Analysis paralysis

by Sandi Miller
17th July 2018

Pictured: Paul Purcell (left) and Dr David Stapleton.

Photo: Leann Purcell

Medicinal cannabis was made legal with prescription at the beginning of last year.

British Medical Journal Open, this month published results of a survey of 640 Australian General Practitioners, and found almost two-thirds have had at least one patient ask about the drug, some as many as 10.

According to the survey, while more than half the doctors said they’d like to be able to prescribe medicinal cannabis, they feel they don’t know enough about it, are uncomfortable discussing it with patients, and feel overwhelmed by the bureaucratic access scheme.

This is leaving patients who may benefit from the drug in no-man’s land.

Paul Purcell was involved in a workplace accident two years ago, which has left him confined to a wheelchair and in unrelenting pain.

Paul suffered a crush injury with severe damage to the spinal cord, leaving him with no sensation from the chest down.

“Nothing, I can’t even move my toes, there is no signal getting through… there is no sensation apart from the pain,” he said.

Chronic pain is one of the conditions where doctors are allowed to prescribe medicinal cannabis, alongside conditions such as cancer pain, MS, and Parkinson’s, but according to Paul, he has been unable to find a doctor willing to allow him to try it for his pain.

He says the drugs he is currently taking for his pain have left him feeling foggy and forgetful.

“Sometimes you will stop mid-sentence you will forget what you are talking about… but often there are days when I wonder to myself whether it really does anything [for the pain].”

“The pain is the hardest thing to deal with — then there is the mental side of it, the grief — the sadness, your old life, you know it’s right there and just you want to get it back and you can’t — and then the wheelchair.”

“I have experienced a lot of pain, but the neuropathic pain is like nothing else.”

Paul told the Diary that when he was in hospital and rehab he had no neuropathic pain.

“I’ve heard it is not uncommon for the pain not to come on immediately,” he said.

“But now, it’s like when you touch an electric fence, very mild impulses right down to your feet every day all day, probably every two to three minutes, and that goes on all the time, so that is on a mild day — on a bad day I have heat on my stomach and my back like severe sunburn and I feel like I have someone on my shoulders pushing me down into the chair — this is all at the time,” Mr Purcell told the Diary.

“When I go to bed and I go to sleep, I think I go to sleep because I am exhausted just from the whole day of pain — it is really hard to live with,” he said.

Mr Purcell is being supported in his search for a solution by Warrandyte distributor of medicinal cannabis, Dr David Stapleton, who, with his partner, runs a company which imports medicinal cannabis.

“We have all the permits, ASIO has checked us out, it is all good, we can bring it into the country, the TGA has looked at all our products and given approval to them,” he said.

However, they are unable to supply the product without prescription.

“Paul’s doctor should be able to prescribe it — they have to fill out a form write two to three lines with a clinical justification why Paul would need medicinal cannabis over the current medication he is on, fax that off to the TGA, someone there says yes or no, if it is no then that is the end of it, if it is yes they send a number back, they give it to Paul he goes to a chemist and he can order it.

“We have been approved to import products from Switzerland where they have created a strain of marijuana with very little THC in it, the part that makes you high — it has all the good stuff in it, all the healing components — but just not the part that makes you high.

“It has been legal for a year and a half now and yet there are a handful of doctors that have managed to get it through the system, and I understand there is a lot of work for them because they have to sit and write this and send it off and they also have to find a whole lot of scientific factors that back it as well.

“I have all that information to give to them but for whatever reason they are just saying no, no, no to it,” said David.

Speaking with ABC radio, Dr Vicki Kotsirilos, a general practitioner who has managed to successfully prescribe the drug, says the process for doctors is onerous and time consuming.

“I had to justify the applications to the TGA for each patient, each prescription and each product,” she said.

Paul’s wife, Leann Purcell said Paul’s doctor wouldn’t sign the form for him to have it, saying there wasn’t enough research and he should consult his pain specialist.

“But [the specialist] won’t do it either, he passes the buck and says you have to go to the doctor,” she said.

David said that he believes the reluctance for the medical profession to embrace cannabis comes from its association with marijuana.

“Hemp seed oil was banned because of the word ‘hemp’ in the name, it took intense lobbying in Australia and NZ to get that — it takes lobbying that hard over a word…it is very hard to break through the barriers, people are still very nervous about it.”

Paul’s only other alternative is to take opioids, which he is reluctant to do.

“I take a low dosage if I take anything because they are highly addictive.

“I don’t know if it does anything for the neuropathic pain, maybe some temporary relief — it makes me a little bit light headed and then I forget about the pain….”

Paul is frustrated by the reluctance for GPs to continue to prescribe opioids without even considering medicinal cannabis as an alternative.

“I mean I don’t know what we are all waiting for — is it fear of something happening and someone getting sued, the whole world is playing the blame game… but someone should give it a go,” he said.