Q&A: Dr Danial Schecter

Following the ongoing debate across New Zealand on cannabis, we sat down with the Director of Global Medical Services at Spectrum Therapeutics, Dr Danial Schecter, to help us understand the medical perspective.

With over a decade of experience specialising in cannabinoid medicine and practising as a family physician, Dr Schecter shares his expert insight into medicinal cannabis and its effects.

1. Why do you think there is such a stigma around cannabis in New Zealand?

For the last 80 years, we’ve been told that cannabis is a gateway drug and bad for you at an authoritative level. It’s only recently that we’re now being told that this is different.

In fact, the use of cannabis as a medicine goes back 5,000 years. It has only been in recreational use across the last century, around the time of prohibition.

People focus on the recreational use over the medicinal and that’s significant in understanding why there’s so much stigma. There’s also the fact that many people don’t recognise a distinction between recreational and medicinal. They are incredibly different across intention, use, quantity, quality, product and method of administration.

At Spectrum Therapeutics, in order for us to do an effective job, we cannot let stigma influence how we think and invest in life-changing research for those who need it.

2. What can New Zealand learn from Canada when it comes to medicinal cannabis? Including mistakes NZ can learn from?

Across any country, it is important for doctors to be able to communicate with their patients about a range of treatment options, including medicinal cannabis.

In Canada, a key area for reform was education. There needs to be more balanced and regular education programs in place to support issues such as endocannabinoid science, dosing of THC and CBD, patient screening and monitoring, safety concerns and adverse event reporting.

In terms of mistakes, New Zealand can learn from Canada’s struggle to find a way to balance the need for education with the need for independent review and the interests of the emerging cannabis industry. Finding a balance between these important factors is critical to supporting and protecting patients seeking treatment with medicinal cannabis.

3. What are the benefits of medicinal cannabis?

Medicinal cannabis represents a unique class of medicine, as it’s rare for any one class of drug to have such a broad spectrum of effects – treating a wide range of symptoms including pain, spasticity, nausea, anxiety and seizures.

From experience in the medical field, these effects are supported by enormous scientific advances in our understanding of the body’s own endogenous system (also known as the endocannabinoid system) of cannabinoid molecules and receptors, which plays an important role in a variety of conditions and processes.

This endocannabinoid system (ECS) is involved in many physiological functions, including inflammation, sleep, pain, memory, digestion, immune function, neuroprotection and more. The phytocannabinoids (such as THC and CBD) are produced by the cannabis plant and also interact with the receptors of your ECS. This could partly explain why cannabis seems to affect such a vast range of conditions and symptoms.

4. What can cannabis treat?

Cannabis prohibition has significantly restricted research in terms of access to materials and funding, and this has led to an inability to conduct studies to address important questions of safety and efficacy. The ability to cultivate, produce and develop standardised medical cannabis preparations will allow research to proceed to support therapeutic claims and to inform risk–benefit discussions.

Despite difficulties accessing standardised cannabis products and funding for research, there have been robust attempts to address this research gap. I was part of a team at McGill University that led one of the largest studies looking at the long-term safety of medical cannabis use by patients with chronic pain. The study enrolled more than 400 adults with severe and intractable chronic pain, half of whom used a standardised cannabis product under real-world conditions, and half of whom did not. We observed no difference between groups in serious adverse events, cognitive function, biochemistry, and hematology. Yet over the one year follow-up period, the cannabis group experienced a significant improvement in their levels of pain, symptom distress, mood, and quality of life.

There is now significant clinical data showing the therapeutic value of medical cannabis in some cases for symptoms related to pain, mood, and sleep disorders. An expert committee of the National Academies of Sciences, Engineering, and Medicine in the United States conducted a systematic review of more than 10,000 papers and found conclusive or substantial evidence that cannabis or cannabinoids are effective treatments for chronic pain, as an antiemetic in chemotherapy-induced nausea and vomiting, and for patient-reported spasticity in MS.

5. What are the dangers of people sourcing and using black-market cannabis?

Well there’s a few things, firstly, you don’t know what is in your product when you source illegally, as an example of this is that you might be told the product is low in THC and high in CBD, and it might not be the case at all. That is why regulation is so important.

On top of this, without the proper tests, black-market cannabis may have been subjected to pesticides that can be toxic. While it’s rare, negative health outcomes due to pesticides do exist, which is what we seem to be seeing in the US through unregulated vape products causing lung damage and deaths.

One common chemical used as a fungicide is myclobutanil, which when burnt produces hydrogen cyanide. There are also unregulated synthetic cannabis products called Spice and K2, which looks like cannabis flowers but are extremely risky and dangerous.

Secondly, you might find a product that begins to work for your symptoms as treatment, but due to the fact that unregulated product is not required to be tested and grown under high quality standards required by the governing bodies there are often inconsistencies found in these products, which means often patients are unable to rely on these products as they would regulated pharmaceutical grade products.

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