Donielle Paul BSN, RN follows Dr Ben Jansen along his 500-day journey prescribing medicinal cannabis in Australia.
Dr Ben Jansen’s mission is solid: ‘to do the right thing’. Although this is his third consecutive conference weekend away in a row, he knows that this Monday morning, with his appointment book full of hopeful patients curious to try medicinal cannabis, he’ll have the opportunity to help change a few more lives for the better. Mission almost complete…well, for this morning.
Travelling around the country breaking stigmas and providing education on medicinal cannabis to the medical sector is just a small part of Jansen’s overall mission.
“The more clinicians that get on board with medicinal cannabis, the more their values will align with the oath they took when assuming the role of a physician,” he says – but getting doctors on board presents another challenge.
Jansen elaborates: “Usually, it’s not until doctors see their patients having better outcomes that they want to know more about cannabis as a medicine. The doctors that don’t believe in cannabis haven’t yet seen their miracle patient; however, every doctor I‘ve spoken to has been happy to refer their patient to CDA [Cannabis Doctors Australia] with the hope that they will. Nothing ventured, nothing gained.”
Cannabis Doctors Australia
As curiosity strikes, so does the drive for Jansen to break down decades of barriers. The driving force of doing the right thing and turning stones for one determined individual is difficult with just two hands; and at the beginning of 2019, Jansen knew it was time to build the force that would join him on the mission.
Jansen aimed to bring balance to his force with both female and male clinicians from all over the world: England, Canada, New Zealand, Australia, Nigeria and the US. With this growing group of progressive, brave, truth seeking healthcare professionals, armed with the desire to provide better overall outcomes, the collective driving power behind Cannabis Doctors Australia was established.
The patients who seek the help of CDA present with complex needs; having failed traditional treatment plans and exhausting all other conventional options. Although their backgrounds are varied, ranging in age from three months to 97 years, patients all come seeking medicinal cannabis therapy with two things in common: a sense of need and hope.
Jansen continues: “The majority of patients living with chronic conditions present with physical ailments which can have a negative effect on their state of mind. Medicinal cannabis not only helps a person manage their symptoms; it’s also been shown to help heal the other systems: improvements in sleep and anxiety open the door to potentially improve one’s overall quality of life.
“From 2018 to 2019 the number of approved patients rose drastically, projecting a 136% increase from our data. That indicates the appetite for more natural treatment options is there.”
This is consistent with current data generated by FreshLeaf Analytics, which estimates 140,000 prescriptions could be written for medical cannabis products in 2020 alone1. With a total of 2,660 patients, a number which is growing daily, the team at Cannabis Doctors Australia holistically treats and improves access to medicinal cannabis for patients across Australia. CDA offers patients traditional in-clinic consultations in Varsity Lakes on the Gold Coast of Queensland or over the phone via telehealth, and accessibility has become much more streamlined.
Jansen says: “My first application was paper based, sent via mail and took around 30 days for the Therapeutic Goods Administration to process. With the Special Access Scheme online portal, the process is much more streamlined: with 30 hours’ response time, the state of Queensland was able to issue 10,789 SAS B approvals in 2019.
“In addition to a quick turnaround for approvals, the number of conditions that have been approved to trial cannabis as a potential medical treatment option have also increased substantially: the number one condition we treat, with a 76% margin, is non-cancer related chronic pain in the many different forms it takes; such as fibromyalgia, multiple sclerosis, migraines, irritable bowel syndrome, dysmenorrhoea, to name a few. This is followed closely by anxiety, PTSD, depression and insomnia.”
Because of the improvement in communication with the TGA, conditions that require further supporting documents, such as research papers and supporting statements from the patient’s attending specialist, can be provided to the TGA quickly and easily.
“Our patients are able to start therapy within 10 days of their initial consultation with one of our CDA doctors, which is fantastic compared to the minimum 21 business days on average our patients waited one year ago,” Jansen says. In the last 500 days CDA’s own consultations have also become timelier: with less paperwork, and reliance on postal services, consultations utilising digital health interfaces are more efficient.
“The majority of complex patients are sick of wasting their time going to appointments. With telehealth consultations, doctors and patients can set aside a period of time to connect and formulate treatment plans from the comfort of their own lives, no matter where in Australia they are or what they’re doing. Telehealth is essential because Australia is so vast, and this has resulted in us consulting to every single state and territory.”
Positive patient outcomes
The appeal of appointment ease with telehealth has also become very popular for busy doctors looking for dynamic treatment options for their patients who aren’t quite ready to convert to full time cannabis specialism. “When I started, it was just myself prescribing medicinal cannabis. In the last year we grew to 10 CDA clinicians Australia-wide,” Jansen says. “We hope as research continues to advance, more healthcare professionals will get on board with the same drive as many of our patients: the hope it will work and the need to know why.”
Measuring the success of patients this past year has been challenging but eye opening. “How do we measure success? Titrating off drug dependence? Improvement in sleep? Returning to the workforce? Happier? Increased ability to focus? A better quality of overall life? It’s been incredible to see what a difference a year can make for our patients.”
Jansen and his team have seen it all. “We have encountered many achievements in medicinal cannabis therapy that produced some interesting and unexpected outcomes. A patient who, post bone marrow transplant, acquired graft-versus-host disease (GVHD) came to see us with gastrointestinal symptoms, anorexia and significant weight loss. This is usually a sign of disease progression. Six weeks after commencing cannabis treatment, their bowels regulated, their appetite improved; and they had started to gain weight. We had a female patient living with fibromyalgia and anxiety not only experiencing effective pain relief, ceasing traditional opiates and benzodiazepines and their adverse side effects, which is a success in itself; but finally achieving a good night’s sleep, having a happier sense of self overall, and her menstrual cycle returning after 10 years – that’s a significant feat.”
With 10.2% of Australia’s population of 24.6 million already using cannabis2 and the prohibition of medicinal cannabis coming to an end, there is the potential for 2.5 million patients to access safe, standardised treatment. This increase in patients strengthens the need for doctors and their patients to understand the therapeutic intricacies of the different cannabinoids that come from the plant. The number of medicinal cannabis products available to Australian Doctors for prescribing has also increased, resulting in 100 different options in the current market.
Jansen explains: “The two major cannabinoids we prescribed last year was a pretty even split, with THC accounting for 48%, CBD at 42% and the remaining 10% in blends of both cannabinoids. This is to be expected, as the research keeps demonstrating that the most effective medicinal cannabis therapy provides the full spectrum of cannabinoids. This synergistic dynamic between the cannabinoids and terpenes is a widely known theory referred to as the ‘entourage effect’; ultimately, the interaction of the combined plant constituents, when taken together, determine that chemovar’s therapeutic effect.
Cannabis products
“Another major success we‘ve experienced in the last year is the increase in the range of products. As this medication is highly personalised it’s important to be able to have many treatment options available. Cannabis oils made up 80% of treatment plans last year, followed by flower at 15%, then capsules at 4%: CDA were the first prescribers to be able to offer CBD crystal isolate, the purest form of medicinal CBD in Australia. It seems like the various types of available cannabis medications are going to expand – if you look at what is happening in other parts of the world such as in Canada, the US and Israel for example, not only have they been leading the world in research, they also have a much larger range of plant products available to compliment the majority of patients.”
With 2019 behind them, the mission of Cannabis Doctors Australia remains the same: to provide affordable medicinal cannabis treatment and fulfil patients’ needs. After spending time with Jansen and learning what a difference a year makes, it comes as no surprise that, when asked about his goal for 2020, he hopes to be ‘having greater success in doing the right thing’.
References
1 Lamers, M. (2020, February 10). Australia expects cannabis prescriptions will more than double to 70,000 this year. Marijuana Business Daily. https://mjbizdaily.com/australia-expects-cannabis-prescriptions-will-more-than-double-to-70000-this-year/
2 World Bank/ ABS/ WHO/ UNODC/ Prohibition Partner (n.d.). Australian Cannabis Market. https://cannabusinessplans.com/australian-cannabis-market/
3 Australian Medicinal Cannabis Market Patient, Product and Pricing Analysis, Jan-2020. [Online]. Available: https://freshleafanalytics.com.au/wp-content/uploads/2020/03/Freshleaf-Q1-2020-Report.pdf
Dr Benjamin Jansen
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