GDS2021: Medical cannabis and dependence? Really….give us a break.
While there are lots of reasons why doctors and regulators aren’t jumping more keenly on the medical cannabis train yet – including the need for better research and evidence – at least part of the issue might be their fear that cannabis-based medicines might end up being the next prescription opioid crisis. Yes, I know that is just ridiculous. People can’t overdose on cannabis and that the indications are far broader than just as a pain killer, but doctors and regulators worry about prescribing drugs on which people become dependent. Medicine has a long memory and the halcyon days of benzodiazepine dependence (Valium, diazepam, Xanax etc.) are all in very recent memory and people are worried that even a drug as safe as cannabis might lead to problems down the line. Interestingly, although not surprisingly, lobby groups who pushed for legal recreational and medical cannabis did not give too much attention to the issue of dependence. Why raise the issue, even if you think it’s not a biggie, when the very mention of ‘addiction’ might give some unwanted attention to a topic that would not be good for business?
The companies behind the US opioid epidemic had the research, knew the facts and lied. They are being sued into desolation. One of the reasons they could spin their lies was that the way you assess dependence among people who are prescribed drugs like opioids for pain is different to how you might assess someone using heroin. The fundamentals of dependence are loss of control, craving and compulsion to use, often with escalating use leading to the development of tolerance and withdrawal. People in pain may be preoccupied with their opioid pain killer, without it they can’t function; they may need higher doses to manage their pain; they might worry about their supply as their script runs out. But are they dependent? It depends how you ask and what you ask.
Past work by GDS suggests that less than 15% of people who use cannabis for medical purposes are worried about losing control over their use and a minority report increasing their dose. But we don’t actually have the tools yet to assess dependence among people who use cannabis for medical purposes. We have not asked the right question or the right people. We don’t know if it is anything to be worried about at all. That’s not OK.
GDS wants to see people who may benefit from cannabis-based medicines to have access in the same way as they do to antibiotics or insulin if they need it. We want to help dispel the myths and dismantle the barriers to get cannabis-based medicines to those who need it. GDS thinks it’s better to know what the risks of dependence are among people who use cannabis for medical reasons rather than to ignore that it might be a thing. So, this year please take part in GDS2021 so we can trial a new tool developed to assess dependence in people who use cannabis for medical reasons. Take 20-30 minutes to help us have honest conversations about cannabis and other drugs so we can get the right policies in place to help people get the medicines they need. Anonymous, confidential and kind of important, really.
Prof Adam R Winstock & Assoc Prof Jason Ferris (with big thanks Prof Val Curran)