Following the ongoing national debate, we sat down with the Director of Global Medical Services at Spectrum Therapeutics, Dr Danial Schecter, to talk all things cannabis.
With more than a decade of experience specialising in cannabinoid medicine and practicing as a family physician, Dr Schecter shares his expert insight into medicinal cannabis and its effects.
Good: What are the benefits of medicinal cannabis?
Dr Danial Schecter: Medicinal cannabis represents a unique class of medicine, as it’s rare for any one class of drug to have such a broad spectrum of effects – treating a wide range of symptoms including pain, spasticity, nausea, anxiety and seizures. From experience in the medical field, these effects are supported by enormous scientific advances in our understanding of the body’s own endogenous system (also known as the endocannabinoid system) of cannabinoid molecules and receptors, which plays an important role in a variety of conditions and processes.This endocannabinoid system (ECS) is involved in many physiological functions, including inflammation, sleep, pain, memory, digestion, immune function, neuroprotection and more. The phytocannabinoids (such as THC and CBD) are produced by the cannabis plant and also interact with the receptors of your ECS. This could partly explain why cannabis seems to affect such a vast range of conditions and symptoms.
What can cannabis treat?
Cannabis prohibition has significantly restricted research in terms of access to materials and funding, and this has led to an inability to conduct studies to address important questions of safety and efficacy. The ability to cultivate, produce and develop standardised medical cannabis preparations will allow research to proceed to support therapeutic claims and to inform risk–benefit discussions.
Despite difficulties accessing standardised cannabis products and funding for research, there have been robust attempts to address this research gap. I was part of a team at McGill University that led one of the largest studies looking at the long-term safety of medical cannabis use by patients with chronic pain. The study enrolled more than 400 adults with severe and intractable chronic pain, half of whom used a standardised cannabis product under real-world conditions, and half of whom did not. We observed no difference between groups in serious adverse events, cognitive function, biochemistry, and hematology. Yet over the one year follow-up period, the cannabis group experienced a significant improvement in their levels of pain, symptom distress, mood, and quality of life.
There is now significant clinical data showing the therapeutic value of medical cannabis in some cases for symptoms related to pain, mood, and sleep disorders. An expert committee of the National Academies of Sciences, Engineering, and Medicine in the United States conducted a systematic review of more than 10,000 papers and found conclusive or substantial evidence that cannabis or cannabinoids are effective treatments for chronic pain, as an antiemetic in chemotherapy-induced nausea and vomiting, and for patient-reported spasticity in MS.
What are the potential dangers of medicinal cannabis?
Like any drug, there are potential side effects. The impact of THC on the cannabinoid receptors in the brain may have both positive and negative effects. Negative effects often depend on the dose (especially related to THC), mode of administration (whether taken through inhalation or oral), age of patient, experience with cannabis and frequency of use.
Under medical supervision, at therapeutic doses, cannabinoids are very well tolerated and may have only mild-moderate effects, such as dizziness and drowsiness. Non-medicinal or field cannabis, as used for recreational purposes and often in large doses, may have important effects, especially in young people on cognition, brain development and psychosis in people at risk of schizophrenia. In medical use, side effects can be reduced by using low doses and by comprehensive screening for patients with an active history of mental health disorders.
What can New Zealand learn from Canada when it comes to medicinal cannabis? Including mistakes New Zealand can learn from?
Across any country, it is important for doctors to be able to communicate with their patients about a range of treatment options, including medicinal cannabis.
In Canada, a key area for reform was education. There needs to be more balanced and regular education programs in place to support issues such as endocannabinoid science, dosing of THC and CBD, patient screening and monitoring, safety concerns and adverse event reporting.
In terms of mistakes, New Zealand can learn from Canada’s struggle to find a way to balance the need for education with the need for independent review and the interests of the emerging cannabis industry. Finding a balance between these important factors is critical to supporting and protecting patients seeking treatment with medicinal cannabis.