Keeping Things Real With Medical Cannabis

 I hear many medical cannabis (MC) opinions with utter bemusement.  The recycled assertions go something like this:

- Cannabis is already medicine with a proven [sic] record of efficacy and safety, so what are most doctors waiting for?

- Non-prescribing physicians lack education on the endocannabinoid system, consider cannabis a gateway drug or see weed through a stigma lens. If only they would listen to us and learn…

- Big pharma is conspiring to keep MC from patients

There is an element of truth with some of these sentiments.  Mostly however, they reflect ignorance about why and when doctors prescribe therapies and how the drug approval process works. 

I have spent a lot of time consulting to pharma companies on their clinical research and new product strategies, including speaking to doctors about their patient needs – and their own.

Below are some of the actual reasons why MC is not getting prescribed-

> As an under-researched treatment, MC faces system inertia.   North American healthcare is a risk adverse, highly regulated and complex infrastructure.  Fundamentally, most physicians won’t prescribe a new drug when there is a lack of positive clinical research.

> Doctors will see MC as a viable option IF no other therapy is available OR first/second line treatments are ineffective. Unsurprisingly, adoption will be slower than what MC advocates expect.   

> Physicians are mindful of legal and regulatory risk with new, un-researched medicines that may have safety concerns 

> Similar to procedures like abortion, many physicians shy away from MC because of politics and perceived hassle 

As an industry, we want to accelerate MC beyond its nascent status and towards the therapeutic mainstream.  To reach this state, 4 things need to happen – and changing the healthcare system is not a realistic expectation.

1. Regulatory reform, funding and capacity is required to support more research and trials

2. Complete more valid research (e.g, peer reviewed, double blind, randomized control trials, or as close to this gold-standard as possible) that proves that MC is efficacious and safe in a clinical setting  

3. Get medical key opinion leaders to vet and endorse the research

4. Educate the clinicians through continuing medical education 

5. Secure MC approval in government formulary and insurance reimbursement schemes

Utopian visions aside, doctors trust and rely on the existing regulatory framework.  This combined with Big Pharma’s research and marketing heft is what’s needed to stimulate more prescribing.  All of this will happen with sufficient time, capital and patience. 

#medicalcannabis #FDA #HealthCanada #prescribing #research