Medicinal cannabis and the future of palliative care

By Professor Phillip Good

Professor Phillip Good explains his research in medicinal cannabis and what this means for the future of palliative care

Approximately 100,000 palliative care patients die in Australia each year. Despite improvements in medical care, some patients with advanced cancer can still experience symptom distress.
St Vincent’s Private Hospital Brisbane Director of Palliative Care, Prof Phillip Good said finding better treatments is critical for our care of those at the end of life.

“There has been increasing interest in the use of medicinal cannabis to relieve symptoms in palliative care patients. However, to date, there is little high-quality evidence of benefit,” Prof Good said.

Cannabis contains almost 500 bioactive compounds, including over 70 different cannabinoids. The predominant cannabinoids include delta-9-tetrahydrocannabinol (THC) and cannabidiol (CBD). THC is the main active component of cannabinoids and potential benefits of THC include analgesia, anti-nausea, and muscle relaxation, with potential side effects including intoxication, psychosis, anxiety and sedation. In contrast, CBD is not intoxicating, and has a range of anxiolytic, antipsychotic, anti-inflammatory, anti-oxidative, anti-convulsant and neuroprotective effects. CBD is also considered to modulate many of the adverse effects of THC, although this research is still emerging.

World-leading research

The Palliative Care Service at St Vincent’s Private Hospital Brisbane is part of an internationally leading medicinal cannabis research program.

“So far, we have completed an open label pilot study that shows promising preliminary data of improvement in emotional well-being,” Prof Good said.

The ideal combination and dose of medicinal cannabis remains unknown.

Recruiting trial participants

“We are recruiting to two trials of two different medicinal cannabis products. We are also very interested in patient experience and are recruiting to a qualitative study exploring patients’ views of medicinal cannabis.”

“This recruitment is going very well and we hope to complete at least one of the randomized controlled trials next year,” Prof Good said.

Currently medicinal cannabis is not available on the Pharmaceutical Benefits Scheme (PBS) in Australia. This means that it is expensive and for many patients unaffordable.

“In our research program, we are hoping to provide high quality evidence about the benefits and adverse effects of medicinal cannabis – so that if found to be beneficial, medicinal cannabis companies will be able to apply for registration of these medications in Australia,” Prof Good said.

Professor Phillip Good
Prof Phillip Good was appointed Director of Palliative Care at St Vincent’s Private Hospital Brisbane in 2015. Prof Good is involved in both quantitative and qualitative research studies and committed to leading evidence-based palliative care, including medicinal cannabis in palliative care, activity monitors to monitor pain outcomes and gastrografin for bowel obstruction.

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