Answers to Questions

Medical Cannabis

In reply to the Hon. K.L. VINCENT (17 June 2014). (First Session)

The Hon. I.K. HUNTER (Minister for Sustainability, Environment and Conservation, Minister for Water and the River Murray, Minister for Climate Change): The Minister for Mental Health and Substance Abuse has received this advice:

In South Australia, cannabis is a controlled drug under the Controlled Substances Act 1984. While the production, sale, possession or use of cannabis is illegal in South Australia, court action and a potential criminal conviction can be avoided for minor offences (i.e. possession, use or cultivation of small amounts of cannabis) by payment of an expiation fee.

The South Australian Government takes the view that cannabis is not a harmless drug. The available evidence highlights the long-term harmful effects of cannabis use, including increased risk of respiratory diseases associated with smoking (including cancer), dependence, decreased memory and learning abilities, decreased motivation in areas such as study, work or concentration.

While there is a growing body of evidence for therapeutic benefits from cannabis, including antispastic, analgesic, anti-emetic, and anti-inflammatory actions, the therapeutic use of cannabis and products derived from cannabis is still experimental. Smoking as a route of administration is problematic for medical treatment, with the risks of respiratory harm from smoking outweighing potential benefits of use for medical conditions.

The Government is committed to ensuring medicines available in South Australia are safe and effective, and that they do not cause unintended harm to patients or their families. For cannabis to be used therapeutically, more research is required into its efficacy for particular conditions, as well as methods of delivery, to avoid the harms of smoking and to control the psychoactive effects.

The Council of Australian Government Health Ministers agreed at its meeting on 10 October 2014 to work collaboratively to share knowledge and information on issues relating to the use of appropriate therapeutic products derived from cannabis for medicinal purposes. New South Wales has announced its intention to undertake clinical trials of medical cannabis. The South Australian Government supports the New South Wales trial and will cooperate as required.

Responsibility for the assessment and approval of medical cannabis for therapeutic purposes in Australia rests with the Australian Government's Therapeutic Goods Administration (T.G.A.), which is responsible for assessing and registering pharmaceutical preparations and products for medical use in Australia, based on standards of quality, safety and efficacy. The T.G.A. carries out a range of assessment and monitoring activities to ensure that any drug or substance used for therapeutic purposes should be safe, of high quality, and reliable in terms of both dose and effect. Any trial involving cannabis will need to be conducted under T.G.A. auspices.

On present evidence, pharmaceutical cannabis treatments will only be appropriate for a very restricted group of eligible patients in specific circumstances, and under the supervision of medical practitioners with suitable expertise. Those patients would necessarily be people with severe and distressing symptoms that are not able to be relieved by existing medications.

I am advised that some synthetic cannabis products are currently included on the Australian Register of Therapeutic Goods, meaning they are available for medicinal use. One such product, Nabiximols (Sativex®) is administered as an oral spray, which avoids the harms of smoking. In addition to delta-9-tetrahydrocannabinol, Sativex® contains another compound, cannabidiol, which balances some of the psychoactive effects of THC, and is thought to be important in the therapeutic effects of cannabis.

Clinical trials have been conducted on the effectiveness of Sativex® for conditions such as multiple sclerosis and pain relief in terminal cancers. Sativex® is registered for therapeutic use in Australia and was included on the Australian Register of Therapeutic Goods on 26 November 2012, but can only be prescribed by medical practitioners under the TGA Special Access Scheme. The synthetic cannabinoids Nabilone (a synthetic cannabinoid used for treatment of anorexia and for its antiemetic effects—e.g. in cancer patients receiving chemotherapy); and Dronabinol (synthetically produced pure THC used in multiple sclerosis and pain patients) are scheduled by authorities for medicinal use in Australia.

The use of products such as Sativex®, Nabilone and Dronabinol have many advantages over smoked cannabis, not least being the very clear separation of therapeutic and illicit use. However, it remains a clinical decision as to whether such products are prescribed.