A (3:31)

Okay, but you have just written about a new study. This was just published in Lancet Psychiatry on Tuesday, and it has thrown, I would say, a pretty big question mark over the use of cannabis to treat various ailments. So tell us about this study. What did it say?

B (3:48)

This study, Sam, was from researchers at the University of Sydney and it looked at more than 50 randomized control trials test the effectiveness of medicinal cannabis to treat mental health and substance use disorders. Specifically, these studies involved about two and a half thousand participants, so quite a large group. And it looked at a range of conditions. So the review found no evidence that cannabis was effective for treating anxiety, depression and post traumatic stress disorder, ptsd. There was some evidence that cannabis could help reduce tic severity for people with Tourette's syndrome, increase for people with insomnia, and help manage autism traits in people with cocaine use disorder. Cannabis actually increased cravings, but overall, the researchers cautioned that the quality of studies included in the review was quite low. So we can't exactly draw conclusive evidence from this study, but it does add to the evidence and the constantly updated evidence that we need perhaps more research into these before we can say whether or not they are effective at a population level.

A (5:04)

And so I've got to ask you, Angus, is this finding a surprising and B, going to anger anyone?

B (5:12)

It's not particularly surprising on you. I think these kind of systematic reviews of medicinal cannabis studies have been around and there's been many of them for many years. This study was somewhat unique in the sense that it looked at a range of mental health and substance use conditions. But it again highlights a really important point, which is that there is just not much research into medicinal cannabis, which is somewhat surprising given it has been legalized and regulated for decades in some countries. I think California first legalized medicinal marijuana in the 90s. So it has been around for a while and yet there's just not much research into especially these mental health conditions which make up such a large proportion of the reasons why it's being prescribed. In terms of who is angry, I think this kind of study would really frustrate those people out there who have found medicinal cannabis to be useful to treat their conditions. And the authors have acknowledged that people do experience benefits from them, but for whatever reason, we just aren't seeing that bearing out in population wide gold standard clinical trials. There was also some frustration among experts that I spoke to that these types of reviews distract from what they think we should be doing, which is funding new clinical trials to understand more about how these drugs work rather than looking at trials that have been around for

A (6:43)

years after the break.

B (6:46)

Well, I think the difficulty with having a lack of research, Sam, is that we don't know for sure whether what the harms could be. There is perhaps less risk to it. But I don't want to say there's no harms involved because there could be really serious harms that we don't know about because it hasn't been studied.

A (7:15)

And another really fascinating part of the feature that you've just written about, this was a young father who you spoke to. He's living in Darwin and he is an example, I guess, of what can go wrong if you become a habitual cannabis user. So tell us about his experience.

B (7:34)

That's right. So I spoke to Daniel Yakuel. He's a young dad living in Darwin and he was prescribed medicinal cannabis about two years ago to help him deal with anxiety and depression following a relationship breakdown. So he had smoked marijuana recreationally in the past, but he found himself going more reliant on the legal product, which was far more potent than what he'd dealt with before. And he said anytime he wasn't at work he'd be using it. And at the peak, he was consuming 60 grams of cannabis a month, which is quite a large amount. He was spending more on his cannabis prescription per week than his $300 rent. So the cost and the realization that he was slipping into dependency really were the things that he that motivated him to get off it. And he has been off cannabis now for four months. He said he's found his mental health has improved, his emotions are more regulated and he's getting better quality sleep and actually, interestingly, dreaming vivid apparently. He was telling me that when you use cannabis regularly, you don't dream as much, but he's found that his dreams are coming back and more vivid. And he said that it's probably one of the best decisions that he's ever made. So he's one out of many people who use it. Obviously there is a spectrum of people that use it and they all experience different things. But that was one case where he really benefited from coming off it and had noticed that he was getting an addiction growing dependent on this particular product,

A (9:18)

which is so interesting, given that you said before, that, you know, people use cannabis to treat substance abuse. Anyway, that's just a fascinating element to this. But I really want to ask you, like, how is it that there have been very few trials in the safety and effectiveness of cannabis and yet at the same time, we've got more and more Australians legally using medicinal cannabis through what you've, you know, spoken about, which is the Special Access Scheme, which is a pathway that essentially allows doctors to prescribe products that haven't gone through the rigorous testing needed to be classified as an approved medicine. Like, is this a problem?

B (9:55)

Well, there's a couple of things that are quite unique about medicinal cannabis in Australia. And so it was legalised, as we said, in 2016, and the way that it has been made accessible to people is through this Special Access scheme, which basically allows doctors to prescribe unapproved products. So these are products that haven't been through really rigorous clinical trials to people who have a justification for using it. So through that pathway, hundreds of thousands, almost a million Australians have been prescribed cannabis. And so that has resulted in a big industry cropping up around, particularly around telehealth and these vertically integrated clinics where you go online, you speak to a doctor, they consult, you recommend medicinal cannabis, then that same company distributes you the cannabis and then you get it mailed to you or such. So that has been a big boon for some of these companies and it has also raised questions with regulators about how to regulate this new industry that is making cannabis so accessible to Australians. The other thing is that clinical trials are really, really expensive. I think Ian McGregor, who, he's a psychopharmacologist at the University of Sydney, he said these trials can cost anywhere between 3 to 10 million dollars to do. And he was saying that there isn't that much incentive for these companies to invest in these trials because they're already making money and they're already got quite small margins on prescribing medicinal cannabis to Australians. And it's growing exponentially, almost it's tripled in the last four years. So there's not much financial incentive for the private sector to invest in these kind of trials. And so that's where he and others have argued for other people to step in, whether that's the government or philanthropy. So it's a factor of two things. It's. It's the fact that clinical trials are really expensive and that there is not a lot of motivation for people to invest in them.

A (12:22)

And, you know, you've written that legal cannabis sales have tripled in Australia in the last four years. But Ian McGregor, who you've just mentioned, a professor of psychopharmacology, he told you, you know, that research hasn't kept pace with prescribing rates. So I'm just wondering, how is this affecting treatment outcomes for patients ultimately?

B (12:42)

Well, I think the bottom line is that it doesn't give people who are prescribed medicinal cannabis the overarching evidence or confidence that it will work for them. So a lot of it is their relationship with their doctor, their sort of process of trial and error and how it works for them. The good news with these kind of products, which I think is good to note from this study. The study found that medicinal cannabis products were associated with a greater risk of adverse events. So these are things like headaches and nausea, but it wasn't actually. It didn't lead to very serious adverse events, things like hospitalisations, psychotic episodes. So that's comforting to know that these products aren't necessarily unsafe in that sense of, you know, leading to serious outcomes, but it does leave patients and people using these products having to fend for themselves a little bit without overarching really strong evidence that it. It is actually effective.

A (13:52)

And so is the upshot, do you think, after looking into this area, that cannabis is unlikely to really hurt someone in a serious way, like hospitalizing them? And therefore, even if it's not particularly effective to treat, say, depression or PTSD or anorexia or a number of the conditions that it's being sort of prescribed for, that really, people are unlikely to get hurt and at best, maybe there'll be a placebo effect.

B (14:16)

Well, I think the difficulty with having a lack of research, Sam, is that we don't know for sure whether what the harms could be, especially when you look over a population level. Certainly there are drugs in the literature. Obviously, cannabis has been legal for medicinal use for a relatively short period, but there has been a lot of studies of drug use recreationally as well. And certainly cannabis, marijuana is much lower down that scale of. Of drugs that harm, which is a lot, by and large, alcohol and things like cocaine and methamphetamine. So there is perhaps less risk to it. But I don't want to say. Yeah, I don't want to say that it. There's no harms involved because there could be really serious harms that we don't know about because it hasn't been studied.

A (15:17)

And, Angus, just to wrap up, can you tell us about the draft bill that the New South Wales government might soon be releasing, which might really have an impact in this area.

B (15:27)

Yeah. So, Sam, this week we're expecting the New South Wales government to release a draft bill that lays out their plans to amend New South Wales driving laws to create an exemption for people with medicinal cannabis prescriptions who aren't impaired while they're driving. Obviously, in rural areas of New South Wales and Australia in general, this is a big issue because there's a lack of public transport and people rely on their cars every day. So this is a really big issue for people. It's also a big issue for people who might be considering using medicinal cannabis who aren't taking that leap because they need to be able to drive. And so I think all this goes to the fact that we need really rigorous evidence based trials into this medication and whether it works or whether it doesn't, what conditions it works for and which conditions it might be less effective for.

A (16:29)

Well, it's fascinating space on this 10 year milestone of the legalization here. So thank you so much, Angus, for your time time.

B (16:36)

Thanks for having me, Sam.

A (16:42)

And in other news today, with the Reserve bank hiking interest rates yesterday to 4.1%, new data shows many Australian homeowners prepared for the increase by pouring record amounts into offset counts. Four time F1 world champion Max Verstappen says the new era of Formula One racing with 5050 electric hybrids is not racing. And like playing Mario Kart. And last week, Atlassian cut 1600 jobs globally, blaming AI. White collar workers are watching the AI job carnage, wondering what jobs are on the chopping block and what jobs have a future. Today's episode was produced by Chi Wong. Our executive producer is Tammy Mills. And our podcasts are overseen by Lisa Muxworthy and Tom McKendrick. If you like our show, follow the MORNING Edition and leave a review for us on Apple or Spotify. Thanks for listening.