Evidence on medical marijuana still iffy

HEALTH experts are cautious about their stand on medical marijuana.

This is because there is still very weak scientific evidence on the effectiveness of the drug for medical purposes.

Malaysian Association for the Study of Pain (MASP) president Dr Mary Cardosa says more clinical trials are needed to determine its use in a variety of conditions, including neuropathic pain, or pain caused by damage, injury or dysfunction of nerves.

“Aside from having public discourse on medical marijuana, we also need to have this discussion among the medical community ourselves. MASP is planning to hold a meeting with its members about this soon,” she tells Sunday Star.

Dr Cardosa says side effects for medical marijuana include nausea, euphoria, giddiness, confusion, fatigue and hallucinations.

“Long term effects include impaired memory and mental health issues,” she says.

Before pushing for the legalisation of medical marijuana, there has to be clear indications with good scientific evidence for its use.

“Also, we should not legalise the smoking of marijuana for medical purposes, like in some countries. However, I don’t support the capital punishment associated with the possession of marijuana. It’s too harsh,” she says.

Hospis Malaysia chief executive officer Dr Ednin Hamzah concurs, saying that there’s no strong evidence to recommend medical marijuana.

“Even if it is advocated for pain, what kind of pain can it be used to treat?” he questions.

However, Malaysian Medical Association president Dr Mohamed Namazie Ibrahim says there is good evidence for the use of cannabinoids in some forms of pain.

But more research is needed in our local context.

“If it is to be used, it must be under strict control by the trained medical practitioners. Not all doctors should be allowed to use it until research results and recommendations are given by the Health Ministry.

“It is dangerous like any other drugs when used indiscriminately without adequate supervision,” he cautions.

He points out that the ministry has methadone replacement therapy for those addicted to narcotics but it’s restricted to only those doctors who have undergone special training in this therapy.

“A similar programme is necessary if cannabinoids are going to be used under strict controlled conditions,” Dr Mohamed Namazie suggests.

As far using cannabinoids in pain management is concerned, he says only pain specialists who have experience in using this drug should administer it.

However, he stresses that medical use of cannabinoids should not be construed as legalising ganja smoking for leisure.

Malaysian Pharmaceutical Society president Amrahi Buang agrees that further research must be done to evaluate the safety and efficacy of medical marijuana before using it widely.

“If a drug is deemed to be effective, it must be seen to give good outcomes to a large number of patients determined by statistical and clinical models.

“Indeed, medical marijuana is still at its infant stage. It must go through the same process for medical morphine and be controlled under the Dangerous Drugs Act,” he says.

On the laws allowing medical marijuana-based products, Amrahi says the product must have enough evidence to prove its efficacy.

“This is as long as it goes through the proper registration process with the Drug Control Authority under the Health Ministry.

“Our existing laws are sufficient to handle this,” he adds.

Amrahi says medical morphine, another drug listed under the Act, also went through necessary procedures first before medicinal usage in Malaysia.

“However, pushing for marijuana to be legally planted and sold in Malaysia is an entirely different matter.

“The main challenge is the control the substance, since it has been used for recreational purposes. Do we have enough enforcement, or our society can practice self-regulation?” he says.