| A recent medicinal cannabis study has shown that doctors were the most common health professional patients told about their medicinal cannabis use.
Analysis of the Nimbin HEMP medicinal cannabis survey for Northern Rivers postcodes showed that 63% of respondents have discussed their medicinal cannabis use with health workers. By far the most, 56%, had discussed this with a doctor.
The survey was carried out at the Nimbin HEMP Embassy between August 1998 and January 1999. Surveys were filled in at the HEMP Embassy and some were mailed in from a survey in a local newspaper The Nimbin Good Times. The male to female response ratio was 3:2. With 202 respondents from New South Wales, Queensland, Victoria, South Australia and overseas, the survey is rich in data and appears to include both serious and not-so-serious medicinal users.
Health reasons given for using cannabis
- Anxiety and stress 71%
- Depression 56%
- Somatic pain 55%
- Pre-menstrual tension and dsymenorrhoea, 51% of female respondents
- Nausea 32%
- Chronic pain 31%
- Muscular spasm 23.5%
- Digestive disorders 21.5%
Previously well documented medicinal uses of cannabis were well represented for a static survey targeting the general public. Response rates were as follows; glaucoma 4.5%, nausea associated with chemotherapy 3.5%, muscle spasm associated with multiple sclerosis 2.5% and wasting associated with HIV/AIDS 1.5%.
Methods of ingestion of cannabis were also documented. Nearly half, 45%, smoked cannabis with tobacco while other methods of ingestion included cannabis alone (45%), cannabis with other herbs (17%), ìbongsî (32%) and orally (40%).
What recommendations would I hazard to make from the survey?
Firstly, I would recommend that we could be asking our patients about medicinal cannabis use. While it is gratifying to see that doctors are the most likely health worker to discuss medicinal cannabis use with users, I suspect we are missing out on giving some patients a chance to discuss their cannabis use.
The medical conditions listed in the survey may help identify medicinal cannabis users presenting in general practice. It would be helpful to enquire about cannabis use in patients with mood disorders, chronic pain, gastrointestinal conditions and menstrual disorders. It would also be advisable to enquire about cannabis use in patients undergoing chemotherapy, patients with HIV/AIDS and patients with multiple sclerosis. If we are proactive on this issue then we can start to explore the area of harm reduction in medicinal cannabis use.
Smoking is one major concern many respondents mentioned. Concurrent tobacco administration, given its highly addictive nature, is another area of potential harm. ëBongsí, according to the only study Iíve ever seen published, tend to cause more harm as they do not remove a significant amount of tar and may actually remove THC, causing users to smoke more. Vapourisers are becoming available for inhaling cannabis vapour without combustion and their availability will be a great help in removing the harm associated with smoking. Patients would be well advised to use medicinal cannabis orally, although some respondents reported more variable effects and side effects when taking cannabis this way.
The risk of arrest and prosecution was a major concern to most medicinal cannabis users who replied to the survey. Concerns about variability in supply, quality and high street prices were also mentioned by many of the respondents. 62% of the Northern Rivers respondents said they would support and use a ëcannabis buyers clubí to deal with these problems. Given the legal problems with medicinal cannabis use, it would be helpful for GPs to document medicinal cannabis use in a patientís notes. A written record of medicinal cannabis use that pre-dates any criminal charge has much more weight in a court than a history of medicinal use given after arrest.
Many patients are confused and unsure about the issue of medicinal cannabis. It would be helpful for their GPs to become better informed on some of the more recent research into medicinal cannabis. Since the discovery of the amandamine receptor in humans, a wealth of research has been published. Cannabinoids have been demonstrated to have anti-inflammatory and anti-convulsant activity. They have been shown to potentiate the endorphin system and hence help modulate pain. Amandamine receptors have even been located in the skin. Cannabinoids show a potential to guiding us towards pharmaceutical agents acting through new pathways. I hope to be able to produce another article on recent research on cannabinoids and their application in medicine.
I would like to thank all the crew at the HEMP Embassy for administering this survey and I would also like to thank my consultant statistician, Greg Crane B.A., B.Sc.(Hons), M.Litt.(Psyche) for his help with statistical analysis.
Dr David Helliwell is a GP in Nimbin, NSW, Australia.
| 
