Limited access, perceived stigma and cost lead patients to go through unofficial routes.
Although medicinal cannabis (MC) products have been legal to prescribe in Australia since 2016, most are still unregistered with the ARTG and access to them remains limited and time-consuming.
For most patients, it means finding a medical professional willing to make an application to the TGA on their behalf via the Special Access Scheme Category B (SAS-B). The application needs to justify why a specific category of MC products would be of greater benefit to that patient than products already included in the ARTG.1
SAS-B applications also need to specify the seriousness of the patient’s condition, their treatment history and the risks versus benefits of the proposed MC treatment. However, there are no restrictions on the medical conditions for which a prescriber may apply via the SAS-B to access an unapproved medicinal cannabis product for their patient.
There are hundreds of unapproved MC products available through the SAS-B. These are categorised based on the proportion of CBD and THC cannabidiol content compared with the total cannabinoid content of the medicine.2
Analysis of the SAS-B approval data as of 31 August 2021 showed a total of 159,665 approvals granted for medicinal cannabis. Leading indications for approval were pain, anxiety and sleep disorders.3
The above figure is very low compared to research conducted in 2019 which showed that 11.7 % of people (or about 2.5 million Australians) aged 14 and over had used cannabis in the previous 12 months. These results also showed only 3.9 % of those who said they used cannabis for medical purposes obtained it by prescription.4
That means the other 96.1% of this group are accessing it elsewhere and probably without the guidance of a health professional. The perceived stigma associated with MC use is likely a key reason people are reluctant to talk to their doctors about it. However, patients still want to try it.
In 2019, our CreakyJoints colleagues in the US presented their research findings on patients’ perceptions of medical marijuana to the EULAR meeting in Madrid, Spain.5
In their survey of 1,059 patients with arthritis, only 30% were satisfied with their current treatment. A total of 89% reported trying THC and/or CBD for a purpose they perceived as medical and 83% reported that THC improved their symptoms.
Our parent organisation, Global Healthy Living Foundation, published their review of current literature on Cannabis for Rheumatic Disease Pain in Current Rheumatology Reports in April 2022.6
They noted that observational and survey studies show increased use of medicinal cannabis, both by people with rheumatic disease and the general population, and suggest that patients find these treatments beneficial. However, prospective studies, including randomised controlled clinical trials, are rare and sorely needed.
The Australian Rheumatology Association supports the increasing worldwide research aimed at assessing the safety and effectiveness of cannabis-based treatments for people with arthritis and other musculoskeletal conditions. However, they do not currently recommend the routine use of these products for arthritis and other musculoskeletal conditions.
“Research so far shows that only a small number of people treated with cannabinoids for painful conditions notice a small improvement in pain and sleep, and there is little or no improvement in their ability to participate in daily activities. Many people experience unpleasant side-effects (such as nausea, dizziness or difficulty thinking clearly) and there may be other important side effects in the long term that we do not know about yet.”7
CreakyJoints Australia is currently running a mini survey asking people if they have taken cannabis to manage their symptoms of arthritis or related conditions.8 Early responses indicate people are willing to try it. Some have had good results while others have struggled with access.
“It initially worked well and improved my joints, pain and function by about 80% but the efficacy waned. Since stopping, I have had many months of increased pain.”
“THC medicinal cannabis was prescribed for me by my rheumatologist. It has proved as effective as Tramadol for pain relief at night and I also feel more comfortable using it at other times, meaning that my pain is now better managed during the day. I have not experienced any side effects, so the only real downside is the current high cost.”
“The legal route is financially prohibitive. It’s also a cumbersome process and not well understood by most practitioners.”
“I want to try CBD oil but my GP said she couldn’t do it without my rheumatologist’s approval. My rheumatologist wanted me to go to a pain clinic instead, so I am stuck. I have heard great things about it, but I can’t access it.”
We believe it is important for patients using cannabis products to speak openly with their doctor to avoid potential drug interactions and other risks.
As we wait for more research and guidelines to become available, CreakyJoints Australia invites rheumatologists and other health care providers to engage in discussions about medicinal cannabis with patients in an objective and empathetic way.
Sources
1 Australian Government Therapeutic Goods Administration – Accessing medicinal cannabis for a patient tga.gov.au/accessing-medicinal-cannabis-patient
2 Australian Government Therapeutic Goods Administration – Medicinal cannabis products by active ingredients tga.gov.au/medicinal-cannabis-products-active-ingredients
3 McPhail S L, et al, Medicinal Cannabis Prescribing in Australia: An Analysis of Trends Over the First Five Years. Frontiers in Pharmacology. Sec. Drugs Outcomes Research and Policies. 10 May 2022. doi.org/10.3389/fphar.2022.885655
5 Gavigan K, Venkatachalam S, Curtis J, et al. THU0644 Patients’ Perception and Use of Medical Marijuana, Annals of the Rheumatic Diseases 2019;78:617-618. ard.bmj.com/content/78/Suppl_2/617.2
6 Nowell WB, et al. Cannabis for Rheumatic Disease Pain: A Review of Current Literature. Current Rheumatology Reports. February 16, 2022. doi.org/10.1007/s11926-022-01065-7
7 Australian Rheumatology Association – Position Statement on the Use of Cannabinoids For Arthritis and Other Musculoskeletal Conditions in Adults rheumatology.org.au/For-Patients/Medication-Information/C-G/Cannabinoids-Medicinal-Cannabis
8 CreakyJoints Australia – Mini survey: Using Cannabis to Manage Your Arthritis or Related Conditions creakyjoints.org.au/advocacy/mini-survey-using-cannabis-to-manage-your-arthritis-or-related-conditions/
Rosemary Ainley wrote this article on behalf of the CreakyJoints Australia team.
CreakyJoints Australia would like to thank Rheumatology Republic for this opportunity to share the patient voice within the Australian rheumatology community. creakyjoints.org.au
