Cannabis/Hemp Products/Medicinal/Legal

Kidchameleon

jh79 wrote: »

Even if it was legal you still couldn't offer or promote it as a cure.

Who cares. Simple disclaimer in the small print is all thats needed. Have you ever seen a lottery ad?

farmerwifelet

My husband has MS tried CBD oil and it made his symptoms worse. I'm all for all for new medicines but they don't always work for everyone. I would be wary of anyone claiming "cures" without some proper long term medical studies to back it up.

jh79

Kidchameleon wrote: »

Who cares. Simple disclaimer in the small print is all thats needed. Have you ever seen a lottery ad?

Have to wait and see what's in the bill but i'm confident enough it won't be that easy to exploit.

Wonder will this delay Gino's bill as they can't contradict each other?

jh79

Came across this on reddit, a statement from Kate O Connel on Gino child like bill;

I think it appropriate that I respond to you all honestly and outline the facts of the matter regarding the cannabis for medicinal use bill.

There has been a lot of misinformation circulating online and quite a lot of abuse leveled at the members of the committee and in particular, myself.

Let me be clear:

I absolutely recognise that cannabis has been used for its medicinal effects for centuries. I fully accept and appreciate that cannabis has properties which some people find to be effective in the treatment of many conditions, including pain, nausea, seizures. There is however still a shortage of peer-reviewed evidence for the efficacy and safety of cannabinoid treatment. Peer-reviewed evidence is usually the cornerstone of clinical best practice in medicine.

Bypassing this approach exposes the public to incomplete and unpredictable medical treatment.

I wish that the bill had been written and presented in a way that made it possible for it to progress to committee stage and beyond. As it is, the bill contains significant legislative contradictions between it and many other existing Acts. I hope that a new bill is drafted that addresses all the failings of this bill, so that medicinal cannabis can proceed through the normal regulatory framework processes, and can be potentially made more freely available where appropriate.

As it stands, anyone who is diagnosed by a consultant medical doctor, registered in Ireland, as needing (or benefiting from) treatment with medicinal cannabis can get it, legally, in Ireland. If consultant medical doctors wish to prescribe it for their patients, they may do so, via two processes.

The first process has been in existence for many years, whereby a consultant can request supply of ANY drug, for a named patient, from the Minister for Health of the day.

Further to this, the Minister for Health has established the Compassionate Access Programme. This move has made the pathway to accessing medicinal cannabis possible and less difficult for patients suffering from three specific conditions: Nausea & vomiting associated with chemotherapy Certain forms of epilepsy Certain patients suffering from multiple sclerosis

The Minister has tasked an expert group with the job of seeking to expand patient groups that can access medicinal cannabis under the Compassionate Access Programme.

The Health committee is chaired by Dr Michael Harty, an independent TD and medical doctor from County Clare. the rest of the members of the committee are: Bernard Durkan TD [Fine Gael] Billy Kelleher TD [Fianna Fail] Alan Kelly TD [Labour] Margaret Murphy O'Mahony TD [Fianna Fáil] Louise O'Reilly TD [Sinn Fein] Senator Colm Burke TD [Fine Gael] Senator John Dolan TD [Civil Engagement Technical Group] Senator Ronan Mullen [Independent] Senator Dr. Keith Swanick [Fianna Fall]

As a committee, we were tasked with scrutinising the bill put forth by Deputy Gino Kenny TD last year, "Cannabis for Medicinal Use Regulation Bill 2016".

As you now know, the committee as a whole voted that the Bill should not proceed to Committee stage, given the technical issues, the implementation difficulties, the unintended policy consequences, the lack of safeguards against harmful use, and the major legal issues within the bill.

The stated aim of the bill was to make cannabis available for medicinal use through licensed pharmacies. Further to that, the purpose of the bill was to make cannabis available as a medicinal product for people who receive certification from a registered medical doctor.

The bill also proposed the foundation of a Cannabis Regulation Authority to regulate the sale of medicinal cannabis and oversee a licensing system to allow pharmacies have a license to sell medicinal cannabis. The committee did not arrive at its conclusion without hearing considerable evidence from officials from the Department of Health and further afield.

While the committee appreciated Deputy Kenny's stated aim "to alleviate unnecessary suffering", many aspects of the bill caused the committee to be concerned. The health committee is mandated to adopt a careful approach when supporting the passage of legislation, so they felt they would be unable to reconcile the bill with their stated duties.

Firstly the committee was concerned with the establishment of a Cannabis Regulatory Authority, establishing a parallel system of drug regulation, duplicating the functions of the current authority for drug regulation [the Health Products Regulatory Authority].

This 'new authority' would be allowing the supply of a substance which has not received authorisation from the HPRA to be considered a medicine. It would subvert the current agency's regulatory authority, ignore its expert advice that cannabis is not capable of being authorised as a medicine, and could create an undesirable precedent in law.

Authorised medicines must be of high quality, must be safe, and must be effective. The dosing must be appropriate to specific population groups, as per standard medical guidelines. Prescribers need to be guided and protected by sound pharmacological data in order to treat the public in the safest and most effective manner.

The scientific and peer-reviewed study of cannabis evidence so far, conducted by the HPRA has thus far shown it is not possible to regulate the whole plant extract of a plant, which has over 100 varieties, and within those varieties: several hundred components.

The bill also sought to remove cannabis from the Misuse of Drugs Act as a controlled substance. This would effectively legalise it for recreational use. This move towards decriminalisation of cannabis in non-medicinal circumstances conflicted with the stated intention of the bill...which initially claimed to be about making cannabis available for medicinal use.

Again, this did not seem a safe course of action for the committee to pursue given that it contradicted the purpose of what the bill had set out to do.

The bill allowed for a doctor to certify a person as having a condition which could reasonably be treated by cannabis, without having to stipulate a dosage amount, or a finite amount of time for treatment. This concerned the committee that any individual who received a certification from a doctor just once would then be able to buy as much cannabis as they wanted, indefinitely, without continued medical supervision.

It also never stipulated the type of cannabinoid a patient should be treated with, even though different cannabinoid ratios have shown different efficacy for different conditions. The isolation of cannabinoids which have proven medicinal beneficial effects, and have scientifically proven efficacy and safety, is the the key to developing medicinal cannabis products which can be legally prescribed and dispensed.

Further, labeling of the product would be required to indicate its contents...however it was unclear how this would be achieved, given the numerous varieties of cannabis plants and their multiplicity of components.

Other things that were seriously problematic within the bill were:

It limited the maximum amount to be sold per transaction as one ounce... however there was no provision at all for limiting the number of transactions that could happen.
There seemed to be no provision in the bill for a medical follow-up or medical provision beyond initial certification.
There was no scope to monitor possible negative side effects or interaction with other medicines.
Medication is usually prescribed in milligrams as a reference to strength. The bill did not do this, it used imperial measurements such as ‘ounces’ instead, which was very unorthodox.
Normally medicines are given with instructions regarding frequency of administration and length of use - the Bill didn't provide for this anywhere.
It used the word "consumer" to describe medicinal users of cannabis.
It proposed that whole or full plant extracts be made available in whatever form, including smoking.
I want to help as many people as best I can, as a TD with a specific interest in safeguarding and promoting public health. There is no ‘Big Pharma’ conspiracy at play here. The irony of that ridiculous claim is that pharmacies could stand to profit from the expansion of access to medicinal cannabis - as they would likely be the approved dispensing bodies. I have dedicated my professional life to helping people, by trying to make their lives better through safe medicinal treatments and by trying to alleviate their pain in times of suffering.

It would have been far simpler for me to take the easy option, disregard the safety concerns, and vote in favour of the bill’s progress - not that my vote would have mattered, given the fact the committee unanimously voted it down.

If this bill were solely about the decriminalisation of cannabis and had appeared before the Justice committee - I would likely have come down strongly on the liberal side of that argument. As it stands though, from a health and safety perspective, and for all the reasons outlined above, I could not in good conscience put my name to supporting such a flawed bill.

This whole exercise has now had the unfortunate effect of delaying the wider prescribed access for patients of medicinal cannabis, which I find very disappointing.

Best,

Kate.

jh79

New article from science based medicine on medical marijuana.Focuses on the evidence for the treatment if chronic pain;

Chronic pain: 39% experience pain reduction of >30% versus 30% with placebo, resulting in a number needed to treat (NNT)=11. Larger and longer RCT show no effects. The mean pain improvement is 0.5 on a 0-10 scale, which isn’t clinically meaningful.

Neuropathic pain: With inhaled MC, the NNT=6. With any MC, the NNT=14.

Cancer pain: In six randomized controlled trials, the pain reduction was not statistically significant.

HIV neuropathy: with smoked MC: NNT=4.

Pain from multiple sclerosis: Mean pain improvement over placebo was 0.8 on a 1-10 scale which was borderline insignificant.

Acute pain: One positive trial, one negative trial, and five trials showing MC is equivalent to placebo.

When compared to medication, MC was no better than amitriptyline (with more adverse events), or worse than dihydrocodeine with similar adverse events.

No overall differences shown in quality of life.

Little evidence for back pain, fibromyalgia, or osteoarthritis.

https://sciencebasedmedicine.org/medical-marijuana-where-is-the-evidence/

mulbot

jh79 wrote: »

New article from science based medicine on medical marijuana.Focuses on the evidence for the treatment if chronic pain;

Chronic pain: 39% experience pain reduction of >30% versus 30% with placebo, resulting in a number needed to treat (NNT)=11. Larger and longer RCT show no effects. The mean pain improvement is 0.5 on a 0-10 scale, which isn’t clinically meaningful.

Neuropathic pain: With inhaled MC, the NNT=6. With any MC, the NNT=14.

Cancer pain: In six randomized controlled trials, the pain reduction was not statistically significant.

HIV neuropathy: with smoked MC: NNT=4.

Pain from multiple sclerosis: Mean pain improvement over placebo was 0.8 on a 1-10 scale which was borderline insignificant.

Acute pain: One positive trial, one negative trial, and five trials showing MC is equivalent to placebo.

When compared to medication, MC was no better than amitriptyline (with more adverse events), or worse than dihydrocodeine with similar adverse events.

No overall differences shown in quality of life.

Little evidence for back pain, fibromyalgia, or osteoarthritis.

https://sciencebasedmedicine.org/medical-marijuana-where-is-the-evidence/

I can't seem to find what way the cannabis wasadministered? Was it smoked, or given as oil? Were the subjects in the tests taking any other medication at the time?

jh79

mulbot wrote: »

I can't seem to find what way the cannabis wasadministered? Was it smoked, or given as oil? Were the subjects in the tests taking any other medication at the time?

Inhaled MC meams it was smoked or vapourised. None of the various formulations had any real benefit.

It is just not an effective treatment for chronic pain.

jh79

NNT is a new term for me

It means number need to treat. Basically an NMT of 11 means you would need to treat 11 people to see one positive outcome.

While medical marijuana for chronic pain is expected to be allowed here in the future it really shouldn't be.

Kurtosis

jh79 wrote: »

NNT is a new term for me

It means number need to treat. Basically an NMT of 11 means you would need to treat 11 people to see one positive outcome.

While medical marijuana for chronic pain is expected to be allowed here in the future it really shouldn't be.

It's important to note that the comparator and time frame are important when interpreting the NNT. So in that case, 11 people treated with cannabis instead of placebo for the study length would result in one additional person with a positive outcome. An NNT of 11 is actually good relative to a lot of treatments in modern medicine, however one needs to know what the uncertainty in that estimate is (e.g. 95% confidence intervals) to determine how likely it is that the beneficial effect could be a chance finding.

jh79

Kurtosis wrote: »

It's important to note that the comparator and time frame are important when interpreting the NNT. So in that case, 11 people treated with cannabis instead of placebo for the study length would result in one additional person with a positive outcome. An NNT of 11 is actually good relative to a lot of treatments in modern medicine, however one needs to know what the uncertainty in that estimate is (e.g. 95% confidence intervals) to determine how likely it is that the beneficial effect could be a chance finding.

I'm not a clinical scientist so struggle with interpreting clinical trials. 1 in 11 sounds poor but as i said it's a new term to me. I work in early stage drug development so wouldn't be great with clinical data.

What's your opinion of the clincal data available for chronic pain? Would i be correct in saying it's no better than what's already available

Kurtosis

jh79 wrote: »

I'm not a clinical scientist so struggle with interpreting clinical trials. 1 in 11 sounds poor but as i said it's a new term to me. I work in early stage drug development so wouldn't be great with clinical data.

What's your opinion of the clincal data available for chronic pain? Would i be correct in saying it's no better than what's already available

Interpreting an NNT needs the context of the study (or studies) that generated it, including the type of patients included in it, what were the intervention and control, and what was the outcome and the timeframe this was measured over. A couple of articles elaborating on it and giving examples here and here.

I haven't had a chance to have an in depth look at what studies have been conducted. In the absence of any trials using other analgesics as the comparator, it would be hard to say cannabis is not better in chronic pain. If there are such trials, I'd want to know some of the following to appraise it:
What kind of patients are included? Are they already taking analgesics
Have they really been randomised between the two treatments? Was there anything to prevent this being fiddled by the researchers?
Do the researchers, patients and health professionals involved know what treatment each patient has been assigned or have they been "blinded"?
How is the outcome measured and who is it being measured by?

There's a series of articles on how to read clinical research papers from the BMJ which are quite good: http://www.bmj.com/about-bmj/resources-readers/publications/how-read-paper

The point I made about the NNT of 11 in the linked report is that one has to consider how much data is this single figure based on. Obviously one might find it more trustworthy if this came from a study of 10,000 patients, rather than a study of 10. We want to try rule out chance results (e.g. one could manage to get eight heads out of ten coin flips without believing the coin favours heads 3:1) which happens with large numbers of patients and more data supporting a particular magnitude and direction of effect.

poo poo

Free da weed!!

Seanachai

poo poo wrote: »

Free da weed!!

Another couple of years I'd say, you'll have access to all the properly grown product you could dream of

jh79

Another review, this time from Canada, on the evidence for medical marijuana. It is meant as a guide for Doctors.

"According to the guideline, there is acceptable research for the use of medical cannabinoids to treat a handful of very specific medical conditions. They include chronic neuropathic (nerve) pain, palliative cancer pain, spasticity associated with multiple sclerosis or spinal cord injury, and nausea and vomiting from chemotherapy. Even in those specific cases, the benefits were found to be generally minor."

https://medicalxpress.com/news/2018-02-guideline-pain-benefits-medical-cannabis.html

Here is the actual paper;

http://www.cfp.ca/content/64/2/111

evolving_doors

jh79 wrote: »

Another review, this time from Canada, on the evidence for medical marijuana. It is meant as a guide for Doctors.

"According to the guideline, there is acceptable research for the use of medical cannabinoids to treat a handful of very specific medical conditions. They include chronic neuropathic (nerve) pain, palliative cancer pain, spasticity associated with multiple sclerosis or spinal cord injury, and nausea and vomiting from chemotherapy. Even in those specific cases, the benefits were found to be generally minor."

https://medicalxpress.com/news/2018-02-guideline-pain-benefits-medical-cannabis.html

Here is the actual paper;

http://www.cfp.ca/content/64/2/111

That 'handful of conditions' is a heck of a lot of people isn't it!

Also some promising implications for Parkinson's... Maybe!
https://parkinsonsnewstoday.com/2018/02/16/compound-ehp-102-beneficial-parkinsons-mouse-study-finds/

jh79

evolving_doors wrote: »

That 'handful of conditions' is a heck of a lot of people isn't it!

Also some promising implications for Parkinson's... Maybe!
https://parkinsonsnewstoday.com/2018/02/16/compound-ehp-102-beneficial-parkinsons-mouse-study-finds/

Yeah, a heck of a lot of people that would see little or no benefit.

burnsey1987

I’ve just been listening to LBC where somebody who claimed to represent a UK-based epilepsy charity phoned in and commented on a 6-year-old boy who needs to go to the Netherlands to obtain CBD oil as it was allegedly banned in the UK about a year ago. Yet I have purchased it there legitimately within the last year. From what I can see online it is still possible to do this. So where is this person coming from? Is it possible that she’s mixing up the CBD-only oil with the one that contains CBD & THC?

jh79

burnsey1987 wrote: »

I’ve just been listening to LBC where somebody who claimed to represent a UK-based epilepsy charity phoned in and commented on a 6-year-old boy who needs to go to the Netherlands to obtain CBD oil as it was allegedly banned in the UK about a year ago. Yet I have purchased it there legitimately within the last year. From what I can see online it is still possible to do this. So where is this person coming from? Is it possible that she’s mixing up the CBD-only oil with the one that contains CBD & THC?

CBD oil is not available in the uk as it was being sold as medicine without the appropriate clinical trials and approval.

If they sold it as a supplement it would not of been banned but the sellers got too greedy and claimed it could cure all sorts.

Funny thing is the decision of the uk government to classify it as medicine because that's what it was being sold as (the classification had nothing to do with the scientific evidence) was claimed as a victory for medicinal cannabis on this thread and by Gino and Vera and the journal.ie too!

mulbot

burnsey1987 wrote: »

I’ve just been listening to LBC where somebody who claimed to represent a UK-based epilepsy charity phoned in and commented on a 6-year-old boy who needs to go to the Netherlands to obtain CBD oil as it was allegedly banned in the UK about a year ago. Yet I have purchased it there legitimately within the last year. From what I can see online it is still possible to do this. So where is this person coming from? Is it possible that she’s mixing up the CBD-only oil with the one that contains CBD & THC?

I think Holland and Barrett in UK are selling cbd oil

jh79

mulbot wrote: »

I think Holland and Barrett in UK are selling cbd oil

You're right it is, it is sold as a supplement with no claims of a clinical effect.

burnsey1987

jh79 wrote: »

Your right it is, it is sold as a supplement with no claims of a clinical effect.

Okay so what was that person going on about on the radio this morning so??? Considering that anyone looking for CBD oil can just walk into any H&B shop and buy some...

jh79

burnsey1987 wrote: »

Okay so what was that person going on about on the radio this morning so??? Considering that anyone looking for CBD oil can just walk into any H&B shop and buy some...

Dunno probably harder to get from independant retailers. I think you have to get approval form the MHRA to sell it since the classification was changed.

burnsey1987

jh79 wrote: »

Dunno probably harder to get from independant retailers. I think you have to get approval form the MHRA to sell it since the classification was changed.

Okay I see. Although on reflection my own conclusion would be that the person who phoned the radio station was not actually a real charity spokesperson but someone with nothing better to do than stir sh1te or an actual spokesperson being unprofessional by not knowing her stuff. Because going by what she was saying it wasn’t possible to buy CBD oil in the UK AT ALL... 🙄🙄🙄

jh79

burnsey1987 wrote: »

Okay I see. Although on reflection my own conclusion would be that the person who phoned the radio station was not actually a real charity spokesperson but someone with nothing better to do than stir sh1te or an actual spokesperson being unprofessional by not knowing her stuff. Because going by what she was saying it wasn’t possible to buy CBD oil in the UK AT ALL... 🙄🙄🙄

When the classification changed imports were stopped and only what was left on the shelf was allowed to be sold.

I think H&B selling it is a recent development. The MHRA trust them not to try to exploit vunerable people unlike the independent retailers.

burnsey1987

jh79 wrote: »

When the classification changed imports were stopped and only what was left on the shelf was allowed to be sold.

I think H&B selling it is a recent development. The MHRA trust them not to try to exploit vunerable people unlike the independent retailers.

Well all I’ll say is that I did buy CBD oil from independent retailers (both here & the UK) very recently. Okay they were clearly labeled as supplements which didn’t appear to make any claims. As regards people buying them with the intention of using them for treating certain disease, it’s a bit late to close the Pandora’ box

burnsey1987

Still being discussed on LBC. Get it on 97.3 MHz in the greater London area, 1215 kHz medium wave & on Freesat. “The right to self-medicate”.

burnsey1987

burnsey1987 wrote: »

Still being discussed on LBC. Get it on 97.3 MHz in the greater London area, 1215 kHz medium wave & on Freesat. “The right to self-medicate”.

*1125 MW

Kidchameleon

Who cares what they can and cant claim on the bottle, the fact is that it clearly does have medical benefits and I'm glad those who need it can easily avail of it.

jh79

Kidchameleon wrote: »

Who cares what they can and cant claim on the bottle, the fact is that it clearly does have medical benefits and I'm glad those who need it can easily avail of it.

The people selling it care , the more illnesses they pretend it can cure the more profit they make.

beans

burnsey1987 wrote: »

Because going by what she was saying it wasn’t possible to buy CBD oil in the UK AT ALL... ������

For the record, my local chemist (London) sells a wide range of CBD products, oils and vapes.