#ANZSPM16 tweet chat: Medicinal cannabis and palliative care


In recent years scientific research into the effects of cannabinoids has been on the increase. Some would say that not-so-scientific research on the effects of cannabis has been underway for many hundreds of years, in many different countries and cultures.

Until recently I didn’t know that our own bodies produce endogenous cannabinoids, the various effects of which are still being studied. 

Two years ago, colleagues had informed me that at the Montreal Conference 2015 it was a ‘smokingly hot’ topic. The most widely studied cannabis-derived cannabinoids are Cannabidiol (CBD) and Tetrahydrocannabinol (THC.) You may have heard of some of the medications that have ‘come to market’ since then: 

  • US FDA-approved THC-containing dronabinol and nabilone for the treatment of nausea caused by chemotherapy and for appetite stimulation for patients with extreme weight loss caused by AIDS.
  • The United Kingdom, Canada, and several European countries have approved nabiximols (Sativex®), which contains a combination of THC and CBD. It is currently indicated for muscle control problems caused by multiple sclerosis, though it is being studied for the treatment of cancer pain. A rate-limiting step in uptake of this medication is its prohibitive cost. 

It was only a matter of time before this topical subject would arrive ‘Down Under.’ At the recent ANZSPM 2016 Conference, Medicinal cannabis was discussed in a plenary address by the esteemed Maureen Mitchell and Pippa Hawley. Medicinal cannabis was also the topic of a workshop, and my sources have informed me that everyone who attended had a good time.  

Plenary take home messages: there’s not a huge amount of evidence for medicinal cannabis but a lot of anecdotes and people will use it regardless of what we tell them, so we should try to work with patients. Pippa Hawley said that the pharmacology of cannabis may be such that combinations of chemical effects (CBD/THC etc) are more important than single receptor effects in producing positive outcomes. She suggested this may be one of the reasons that the cannabis itself is ‘more effective’ and more popular than the cannabinoids or derivations. Researchers including Pippa are trying to build the evidence base but it’s difficult, both due to the pharmacology and also due to regulations/stigma – even in places where it is legalised. 

I’ve been warned not to call it ‘medical marijuana’ as it stigmatises those who use cannabis for medicinal purposes. I think its already far too late for that. Its not as if palliative care patients experience any form of stigmatisation, right? And of course society is fully accepting of people using strong opioids for relief of severe pain, eh? Judgemental much?

I mean, really, what’s in a name?

Acapulco Gold, Panama Gold, Black Russian, Texas Tea, Indo, Maui Wowie, Thai stick, Mexican, Colombo, Pakalolo, Dagga, Mota, Kif, Pot, Weed, Grass, 420, Ganga, Dope, Herb, Joint, Blunt, Cannabis, Reefer, MaryJane, Buds, Stinkweed, Nuggets, Chronic, Tobacco, Hay, Rope, Gangster, Skunk, Boom, Blaze, Ashes, Block, Boo, Broccoli, Burrito, Burnie, Charge, Marijuana.

Australia, UK and NZ have the highest rates of recreational cannabis use, even though it’s not legal in those countries! I’m not sure what it is like in Australia and other parts of the world, but in most parts of New Zealand, illegal cannabis is easily obtainable – so I’ve been told.

Current first-husband front-runner Bill Clinton was (mis)quoted in 1992 when he famously claimed he didn’t inhale when smoking weed during his Rhodes scholar years. “When I was in England, I experimented with marijuana a time or two, and didn’t like it,” Clinton said. “I didn’t inhale, and I didn’t try it again.” 

In New Zealand, the late Helen Kelly, past-President of the New Zealand Council of Trade Unions, campaigned avidly for the legal right to use medicinal cannabis for the treatment of pain, until she died on 14 October 2016, only a few days ago.

Join the team from @palliverse for the second #ANZSPM16 post-Conference tweet chat on “Medicinal cannabis and palliative care”, featuring special guests Meera Agar (@meera_agar) from Sydney and Maureen Mitchell (@MogsMitchell) from Brisbane.

The tweet chat will be moderated by James Jap (@japmanforever), who as you know steers well away from controversy and never expresses his own opinions. He doesn’t know the meaning of the word ‘disruption’ and would not even consider trying to challenge anyone’s thinking or the stasis quo.

Join us all on Thursday 20th October at:

  • 4pm AWST (Perth)
  • 6pm AEST (Brisbane)
  • 6:30pm ACDT (Adelaide)
  • 7pm AEDT (Sydney)
  • 9pm NZDT (Auckland)
  • (See here for other times)

Carers and patients are especially welcome, as well as health professionals, researchers, policymakers and interested community members!

If you are new to Twitter and tweet chats, check out our tutorial here!

Tweet chat schedule & topics

  • Welcome & introductions
  • T1 Is it part of your regular practice to ask about the use of cannabis and other ‘herbal medicines’? If so, how does the conversation usually go? If not, why not? Dear consumers – how does it feel being asked these questions?
  • T2  Due to the laws of our lands, cannabis remains an illegal substance, but is gaining in popularity for the treatment of various palliative care symptoms. How can we as members of a speciality / community deal with this issue? Is ignorance truly bliss?
  • T3  Opioids once were banned substances and are now routinely prescribed for symptom control – but only in a few countries around the world. For most people, access to opioids is either non-existent or extremely limited. With this in mind, could the same fate be suffered by medicinal cannabis if it is ever legalised more widely?
  • T4  What strategies can be employed to deal with the stigma that users of medicinal cannabis is likely to face? Would these strategies be applicable for other forms of stigma that palliative care patients might face?
  • CT – closing tweets

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