MARIJUANA TRIAL

The medical use of marijuana has been given the go-ahead in NSW, a move
welcomed by many terminally ill patients. The drug will now be available on
a trial basis for the first time in Australia. While some doctors have
applauded the move, others say there are problems.

Tony Jones then speaks with Dr John Anderson, a psycho-physiologist who
believes a marijuana trial could cause more problems than it solves, and
Professor Wayne Hall, who is chairman of the working party Cannabis for
Medical Purposes.

HELEN VATSIKOPOULOS: British and American studies have shown that THC, the
active ingredient in cannabis, can relieve the suffering of chronic and
terminally ill patients.

The NSW Government will now allow the seriously ill to grow up to five
plants for consumption in a 2-year trial of medical marijuana.

BOB CARR, NSW PREMIER: I think there is an overwhelming moral obligation on
all of us, if we can relieve suffering in this world, to do it.

PROF. WAYNE HALL, CANNABIS FOR MEDICAL PURPOSES: There are already people in
the community with these conditions who are using cannabis for medical
reasons and we thought it appropriate that the Government not add to their
distress and suffering the fear of a criminal prosecution.

HELEN VATSIKOPOULOS: Patients will only be eligible for the trial if more
conventional relief has failed, and their suitability will have to be
reconfirmed by a doctor every six months.

DR KERRYN PHELPS: I think a clinical trial is the way to go.

HELEN VATSIKOPOULOS: The AMA's Dr Kerryn Phelps has welcomed the move, but
some drug experts are concerned at what this may lead to.

In nine states of the USA, there's a system of medical marijuana in place,
whereby it's legal to possess, grow and smoke with a doctor's
recommendation.

Sufferers can even go to cannabis cafes.

This is a long way from the NSW trial, which will begin after community
consultation.

Tasmania is also considering a similar move.

Helen Vatsikopoulos, Lateline.

TONY JONES: Now, Wayne Hall, your report clearly supports findings that
marijuana is medically useful.

First, what are the range of ailments that you think cannabis could be used
to treat?

PROFESSOR WAYNE HALL, CANNABIS FOR MEDICAL PURPOSES: Well, I'd just clarify
a thing.

I think what's tended to assume a great deal of significance in the public
reception of the report is one recommendation, which is really an interim
recommendation, that patients be allowed to use this until more effective
forms of drugs are developed and registered for medical prescription, so I
think that's the important point to make.

TONY JONES: But in this interim period, you are recommending that
chronically ill patients be able to use marijuana and possibly even grow it
themselves.

My question was about what sorts of ailments specifically marijuana could be
used to deal with.

PROFESSOR WAYNE HALL: Well, the four main groups are ones that have been
widely recognised in US and British reports.

There'd be age-related and cancer-related wasting -- it stimulates appetite
in patients with those problems and enables them to enjoy a better quality
of life -- and nausea and vomiting in cancer patients undergoing
chemotherapy.

They're the two indications for which THC is registered in the US.

The other two are a bit more contentious, I guess, and the evidence isn't as
strong for those.

They'd be some neurological disorders with painful muscle spasms, such as
multiple sclerosis and spinal cord injury, and chronic pain that has failed
to respond to other forms of medical treatment.

TONY JONES: Alright.

John Anderson, do you accept that these sorts of ailments can be treated
with cannabis?

DR JOHN ANDERSON, CONSULTANT PSYCHO-PHYSIOLOGIST: Yes, I certainly do.

However, most of the data that I've reviewed and looked at suggests that, in
terms of efficacy and treatment outcome, they're no more valuable than some
of our weaker forms of antiamedics, such as Proculperizene.

Those which they've been trialled against, and the same in terms of pain
relief, are usually the milder forms of analgesics that comparisons have
been made to, so certainly they do have some efficacy.

However, we do have much stronger antiamedics that are available and can be
used.

I guess my greatest concern in relation to that particular issue, if I was a
pharmaceutical manufacturer and said I had a product that would be a better
antiamedic, that would be very useful in treatment of MS, it would be a good
analgesic and could help in chronic pain, and here is my product and I want
to distribute that product, the TGA would put me through all the hoops in
the world to be able to demonstrate that I've got a dose-related therapeutic
outcome.

It seems to me on this occasion for the sake of expediency -- and I can
understand where the people are coming from --

TONY JONES: Well, let me put that specifically to Wayne Hall, the
dose-related therapeutic outcome.

What sort of scientific evidence have you based your findings on?

PROFESSOR WAYNE HALL: It's been reviewed by the US Academy of Medicine and
it's very clear there are controlled trials that have showed that it's
efficacious.

I'd agree, we're not suggesting this as a first-line treatment or that it's
the best treatment, it's a treatment of last resort often for patients who
fail to respond to conventional treatment.

That's sufficient, I think, to justify it.

The second point I'd like to make is we're not recommending that this be
prescribed.

I think there's a misunderstanding on Dr Anderson's part.

It can't be prescribed and it couldn't be registered.

As he said, it wouldn't pass registration.

What we're suggesting is that patients be exempted from criminal prosecution
if they use it for these indications.

That's a very different recommendation.

TONY JONES: John Anderson, you have claimed, I think, that cannabis actually
suppresses the immune system.

DR JOHN ANDERSON: Well, there's been a number of studies that show that it's
an immunosuppressant.

I find that rather a little bit contradictory in the terms that, yes, it
certainly does help in AIDS waste syndrome in terms of --

TONY JONES: Helping people to put on weight and increasing their appetite?

DR JOHN ANDERSON: But in actual fact there have been a couple of studies
that actually showed the reverse of that.

Nonetheless, accepting that generally it does that, it seems to me a little
bit incongruous that we're going to recommend a person use a particular
immunosuppressant agent in a condition such as HIV AIDS, which in itself --

PROFESSOR WAYNE HALL: No-one is recommending that people use it.

This is a response to the fact that people are using the drug and it's
saying that we shouldn't add to their suffering by imposing on them criminal
penalties.

TONY JONES: What about the claim, though, that it suppresses the immune
system?

That would be a pretty serious claim if in fact AIDS patients, for example,
were using something which suppressed their immune system.

PROFESSOR WAYNE HALL: There's two points about that, I think.

It's certainly true in animals that very high doses it does suppress
immunity.

The human studies have by and large not found that the sorts of doses that
people use it produces enduring changes in immunity.

Recent research has been done on exactly this question with the treatment of
HIV AIDS-related wasting, which has not found evidence of immune suppression
in patients of this sort.

Clearly that is a risk that people would need to be told about and anybody
who contemplated its use would need to do that in full knowledge that that
was a possible risk.

Again, that's something that is part of our recommendation, that people be
counselled about the risks as well as the benefits of medical use.

TONY JONES: John Anderson, in some respects this report has acknowledged a
reality, and that is that a lot of people suffering from AIDS and also from
cancer are taking this drug, are smoking it, indeed.

Now, one of the points of this report, I think, is to make sure that those
people don't get prosecuted for doing that.

I mean, do you at least agree with that as a starting point?

DR JOHN ANDERSON: I have no problems with that.

My concern is that if we're running a trial, and what makes it a rather
preposterous situation for me is that if we're running a scientific trial,
how do we measure outcome of the trial when people are allowed to grow
different forms of cannabis, use it in a different way, use different
portions of the cannabis plant to do that?

PROFESSOR WAYNE HALL: There's a misunderstanding again.

We've recommended a series of trials.

People are talking about a trial here.

It's a trial of the exemption from criminal prosecution.

That was also to be accompanied by clinical trials of THC, alternative
methods of delivering it, and alternative cannabinoid drugs that might be
developed.

TONY JONES: Your report goes a little further than that, though, doesn't it,
because it suggests that people be allowed to grow some cannabis at least
for their own use.

PROFESSOR WAYNE HALL: To avoid purchasing on the black market.

That was largely the --

TONY JONES: To avoid purchasing on the black market.

But why do that?

Why not simply find some way of prescribing it?

PROFESSOR WAYNE HALL: Well, it can't be prescribed, for the very good
reasons Dr Anderson mentioned, that in order to be prescribed, it would have
to pass the Therapeutic Goods Act criteria for registration.

It's not likely to do that.

No plant product that would be smoked would pass those criteria.

That's why it can't be prescribed in this country.

DR JOHN ANDERSON: Therefore, how do we have it called a medicinal product?

The fact that we're referring to it as a medicinal agent or a medicinal
product gives an inference that it will provide benefits and therefore give
a general impression against the argument that, well, it has possible
harmful effects to a lot of people, when we can say "but it's a medicine".

It's sort of contradictory and I think giving a bad message.

TONY JONES: We'll have to leave the debate there.

Dr John Anderson, Professor Wayne Hall, thanks to both of you for joining us
tonight.