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is the perception that people don’t need medicines, that they’re just getting them for non-medical reasons. This is seen a lot with opioids, with medicinal cannabis, and now it’s also emerging with pregabalin and similar medicines. While pharmacists have a responsibility to ensure quality and safe use of medicines, this needs to be done in a manner that doesn’t obstruct a person from accessing medicines that are safe and effective for them. Another aspect of stigma is the perception that pain is all in people’s minds, or that they just haven’t found the right thing to help them yet. There’s no silver bullet for pain; someone who experiences chronic or persistent pain will require a multidisciplinary approach to treatment over a long period of time, just like every chronic condition. To put this in context, we’d never say to a person with diabetes, ‘Have you tried just not eating carbohydrates?’ According to the survey, people living with chronic pain are quite open to seeing other allied health professionals to help them better manage their pain. However, they do experience significant barriers, such as affordability. Why is this still an issue and what can be done to change it? This is a question CPA continually asks decision makers in government. The narrative around access to opioids, for instance, says that people should utilise allied health in order to minimise medicine use, but if we don’t fund allied health the way we fund medicines, then how can we expect people to have equal access? This is particularly problematic in rural areas where access is an even bigger issue than affordability. Medicinal cannabis was shown to be an area of interest for most people in the survey, but more than 60 per cent said they haven’t spoken to their GPs about it. Why do you think this is the case? Stigma is the primary issue here. Respondents to the survey this year mentioned that their health professionals showed disdain or even laughed when asked about medicinal cannabis. Coverage in the media adds to this, as there’s a lot of misinformation, both negative and positive, that muddies the water on this topic. People living with chronic pain who have made inquiries about medicinal cannabis reported that access and cost are major barriers for them to pursue it. Do you see that changing, and in the meantime, what would be your advice for those patients who would benefit from it, but for the reasons I just mentioned, can’t access it? One good thing with medicinal cannabis is that government regulation is reducing, so that it’s almost treated like any other schedule 8 medicine. Regulation is needed, but not more than opioids or schedule 4 medicines, for instance. That being said, manufacturers need to undertake a lot of work to provide the documentation needed to justify TGA and PBS listing. Until this occurs (which will take several years), costs will likely remain high. As a pharmacist, what would be your advice for pharmacists when patients come into the pharmacy inquiring about medicinal cannabis for chronic pain? First, if you aren’t sure, say so, and that you’ll follow up and provide answers. Don’t say it’s not available, or that it’s illegal, or that it doesn’t work. None of these are true, although the benefits are yet to be quantified in large RCTs. There are several resources to educate HCPs and consumers about medicinal cannabis. Start with familiarising yourself with these. The courses delivered by ANU on medicinal cannabis would be the best place to start. Do you see medicinal cannabis as a better alternative to opioids for treating chronic pain in some patients, and if so, is Australia prepared to treat it as a ‘medicinal’ and disregard the current negative stigma it has, even among some health professionals? Not an alternative. Most evidence points to a reduction in overall medicine burden by using medicinal cannabis for pain. That is, the overall dose of opioids and other analgesics is likely to be reduced when medicinal cannabis is added to a person’s medicines. Think of this as akin to blood pressure medicines, where we know an ACE inhibitor combined with a thiazide diuretic is more effective than doubling the ACE inhibitor. COVID-19 changed the way we all live, and people living with chronic pain also had to adjust to these challenges. How did they manage the changes involved, such as using telehealth consultations, working from home, etc? Most respondents found positive impacts by not needing to travel, and not spending time in waiting rooms. The need for physical examination remains, so telehealth is a good option for people when physical contact is not required. NEWS IN FOCUS 15 “Going forward, our health system will need to develop new strategies for how to respond to situations like COVID-19 to ensure that there’s minimal disruption on essential healthcare, while keeping everyone as safe as possible.” While on the subject, what do you think will be the challenges of COVID-19 moving forward for people living with chronic pain? Chronic pain has an ongoing impact on people’s lives, and anything new that adds any level of stress, as COVID-19 certainly is doing, contributes to people’s experience of pain. In addition, it’s creating new barriers to accessing treatment. For instance, people have had surgical procedures cancelled, have had difficulty accessing their normal healthcare, or have felt unsafe attending healthcare settings. There’s been an impact on what people consider ‘essential’ treatment, with treatments or procedures for pain some of the first ‘elective’ treatments to be cancelled. All of this contributes to a poorer outcome for people experiencing chronic pain. Going forward, our health system will need to develop new strategies for how to respond to situations like COVID-19 to ensure that there’s minimal disruption on essential healthcare, while keeping everyone as safe as possible. RETAIL PHARMACY • AUG 2020