cannabis Market and its Patients.'
Quality of Life
Dr. Jamie Cox, Chief Medical Officer at Sundial, became involved in the cannabis industry three years ago when he started exploring quality outcome metrics and the issues in polypharmacy (a patient's use of multiple medications at the same time).
"I just wasn't seeing quality outcomes. Let's be clear, when you're taking a drug you're not curing the illness—you are treating the symptoms."
Cox's work was focused on helping veterans and cancer patients and time after time, he said he saw diagnostic failures where over time the medication wasn't decreasing. To help some of these patients, he built collaborative relationships with family care physicians and really focused on quality of life care.
"When I started working with cannabis, and seeing vets that had been literally hiding in their sheds, unable to leave the house suddenly being able to go to the store down the street—it doesn't sound like a lot, but that quality of life issue cannot be overlooked."
Cox also spoke to the opioid crisis and quality of life: "We need to help these people. We are perpetuating their life in a circular, down-ward cycle and cannabis can be used on a therapeutic basis to help them."
David Berg, President and Chief Technology Officer of Strainprint agreed with this point and furthered it based on his own personal experience.
"I got involved in cannabis as a patient about three years ago, and I can tell you that the information was sorely lacking. I searched what I could on PubMed, in respect to cannabis as a treatment, but when I tried talking to doctors, all I heard was crickets, and there was a lot of misinformation."
Because cannabis works differently with each individual's endocannabinoid system figuring out how to approach cannabis-based treatment is a complicated equation. Berg points out that the embargo/prohibition on the product has resulted in a lack of research, which impacts the medical community as practitioners don't fully understand it.
Allan Rewak, VP Communications and Stakeholder Relations at Emerald Health Therapeutics, points out that this is not new—cannabis has been used for thousands of years.
"Collectively, we need to listen to the patients' voices and help bring doctors in to see how they can integrate this into therapeutic treatment. People are finding cannabis by looking for alternatives to traditional medicine and those who are finding it, are having success using it," shared Rewak.
Barriers to Medical Use and Availability
The panelists agreed that the barriers to medical use are complicated. However, Cox pointed out that the barrier to everything is physician education.
"My colleagues are really at sea. There is polarization within the health community and who is ultimately suffering are the patients. Physicians don't understand polypharmacy. Here's an example: we know of opioid-induced constipation—but instead of finding ways to decrease the use of the narcotics, we prescribe another drug to treat the side effect."
Currently, without physician support, patients can't get cannabis medically. Rewak points out that there needs to be continuing education for doctors on this topic, but this is a double-edged sword. Rodney Butt—Senior Vice President, Strategic Solutions at Nutrasource—agreed with this and pointed out that most family doctors get their drug information from pharmaceutical companies. Rewak claims that those same doctors who heard the opioid pitch are now seeing the outcomes of the opioid crisis and are resistant to learning about cannabis.
"Physicians are missing the person sitting in the patient's chair," said Cox. He points out that physician education is critical because of the individual nature of cannabis and its impact on the endocannabinoid system and argued we need to "use science to guide us," and not a company's market value.
"The needs of the medical patient related to use are very different than recreational," shared Berg. "This is a calibrated medicine that we know works on so many things (epilepsy, debilitating arthritis, insomnia, anxiety). There's a real need for government and doctors to have a program so they can understand that cannabis is not about obliterating the pain—people using it medically need regular, consistent access—it means being more mobile and functioning."
Butts pointed out the from a medical development perspective, there's no clear path forward, and that presents a real challenge. Currently, cannabis is under a release program, whereas other drugs go through an approved program. "Once it's approved, it can be covered by insurance. But the way it is now, we're in oblivion with no clear path."
The panel all agreed that it's really going to take collaboration to continue to move the mark and help communities.
Helping Navigate the Way
Butts felt that one of the issues with cannabis is that it was introduced as something you would smoke and that this impacts the regulatory pathway to it being more accepted in the medical community.
Berg pointed out that his company has been compiling patient-based research that allows physicians and pharmacists, and those practicing in the field of medicine to better understand how patients are using cannabis products for medical reasons.
"If you think of the concept of the Babel fish—how can we get the education and information in to pharmacists and doctors' hands," Berg said. "Cannabis and the way outcomes are managed isn't communicated in a way that they hear and are comfortable with. Our company does this role to help guide the pharmacist to guide the patient to the best medical choice. It's about getting them comfortable."
Rewak then pointed out that prohibition has really been the most harmful aspect of cannabis.
"Cannabis can really improve the lives of people in our communities. Legalization of cannabis is good for the economy—it is known to be helpful in the opioid crisis, we know that it helps the long term effects on PTSD. It is making communities better and improving the lives of patients."
Rewak went on: "There are reams of evidence of how therapeutic cannabis is but we're being prescribed opioids like candy. Anecdotally, cannabis is providing so much help. Cannabis doesn't make things go away, but it can make things better."