Professor James Angus, an awarded and recognized academic pharmacologist at the University of Melbourne, and Chair of the Australian Advisory Council on Medicinal Use of Cannabis, will present an update on the use and availability of cannabis for medical use.
Professor Angus has been an Honorary Professorial Fellow and Professor Emeritus of the Department of Pharmacology and Therapeutics, Faculty of Medicine, Dentistry and Health Sciences at the University of Melbourne since 2014. From 2003 to 2013, Prof. Angus was Dean of the Faculty of Medicine, Dentistry and Health Sciences. Prof. Angus earned a Bachelor of Science in pharmacology with Honours and Ph.D. from the University of Sydney. In 1974, he was a NHMRC Senior Research Officer at the Hallstrom Institute of Cardiology, Royal Prince Alfred Hospital & Department of Medicine at the University of Sydney, and the Baker Medical Research Institute in Prahran, Victoria. In 1977 he received the NHMRC CJ Martin Travelling Fellowship to work with Sir James Black who would go on to receive the Nobel Prize for Medicine in 1988. Prof. Angus then continued to work at the Baker Medical Research Institute in a variety of roles over the next 15 years including Senior Research Officer, Research Fellow, Senior Research Fellow, Principal Research Fellow, and Senior Principal Research Fellow of the NHMRC. He was appointed Deputy Director of the Baker Medical Research Institute in 1992. In 1993, Prof. Angus was appointed to the Chair of Pharmacology at the University of Melbourne until he resigned in 2003 to become Dean of the Faculty.
His appointments include Chair of the Melbourne Genomics Health Alliance Phase 1 (2014-2016), Governor and Director of the Howard Florey Institute of Neuroscience and Mental Health since 2003, member of the Program Steering Committee of the Australian Council of Learned Academies (2014-2016), member of the Steering Committee to establish the Australian Academy of Health and Medical Sciences (2013-2014), current President of the National Stroke Foundation, current Chair of the University of Melbourne Sport Board, current Board Director of the Jack Brockhoff Foundation since 2015 and current Chair of the Australian Advisory Council on Medicinal Use of Cannabis.
Prof. Angus is a Fellow and former Council Member of the Australian Academy of Science as well as the International Academy of Cardiovascular Sciences, and an Honorary Fellow of the Australian Academy of Health and Medical Sciences. He was the recipient of the Alfred Gottschalk Medal of the Australian Academy of Science in 1984, and the Thomson ISI: Australian Citation Laureate in Pharmacology in 2004. In 2010, Prof. Angus was appointed an Officer to The Order of Australia for distinguished service to biomedical research, particularly in the fields of pharmacology and cardiovascular disease, as a leading academic and medical educator, and as a contributor to a range of advisory boards and professional organisations both nationally and internationally. Further, he received the Centenary Medal in 2003 for services to pharmacology and the community.
His current research interests are in analytical pharmacology, cardiovascular effects of endothelin and selective antagonists, and determining mechanisms of action of various medicinal cannabis products.
Victorian Parliament legislated for cannabis cultivation, manufacture and supply in February 2016. The original intention was for a self-contained Victorian scheme that would be exempted from much of the existing Commonwealth drug regulation frameworks.
Commonwealth legislation followed, which exerted exclusive control over domestic cultivation and non-exclusive control over manufacture. The Commonwealth instituted a policy to regulate cannabis within the existing drugs regulation framework, treating it in the same way as any other unapproved medicine. Concurrently, the Commonwealth changed its policy on importation and began to allow imports of high quality products.
In October 2016, to coincide with the commencement of the Commonwealth legislation and regulations, cannabis products were mostly down-scheduled from Schedule 9 (prohibited substances) to Schedule 8 (controlled substances) or Schedule 4 (prescription medicine). These combined changes to law and policy allowed for the legal prescription of imported medicinal cannabis products pending the development of locally manufactured products.
Development of Victorian products is progressing well, with a small number of quality assured cultivator licenses and manufacturing licenses having been issued by the Office of Drug Control to Victorian producers, including the Victorian government. The Victorian government is developing its own product specifically formulated for children with severe intractable epilepsy. The Victorian access scheme, legislated in the Access to Medicinal Cannabis Act 2016, does not cover imported products and is not anticipated to commence until the locally manufactured Victorian government product is available.
In the meantime, Victorians are accessing imported medicinal cannabis products via Commonwealth pathways. As at 31 July 2017, approximately 60 Victorian patients had been granted access to a variety of imported medicinal cannabis products via Commonwealth pathways. While the majority of those patients are children with severe intractable epilepsy, permissions have also been granted for patients with multiple sclerosis and for patients suffering pain, nausea and vomiting resulting from cancer or cancer treatment.
While there are no legislative barriers to patients with conditions such as palliative care, chronic pain, multiple sclerosis, chemotherapy induced nausea and vomiting and epilepsy, to access medicinal cannabis there is still a reluctance by clinicians to prescribe a product with which they are unfamiliar, and for which limited high quality evidence of efficacy exists. If patients can find a clinician willing to prescribe the cost of products is often unaffordable.
Many challenges remain. Cannabis and its refined products are unregistered medicines in Australia and thus will be controlled through the Therapeutic Goods Administration (TGA) and Office of Drug Control under the Therapeutic Goods Act 1989 and the Narcotics Drugs Act 1967. Cannabis is still illegal in Australia unless it is prescribed by doctors and specialists and approved by the TGA under the following schemes: Special Access Scheme, Clinical Trials, Approved Prescriber or for research purposes.
Guidances for doctors and health professionals are being prepared by the Commonwealth, in consultation with the States and Territories, to give information on drugs, dosage, safety, side effects and efficacy but there is a lack of quality research and evidence from double blind clinical trials for most uses.
Community patient groups continue to advocate for a ready supply of quality product at a subsidized price. There are currently no medicinal cannabis products on the Pharmaceutical Benefits Scheme, and the high cost of most products will make them unaffordable for most people. Traditionally, the subsidization of pharmaceuticals is a Commonwealth responsibility, although Tasmania has just commenced a controlled access scheme, under which the Tasmanian government will subsidize products for Tasmanian patients approved through a government clinical panel process.
Australian standard of control of quality medicines is priceless and the future of the medicinal use of cannabis depends on the safety, quality and evidence that may lead to registration. However, this will inevitably be years away.
There is no doubt that there is a world – wide interest in medicinal use of cannabis but the challenge is firstly to educate, communicate and foster best research practice as the health profession plays catch up for at least 50 years when cannabis has been illegal, and secondly to address issues of affordability.