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24 Jan 2018

The AMA has repeated its position on medicinal marijuana, following the Victorian Government’s decision to expand the sector, conduct more trials, and make cannabis products more widely available to severely sick children.

AMA Vice President Dr Tony Bartone told journalists at a Melbourne media conference that the AMA’s position on medicinal cannabis continues to be one of support for the clinical trials to establish clinical guidelines, and only then wider promulgation throughout the community if needs be.

“We need the evidence and we need the clinical guidelines and the validation of the local product in terms of dosages, formations, composition, to assist us in then determining where, when, and how its place will be,” Dr Bartone said.

“It’s still early days, we’re very much guided by international evidence but we need the local evidence to validate and further give us the information required to then determine its exact goal.

“Evidence to date has been clearly that it is not going to be a first-line product. It has really got a specific niche in terms of some specialised neurological conditions, conditions involving the cachexia of chemotherapy, and of AIDS, of multiple sclerosis, and other neurological conditions.

“So, we’re talking specific conditions and not as a first line, but more in terms of refractory cases or difficult cases, and that’s what the clinical guidelines would give us information about. We’re supportive of the trials, we’re supportive of the fact-finding, and then – and only then – as the evidence dictates will we then see a wider usage if it's deemed appropriate.

“These trials will be very instructive in terms of the long-term usages and availability of medicinal cannabis in Australia, so it’s important that these trials are completed and are resourced as appropriate.

“The announcements will then see those trials become more robust and more detailed, allowing further evidence and further information to be gleaned and obtained. It's a positive step, but it’s still another piece of the puzzle that needs to be put together before we can significantly depend upon medicinal cannabis having a regular role in the treatment armamentarium in Australia.

Let’s be very clear about this. What we want to see is the gathering of information, the evidence and the research to validate the clinical guidelines. As that is all obtained, as that’s all put together, then we can establish a clear pathway in terms of the where, the when, and the how. And that’s what we’re about.

“Once the research is there, once it’s really validated in terms of the conditions, the dosages, the local product, et cetera, then the clinical guidelines will be developed, and that’s what we've said all along. And then there’ll be a place for it in terms of the treatment scale, the treatment options for doctors in Australia.

“At the moment, we’re still very much in its infancy, and these trials are about obtaining the information, the foundations on which to build the recommendations going forward.”

Information obtained from around the world suggests that there is a role in certain difficult cases. Dr Bartone pointed to refractory cases, of paediatric epilepsy, of multiple sclerosis, or the wasting that goes along with HIV and post-chemotherapy.

“So there are some roles for it, potentially, and what we need to do is rapidly try to get the information and the evidence to do that,” he said.

“What we’ve seen to date is that there is potential for it. We need to really validate and really build upon that potential so that we’re very clear about when we can offer it and how we can offer it.

“Whatever the evidence dictates, whatever the evidence shows, is what you will see clinicians really then offer to their patients, because that’s what they want to do – offer their patients the very best of care, and world-class care at that.

“It’s quite likely that, at the end of the day, medicinal cannabis will have a significant but very small role to play in a suite of options to offer.

“It won’t be a first-line therapy for established conditions, but it’s more where we’ve got difficult or what we call refractory cases, cases which have not responded to first or second or third line options.

“So, it’s about understanding that it isn’t going to be a magic option that we can use in any difficult case. But we’re going to be guided by the evidence, and at this stage it’s still working through that, and the indications are small and potentially not that expansive. But we'll be guided by what comes through the pipeline.”


Published: 24 Jan 2018