© iStock/GeorgePeters Dr Andrew Agius, Medical Director at the Pain
Clinic, speaks to HEQ about the advantages of cannabis in treating chronic pain. Marijuana has actually been utilized to alleviate acute and chronic discomfort symptoms for more than 5,000 years, due to its capability to ease pain with minimal negative effects– particularly in comparison with stronger pharmaceutical painkillers, which can cause dependency and long-term physical damage.
With an increasing number of nations around the globe relocating to legalise the medical usage of marijuana, and consumer demand rising as clients become more conscious of the possible advantages of cannabis-based medications, health, and care centres such as Malta’s Discomfort Center are turning to marijuana to fulfill the complex discomfort management requirements of susceptible clients. Dr Andrew Agius, Medical Director at the Discomfort Clinic, speaks to HEQ about the benefits of cannabis in dealing with pain.
What is the present legal and medical status of marijuana in Malta?
Medical marijuana has actually been lawfully readily available in Malta given that the law was modified in February 2018. Prior to this, a previous law enacted in 2015 just allowed registered pharmaceutical items such as Sativex to be prescribed; and they might just be recommended by oncologists, psychiatrists, neurologists, and anaesthetists. Sativex was not offered in Malta and all the professionals who were able to prescribe it refused to do so.
Patients just started to be able to gain access to medical marijuana when all medical professionals were allowed to prescribe it, and new items including raw marijuana flowers produced under Great Manufacturing Practice (GMP) started to be imported around Might 2018. Ever since, numerous clients have actually been accessing medical cannabis through a small percentage of physicians, most of whom specialise in household medication. Many medical professionals in Malta still refuse to prescribe medical marijuana; and some also encourage patients against it.
Medical cannabis is mostly recommended for chronic pain conditions like fibromyalgia where pharmaceutical medication has not worked or has caused side results. It is really often prescribed in cases of cancer, where it can assist with cravings, pain and the adverse effects of chemotherapy. It can also be advantageous for other conditions, such as stress and anxiety and sleeping disorders, where many patients are prescribed medical cannabis since it supplies relief with fewer side effects than pharmaceutical medication.
To gain access to medical marijuana in Malta, a client needs to be assessed by a physician who is signed up with the Medical Council. Medical marijuana can just be prescribed if the client has a chronic medical condition for which standard medication has actually been prescribed and this medication was not reliable or triggered devastating side impacts. If the client is qualified, an application is made to the Superintendent of Public Health, where the physician states that they take full responsibility for the patient’s use of the medication. After due diligence by the Superintendent and a background check to determine whether the client has gone to a drug detoxification program in the past, patients are authorized within 2 weeks and they are then allowed a 30-day trial of the medication. If the trial goes well, the medical professional can request a six-month approval from the Superintendent. Clients are then able to access medical cannabis from designated drug stores with a 30-day prescription for narcotic and psychotropic drugs, a control card which is renewed yearly and a permit from the Superintendent which is renewed every six months.
If a marijuana user is not signed up as a medical client, the individual may be fined in between EUR50 and EUR100; and they may deal with more major charges if they have more than 3.5 g in their belongings. If an individual is captured cultivating one cannabis plant, they may have the ability to battle it in court on the premises that it is for individual use; but more than that or any indication that the marijuana may not be entirely for individual usage could land the cultivator in jail.
Another law allowing the production and processing of medical cannabis in Malta, which was adopted later on in 2018, will suggest that extremely quickly Malta will be importing raw medical marijuana, processing it in your area, and after that exporting it to the rest of Europe. The costs of medical marijuana products will undoubtedly go down as the choice of products boosts, and clients will hopefully have much easier and more cost effective access to their medicine.
What advantages does medical marijuana deal in the treatment of chronic discomfort?
Chronic pain is a common disabling condition impacting 20% of the population in Europe, and the occurrence of persistent discomfort is expected to increase following the COVID-19 pandemic. Unfortunately, there are really few pharmaceutical medications which can be utilized to eliminate chronic discomfort efficiently; and these also very typically cause side impacts which can compound the special needs. Recent research shows that the endocannabinoid system is really much involved in the pathophysiology of chronic pain. Patients who establish persistent pain frequently have a hereditary predisposition towards it, which might be related to a dysfunctional endocannabinoid system. Loss of homeostasis and imbalances in neurotransmitter levels frequently add to the symptoms of clients with chronic pain.
THC and CBD are two potent healing compounds in medical cannabis which can assist to rebalance the endocannabinoid system and therefore improve symptoms of chronic discomfort. Full-spectrum medical cannabis preparations have more than just THC and CBD: they consist of more than 140 restorative cannabinoids, as well as terpenoids and flavonoids which continue to contribute to the synergistic result. This leads to a powerful therapeutic effect which can not be wholly discussed by the effects of the specific cannabinoids alone, and which is referred to as the entourage effect.
Medical cannabis is extremely effective at minimizing discomfort levels, improving state of mind, minimizing stress and anxiety and promoting restful sleep with very few to no undesirable adverse effects. Patients experience a remarkable improvement in their lifestyle and a lot of patients report feeling ‘reborn’ or that they have been ‘allowed another possibility to delight in life’. Medical marijuana literally offers these handicapped patients their life back, by assisting them manage their symptoms much better than anything they would have attempted previously.
In what locations should additional research study be carried out to support the function of cannabis in pain management?
We understand that full-spectrum medical cannabis is a lot more efficient at alleviating persistent discomfort than single-molecule THC or CBD. This is since of the synergistic impact of the cannabinoids with the other restorative compounds in the plant. Everyone responds in a different way and some patients react much better than others. We can see the incredible healing potential of this plant, yet there is still a lot that we do not understand therefore much we need to explore. It may take decades before we totally understand the various restorative substances in this plant.
THC has actually been extensively studied in persistent discomfort and we have strong proof that supports its use. Additional research must investigate the role of CBD, CBG, CBC, CBN and other cannabinoids as treatment in chronic pain, both alone and in mix. Ideally, the changing laws around the globe will allow us much better access and make this research much easier.
What essential elements should clinicians bear in mind when prescribing medical cannabis?
Medical marijuana is relatively safe compared to pharmaceutical medication, since it has fewer side results and is much better tolerated. Nevertheless, there are contraindications when recommending and clinicians should likewise be mindful of possible drug interactions.
Since THC may trigger psychosis in 1% of the population, clinicians should screen for a possible household history or any symptoms which might indicate an increased danger. Utilizing strains or items with higher levels of CBD and lower levels of THC would decrease the danger of patients establishing psychotic adverse effects, because CBD is an anti-psychotic. Medical cannabis with high levels of THC is likewise contraindicated in patients who are pregnant or breastfeeding, or who have unstable heart conditions.
Given that patients respond in a different way, it is suggested to begin with a low dosage and tail up really slowly till a restorative impact is achieved. Clients are not likely to experience side impacts at these doses. Intoxication can occur with higher dosages of THC, but these normally go away within a couple of hours with no long-lasting repercussions.
How do you visualize the medical marijuana landscape in Malta developing in the next year?
As the production of medical marijuana in Malta is predicted to begin later this year, we are anticipating a number of new products to appear in drug stores from the various business that are slowly beginning their operations in the next couple of months. Prices for medical cannabis items should drop dramatically (currently medical marijuana flowers cost EUR16 per gram) and we are hoping to see a wide array of CBD and THC products in various types and preparations. Malta is anticipated to turn into one of the very first nations in Europe to produce EU-GMP cannabis medicines which will then be offered in your area and exported to the rest of Europe.
Dr Andrew Agius MD MSc EDPM
The Discomfort Clinic
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Released at Mon, 29 Mar 2021 14:03:45 +0000