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Medicinal cannabis - guidance documents
Medicinal cannabis - guidance documents
Over the past few years, a number of Australians have expressed interest in the use of cannabis for medicinal purposes. There have only been a limited number of well-designed clinical studies on medicinal cannabis and so it is hard for some doctors to find quality evidence to support decisions to prescribe medicinal cannabis.
The Commonwealth Department of Health, in conjunction with state and territory governments, has helped coordinate the development new clinical guidance documents for prescribers of medicinal cannabis products for treating chemotherapy-induced nausea and vomiting, epilepsy, multiple sclerosis, chronic non-cancer pain and palliative care, as well as an overview document.
The guidances are based on the work of a team from the Universities of New South Wales, Sydney and Queensland, under the co-ordination of the National Drug and Alcohol Research Centre, who reviewed the clinical evidence for the use of medicinal cannabis that had been published in refereed medical journals since 1980.
In this work, the researchers conducted a systematic 'review of reviews' of previously published systematic reviews, and synthesised the findings of the individual studies as well as the conclusions of the reviews.
Evidence came from review of the following databases - Medline, Embase, PsycINFO, and EBM Reviews. Searches were limited to studies published from 1980 to late 2016 - early 2017. Reviews in these databases were screened for quality, and required that reviews conduct a comprehensive search of the literature, and described the characteristics of the individual studies inclusion.
Multiple databases were searched using specific search terms and the search strategy guided by a specialist Librarian. The review protocols were each registered to Prospero, an international prospective register of systematic reviews supported by the UK National Institute for Health Research. In the systematic reviews, priority was given to randomised controlled trials conducted since 1980, but the reviewers also included observational studies, e.g. case reports, retrospective chart reviews, self-report surveys.
Two reviewers independently examined titles and abstracts for relevance, using Covidence Software which improves healthcare evidence synthesis by improving the efficiency and experience of creating and maintaining databases for reviews and integrates tools for assessing risk of bias in articles. Relevant articles were obtained in full, and independently assessed by two reviewers for suitability for inclusion and if excluded from the analysis, reasons for exclusion were documented in Covidence. The Cochrane Risk of Bias tool was used to assess studies. The GRADE approach to evaluating the quality of empirical studies was also used.
The linked documents are bibliographies of the major studies used in developing the five reviews. For each study, they include the
- Abstract (summary) of the study, as prepared by the original researchers who carried out the study
- Publication details (authors names, date, details of the particular medical journal)
- Type of study performed (e.g. Randomised Controlled Trial, Case controlled, Open label observational, self-reported etc.)
- Grade of evidence
Bibliographies
Update: In February 2020, the National Drug and Alcohol Research Centre reviewed the clinical evidence for the use of medicinal cannabis published in refereed medical journals since the guidance documents were released in 2018. Additional relevant studies were included in the bibliographies for epilepsy and pain.
- Epilepsy - randomised controlled trials and other studies
- Pain - randomised controlled trials and other studies
- Multiple sclerosis - randomised controlled trials and other studies
- Nausea and vomiting - randomised controlled trials and other studies
- Palliation - randomised controlled trials and other studies
Guidance documents
A range of organisations from across Australia were involved in developing the guidance documents, including:
- 18 patient and consumer representative groups
- All state and territory health departments
- 15 health care professional organisations
- Clinical staff from 29 hospitals and health care systems
- 14 outpatient or primary health networks.
The documents have been endorsed by the Australian Advisory Council on the Medicinal Use of Cannabis.
There is also a specific consumer brochure. These guidance documents will be updated iteratively when new evidence emerges.
- Medicinal cannabis products: Patient information
- Guidance for the use of medicinal cannabis in Australia: Patient information
- Guidance for the use of medicinal cannabis in Australia: Overview
- Guidance for the use of medicinal cannabis in the treatment of multiple sclerosis in Australia
- Guidance for the use of medicinal cannabis in the treatment of palliative care patients in Australia
- Guidance for the use of medicinal cannabis in the treatment of epilepsy in paediatric and young adult patients in Australia
- Guidance for the use of medicinal cannabis for the prevention or management of nausea and vomiting in Australia
- Guidance for the use of medicinal cannabis in the treatment of chronic non-cancer pain in Australia
Questions and answers
Systematic reviews
Evidence for cannabis and cannabinoids for epilepsy: a systematic review of controlled and observational evidence
Emily Stockings, Dino Zagic, Gabrielle Campbell, Megan Weier, Wayne D Hall, Suzanne Nielsen, Geoffrey K Herkes, Michael Farrell, Louisa Degenhardt
The use of cannabis and cannabinoids in treating symptoms of multiple sclerosis: a systematic review of reviews
Suzanne Nielsen, Rada Germanos, Megan Weier, John Pollard, Louisa Degenhardt, Wayne Hall, Nicholas Buckley, Michael Farrell
Systematic review and meta-analysis of cannabinoids in palliative medicine
Martin Mücke, Megan Weier, Christopher Carter, Jan Copeland, Louisa Degenhardt, Henning Cuhls, Lukas Radbruch, Winfried Häuser, Rupert Conrad
Access to medicinal cannabis products
Guidance for consumers, health professionals, sponsors and manufacturers who are involved in providing appropriate patients with access to medicinal cannabis products as an unapproved drug through the Special Access Scheme (SAS) or Authorised Prescriber Scheme is available at: Access to medicinal cannabis products.