Author: rhys

Dr Katrina Green

Medical & Health Sciences Lecturer, School of Medicine – University of Wollongong Continue Reading…

Leah Bisiani, MHlthSc/RN.1 – Dementia Consultant, Director of Research and Advisory, Leafcann™ Research and Advisory

Leah is a health scientist, dementia expert and Director of Research and Advisory at Leafcann™ Research and Advisory, a Melbourne-based medicinal cannabis organisation.

How did you first get involved with medicinal cannabis?

My life’s work has been focused on the aged care sector within Australia and globally, with my area of expertise being dementia research; creating catalysts to change old malignant philosophies and cultures of care within the industry.

I have demonstrated how negative and stereotypical views can be fostered by judgemental perspectives of society and often do not reflect in any way, the reality of the people we care for. Thus, my interest in medicinal cannabis originated from the same type of vision – an identified area of need that I felt required an alternative, and one that I could utilise my leverage in the medical field for.

The emerging medicinal cannabis industry seemed to me a wonderfully fresh alternative to the current ineffective management of many medical conditions in aged care.

The argument that medicinal cannabis can benefit people in ways that other methods cannot, is a crucial element that I believe we are duty bound to honour. Furthermore, there are younger people who already seek out cannabis and utilise it for a range of conditions, currently posing a risk to themselves in relation to possible legal action under the current restrictions.

This seems an unfair and unjust position to place any human being in, who essentially needs a medication to manage the symptomatology of a wide range of chronic or debilitating conditions. If we consider the present alternative, and continue ignoring the significant benefits of cannabis, are we not then condoning and prolonging the suffering of a population in need?

This vision has led me to dedicate myself to advancing and establishing pioneering outcomes to contribute and promote a healthier Australian community, and ultimately, global population. My primary focus was to initiate and propose life quality enhancement for our ageing population by examining and investigating unsuccessful and incapacitating pain medication regimes and polypharmacy.

This commitment to humanity challenges current boundaries and existing technologies, and is dedicated to utilising evidence based research and clinical trials to support interventions that emphasise innovation and the development of fresh perspectives.

Working with Leafcann™ Research and Advisory, and Ward Medication Management, we imagine a future together, paving the way forward to support recognition of the abundant benefits and promise by specifically selected strains, and measured dose medications, compounded from this natural, organic plant.

By operating closely together, we represent a culture of excellence, supported by front-line, forward-thinking medical advances; integrating an inspiring medical discipline, a unique person-centred care philosophy, and a commitment to supremacy and excellence.

What most excites you about the work you’re currently doing?

What excites me most about this journey, is the privilege of working with Leafcann™ and having the ability to work with leaders in this field, who believe in innovative approaches.

Leafcann™ think outside the square, and shall, without doubt be pioneers in creating extraordinary change, through the courage of their convictions, their expertise, their powerful leadership synergy and team, and their exemplary knowledge basis.

We also have one chief commonality. This is the interminable desire to benefit humanity, and provide answers to identified problems and recognised conditions that are not responding to traditional medicine and methods. Making a difference to a civilization in need, is the greatest reward of all. This vision is becoming more tangible by the moment. It’s not negative nor fanciful, but real, positive, logical and humane.

I am thrilled, delighted and excited to be part of Leafcanns™ powerful voice. We continue to inspire each other, becoming progressively stronger, encouraging a solid robust duty of care, and creating baseline opportunities for modern medicine. By speaking with empathy and compassion from the perspective of those who need care, we can lead by example, thus we can alleviate suffering on a grand scale.

My excitement additionally lies in dispelling the stigma and myths associated with cannabis through evidence based clinical trials. Leafcann’s™ supportive approach, and collaborative, compassionate framework, not only demonstrates the ‘problem’ but delivers the ‘solutions’ by expediting collaborations between research and health information into improved clinical care, and superior guidelines.

This inspirational perspective shall be a powerful catalyst to revolutionary change, whilst ensuring our inherent purpose constantly advocates the maximisation of health, comfort and wellbeing of our existing and future population.

What are participants going to get out of your session?

As the Director of Research and Advisory, I am directly involved with setting the direction of current and future research into potential medical applications of cannabis. In my session, I will be exploring the findings of a recent research initiative into the nature and treatment of chronic pain in the Australian aged care setting.

Potent opioid analgesics are widely prescribed within the aged care sector, yet these agents are associated with the highest degree of drug-related harm. This research provides evidence of widespread use of analgesia and adjuvant medicines for the management of chronic pain amongst older people living in aged care facilities. The findings illustrate the scope for the use of medicinal cannabis as a beneficial alternative approach to enhancing quality of life and maximizing comfort.

This major research initiative examined current practices in pain management within the Australian aged care sector, exploring the scope for a potential positive and significant impact from the utilization of medicinal cannabis as an alternative to current pain management regimes. This research is the first large-scale, comprehensive examination of pain management investigating in detail the characteristics of medication use amongst a large cohort of older Australians living in residential aged care.

Leafcann™ are partnering with Ward Medication Management to complete the subsequent implementation of research exploring the use of medicinal cannabis as a potentially beneficial alternative to existing approaches.

 

Cannabis and Chronic Pain in Australia

Australia legalised medicinal cannabis in February 2016, but as of May this year, fewer than 150 people had been given legal access.[1] With the growing body of scientific evidence, will medicinal cannabis be able to save us from the increasing pressures on our health system caused by chronic pain and an ageing population?

Chronic pain costs Australia billions of dollars a year

In 2013, epidemiological research published by Henderson et al in the journal Pain Medicine estimated 15.7% of Australians were living with chronic pain.[2] That’s around 3.8 million people based on 2016 population figures.

Previous research by the MBF Foundation estimated the societal costs of chronic pain in Australia at $10,847 per affected person in 2007, mostly due to premature death and disability, health system and productivity costs.[3]

If we assume a prevalence rate of 15.7%, update the per-person costs to 2016 dollars ($13,453.12)[4] and take the national December 2016 population figures (24.3 million), chronic pain currently costs Australia over $50 billion a year.

And it’s getting worse

We are all aware of Australia’s ageing population. And chronic pain is much more prevalent among people 45 years or older. A comprehensive forecast has not been attempted here, but to illustrate, this is the age distribution of chronic pain prevalence in Australia:[5]

 

And this is a forecast of the proportion of Australians who will be 45 years or older from 2016 to 2050:[6]

Chronic pain is affecting more Australians, causing more suffering, and costing more money than ever before. And it’s getting worse.

Chronic pain has many causes

The biological, psychological and environmental aspects of chronic pain – and their interaction and reinforcement – can make it very hard to treat.

It’s something many people have experience with, either personally or through a loved one: the feeling of persistent pain is unpleasant, and you learn to avoid physical activities that make it worse. You become more sedentary, leading to additional problems and new sources of pain. This impacts your sleep and make you anxious, so your work suffers. You become irritable and frustrated, and take more medication to cope. The spiral continues.

And can be hard to treat

Around 80% of Australians reported osteoarthritis or back problems as the cause of their chronic pain,[7] which are both more difficult to treat if the person is overweight. Unfortunately, a majority of Australians in the most at-risk age groups for chronic pain, osteoarthritis and back problems are either overweight or obese.

This trend is not unique to Australia. A combination of longer lives, higher rates of obesity and sedentary lifestyles has contributed to neck and lower back pain becoming the leading causes of disability in every high-income country in the world.[8]

Pharmaceuticals can help

Although multidisciplinary pain management can help address the psychological, environmental and physical causes of chronic pain, around 85% of Australians with chronic pain use pharmaceuticals, and over 55% rely exclusively on pharmaceuticals to manage their condition.[9]

The most common pharmaceutical is paracetamol, used by 42.8% of Australians with chronic pain, although there is very limited evidence that this is an effective treatment for chronic back pain, and its effectiveness in treating acute back pain has recently been thrown into doubt.[10] The second most common class of pharmaceuticals are opioids, used by 34% of Australians with chronic pain.[11]

But they have their own risks

The level of opioid use is a major public health concern, as these medications can have very unpleasant side effects including nausea, vomiting, constipation and dizziness.[12] Not to mention the additional harms people are exposed to through misuse and abuse of prescription opioids. But a lack of viable alternatives, and the persistence of chronic and other types of pain, has helped accelerate opioid use in developed countries.

In the USA, levels of prescription opioid use and abuse have reached epidemic levels. In 2014, nearly 2 million Americans were addicted to or dependent on prescription opioids, and nearly half of all US opioid overdose deaths in 2015 involved a prescription opioid. That’s more than 15,000 people.[13]

Similar trends have been observed in Australia: from 2001 to 2013, the number of Australians using prescription opioids increased by 300%.[14] And from 2003 to 2013, the prescription rate of the opioid Oxycodone increased by 600%, alongside increases in deaths and hospitalisations from prescription opioid overdoses.[15]

We know cannabis is a viable alternative

According to the Health and Medicines Division of the U.S. National Academies of Sciences, Engineering, and Medicine, ‘there is substantial evidence that cannabis is an effective treatment for chronic pain in adults’.[16] Compared with paracetamol, there is significant evidence that cannabis is an effective treatment for many types chronic pain including lower back pain and osteoarthritis. Compared with opioids, cannabis offers a highly effective treatment option with a risk profile lower than codeine.

Medicinal cannabis, when used in conjunction with other medicines, and with appropriate multidisciplinary pain management strategies, can substantially reduce opiate use. Although rigorous clinical guidelines are still being developed in this area, there is compelling evidence that access to medicinal cannabis is correlated with significant reductions in opiate prescriptions and overdoses. This is supported by macro-level data as well as patient survey studies.[17]

So, when will Australian doctors start prescribing cannabis for chronic pain?

Some already have, but it can be hard for doctors to educate themselves on the emerging medical scientific evidence while also navigating new and quite convoluted approval processes. From what we’ve heard so far from patients, carers, the Office of Drug Control and the Therapeutic Goods Administration, the main challenges include:

  • Unclear State and Territory approval processes
  • A lack of clinical guidelines for physicians
  • High prices of available cannabis medicines
  • A lack of education available for physicians, scientists, regulators and entrepreneurs

But some, albeit slow, progress is being made. The Federal Department of Health currently is developing clinical guidance documents for epilepsy and chemotherapy-induced nausea and vomiting. Hopefully chronic pain will be next on their agenda. And there are some positive patient access reforms that have been made in South Australia[18] that other States could certainly learn from.

As domestic manufacturing comes online throughout 2018, cheaper local medicines should become available, and developing medicines for chronic pain is a primary focus for many cannabis companies. And there are several groups – including Cann10 Australia – working on developing and delivering education and training programs.

In the meantime, it is up to all of us involved with medicinal cannabis to continue lobbying and working towards practical solutions to these challenges.

You can learn more about the political, economic and medical aspects of cannabis by enrolling in the Cann10 Medicinal Cannabis Leadership Program.

September enrolments are closing soon, so don’t miss out! Click here to register now


[1] Woodley, N. (2017). Fewer than 150 people given access to medicinal cannabis, Senate committee told. [online] ABC News. Available at: http://www.abc.net.au/news/2017-05-30/medicinal-cannabis-access-fewer-than-150-people-senate-estimates/8571176 [Accessed 14 Jul. 2017]

[2] Henderson, J., Harrison, C., Britt, H., Bayram, C. and Miller, G. (2013). Prevalence, Causes, Severity, Impact, and Management of Chronic Pain in Australian General Practice Patients. Pain Medicine, 14(9): 1346-1361

[3] Access Economics Pty Limited (2007). The high price of pain: the economic impact of persistent pain in Australia. MBF Foundation: 52

[4] Reserve Bank of Australia. (2017). Inflation Calculator | RBA. [online] Available at: http://www.rba.gov.au/calculator/annualDecimal.html [Accessed 14 Jul. 2017]

[5] Henderson et al: 1350

[6] ABS Dataset: Population Projections, Australia

[7] Henderson et al: 1351

[8] The Lancet (2016). GBD 2015: from big data to meaningful change. The Lancet, 388(10053): 1544

[9] Henderson et al: 1352

[10] Saragiotto, B., Machado, G., Ferreira, M., Pinheiro, M., Abdel Shaheed, C. and Maher, C. (2016). Paracetamol for low back pain. Cochrane Database of Systematic Reviews

[11] Henderson et al

[12] Rodriguez, R.F., Bravo, L.E., Castro, F., Montoya, O., Castillo, J.M., Castillo, M.P., Daza, P., Restrepo, J.M., Rodriguez, M.F., 2007. Incidence of Weak Opioids Adverse Events in the Management of Cancer Pain: A Double-Blind Comparative Trial. Journal of Palliative Medicine 10: 56–60

[13] CDC.gov. (2017). Prescription Opioid Overdose Data | Drug Overdose | CDC Injury Center. [online] Available at: https://www.cdc.gov/drugoverdose/data/overdose.html [Accessed 14 Jul. 2017]

[14] Kerin, L. (2017). Opiate use quadruples in Australia: study. [online] ABC News. Available at: http://www.abc.net.au/news/2016-02-04/opiate-use-rises-in-developed-countries/7139356 [Accessed 14 Jul. 2017]

[15] Henderson et al: 1355

[16] National Academies of Sciences, Engineering, and Medicine (2017). The Health Effects of Cannabis and Cannabinoids: The Current State of Evidence and Recommendations for Research. Washington, DC: The National Academies Press: section 4-4

[17] Piper, B., DeKeuster, R., Beals, M., Cobb, C., Burchman, C., Perkinson, L., Lynn, S., Nichols, S. and Abess, A. (2017). Substitution of medical cannabis for pharmaceutical agents for pain, anxiety, and sleep. Journal of Psychopharmacology, 31(5): 569-575

[18] sahealth.sa.gov.au. (2017). Medicinal cannabis, Patient access in South Australia. [online] Available at: http://www.sahealth.sa.gov.au/wps/wcm/connect/public+content/sa+health+internet/health+topics/health+conditions+prevention+and+treatment/medicines/medicinal+cannabis/medicinal+cannabis+patient+access+in+south+australia [Accessed 14 Jul. 2017]

Dr Kathryn Mumford

Senior Lecturer, Chemical and Biomolecular Engineering – The University of MelbourneContinue Reading…

Elaine Darby

Managing Director – AusCannContinue Reading…

Meet your facilitators: Tom Forrest – Co-founder, Indicated Technology

Tom is a cannabis horticulture specialist working with several Australian cannabis firms, universities and research groups.

How did you first get involved with medicinal cannabis?

In 2011, my mother was forced to undergo a course of medication with extremely horrible side effects. I often visited her home in Mt. White on the Central Coast of NSW to take care of her. Sometimes she was unable to even get out of bed. It was here that I first noticed that vaporising or smoking cannabis drastically helped with her nausea, appetite, energy and overall mood. She was fortunate that one of the neighbours had experience with medical cannabis and was growing a small organic crop that could provide her with flowers and tinctures.

The initial medication courses that Mum trialled were unsuccessful and we had both moved to Melbourne to be closer to family. There were months on end when I would watch her bravely battling with horrible side effects and only finding relief through ‘black-market’ cannabis of varying qualities. It was astounding that she could be prescribed such a brutal ‘medicine’ yet not have any access to any form of proven relief during these tough months. I’m happy to report that the most recent course of medication was successful and Mum continues to happily potter around the garden!

My mother has always inspired me with her passion for gardening and her natural green thumb. We’ve lived in average houses, but always had beautiful gardens. While living on the Mornington Peninsula a close friend introduced me to aquaponics. I found myself spending hours in the garden with Mum building giant veggie beds, hydroponic systems and fishtanks! It was at this time that I quit my job, found work in the hydroponics industry, and enrolled in the first of my horticulture courses. This blissful garden enthusiasm and Mums ongoing bravery has inspired and motivated me to become involved in the medical cannabis space.

What most excites you about the work you’re currently doing?

I spent my childhood in the heart of cotton country in Moree, NSW and witnessed one of the worst droughts of this century. It was heart-breaking to see the town crumbling into poverty. My father still works in rural agri-business and our family had always been involved in Australian agriculture. I personally believe we now have a fantastic opportunity to provide new industries to struggling farming sectors. Our strong history of innovative farming and unique resources provides an incredible foundation for a strong cannabis industry in Australia.

I’m proud to help patients access a quality grown medical plant that can contribute to so many aspects of society. From broadacre hemp farming for industrial purposes, to advanced medical cannabis research at laboratory facilities; we are in a unique position to set unprecedented cultivation standards that are sustainable and economical, and with modern technology we can also achieve unparalleled efficiency in plant growth.

This continual development of a rapidly blooming industry is truly exciting, and I can’t wait to see some of the innovations that Australia can produce for the cannabis space.

What are participants going to get out of your session?

In my session I will explain relevant cannabis botanical features regarding their growth patterns and breeding, discuss different stages of plant development, alongside common harvest and production methods. We will also explore cannabis nutrition, facility design and horticultural lighting, environmental control, production systems and organic interactions.

I’ll be bringing a variety of horticultural technology and examples of equipment for participants to experience, including the latest digital lighting, fertilisers and water control technology. I hope at the end of my session students will have a comprehensive understanding of cultivating the cannabis plant in a variety of methods, and the relevant botanical requirements for successful growth. Whether they are looking for work in the industry, to setup a facility or to expand their own personal gardening skills, I truly believe this session will be beneficial.

Click here to enrol and learn from world-class experts like Tom Forrest

You can find Tom on LinkedIn

Why are so many Australians joining the medicinal cannabis industry?

Whether it’s the huge medical potential for cannabis treatments, the exciting new opportunities for pharmacology and biotech, or the commercial success of cannabis industries in other countries, Australians are completely embracing medicinal cannabis.

The legalisation of medicinal cannabis in February 2016 finally started to allow people to access cannabis medicines. It also made it much easier to engage in scientific research, and millions of dollars of research funding ha

CEO – Green C Medical – A facilitator in the program

s already flooded into the Australian cannabis industry. With the exciting opportunities presented by such a neglected field of study, Australia is currently home to some of the largest ever medicinal cannabis clinical trials in the world. By the end of 2017, dozens of universities and research centres across Australia will be researching cannabis treatments for cancer, epilepsy, MS, chronic pain and more. As well as the development of new strains, and how best to grow them.

Founder – Aunt Zelda’s, Inc. and Calla Spring Wellness; Director – Zelda Therapeutics

The commercial side of medicinal cannabis is also very attractive to many Australians who have seen the success of similar industries in California, Canada, Israel and the Netherlands. Across the globe, medicinal cannabis is a multi billion-dollar industry. And Australia is uniquely placed to lead the world in this field. We are renown for our biotechnology sector – especially in the State of Victoria – and our innovative approach to science. We are already a world leader in high-quality agricultural production, poppy straw manufacture, and science education. We have strong trading relationships with Europe, North America and Asia. And our Governments – at the State and Federal level – are committed to making these medicines available to Australians and around the world.

 

The opportunities are there, but many people are unclear about what this industry looks like, where it’s going, and how they might be able to contribute. Scientists and health professionals want to find out where the cutting-edge research is focused, and what kinds of clinical treatments might become available. Young people want to gain the skills that cannabis companies are looking for so they can get a job in the industry. And prospective entrepreneurs and investors want to know the lay of the land, and where the strategic opportunities are.

This is why the Medicinal Cannabis Leadership Program has been designed as a holistic training program spanning commerce, science and regulation with a strong focus on networking and practical industry knowledge.

 
Learn more about the program

The 3 stages of the cannabis supply chain

The medicinal cannabis supply chain has 3 main stages:

• Cultivation
• Manufacture and product development
• Patient access

Many people want to learn more about medicinal cannabis, and generally their interest is limited to one of these three areas.

People with an interest in agriculture, horticulture and plant biology tend to focus on cultivation and extraction. Topics such as manufacturing and product development tend to attract people with backgrounds in pharmacology, biotechnology, and medical science R&D. For doctors, nurses, health practitioners, and medicinal cannabis users, patient access is a primary area of interest.

But what most people are unaware of is that, due the Australian regulatory environment, to properly understand one of these areas, you must also understand the others.

For example, if you want to set up a business to exclusively cultivate medicinal cannabis, you need to partner with someone who want to manufacture your plants into finished products. This manufacturing partner also needs to understand the unique requirements of different patient groups, and develop medicines accordingly. In order for manufacturers to provide these medicines, they need a solid understanding of the patient access systems in place across the country.

For a cultivator, this means before you start your business, you need to know which patients you’ll be serving and how they can access your medicines, as this will inform both the types of cannabis you choose to cultivate, the techniques you use, and the scale of your infrastructure.

For a scientist hoping to engage in cannabinoid research, a clinician learning to prescribe cannabis medicines, or an entrepreneur aiming to build a medicinal cannabis start-up, knowing how the whole supply chain fits together is essential.

This is why the Medicinal Cannabis Leadership Program has been designed as a holistic training program spanning commerce, science and regulation.

Click here to learn more!

Dr Danial Schecter

Chief Medical Adviser – AusCann 

Executive Director and Co-Founder – Cannabinoid Medical ClinicContinue Reading…

Tom Forrest

Co-founder – Indicated TechnologiesContinue Reading…