In this weeks podcast we talk with Dr. Shu Ng, a Cannabis Clinician and Medical Doctor, about oncology symptoms treatment, SAS-A, general questions from patients and why they might be declined, products and affiliations of clinics, common questions and independent doctors.

Key Points

1:30 – Dr. Shu Ng is a cannabis clinician who has been practicing medicine for over 10 years.

01:43 – Initially affiliated with general medicine and cancer research, Shu completed a research fellowship from New York and became interested in medicinal cannabis in 2017 after hearing about it from a patient.

03:00 – Skeptical at first, Shu gradually realised the immense benefits of medicinal CBD for numerous diseases.

7:00 – Dr. Shu believed that although the medicinal cannabis is not meant to replace the chemotherapy due to the lack of rigorous testing, however she believes it is the best support therapy for managing the various side effects that patients experience during treatment.

7:30 – Dr. Shu reasserts that Medicinal cannabis is not a replacement to immunotherapy or chemotherapy, but it is used well as an adjunct to treat symptoms of side effects of cancer and cancer therapies.

09:08 – Dr Shu. Recounts a story about the family of one of her patients with GBM (Glioblastoma).  This family had read on the internet that medicinal cannabis may be effective in reducing tumour sizes.  Shu points out that, whilst there are many people doing this type of home research, there are a lack of studies that have yet proved this, especially in specific dosing or strengths.

10:22 – Dr. Shu explains that the TGA requires patients to have tried another therapy before they qualify for medicinal cannabis or medicinal CBD oil.

12:09 – Dr. Shu highlights that the SAS-A pathway (Special Access Scheme) is used for palliative care such as cancer patients with end of life pain.  This pathway is set up to allow patients to receive products quickly without having to wait for approval from the TGA.  The issue with this pathway is that the scheme requires products to be imported that don’t currently exist on the Special Access Scheme under category B, and unfortunately, this takes a long time, and in many cases longer than under SAS-B pathway.

15:49 – Dr. Shu talks about medicinal cannabis and CBD oil approval times.  in Dr. Shu’s experience, approvals times can vary from two hours, to 24 hours to seven days.

16:50 – Dr. Shu explains that various formulations of medicinal cannabis are available which could aid in a lot of situations including nausea, nerve pain after surgery, anxiety, insomnia, radiation therapy and chronic pain. It is used for many different causes such as one patient with oesophageal cancer, who uses it for multiple indications such as poor sleep, weight loss, nausea, vomiting and pain.

19:15 – THC and CBD are not the only considerations, as driving is an important factor for many patients.  Sometimes patients use THC at night and CBD during the day so that they are able to drive to work.

19:50 – Dr. Shu mentions that a lot of patients benefit from a ‘balanced’ product with THC and CBD, such as mood disorders and pain, appetite, insomnia. This also is dependent on time of day.  For example, medicinal THC oil is better at night time for sleep, while many patients prefer medicinal CBD oil for anxiety during the day.

21:30 – Dr. Shu recounts her time at the medicinal cannabis clinic, Cannadoc.  During her time at the clinic, Dr. Shu learned a lot about diversified dosing regimes and and received a lot of valuable exposure to a diverse range of patients came through the clinic looking for medicinal cannabis treatment and prescriptions such as medicinal CBD oil.  This included patients suffering from multiple sclerosis, chronic cancer, non-cancer pain and anxiety.  She asserted that without Cannadoc, she could never have gained the confidence, passion and knowledge she has gathered for her individual practice.  Dr. Shu comments that she might have 10 patients all presenting with pain, however each patient may need different dosing and/or products to manage their conditions.

23:10 – Dr. Shu Ng discloses that doctors at medicinal cannabis clinics such as Cannadoc still maintain independence in their prescribing and patient managing practices.  Since going fully independent, Dr. Shu’s patients are finding her through pharmacies or online.

25:30 – Dr. Shu explains that sometimes having specific products is easier for some doctors, as they don’t have to think as much about their prescribing habits.  However, maintaining independence as a cannabis practitioner is important as patients are more comfortable with unbiased, personalised prescriptions and the flexibility to choose brands of medicine.  Shu recounts that she has seen patients from other clinics where patients had received medicine that some of the other clinics may have had a vested interest in prescribing.  Dr. Shu explains that she is open to patients who approach her with their own research and/or anecdotes around specific medication brands and their condition, if she feels it is appropriate.

29:20 – Dr. Shu highlights a few trends amongst patients including the cost or price of medicinal cannabis products, the type of product and the formulations of different brands such as balanced THC and CBD oil, CBD isolate oil or full spectrum cannabis oil.  Previous experience, communication with distributers or suppliers and general support is also a factor.  Dr. Shu recounts a conversation with a patient who chose a product because they had direct communication with staff from the brand.

32:40 – Dr. Shu mentions that patients do ask if products are Australian made, grown and owned, especially during COVID times.  Dr. Shu agrees that the ideal climate, textbook cultivation practices as well as high quality standards being followed in the production of medicinal cannabis in Australia actually led to a huge demand of these products globally.

36:20 – Dr. Shu lists the main questions she gets asked as a medicinal cannabis prescriber.  “Can I access medicinal cannabis?” This is the most common questions she is asked, as eligibility is still poorly understood by the majority of the public.  Alongside this, questions about eligibility for specific medical conditions is a high volume enquiry. Another main question she is asked is “do i have to smoke weed?”  Dr. Shu explains that there are many forms of finished and compounded cannabis including oils, capsules and vaporisers.  Finally, cost is also one of the most frequent questions, and this is more a subjective question depending on the patient and doctors perspective, as it might be cheaper than other, more niche expensive medications or more expensive than common mass produced pharmacy medications.

39:50 – Dr. Shu dispels numerous myths regarding the access and cost of medicinal cannabis and explains the eligibility criteria for accessing medicinal cannabis.  This includes the presence of an acute or chronic health issue, the previous trialling of a first line therapy or traditional medicine for that specific condition, and a low risk profile in terms of psychological issues or family background.

42:30 – Dr. Shu explains that the TGA highlights any individual with family history of psychological risk, such as schizophrenia or multiple personality disorder does not preclude patients from medicinal cannabis, but rather, additional care is required when considering the form, such as CBD oil rather than THC.

44:50 – Dr. Shu mentions that some patients cycle through clinics and doctors until they find one who will prescribe them the medicinal cannabis treatment they are looking for.

48:10 – Dr. Shu thinks that Australia is very conservative in its medical policy and that we are about five years behind the USA.  Dr. Shu is of the view that Australia would take about 5 to 10 years for legalising the recreational use of cannabis.  This is dependent upon the social and political pressures on the local industry, and the data gathered from medical investigation over the next few years.

Link

Dr Shu Ng: https://www.drshu.com.au/