Preamble: this opinion based on the need to regulate CBD (and all other non-psychoactive cannabinoids) as food supplements.
More preamble: this opinion is one of semantics, at no point does the author diminish the credibility of the very many real examples of conditions that have been treated using cannabis.
There is overwhelming evidence that cannabis has significant and varied therapeutic properties, however, it is NOT medicine…at least not yet. Medicine is the science and practice of the diagnosis, treatment, and prevention of disease. The word “medicine” is derived from Latin medicus, meaning ‘a physician’.
Medicine encompasses a variety of healthcare practices used to maintain and restore health through the prevention and treatment of illness. Global healthcare systems have objectively been built and maintained by large pharmaceutical companies where the only currency of value in the drug approval corridors are ‘controlled clinical trials’ (double-blind, random, long-term, large clinical human study) The type that for each disease costs hundreds of millions of pounds and in some cases up to 10 years before a medical marketing authorization is granted by the EMEA / FDA / MHRA.
Only 4 cannabis derived drugs have made it that far; Marinol, Cesamet, Sativex and Epidiolex. Those four cannabinoid products can rightly be called medicine. The ‘healthcare system’ has recognized them, understands their efficacy and side effects and therefore has approved its physicians to safely prescribe.
For those 4 drugs, a patient can receive a prescription and crucially, there is sufficient validated scientific data that informs every decision of every stakeholder within the healthcare world. Without such data it’s inaccurate to label cannabis, ‘Medicine’.
On the other side of the table are ‘patients’ who’re recipients of health care services. The patient is ill or injured and in need of treatment by a physician, registered nurse, physiotherapist, physician assistant, psychologist, dentist, pediatric, veterinarian, or other health care provider.
A patient can be the recipient (by way of prescription) for a clinically validated drug from a registered healthcare professional. To label someone a ‘patient’ in relation to cannabis and use that label to lobby for change is a stretch at best.
In a global climate of cannabis regulatory confusion and fear, demanding of a gov’t to force the square cannabis peg into the round healthcare hole is unrealistic. Our doctors may never have sufficient data to prescribe cannabis. We’ve come to expect our doctors to prescribe other medications.
Cannabis could be considered ‘Alternative Medicine’, cannabis could be similar to other herbal remedies that claim to heal but does yet have the body of scientific evidence of it’s safety or efficacy. As with cannabis, most alternative therapies are based on traditions and anecdotal evidence, instead of modern scientific evidence. Scientific or ‘evidence based medicine’ refers to, for example, demonstrating the effectiveness of a therapy or drug in a double-blind, random, long-term, large clinical human study (clinical trial), in which the therapy or drug is compared to either a placebo or another therapy/drug.
We all want cannabis to be considered modern medicine and for doctors to prescribe it to patients. However, until that happens ‘medicine’ & ‘patient’ are words not to be used in the fight for reform or legalization of any kind… Why?
As the simple logic goes. In the UK, the MHRA are very clear on what compounds require regulation, either:
1. a substance clinically proven to make pharmacological change
2. a substance marketed as a medicine
And herein lies the self-imposed obstacle. Industry executives alongside the sick, injured and others with vested interests are demanding ‘patient access for cannabis medicines’. The industry is therefore by default asking govt institutions to close down the industry unless someone can come up with millions of pounds and can wait decades for cannabis to be proven to treat or cure each and every illness.
If we call it medicine, it must be regulated as medicine. Stop saying ‘medicine’ & ‘patient’ and it’ll be easier and faster to regulate.
In some countries; USA, Israel, Canada, Australia and now Germany have all made major inroads to creating a new healthcare channel especially for cannabis. Doctors who agree are able to ‘approve’ the use of cannabis for those who fit a pre-determined checklist. The decision is not based on or supported by sufficient data or the healthcare system at the root. All those countries are struggling to on-board doctors who’re prepared to abandon their programming and begin acting outside the framework they’ve been conditioned to depend upon.
If we want doctors to be able to answer questions and prescribe, then a training course whilst useful is not the solution. The solution is to invest the time and money in those expensive and long term clinical trials. This is a fundamental requirement for it to be an effective drug within the armory of the health care system. The sacrifice is govt may in the meantime prevent the marketing of cannabinoid products.
What’s cannabis? It’s simply a herbal product that empowered and educated consumers should be able to buy.
In fact, it’s not far different to aloe vera in its ability to give therapeutic value and the quantity of clinical trials completed. Today, consumers buy aloe vera for the anecdotal reasons they know about. It’s purchased online or over the counter without the need for physician intervention.
Products containing CBD (proven non-psychoactive) are in a prime position to be regulated as food / dietary supplements and cosmetics. The directives and guidelines are clear and products can be available to consumers today.
There are question marks over where THC fits in. Where even the most sophisticated supporters of the entourage effect are unable to give a definitive quantity of THC required. It is generally considered to be potentially as low as that found in Industrial Hemp, which is legal, low-cost to produce and the source of most of the worlds CBD products.
Ideally hemp though minimally CBD, should be considered a food supplement and should be available on the shelf alongside; aloe vera, ginseng and omega-3 and other traditional herbal remedies.
We need to stop using the word medicine until it is. We need to stop using the word patient until they are.
So what’s more important, to get cannabis products in the hands of users today, or medicines in the hands of patients in 10 years?
Those of us in the industry and those of us who rely on consuming cannabis for their health and well-being should reflect. If we’re not careful we’ll force governments hand to close down the industry.
Cannabis is not a medicine…at least not yet.