Medicinal Cannabis: A Therapeutic Alternative for Management of Chronic Pain in Older Australians by Leah Bisiani MHlthSc., Dip Bus., RN1., Dementia Consultant

DISCLAIMER: This article is not advocating medicating people living with dementia with cannabis, but is only considering the utilisation of medicinal cannabis for chronic intractable pain in our older population.

Pain has been described as a fundamental and universal human experience, and thus access to effective pain relief should be regarded as an essential and universal human right.1 Chronic unremitting pain has become a grave problem in modern civilization.
The human toll associated with chronic pain is massive, and is linked to considerable economic impact, including an enormous Health Service utilisation burden. 2-3
It could be perceived as perhaps quite paradoxical that people who do not have a condition that is life restrictive, but who suffer chronic pain, receive lesser efficient and effective means to successfully manage their pain. Hence the permanent nature of their pain creates enduring suffering and debility, which may, in some cases, encompass a period of time that could feasibly be decades. With respect to the incidence of chronic pain among the older population, there are abundant indications confirming older Australians continue to suffer considerably, and this has a drastic impact on their future and quality of life. 4-7

‘Duty of care’ is considered an area never to be compromised as per the code outlined by the Hippocratic oath that all medical professionals are supposed to uphold.

The foundation of this oath is: “DO NO HARM”.

Thus, every person has an integral right to the provision of the finest treatment possible to alleviate any form of suffering endured from chronic, relentless, excruciating pain.

Potent opioid analgesics, are widely prescribed for older Australians in chronic pain, yet these agents are associated with the highest degree of drug-related harm. It has been surmised that up to 73% of older people on opioid regimes are NOT receiving effective pain management!!!!!

It is therefore illustrated, there is an urgent need for an alternative approach.
Given the high prevalence of chronic unrelieved pain in the aged, this should be regarded as a matter of “high priority and focus”, of which we are duty bound to honour. The potential benefits of medicinal cannabis in treating poorly managed intractable chronic pain is considered a beneficial alternative approach to enhancing quality of life. and maximizing comfort and well-being in Australia’s older population!!!!!!!!!!!!! Otherwise are we not condoning neglect?!?! In supporting the concept of a compassionate and empathetic culture, it is time for us to avoid and negate the subjective views based purely on stereotypical interpretations of street cannabis.
Bureaucratic law is enabling a gross injustice to transpire against our population in need, by continuing to construct negative viewpoints related to outdated, propagated rigid regulations, intentional barriers and stigma.
This is institutionalised bias at its worst and should not be tolerated!!!!!!!!
Is it fear of the unknown stopping Australia’s Government from legalising a natural medication, that exhibits less risks than countless prescribed drugs handed out daily, or is it fear that some of the public may judge political decisions of this nature as a negative because of their own rigid views??
This topic really should not be creating such division in society due to political correctness.
The bottom line is, we ought to be analysing the product only in relation to its efficacy in alleviating suffering for specific conditions, hence basing it on the necessity of promoting a civilised and humane philosophy of care for our society.
If preferred pharmaceuticals and other methods of treatment have demonstrated persistently, to be unsuccessful in treating a person regarding their specific conditions, it seems again, neglectful not to consider and utilise a medicine that may alleviate the issue and ensure comfort and relief.
Well-being of our older population should ultimately dominate all decisions.
Thus, it is crucial we examine the genuine medicinal usefulness, (currently being ignored), and embrace the numerous and substantial benefits of medicinal cannabis as a viable alternative.
Excruciating, relentless, debilitating chronic unmanaged pain cannot be condoned!!!!!!
The frequent and significantly hazardous and destructive adverse effects associated with opioids are detrimental to living risk free, as they habitually and predominantly affect mood, conscious thought, judgement, may create hallucinations and delusions, alter cognition, and affect mobility.
It is unlikely that even enormous doses of medicinal cannabis would even precipitate side effects of this magnitude, thus cannabis must be considered a safer and more innocuous option.
Furthermore, withdrawal symptoms may be considerably less than with heavier compounds such as opiates, may limit and prevent the probability of accidental death/fatality, and consequently should be considered a beneficial alternative.
Side effects are evident in majority of mainstream drugs in the current market, just as there are people who exhibit allergic reactions, intolerance, and/or have the predisposition of an addictive background.
These factors are managed and reviewed ongoing during the commencement of any pain management regime, and have long been a regulated method of monitoring medications, understanding hazard management and avoiding any circumstance that may pose risk of abuse or misuse to the patient.
Precise strains, developed as a medicine, in specific measured doses and reproducible formulas, are also reinforced with all medicine, as the aim is to avoid or prevent elements of high risk.
Thus, it seems quite simple to consider that when prescribing medicinal cannabis for chronic pain, the same existing frameworks and regulatory compliance methods could easily be implemented, and utilised to minimise peril.
Consequently, the argument in regard to safety and risk of medicinal cannabis is ultimately void.
It should not be this complex!!!!!!!!!
It is essential we prioritise those who require urgent management of their suffering, thus reinstate a meaningful life to those who live in chronic, unremitting, daily agony.
In accordance with the introduction of any new medicine, an educational scheme needs to be instigated for all Medical Practitioners and Specialists who shall prescribe medicinal cannabis.
Adequate knowledge is crucial in providing information regarding the most superior available cannabis medicine best used for the treatment of chronic pain in the older population, prescription methods and preferred forms of administration.
Then prescribers may easily regulate and monitor as per proper process and regulatory compliance.
Furthermore, there can be no excuses based on ignorance once people are well educated.
It seems that the law continues to complicate an issue that admittedly requires careful consideration, but is not as intricate as it seems.
The negative impact current rigid ideals have on this area, remain evident.
Australians cannot ignore the progression of other countries, since by disregarding this evidence, we postpone the capacity to assist our older population in the present, and therefore prolong their suffering if we do not act accordingly.
Surely if Australians are not bound by old archaic ideals, we can initiate a successful strategy that enables us to follow in the footsteps of other forward-thinking countries who have successfully introduced the use of medicinal cannabis as a therapeutic pharmaceutical to benefit the population who require it.
There can be no excuses in permitting the continuation of a system that disregards the needs of those who deserve the benefits of medicinal cannabis to assuage pain and misery.
Time is not always on the side of those who agonize, thus we do not have the right to ignore this potentially lifesaving treatment, disregarding the unending suffering of older Australians.
The harsh ramifications of these decisions are discriminating and negligent.
This argument is so compelling it cannot be ignored.
We must challenge why people continue to waste valuable time overthinking and demonising the healing properties of cannabis.

Let us make a stand and give a voice to and advocate for more empathetic approaches that will benefit our population, alleviate suffering and maximise dignity, value, and quality of life.
We cannot tolerate this unacceptable ongoing cruelty to humanity!!!!!!!!!!!!!!
“Consider, the present alternative, which is, we continue ignoring the significant benefits of cannabis, and refuse to contemplate the countless areas where traditional medicine is ineffectively managing critical conditions. We must provide a united front in advocating medicinal cannabis as an innovative solution and way forward within the convoluted realms of modern medicine by challenging and dispelling the myths and attitudes associated with cannabis, and reinforcing, what we have recognised as the beneficial attributes associated with this natural plant”.

Leah Bisiani – MHlthSc/Dementia Consultant/RN.1 “Uplifting Dementia” 30.10.2017

Leah recently co-authored a research paper (Australian Journal of Pharmacy, Practice and Research, vol.48, issue 1)

UNderstanding pain in aged care: the UNPAC study – exploring the nature & treatment of chronic pain in the Australian aged care setting

Objective – To analyse management of chronic pain in the Australian aged care setting.
Methods -In the course of performing medication reviews, details of medications prescribed (including dosage) were collated and stored in a secure database along with information about medical morbidities, demographic data and the results of clinical investigations. Details of analgesic and adjuvant medication used in pain management was subjected to de‐identified analysis.
Results -There were 22 319 reviews analysed. Prescribing of opiate analgesics was widespread, with products containing oxycodone used in 24% of cases. Many residents were concurrently prescribed two or more analgesics. Adjuvant agents were prescribed in 3073 cases, with the most commonly used individual agent being pregabalin (n = 1411). Use of medications for management of adverse effects associated with opioids was common.
Conclusion -Use of analgesics and related medications is widespread in the aged care sector. These agents are associated with significant adverse effects, and older people may not tolerate doses that deliver satisfactory pain control.

Biography: Leah Bisiani is a highly skilled registered nurse/dementia consultant, having completed her Masters in Health Science/dementia stream, and Diploma in Business/Frontline Management, with more than 30 years’ experience in aged /dementia specific care.

After completing her Registered Nurse training at the Alfred Hospital in 1985, Leah undertook further studies and management/corporate employment within the aged care industry, establishing a knowledge and experience base placing her at the forefront of the industry, with her primary area of expertise being dementia specific care.

Leah has a passionate dedication towards Best Practice and is constantly researching and utilizing progressive and innovative approaches to obtain the highest possible quality of life for older people living with dementia. She distributes and publishes her evidence based research within the medical field, aged care sector and community, enabling others to accomplish maximized care for people living with dementia.

Self-development has been a priority, and has not only benefited Leah in her chosen pathway, but allowed her to expand on her proficiency, working in consulting, research, education/learning and development. Her goals continue to be focused on creating the ultimate benchmark for dementia specific care. Her vision has changed cultures and philosophies of care, providing a powerful voice that confront current practice, thus advocates and upholds the rights of all people living with dementia.

Leah has successfully demonstrated how creating environments in which persons with dementia continue to thrive, enables continuation of life based on recognition of self, and valuing individual preference and choices.

As a result of her ground-breaking and highly effective work, Leah’s increased profile has inevitably resulted in numerous, ongoing invitations over the years to lecture at leading national and global conferences on topics directly associated with her research, specifically behavioural expression and lifestyle.

Leah won both the 2010/11 Lend Lease ‘Australian’, and ‘Global’, Award for “Excellence in Innovation” for her personcentred models of care, designed for people living with dementia.

This award recognised Leah’s contribution to the aged care sector and specifically to the lives of those living with dementia.

Her pioneering revelations have enabled people living with dementia to attain maximised and enriched lifestyles, and furthermore, successfully empowered and motivated care partners to embrace her dreams of change.

In 2012 Leah was published by Sage Publications in regard to her research, and continues to write key articles for the “International Dementia Journal”, “Australian Dementia Journal” and various key dementia journals globally.

Leah was privileged to be invited to become an “International Care Team Member” of the ICA, (International Caregivers Association), a revered panel of dementia experts, based in Mapleton, USA, in 2014.

Having developed herself as a leader in the field, Leah has further added to her repertoire and become an advisory board member with the “Alive Inside Foundation”, USA. The Alive Inside Foundation is a non-profit organization dedicated to inspiring an Empathy Revolution—using education, intergenerational practices, music, and film. They empower youth and local communities to create meaningful, shared experiences that link generations, transform dementia care and expand aliveness globally.

Leah contributes her assistance to “Dementia Alliance International”, an Australian based registered non-profit organisation whose membership is exclusively for people with a medically confirmed diagnosis of any type of a dementia from all around the world. They seek to represent, support, and educate others living with dementia, and the wider dementia
community. They strive to provide a unified voice of strength, advocacy and support in the fight for individual autonomy and improved quality of life.

This provides Leah another niche area in which she can continue to make a difference to, and enrich the lives of people living with dementia.

In 2015 Leah published a submission to the Victorian Law Reform regarding her support of medicinal cannabis as a healing medicine.
Leah is interested in advancing the development of medicinal cannabis clinical promotion and has presented at the, “Cann10 International Medicinal Cannabis Conference”, in Tel Aviv, Israel in September 2016, and “CannaTech Conference” in March 2017, where she was also Master of Ceremonies.
She has since become a popular and prominent speaker at foremost Australian and Global medicinal cannabis conferences, symposiums and summits, discussing the promising therapeutic benefits of medicinal cannabis for the treatment of chronic intractable pain in the older population.
Leah co-authored – “Understanding pain in aged care: the UNPAC study – exploring the nature and treatment of chronic pain in the Australian aged care setting” Published Feb.2018 in the Journal of Pharmacy Practice and examine and demonstrate supportive evidence within this arena.
As per the words of Ghandi, Leah believes:

“Be the Change You Want to See in the World”.


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