A CARDIFF GP concerned patients are turning to risky "underground sources" to access medicinal cannabis is set to begin offering his services to help them navigate the "convoluted" approvals process to access a safe and standardised product.
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Patients are already referred to Dr Allan Kirkpatrick, of Cardiff General Practice, for his extensive experience in palliative care, and he sees offering advice about medicinal cannabis as an extension of that service.
"Medical cannabis has been around for a while, and a lot of us doctors have a healthy skepticism, because the way that most drugs get to market is through a rigorous series of investigations and trials," he said.
"It has been a bit of a case of the tail wagging the dog that politicians have caved into public demand - but they have also made it a very convoluted approvals process, which would deter anyone from prescribing it.
"GPs and my colleagues have had families coming to them, begging to get cannabis for them or for a family member, but when the doctor has looked at the approvals process, he has just gone, 'Sorry'. But apart from that, I can't just write a prescription for cannabis and send you down to the local chemist, because they don't have it."
Dr Kirkpatrick said until recently, people would have just gone out and found the most convenient, "underground" source. He knows of people who have been selling medicinal cannabis diluted with another product, like olive oil.
"There is a lack of access to a standardised product that is quality controlled," he said. "Even if you're getting it from the same place, is it going to be the same strength as last time? Or is someone there thinking business will be booming if they can get 15 doses out of it, rather than 10, by diluting it?"
More recently, "several" medicinal cannabis companies have started up in Australia.
"Most of them seem to have a model whereby they hand the GPs the information, and say that if they get a patient asking for medicinal cannabis, to put them in touch, and they'll take over," he said. "What I assume then happens is you're going to be Skype-ing with a doctor down in Melbourne, who has probably got a vested interest in giving you the stuff, who perhaps won't look for or identify other concerning symptoms and suggest further investigations, or going back to your oncologist, or any other options.
"If it's not working, or it's making them sick, the doctor they spoke to on the end of the phone may not be there next week to advise.
"GPs know a little about a lot - that's our place in the world. This way, it's a little bit more controlled, a little bit more holistic. And no one, as far as I know, is offering a service like that."
Dr Kirkpatrick said the approvals process involved making an application to the Therapeutic Goods Administration.
"You have to say what the patient has, what they have tried, why you think cannabis might work, and what particular dose," he said.
"If it's approved, you get your approval for one month, for one dose, from one doctor, and from one pharmacist - that's it. The chemist doesn't stock it, so it comes from somewhere where it's locked up.
"I think it will be something that will be very well controlled.
"I think it will be a safe, and a more holistic approach to symptom management.
"I'm not here to pinch patients, I'm here to advise them on the medicinal cannabis side of things, as well as in a general palliative care sense, and return them to their GP, and keep their GP in the loop."
Dr Kirkpatrick said medicinal cannabis company, CannaPacific, was helping him to set up an online-based portal to streamline the approvals process, but - with the exception of the consultation fee - he did not stand to make any money out of prescribing the product.
"I have no vested interest in prescribing it. I'm not allowed to," he said.
"There is definitely nothing that says it will cure anything. But people with cancer can be in very desperate situations, and there is a feeling of conspiracy out there that big pharma has kept cannabis buried because, after all, you can grow it in your backyard, and they're not going to make any money out of it.
"There is some evidence, and lots of anecdotal evidence, that it can help with epilepsy. And we think it may potentiate some of the standard drugs. So it's a matter of leaving them on what they are on, and adding - cautiously - small amounts of medicinal cannabis."
He expected to see patients wanting access to it to increase their appetite during cancer treatment, and for help with anxiety, nausea and insomnia.
"There could still be this catch 22 where you can apply, but they won't give approval," he said. "And it's a couple of weeks turnaround anyway. You are not going to get it straight away.
"Ultimately, I'd like to then share my experience with other GPs, because I don't want this to take over my practice. I don't want to be Dr Cannabis. I would rather that if cannabis does become mainstream, that everyone might start to prescribe it."