Dr Kylie O’Brien: Medicinal Cannabis – Is It for You?

Dr Kylie O’Brien PhD is an Adjunct Professor at Torrens University with an academic career in the fields of Chinese medicine, integrative medicine, and, since 2018, in medicinal cannabis. She has worked for the Victorian Department of Human Services, and held senior leadership roles in the university and private education sector. An internationally recognised expert in Chinese medicine and integrative medicine, she has published extensively, including a book on integrative oncology and second book, with co-author Dr Philip Blair on Medicinal Cannabis and CBD in Mental Healthcare. Kylie is a member of the Australian Government’s Tertiary Education and Quality Standards Agency (TEQSA) Expert Panel and a previous TGA Advisory Committee for Complementary Medicines member.

Kylie has been leading doctor education on medicinal cannabis in Australia since 2018. Her courses were the first to receive RACGP Category 1 CPD accreditation. She also set up the pathway via the National Institute of Integrative Medicine Ethics Committee for doctors to apply to become authorised prescribers of medicinal cannabis under the TGA’s Authorised Prescriber Scheme.

Dr Kylie O’Brien: Medicinal Cannabis – Is It for You? 

Dr Ron Ehrlich [00:00:00] Hello and welcome to Unstress. My name is Dr Ron Ehrlich. I’d like to acknowledge the traditional custodians of the land on which I am recording this podcast, the Gadigal People of the Eora Nation and pay my respects to their Elders – past, present and emerging.


Dr Ron Ehrlich [00:00:17] And I do this. I pay this respect because I believe we have so much to learn from our First Nations People about connection and respect. And interestingly, I recently learnt that in the Indigenous language there’s no word for “me,” “I,” or “my.” I have to reflect on that.


Dr Ron Ehrlich [00:00:42] Now, today we are exploring Medicinal Cannabis. Now Cannabis, as you will hear, as you may already know, has had a long history in our human journey. And we go into a little bit of the historical perspective in this in this episode today. My guest is Dr Kylie O’Brien.


Dr Ron Ehrlich [00:01:00] Now, Kylie has had a strong academic career in the fields of Chinese Medicine and Integrative Medicine, and since 2018, in Medicinal Cannabis. She’s worked for the Victorian Department of Human Services and held senior leadership roles in the university and private education sector. And she has also been the Educational Director of the Australasian College of Nutritional and Environmental Medicine (ACNEM) and has also been connected with the National Institute of Integrative Medicine (NIIM). Now Kylie is an internationally recognised expert in Chinese Medicine and Integrative Medicine, and she’s published extensively, including a book on Integrative Oncology. Kylie’s second book, which she co-authored with Dr Philip Blair, was on Medicinal Cannabis and CBD in Mental Health Care. It was published in 2021. She’s a member of the Australian Government’s Tertiary Education and Quality Standards Agency, Expert Panel and a previous member of the TGA, the Therapeutic Goods Administration, Advisory Committee for Complementary Medicine. I hope you enjoy this conversation I had with Dr Kylie O’Brien.


Dr Ron Ehrlich [00:02:14] Welcome, Kylie.


Dr Kylie O’Brien [00:02:15] Hi, Ron!


Dr Ron Ehrlich [00:02:17] Kylie. Medicinal Cannabis. You know, that’s a subject we’re going to be touching on talking about today. But I was wondering what led you to your involvement in Medicinal Cannabis. What’s brought you to this point?


Dr Kylie O’Brien [00:02:30] Well, my background is firstly Optometry and then Chinese Medicine. So, I have a Bachelor’s and Ph. D in Chinese Medicine. So, I guess that’s kind of, in a way, sort of ticking away in the background there. But when I was working at the National Institute of Integrative Medicine some years ago, a colleague of mine, Professor Ian Brighthope, came to me and said, “Look, medicinal cannabis is now able to be prescribed legally by doctors, but none of them knows much about it. Can you help out?” Because he knew that I had a background and at the time I was working as Director of Education at NIIM. So, he knew I had a background in education.


Dr Ron Ehrlich [00:03:05] Which was the National Institute of Integrative Medicine.


Dr Kylie O’Brien [00:03:10] That’s right. So, I was the Director of Education there. And so, I started to set up two-day training courses in medicinal cannabis for doctors and pharmacists. So, at the time that was 2018, and we ran a few of those in collaboration with ACNEM and it sort of kind of went on from there. At the same time, there was the ability for doctors to be able to apply to the TGA to be authorised prescribers of medicinal cannabis. But there really wasn’t any specialist college or ethics committee at the time that was actually processing applications because it’s a two-step process. You’ve got to be approved by either the ethics committee or specialist college first and then the TGA gives you the final approval.


Dr Kylie O’Brien [00:03:57] So I happened to be an Interim Chair of the Ethics Committee at NIIM at the time, and so I set up the process by which doctors could eventually become authorised prescribers, you know, through the NIIM Ethics Committee, and that’s been running since 2018. So really, all that sort of led me to become much more heavily involved in medicinal cannabis. And I got really fascinated with the herb. As a Chinese medicine practitioner, you know, Chinese herbal medicine is, you know, one half of your sort of bag of tricks that you use as a practitioner. But I was never captured by any Chinese herbal medicine herb in the same way that my attention has been captured by cannabis.


Dr Ron Ehrlich [00:04:47] Yes. Well, now, you know, you’ve mentioned Ian Brighthope, who has been on the podcast several times, and you’ve also mentioned ACNEM, which for my regular listeners would know that stands for the Australasian College of Nutritional and Environmental Medicine, where we work together. You were the Director of Education there, right?


Dr Kylie O’Brien [00:05:05] That’s right. I was. Indeed.


Dr Ron Ehrlich [00:05:07] So we put on a fabulous global conference together and co-hosted that with over 70 speakers from around the world. So, it was a wonderful, wonderful experience. But back to cannabis, you know, can you put it into kind of a historical perspective because it’s hardly a new compound?


Dr Kylie O’Brien [00:05:24] No, it’s not new. Look, in historical records, depending on where you’re talking about in the world, go back sort of thousands of years. So, I guess an early medical record of it in Chinese medicine was basically the materia medica of Chinese herbal medicine – the Shen Nong Ben Cao Jing. Now realistically was probably written around 100 to 200 AD, but it’s supposed to have been written many centuries before that. It’s mentioned in the Vedas in India. So, you know, that’s a very old historical record. And I even saw a picture of an Egyptian papyrus, which was an asthma remedy, where supposedly the person inhaled the fumes from the cannabis plant and probably other herbs in that as well. And that was for asthma. That was recorded something like 3000 years ago. So, you know, hemp, which is also cannabis. I think there have been records of that back to 12,000 years. So, you know, very long history. And whether or not it was used more for the industrial side of it, the medicinal side perhaps came later, but certainly there are very early records of the using it for its fibre.


Dr Ron Ehrlich [00:06:43] Right. Right. And of course, recreationally, it’s been something that has been used for thousands of years as well, I guess.


Dr Kylie O’Brien [00:06:52] Yeah, that’s right. And look, I don’t like the word ‘recreational’ because I think, you know, I tend to use the word ‘adult use’ or, you know, lifestyle use of cannabis because, you know, a lot of people will sort of use that term to sort of denigrate it. We don’t talk about drinking a glass of wine as a recreational thing, do we? And I also think there’s a bit of a crossover between what people will say is adult use, recreational use and medicinal use, because in a lot of cases, people are taking it perhaps to reduce their stress. You’d probably say, “Well, that’s a kind of medicinal use.” In the same way that some people will have a glass of wine supposedly to de-stress. So, I think there’s a blurring of those boundaries between what people will say is sort of recreational if you like, and what’s medicinal. I think there’s a bit of overlap there.


Dr Ron Ehrlich [00:07:46] But for a compound that’s been around for a long time, in our modern society, it has been demonised, but I guess only relatively recently.


Dr Kylie O’Brien [00:07:57] Yeah. And that was an interesting part of history in the US. So, something I didn’t realise when I sort of started reading into the history of medicinal cannabis was that back in the 1920s alcohol was actually prohibited in the US and so the Federal Bureau of Narcotics was running around policing that, but then it was no longer a banned substance. And so, the story goes that the head of the Federal Bureau of Narcotics, Harry J. Anslinger, really needed to find something else for his staff to do and to legitimise his big department. And so, it was he that was instrumental in demonising turning it into a so-called drug that was menacing the US. And it was aided and abetted by probably the Rupert Murdoch of the Times, a newspaper magnate, they lobbied Congress, and they got the Marijuana Tax Act passed in 1937, which essentially prohibited it. The AMA, The American Medical Association, challenged it at the time that it was a dangerous drug because of course, it was in quite common use. You know, the founding father of modern medicine, Sir William Osler, recommended it and the personal physician to Queen Victoria, Sir John Russell Reynolds also recommended it. You know, so you’ve got two very heavy hitters of Western medicine, both recommending the use of cannabis with various conditions. But, you know, it went through and of course, it was a systematic sort of demonisation from then on. And an awful lot of myths have been propagated, which of course, is, you know, damaged it in terms of its reputation as medicine.


Dr Ron Ehrlich [00:09:44] Hmm. So, what is the current legal status of medicinal cannabis in Australia?


Dr Kylie O’Brien [00:09:50] So yeah. Cannabis itself, I suppose, is contained within the schedules of our National Poisons Code, the SUSMP. So, cannabis and THC tetrahydrocannabinol, that’s one of the main constituents and that’s one that’s responsible for the potential euphoria that you can get from cannabis, I say potential because its dose related. They’re contained in Schedule 8 of the SUSMP which is the controlled drug. Cannabidiol is one of the other constituents that’s in Schedule 4 (prescription-only medicine). So cannabidiol doesn’t give you that potential euphoria that we associate with the smoking of cannabis. That’s mainly THC. There’s been provision now for certain kinds of cannabidiol product, CBD products to eventually be prescription only, sorry, pharmacy only medicines in Schedule 3, but there are a whole lot of rules around that.


Dr Kylie O’Brien [00:10:55] For example, I think the maximum daily dosage must be 150 milligrams of CBD or less, and you still have to have at least 98% of the total cannabidiol content as CBD. And there’s other sort of regulations around, you know, stipulations around CBD products, should they eventually get on to Schedule 3 but there are none there at the moment because the cannabis companies need to provide the scientific data to show that it’s efficacious. So that the provision is there, but there are no products on Schedule 3 Pharmacy Only medicines at the moment.


Dr Ron Ehrlich [00:11:37] So you’ve mentioned the two, I guess, active components in it, the THC and the CBD. I think CBD is quite a complex compound or there are many forms of it. What are some of the therapeutic uses of each of those active components? And how would you decide which to use, or how to use it?


Dr Kylie O’Brien [00:12:00] Good question. I mean, look, the plant’s got over 540 secondary metabolites, it’s not just CBD, THC. So, people tend to get very hung up on those two Phyto cannabinoids. But there are actually over 120 Phyto cannabinoids isolated from cannabis. There’s over 200 terpenes or essential oils have been isolated as well as many other sorts of nutrients as well. And the terpenes, as I said, they’re like essential oils, they’re not specific to cannabis. So many plants have terpenes. They’ve got therapeutic actions as well. So, you’ve got your major Phyto cannabinoids, which are CBD and THC, you’ve got your minor Phyto cannabinoids, and they’ve all got their own therapeutic properties and then you’ve got your terpenes.


Dr Kylie O’Brien [00:12:46] So when you look at cannabis, people think it’s one thing, but of course it’s not because there are hundreds of different cultivated varieties of cannabis, and they call them cultivars (that’s just short for cultivated varieties). And each of those has got its own phytochemical profile. So that’ll be the types and amounts of the Phyto cannabinoids, not just THC and CBD, but those minor ones as well. It’s the amount and ratios, I guess, of the terpenes in there as well. And so, each cultivar may have a different effect therapeutically, depending on what’s in it, how much THC or CBD, how much of there is terpenes. So, it’s not as simple, you know, it’s not just about how much CBD is in there compared to THC, the ratio of CBD to THC, that’s important, but it’s not the whole story. And I think as we get more sophisticated in learning about the plant and doctors become more knowledgeable about the other components that make up these different flowers or oils that they’re prescribing, then you’ve got an ability to perhaps match the medicines to the person’s complaint. So that hasn’t entirely answered your question. I’ve kind of gone off track a little bit.


Dr Ron Ehrlich [00:14:09] No, no, no. I think it’s laying down a great foundation for many more questions, really.


Dr Kylie O’Brien [00:14:15] You know, THC and CBD, they’re anti-inflammatory, antioxidant, and neuroprotective. Some of them have got anti-cancer actions. And that I’m talking research that comes from cell line research and animal research. There’s much more research, pre-clinical research than there is clinical research. And that has been probably due to the fact that researchers have had a Dickens of a time getting hold of medicinal cannabis because of the prohibition against it. You have got to remember, in the US it’s a Schedule 1 drug, even though various states in the US have actually legalised medical use. So, I think there are probably 38 or more states in the US that have legalised medical use. But yes, so it’s been more difficult, I guess, to get hold of good quality medicinal cannabis to actually research it.


Dr Kylie O’Brien [00:15:10] So we’ve got quite a lot of pre-clinical data and that tells us the mechanisms of actions of how things work and typically they’re done in rodents, in rats and mice. I’m not a big fan of animal studies, I have to say. But there is that’s you know, that’s just the state of play I suppose that’s how we learn about it. But they’ve got lots of different actions and some of them or a lot of them cross over to THC and CBD. So, CBD is anti-epileptic, for example, anti-seizure, anti-psychotic anxiolytic. THC can be anxiogenic in high quantities it actually can cause anxiety. So not every effect of the plant is positive. You can get side effects from cannabis medicines in the same way that people can get side effects from smoking a joint.


Dr Ron Ehrlich [00:16:13] And well, you know, you mention that there are 500 components, 540 active components. Reminds me of a podcast we did with Professor Fred Provenza, who wrote a terrific book called Nourishment. And he made the statement that the humble strawberry has 5000 active components, most of which we don’t know what their roles are. But the beauty of the natural product is that it’s come packaged with the whole balance of compounds.


Dr Kylie O’Brien [00:16:47] That’s right. Yeah. And look, that’s the basis, I suppose, of many forms of herbal medicine. And in Chinese medicine you often use combinations of herbs that are chosen to treat the, you know, in Chinese medicine it’s not only the disease but the pattern of disharmony underneath it. But also, many of those combinations will help mitigate some of the potential side effects of some of the other herbs. So, you know, I often sort of say, well, look, you know. “Nature isn’t stupid, but humans often are.” Because we try to, you know, we think we can do better than Mother Nature. You know, it’s no mistake what’s in the herb or a plant in terms of the entirety of those, what we call, its constituents.


Dr Ron Ehrlich [00:17:34] Yeah. Yeah, I know. The research lab of Mother Nature that’s gone on for hundreds of millions of years, you know, has something to offer. I guess one of the challenges in herbal medicine and when you talk about medicinal cannabis in so many different forms, is knowing exactly what is in each form, in each compound, in each dose, if you like.


Dr Kylie O’Brien [00:18:01] Or each product. Yeah. That’s right. Yeah. Yeah. And that’s where Australia does. I mean, you know, other countries do too, but Australia does quality control very well with complementary medicines, and medicines in general. So, we have therapeutic goods orders that companies must hold evidence against and that’s to quality control. So not only must the product have the, you know, what it says on the label, but you’ve got to hold the evidence of that, you’ve got to make sure that it doesn’t have any contamination with pesticides or heavy metals and mycotoxins and bacteria and things like that. So, I guess that’s the advantage of people getting it prescribed through the legal route in Australia, is that at least you are getting quality products. You don’t know what you’re getting on the grey market or black market or whatever you want to call it.


Dr Ron Ehrlich [00:18:55] Mm hmm. And you’ve mentioned briefly some things. I know epilepsy is always one that has been used very successfully. What would people be prescribed medicinal cannabis for? What are some of the conditions…?


Dr Kylie O’Brien [00:19:09] Yeah, that’s a good question. The top reasons if you look on the TGA website, you’ll actually still see that chronic pain comes in at the top, as the most commonly prescribed under the Special Access Scheme B can be. So, when I look at survey data and when they surveyed people, why are you using medicinal, why are you using cannabis and what for, the top ones usually are chronic pain and anxiety and depression and PTSD, those sorts of conditions. Now, spasticity due to M.S. is another one that you’ll find in American studies.


Dr Ron Ehrlich [00:19:49] It’s interesting you mention chronic pain because that’s an area of interest of mine professionally for over 40 years. And I know the definition, according to the International Association for the Study of Pain, is that it’s “an unpleasant emotional experience caused by the activation of the pain receptor”. So, I can imagine that medicinal cannabis, with its THC component impacting on the emotional part and the CBD part or the other terpene, you know what I’m saying, one acting on the emotional aspect, the other acting at the pain response.


Dr Kylie O’Brien [00:20:26] So it’s not as simple as that. It’s not that… I wish it was. No. But when you look at the cannabinoids, you can find that they will interact with the pain pathways, whether it’s the peripheral or central part of that pain pathway. Both CBD and THC do have analgesic effects, but they don’t necessarily understand perhaps as well for CBD how it does that. There’s a there was a study done on nabiximols, and that’s almost a 1-to-1 ratio of CBD and THC, and it’s a registered drug in Australia. So, the doctor can write a prescription for it. They don’t have to go through the special access scheme for it or the authorised prescriber and there’s been a lot of research on nabiximols. And they did a study where they took out the CBD component just to see what happened in terms of pain relief. And they found that they definitely needed the CBD in there. Now CBD has an anxiolytic effect, so maybe it’s working that way. It’s also anti-inflammatory, maybe it’s working on those pathways as well. But I’d say there’s not one simple mechanism of action of how THC works or how CBD works. It is complex. And as you will probably know very well, is that the whole notion of pain, the experience of pain is very complex, there is an emotional component to it, etc.


Dr Ron Ehrlich [00:22:01] Yeah, yeah, yeah. No, no, totally. Now, I mean, one of the things I guess about it becoming accepted is the pharmaceutical industry loves to package something up and patent and make a lot of money out of it. I mean, that’s the business model of health care, really, a lot of health care in our society. And I guess the possibility of making a lot of money out of medicinal cannabis wouldn’t hold the same allure, would it? Where does it or how does that apply?


Dr Kylie O’Brien [00:22:35] I guess so. I would sort of think there are a lot of people in the cannabis industry, and I think there is a lot of people that got in it to make money. So, yes, same as the pharmaceutical industry. There are a few pharmaceutical companies that have gone into that medicinal cannabis space, I think one of them is a UK company and they developed Sativex or nabiximols[inaudible]. But you’re right, it’s very difficult to patent herbal medicine and so they, you know, it’s hard to hold that IP so intellectual property. So, I guess that has probably put a few off. Now there are synthetic copies of THC on the market in the US and they are FDA-approved. Dronabinol and Nabilone are two of those. But they isolate and yes, of course, they’re probably going to have a patent on them. But whether or not they work as well as a whole plant medicine, you know, we don’t necessarily know. There have been some studies that have compared an isolate versus a full plant medicine. And, you know, there are some results that perhaps are in favour of the full plant or full spectrum cannabis product compared to an isolate. But you’re right, yes, there’s a lot of money in the cannabis industry, but there’s much more money in the pharmaceutical industry. And whether or not some of those big players eventually dip their toes in, I’m not sure. I think there are a few that are looking at it, but its early days.


Dr Ron Ehrlich [00:24:07] When we talk about medicinal cannabis, how is it administered?


Dr Kylie O’Brien [00:24:12] That’s a good question. In many different ways some of the main routes are the inhalation routes and the oral route, they’ve also got the dermatological route (so external application). Now back in 2008 when I started in education, most of the products in the Australian market were oils in bottles. So, you know, you just took them orally versus now where flower has become much more popular. So, you can vaporise the flower in a vaporising device and what is coming onto the market more is now vaporisers where you can vaporise the oil. So, you’ve got both of those entering. The flower’s been popular the last few years and it’s growing in popularity. The oil, the vaporising in cartridges, I’m starting to see that come onto the Australian market as well.


Dr Kylie O’Brien [00:25:03] So the oral route is perhaps good for, it stays in the body longer, so it might be better for chronic conditions. But the inhalation route, the onset of action is usually fairly fast within 3 to 10 minutes, and so it might be more useful for things where you’ve got to jump on it quickly, like perhaps breakthrough pain or nausea and things like that. So, they’ve all got their place and different doctors will use them and they might use a combination to prescribe for a patient. They might use an oil as well as a flower for vaporising. What other forms? Of course, suppositories, those sorts of things-I’m not aware of any on the market at the moment in Australia, but they’re certainly on the market in the US. They’ve got edibles on the market in countries like/ places like the US, which could be cookies for example, and gummies and things like that. They’re not easy to take, but I actually see a lot of problems with those. Personally, I don’t think they’re a great thing to sort of have on our market. That’s just my personal opinion.


Dr Ron Ehrlich [00:26:13] Why? Why do you say?


Dr Kylie O’Brien [00:26:14] Gummies look like little jelly babies, so jellybeans or jelly babies and you don’t want your kids mistaking those. And this is a problem, is that these are medicines. And the other thing is with cookies, for example, because it takes a while when you take cannabis via the oral route for it to take effect, it can take a few hours, people might sort of think, ‘Oh, I didn’t get an effect within 10 minutes’ because they used to smoking or something like that, so why not take another bite? And then end up overdosing themselves. So, I think those are less easily controlled in terms of dosage. I mean, how do you know how much or big a bite you took of a cookie, for example? So, me personally being more conservative, I just think that you’re better off with things where the quality and the dosage can be controlled quite strictly. And I think there are better forms of medicines, you know. You can get those in the US and other places of course.


Dr Ron Ehrlich [00:27:12] Hmm. Yeah. And when they are used because I take your point about gummies and cookies, because we tell our kids not to smoke, but we certainly don’t tell them to have gummies or cookies and they just normalise. So, I can see the potential for that to be a problem should a child consume that. That could be really quite devastating. But when you are consuming it as an oil, do you get the 540 components active? You know, are they all wrapped up in that?


Dr Kylie O’Brien [00:27:43] Well, I suspect in the… And I’m not an expert on the manufacturing process. But I suspect that quite a bit of that is going to be lost in the manufacturing process, Ron.


Dr Ron Ehrlich [00:27:53] Yeah. Hmm. So, is inhalation the way of ensuring that you get that full 540 components?


Dr Kylie O’Brien [00:28:04] Not necessarily either. I think it’s again, it’s not quite as easy as I’m going to get all of those. Yeah, it’s a really good question. And now you have given me some homework to go and look up now.


Dr Ron Ehrlich [00:28:16] Yeah. No, I’m rather taken by the fact that it’s such a complex compound, you know, whether it’s 200, 300 or 400, it’s certainly more than two THC and cannabinoids.


Dr Kylie O’Brien [00:28:28] Exactly.


Dr Ron Ehrlich [00:28:28] So, so so, you know, getting the whole package rather than just extracting one or two, supposedly active compounds.


Dr Kylie O’Brien [00:28:35] Yeah. But you know, as we do sort of more research in this area, you know, more and more will become apparent. And I think the safety aspects need to be considered too, Ron. It’s not for everyone. It’s not considered the first-line therapy. And so, and you have to be careful of potential cannabis drug interactions as well with both CBD and THC and some of the other Phyto cannabinoids. So, it’s another reason why, you know, it’s better to see a practitioner, I think, who’s been well trained in it.


Dr Ron Ehrlich [00:29:13] Yeah. Well, you mentioned, you know, other medications and considering I think at least half the population is on one medication and many are on several. What are some of the interactions? What are some of the contraindications in the interactions that people should avoid?


Dr Kylie O’Brien [00:29:28] Yeah, I think I don’t want to give any medical advice, Ron. So, I think that’s probably something to be discussed with their doctor, which is why I would always encourage it. But you know, if I look in the research literature in epilepsy, for example, where they’ve done studies of CBD, some of the anti-epileptic medications that were used have interacted with and found to interact in some kids with CBD medicines that they were using the clinical studies. But, you know, there are quite a lot of potential interactions. Whether or not they actually translate is another matter. But I do think you have to be careful. You know, heart conditions, for example, those sorts of things, family history of schizophrenia, psychosis, that sort of thing. I think you need to be very careful. So again, I always emphasise that this is herbal medicine but it’s medicine and so it does really need to be prescribed by someone who knows what they’re doing, not just someone, you know, trying to self-medicate.


Dr Ron Ehrlich [00:30:36] Hmm. I know you’re doing research, and I wondered if you might just share with us. You know, what that research is.


Dr Kylie O’Brien [00:30:42] Yes. Yes. We’re running an observational study, Ron, and it’s called Project 2021 Australia. It’s an observational study where we’re following people with who have been prescribed medicinal cannabis through Releaf Clinics for chronic pain, anxiety, PTSD or MS. And so essentially, if they choose to come into the study, we give them questionnaires to fill out at baseline and then every three, six, nine and then 12 months. So, we’re following them for up to 12 months. Some people may not be on cannabis that long, so they might only get followed three months, for example. But we are collecting data at three monthly time periods, and these are all validated questionnaires. We’re also collecting safety data, so we do blood tests at baseline six months and 12 months. So, we started recruiting for that study back in February (2022) and we’ve just submitted the first of our papers, preliminary data, just looking at the quality-of-life changes.


Dr Kylie O’Brien [00:31:42] So we’re looking at a few different things. We’re looking at, as I said, we’ve got conditions-specific questionnaires for each of those conditions. But then we’ve got some general questionnaires around the quality of life and sleep and mood. For example, we are collecting data on any adverse effects, that sort of thing. So, it’s a collaboration with Drug Science Organisation in the UK. They’ve been running Project 2021 for a couple of years now and it’s probably the largest medicinal cannabis registry going at the moment. So, we have a slightly different format. They looked at eight medical conditions and now I think they’re throwing the doors open to anyone who wants to come into their registry, whereas we’re just focusing on chronic pain, anxiety PTSD and MS because our clinics are staffed by GPs and it’s easier for patients to be managed, whereas in the UK GPs can’t prescribe cannabis in the UK only specialists can. So, it’s quite a different system over there. So that’s what we’ve been doing. Our study will finish at the end of next year, but we’ve got a number of preliminary papers in the pipeline now, which are showing positive effects in chronic pain and anxiety and quality of life and sleep, those sorts of things.


Dr Ron Ehrlich [00:33:03] Wow. And in MS as well.


Dr Kylie O’Brien [00:33:05] Well, we don’t have a lot of patients in MS, so I haven’t had a close look at their data, but we’ve included people with MS as well.


Dr Ron Ehrlich [00:33:16] Hmm. I know people who are on chemotherapy and for cancers obviously have a problem with appetite. And I think one of the more well-known side effects of adult use, I’ll use that term. Adult use of cannabis is a definite impact on appetite. What are some of the results I mean is clearly positive there too.


Dr Kylie O’Brien [00:33:41] Yes. The research shows that also the other thing with cancer patients is chemo-induced nausea and vomiting. And the studies and the literature suggest that medicinal cannabis is very useful for that too. So, there was a report put out in 2017 by the National Academies of Sciences, Engineering and Medicine, and they basically used only randomised controlled trial evidence and systematic review evidence. And a systematic review is where you basically pool the results from randomised controlled trials. So, these are considered the gold standard in evidence. Now they reviewed a whole lot of clinical conditions and they basically said at the end of this there’s conclusive or substantial evidence that medicinal cannabis or cannabinoids are effective for the treatment of chronic pain, chemo-induced nausea and vomiting, and spasticity associated with MS. And there was a moderate amount of evidence for short term sleep disorders associated with a range of conditions. So that was an interesting publication that’s well out of date, now, of course, it’s five years since it’s been published. But the striking thing about that to me was that it actually only used the gold standard of evidence. So, it didn’t sort of use other what would be considered lower forms of evidence like case studies, even though in my own mind I don’t think they’re lower forms at all. But that’s the hierarchy of evidence in medicine. So, you know, there’s some other, you know, sort of results that have come out of studies but, you know, there are more studies than most people realise, Ron. There really are.


Dr Ron Ehrlich [00:35:23] Yeah. I mean, I imagine there’s a lot of research going on in a lot of different centres with this is this whole medicinal cannabis approach. Yeah. Look it’s good to get an overall picture of what’s happening on this front because a theme that I like to promote is we have a lot of lessons to be learnt from our past.


Dr Kylie O’Brien [00:35:44] That’s right. Yes.


Dr Ron Ehrlich [00:35:45] And something that has stood the test of time in humanity’s journey for literally thousands of years. There must be something going for it. I just want to ask you a final question, Kylie. Because we’re all on a health journey. I mean, you know, you and I have been associated with the college, but we’re all individuals on a health journey in this modern world, and putting aside your role as a researcher and a teacher, I wonder what you thought the biggest challenge is for you as an individual on that health journey in our modern world?


Dr Kylie O’Brien [00:36:21] Yeah, I think I’m a bit of a workaholic, Ron. So, for me, it’s around stress reduction. And as you and I have talked on many occasions before, it’s how you manage your stress because of course stress underpins a lot of chronic illnesses. And I think the pillars of health are what we promoted, I guess, in our conference that we ran together a couple of years ago. Those pillars of health are important, and that is stress reduction. It’s good nutrition, exercise, it’s good sleep, getting enough sunshine and vitamin D. There are the pillars of health for me. And I suppose I try to incorporate exercise daily even if it’s just walking my dogs. You know, I used to practice a lot of tai chi. You used to, you know, dance as a sort of a form of physical activity and relaxation as well. So, all those things, I think are really important.


Dr Kylie O’Brien [00:37:16] If I put my Chinese medicine hat back on, it’s all about making sure you’ve got adequate chi energy that comes through good food, but it’s also about being able to move your chi so that you regulate your emotions and keep the stress levels down. And that’s where forms of exercise like tai chi can come into it. So, they’re all kind of tied into one another. And I wouldn’t say this is one thing, but the challenge is, I think, with a lot of people who are busy to make sure they actually take some time out from themselves and not feel guilty about it. Yeah, you’ve just you’ve got to schedule it into your day. Otherwise, you know, there’s a propensity just to keep on working, keep doing this or keep doing that and then forget that you actually you have to look after your body, your temple sort of thing.


Dr Ron Ehrlich [00:38:05] Mm hmm. And Kylie, people wanted to find out more about medicinal cannabis and whether it was appropriate for them and who they could get referrals from. You know. Where would they go?


Dr Kylie O’Brien [00:38:18] There are a few associations that are out there that might be more public facing, that they might be able to sort of find practitioners. ACNEM has a directory of practitioners for integrative medicine. So that could be a good place to sort of start as well. So, there are many clinics around that tend to sort of have doctors trained in medicinal cannabis. And obviously I work at one of those. But yeah, there’s less, I guess, public-facing material. You can look at the TGA website but that won’t tell you where to find a practitioner. So, I would go to some of those medicinal cannabis associations that you could probably just Google, and that might be able to put them in contact with, you know, a practitioner or find them that way. But ACNEM is always a very good source of integrative medicine practitioners, and a lot of those practitioners are trained in medicinal cannabis, so that’s probably a good place for people to start.


Dr Ron Ehrlich [00:39:21] Hmm. Kylie, thank you so much for joining us today and sharing your knowledge and wisdom on this subject. Thank you.


Dr Kylie O’Brien [00:39:28] My pleasure, Ron. Anytime.


Dr Ron Ehrlich [00:39:30] Well, there it is. I mean, there is a compound which has been around for thousands of years and has stood the test of time. And I take Kylie’s point about not liking the word recreational use, but more adult use. And interestingly, the pain, the efficacy of this with chronic pain, and to remind our listeners, all of you, that between 20 and 40% of the population experience chronic pain at any one time, and that is pain that continues for more than three months. And musculoskeletal pain in particular, which is things like headaches, neck aches, and lower back pain. This is a huge problem in our society and unfortunately, medications do just they kind of mask well and to anybody in chronic pain that is more than enough if it can just mask and give you some relief for a period of time.


Dr Ron Ehrlich [00:40:32] But something like medicinal cannabis having that effect and with those other active components and the fact that it is a natural product, I think there’s certainly something there. And as I said, I think pain is an emotional experience. And it’s also triggered by a whole lot of inflammatory chemicals. It’s why we take anti-inflammatories like Panadol or Nurofen or corticosteroids to reduce pain incidents because it lowers the inflammatory markers that float around in our body. So, you know, the effect of medicinal cannabis on inflammatory pathways, on pain receptors, on the way we perceive and modulate or facilitate pain all has potential and it’s not perhaps surprising that cannabis is effective there. And also, as anti-nausea is an antiemetic for many chemotherapies and improves appetite which is of course legendary when it comes to cannabis use. The infamous munchies that people experience when they may have had recreational use of this compound. So, we’ll have links to ACNEM the Australasian College of Nutritional and Environmental Medicine. I know it runs courses on medicinal cannabis, also the National Institute of Integrative Medicine, NIIM. They would certainly be able to point you to practitioners that would be able to work with you if medicinal cannabis is something that is of interest to you. So, I hope this finds you well. Until next time. This is Dr Ron Ehrlich. Be well.


Dr Ron Ehrlich [00:42:15] This podcast provides general information and discussion about medicine, health and related subjects. This content is not intended and should not be construed as medical advice or as a substitute for care by a qualified medical practitioner. If you or any other person has a medical concern, he or she should consult with an appropriately qualified medical practitioner. Guests who speak in this podcast express their own opinions, experiences and conclusions.