False hope is driving claims medicinal cannabis is the "magic pill" for chronic pain and doctors should not prescribe it just because they can, an Australian pain specialist warns.
Professor Milton Cohen, director of professional affairs for for the Australian New Zealand College of Anaesthetist's (ANZCA) faculty of pain medicine, says current evidence in support of medicinal cannabis is "not good enough".
"The question of evidence, I think, hangs in the air much like some smoke," he told a meeting of Australian pain specialists in Brisbane on Saturday.
The federal government in 2016 legalised a pathway for patient access to Australian-grown and manufactured medicinal cannabis, subject to state and territory regulations.
Victoria became Australia's first state to legalise cannabis for medical use and was quickly followed by NSW.
Under amendments to the Poisons and Therapeutic Goods regulations, cannabis-based medications are available to a range of people for whom more mainstream treatments are not effective.
This has left physicians treating patients with chronic pain in an "untenable" situation, Prof Cohen told the meeting.
"We are told that cannabinoids might work, surely we need to know that it does work.
"I don't think we are in the position to say with confidence to the community that this is the case."
Chronic pain affects about one in five people in Australia and New Zealand.
It is a complex issue and the very "modest" benefits medical cannabis may provide have been "oversold" to the public, Prof Cohen said.
"We know that chronic pain is a much more complex phenomenon which requires a holistic approach to management that is tailored to the individual's circumstances. To rely only on medicines is just not going to work," Prof Cohen said.
The faculty does not support the use of cannabinoids in chronic non-cancer pain "until such time as a clear therapeutic role for them is identified in the scientific literature".
Dr Jeremey Hayllar, an expert in addiction medicine from Brisbane, says the faculty's position is "sensible and cautious" but medicinal cannabis is potentially a safer option to treating chronic pain.
Dr Hayllar told the ANZCA scientific conference there was no denying medicinal cannabis use had resulted in a drop in opioid-related deaths in the US.
"It's hard to dismiss that evidence," Dr Hayllar said.
The number of pharmaceutical opioid-related deaths during the past 10 years has increased significantly.
According to the National Drug and Alcohol Research Centre, 800 Australians die a year as a result of overdose from prescription painkillers.
"The medicinal cannabis genie is out of the bottle. Things will never be quite the same. Should we not accept a level of uncertainty about evidence?" Dr Hayllar said.
