Pioneering treatment options: How medical cannabis improves patients’ lives (11 min read)

Though not without its critics, medical cannabis has been used as a therapy of last resort. Despite growing evidence that medical cannabis can offer further medical benefits, accessing this treatment can be a challenging process for patients – and can raise questions regarding dosing and treatment planning for medical professionals. Researchers and companies, including Sandoz Canada, are working to improve access to this medicine and related information.

نوفمبر 05, 2018

James O’Hara’s illness had taken over his life. A life-long migraine sufferer, in his 50s he began experiencing sudden seizures. For about two weeks after each seizure, O’Hara was left in a state of confusion and with poor memory. “I couldn’t function properly,” he explains from his hometown of Toronto, Canada. His neurologists ran a battery of tests including MRIs and CAT scans. After they diagnosed focal awareness seizures, O’Hara received standard anti-seizure medication. But his seizures continued, no matter which treatment he was given. And the medications brought their own side effects, including exhaustion. “I was completely disconnected from work and my family – and I knew it.”

Purely by chance, an acquaintance suggested that medical cannabis might help. O’Hara knew little about it. However, the more he began to research it himself, the more he became convinced it was worth a try. Out of desperation, O’Hara searched for a physician who was willing to support him in attempting this treatment. “It was a challenge, but I was lucky to find the right doctor.” The results, says O’Hara, were like night and day. “All of a sudden, I was able to control the seizures while functioning better in daily life. To put it simply, I could work more and contribute to my family more.” But, as O’Hara’s overall health stabilized, he says he also began wondering: Why were people not more aware of medical cannabis? Why didn't more people have access to it?

I think there still is a huge need to educate the general public, policy makers and healthcare providers in order to help people have better access to this treatment.

James O'Hara, patient and CEO of CFAMM (Canadians for Fair Access to Medical Marijuana)

A complex situation

Now a medical cannabis patient for almost a decade, O’Hara admits that the idea of using cannabis for medical reasons can raise eyebrows. “One issue may be the distinction, legally as well as culturally, between cannabis and medical cannabis,” he points out. A central problem is that some believe that medical cannabis produces a ‘high’ like recreational cannabis.¹ But, in fact, as a patient “you are using medical cannabis as an alternative to traditional medicine.”

It’s not just the public that has questions or lacks information, resulting in uncertainty towards medical cannabis. In Canada, the national health service (Health Canada) has approved the use of medical cannabis, but the Canadian Medical Association (CMA) has not. With this lack of official CMA endorsement, not all Canadian doctors may be comfortable or willing to authorize medical cannabis. (See interviews with an advocat of medical cannabis and a critical medical cannabis prescriber.) Although Canada has legalized recreational cannabis as of October 2018, this does not affect the current regime for medical cannabis.²

Once patients find a doctor who will authorize this treatment, they face another obstacle. Canadian patients must order their prescription online from approved producers. Bricks-and-mortar Canadian pharmacies, with live pharmacy professionals, cannot at this time provide medical cannabis. This also means that Canadian patients cannot currently (as of October 2018) get any advice about dosing or counter indications from their local pharmacists.

Looking for answers – filling the gap

This shortage of information about medical cannabis has been a reality around the world for some time. While cannabis has been used as medicine in various cultures for at least 4,000 years, Western civilizations turned their back on this treatment in the 20th century. The precedent was likely set by the US, where cannabis became illegal for any purpose in 1937. Other countries followed the US lead, and cannabis largely disappeared as a recognized means of medical treatment.³ As a consequence, an information gap emerged and developed over the past 80 years.

Medical cannabis: Its active compounds and rational uses

In order to begin filling this gap, some licensed producers like Tilray are currently conducting clinical and observational studies examining a number of indications, including the use of cannabis extracts in the treatment of pediatric epilepsy,⁴ chemotherapy induced nausea and vomiting,⁵ and essential tremors.⁶ “The focus of these studies is examining how different doses and ratios of THC (Tetrahydrocannabinol) and CBD (Cannabidiol), both active compounds of cannabis, affect different symptoms and conditions,” explains Philippe Lucas, Vice President of Global Patient Research & Access at Tilray.⁷ The cannabinoid THC is psychoactive and may provide analgesia and reduce inflammation in chronic pain, and may combat symptoms such as nausea and vomiting (often a side effect of chemotherapy). However, CBD, a non-psychoactive compound, may be able to lower anxiety, depression and pain.⁸

Strict dosage of medical cannabis may be required to influence various physiological processes of the human body. The central nervous system has a specific ‘network’ of cannabinoid receptors and receptor antagonists, the ‘endocannabinoid system.’^{9 10} Here, within this system, THC and CBD trigger signals that are involved in immune responses as well as mental and motor actions including appetite, pain-sensation, mood and memory.¹¹ “Effectively, the human body’s endocannabinoid system has receptors that interact with cannabinoids from the cannabis plant,” explains Lucas. It is this system that mediates the effects on the human body and is, thus, central to the medical use of cannabis.¹² Adds Lucas, “The human body’s endocannabinoid system engages with plant-derived cannabinoids like a lock-and-key.”

How medical cannabis affects the human body: The endocannabinoid system

Alternatives for managing pain

From his office in Nanaimo, British Columbia, Lucas personally investigates a range of applications. As a researcher for the last 15 years, he is interested in “medical cannabis as an alternative to other prescription medications.” He estimates that 80 % of the approximately 270,000 Canadian cannabis patients¹³ use it for chronic pain and mental health conditions.

Tilray’s research department has multiple studies underway on the broader effects of medical cannabis use, including one-called TOPS (the Tilray Observational Patients Study),¹⁴ says Lucas. The data for the study’s first six months has been extremely insightful. “There was a significant rate of substitution for all classes of prescription drugs that we’re tracking – including muscle relaxants, antidepressants, anti-seizure and pain medications,” Lucas explains. Medical cannabis is also being investigated for its potential role in fighting the ongoing opioid crisis in Canada and the US.

We are investigating the benefits of medical cannabis for improving the quality of life for patients. We have to continue refining and building the existing evidence.

Philippe Lucas, Vice President of Global Patient Research and Access, Tilray

Creating access solutions: Informing and supporting

While all of this might be good news for patients suffering from a range of chronic conditions, access to this medicine – and access to information about it – is still required to maximize its potential benefits among doctors and patients. Patient advocates like O’Hara and researchers like Lucas agree. “I think there still is a huge need to educate the general public, policy makers and health care providers in order to help people have better
access to this treatment,” says O’Hara.

Fortunately, the situation is changing. The body of anecdotal evidence has increasingly encouraged doctors to consider medical cannabis as a treatment option, and scientists worldwide have been giving it a second look – which has led in turn to a stunning amount of new research work. As an example, according to a summer 2018 article published in the “Deutsche Ärzteblatt ” (German Physicians’ Journal, a publication co-owned by the German Medical Association), there are 750 scientific publications on the medical effects of cannabis¹⁵, and more than 600 cases, open and controlled studies, have been reported since 1970.

Just as importantly, 80 % of these studies have been carried out in the past 20 years¹⁶. Motivated by patient experiences such as O’Hara’s, and by the growing amount of scientific evidence and medical efficacy, several pharmaceutical companies are investigating the medical cannabis stream. At the forefront is Sandoz Canada and its partner Tilray, a licensed producer of medical cannabis. Together, they have partnered to provide greater access to medical cannabis products for Canadian patients. With their experience in manufacturing medicines, Sandoz Canada will help to develop new and innovative medical cannabis products, including new product dosage forms and delivery systems suited to specific medical uses. In addition, Sandoz and its partner will invest in research studies to advance the science in a variety of medical conditions.

Researchers continue to study the physiological and pharmaceutical effects of medical cannabis to be able to offer patients a safe treatment option.

Vincenzo Ciampi, Executive Director of Innovation and Strategic Projects at Sandoz Canada, and his team believe that making these products more widely available may improve patients’ health outcomes. In 2016, the team embarked on a journey to further legitimize medical cannabis as a mainstream medicine and trusted treatment option, and to support patients to confidently access quality treatments. Sandoz Canada has a strong vision to distribute these treatment options via pharmacies to further ensure accurate usage and invite consultation throughout treatment. “What we have begun doing is educating the pharmacists about medical cannabis,” continues Ciampi.

Facing the questions – understanding the concern

“Sharing medical information and evidence backed by credible research about medical cannabis is crucial for prospective patients, the medical community and the public in general,” he adds.

Along with the perception that it has unwanted narcotic effects, common concerns are that patients could become dependent on medical cannabis or that this medicine is dangerous; neither is correct, according to the World Health Organization.¹⁷ However, others wonder what potential side effects medical cannabis could have. A report by WHO in 2017 states that medical cannabis is generally well-tolerated.¹⁸ “Critics have concerns, and it’s important to provide the facts behind medical cannabis. Further research should clarify the potential benefits of medical cannabis,” says Ciampi. “We trust doctors to make the decisions that they feel best with, whether it’s authorizing medical cannabis or prescribing other treatment methods.”

No ‘must’ – but a choice

For James O’Hara, medical cannabis was the right treatment, and he would like the public to have the same information and options as he did years ago. While his health condition was improving through medical cannabis, he discovered the non-profit CFAMM (Canadians for Fair Access to Medical Marijuana) and became a volunteer. Today, as a healthy 60-year-old, he is the organization’s CEO.

As he moves confidently through meetings, speaking engagements and office-based managerial decisions, it’s clear that O’Hara believes in this mission: to help more Canadians gain access to medical cannabis and experience the relief that he did.
“There was a time, however, when a fully productive professional, and family, life was unimaginable to me,” he says. Today, under an authorized and monitored regime of medical cannabis, O’Hara can look back at his past health issues and say “I’m living again.” Adds O’Hara, “Wouldn’t it be something if even more people knew that such alternative treatment options are already out there that could help them too?”

The history of cannabis as medicine

Long before any researchbased explanation of its molecules and receptors in the human body, cannabis was held in high regard as a herbal therapy in ancient cultures. The earliest record is from 2737 BC, when Chinese Emperor Shen-Nung recognized its suitability as a treatment for over 100 ailments including gout, rheumatism and malaria. Around the same time, cannabis was also used medically in what is now Romania. In 2000 BC, cannabis was mentioned in Ayurvedic medicine; by 1550 BC, it was being used as a medicine by Egyptian healers and, by 400 BC, among the Romans. Since then – with the exception of the past century – healers and medical practitioners around the world have treated their patients with medical cannabis.

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