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70 MEDICINAL CANNABIS FROM PAGE 69 Medicinal cannabis versus opiates An interesting discussion point that arises when discussing the role of medicinal cannabis in pain management, along with its safety profile, is whether medicinal cannabis can potentially take the place of opioids. “The rates of harm from \\\\\\\\\\\\\\\[medicinal\\\\\\\\\\\\\\\] cannabis compared to other medications are usually much lower,” Dr Jansen said. “A number of Australians are killed \\\\\\\\\\\\\\\[each\\\\\\\\\\\\\\\] day by opiates, and the number that go into hospital from opiates is 150 per day in Australia. Whereas, you compare that to THC and CBD, which don’t stop you breathing \\\\\\\\\\\\\\\[potentially\\\\\\\\\\\\\\\] like opiates \\\\\\\\\\\\\\\[may\\\\\\\\\\\\\\\] or make you sedated as \\\\\\\\\\\\\\\[opiates\\\\\\\\\\\\\\\] can do and make you lose consciousness.” However, caution is needed when making links between medicinal cannabis and opioids or opiates. A 2019 study funded by the National Institute on Drug Abuse, which re-examined the relationship between access to medicinal cannabis and overdose death rates from opioids, found “no evidence that either broader cannabis laws (those allowing recreational use) or more restrictive laws (those only permitting the use of marijuana with low THC concentrations) were associated with changes in opioid overdose mortality rates”.7 It was concluded, therefore, that this data “does not support the interpretation that access to cannabis reduces opioid overdose”.8 “Medicinal cannabis is an adjunct therapy, which means it will be added to the patient’s existing prescription medicines,” Mr Sclavos said. “There’s the risk of side-effects and contraindications when medicines are taken together. One of the arguments is that people don’t overdose on cannabis \\\\\\\\\\\\\\\[like they do\\\\\\\\\\\\\\\] on opioids. But it’s still a drug. While it has a \\\\\\\\\\\\\\\[high\\\\\\\\\\\\\\\] safety profile \\\\\\\\\\\\\\\[and it’s\\\\\\\\\\\\\\\] very hard to overdose, there have been overdoses reported in the US.” Dr Sean Hall, CEO and Managing Director of Medlab Clinical, speaking about the medicinal cannabis product, NanaBis, manufactured by his company and undergoing clinical trials, says care needs to be taken as to “how we define it”. “We don’t want it defined as an opioid reduction therapy, because it’s not that,” he said of NanaBis. “And we certainly don’t want it defined as a replacement therapy, because it’s not that either. Where we see NanaBis is as a non- opioid analgesic that firmly fits within the WHO guidelines that, if used correctly for the majority of patients, may stave off their introduction to an opioid. And for those that are on an opioid, it may slow that progression on upward titration and secondary opioidal synthetics added to their pain treatment program.” RETAIL PHARMACY • AUG 2020