Many people with a spinal cord injury will tell you that muscle spasticity and pain are constant companions. And the pain isn’t just your common, garden-variety cut-your-finger type of pain. It’s most often neuropathic (nerve) pain. It can be stabbing, prickling, burning; it can be chronic, debilitating and require strong, potentially addiction-forming analgesics to enable a person to have a better quality of life.

What’s the issue with taking strong analgesics for pain relief?

Strong analgesics can have many negative effects on the body such as constipation, tiredness or fatigue, dizziness, drowsiness, hallucinations, nausea, increased sweating, feeling sad or depressed and, over a long period of time, can cause damage to the stomach and internal organs. The body gets used to the drugs so that they eventually become less effective, meaning stronger and stronger doses are required to achieve the same level of pain relief. People can easily get trapped in an addiction cycle which they may have great difficulty breaking.

Addiction to analgesics is a growing problem and people are dying unnecessarily as a result. Some 1,045 Australians aged 15-64 died of an opioid overdose in 2016, according to a report released by the National Drug and Alcohol Research Centre at the University of NSW in Sydney. The majority of these deaths (76%) were attributable to pharmaceutical opioids.

So how can medicinal cannabis help?

When it comes to treating pain, the use of cannabinoids (CBDs) extracted from cannabis can work in different ways. CBDs used for medicinal benefits are different to tetrahydrocannabinol (THC) which causes the euphoric “high” when cannabis (marijuana) is consumed through smoking, vaping or eating. For some people, CBDs shut down the sensation of pain. In other people, they help them to disassociate and relax so that they’re not so aware of the pain, enabling them to get on with their day.

CBDs act as a kind of circuit breaker, reducing the abnormal neuron activity that’s behind neuropathic pain. A CBD binds itself to CBD receptors in the body that are an important part of the  nervous system. Once in place, they block the release of neurotransmitters that have been found to trigger pain.  

Research

There’s a growing body of evidence supporting the use of medicinal cannabis for the treatment of myriad conditions. A systemic review of the benefits and adverse effects of CBDs concluded moderate quality evidence to support their use for the treatment of muscle spasms, chronic pain and spasticity.

How is medicinal cannabis being prescribed in Australia today?

There is currently no predetermined list of conditions for which a cannabis-based medicine can be prescribed in Australia. However, the Therapeutic Goods Administration (TGA) states that medicinal cannabis is generally being prescribed for conditions including epilepsy, multiple sclerosis, chronic pain, HIV/AIDS, chemotherapy-induced nausea, PTSD and anxiety and depression.

There is currently no predetermined list of conditions for which a cannabis-based medicine can be prescribed in Australia. However, the Therapeutic Goods Administration (TGA) states that medicinal cannabis is generally being prescribed for conditions including epilepsy, multiple sclerosis, chronic pain, HIV/AIDS, chemotherapy-induced nausea, PTSD and anxiety and depression.

But access to medicinal cannabis is far from simple. To obtain it, people can’t simply visit their doctor, report they have chronic neuropathic pain and – voila! – expect a prescription to be immediately written.

There are currently two main avenues in Australia to obtain medicinal cannabis.

The first is through the Special Access Scheme (SAS) category B. Via this method, a doctor makes an application to the TGA which includes the patient’s diagnosis and indications for which the product is sought. The application requires a thorough clinical justification for the use of the product, the seriousness of the patient’s condition, details of previous treatment and reasons why an existing medication can’t be used instead. The application must also include safety and efficacy data to support the proposed use of the product. This may include references to clinical trial results and peer-reviewed data, details of intended monitoring for adverse events and patient response to treatment.

The second way is through a doctor who, as an Authorised Prescriber, is approved to prescribe medicinal cannabis to their patients without further TGA approval. To become an Authorised Prescriber the doctor must have the training and expertise appropriate for the condition being treated and the proposed use of the product, be able to best determine the patient’s needs of the patient monitor the outcome of the treatment. At the time of writing there are only 57 medical professionals registered as Authorised Prescribers in Australia.

How is medicinal cannabis being prescribed in Australia today?

Apart from the onerous application process, another reason people might be finding it challenging to obtain medicinal cannabis is that knowledge amongst medical professionals about the benefits of CBDs is low. A new study from the Queensland University of Technology reports that although medical professionals broadly supported the idea of medicinal cannabis, they lacked information and the confidence to prescribe it, wanting more information before they did so.

Many people would benefit from easier access to medicinal cannabis from their regular doctor. But until this happens the message is clear – do your research so that you’re well informed when you visit your doctor and don’t take no for an answer. If your doctor is reluctant, ask them for a referral to a medicinal cannabis clinic. Such clinics have medical professionals on board who will assess your condition and make a decision about whether to apply for CBD-based pain relief on your behalf.

Visit the SCIA Resource Library for articles and studies or Google medicinal cannabis to become better informed.