Managing Medicinal Cannabis in Australia
Is medicinal cannabis safe and effective as a medicine?
The use of cannabis as a medical treatment has been around for thousands of years, but it wasn’t until the past couple decades that deeper research has been done on the plant and its benefits to human health. Research is still in its early stages and because the plant has been highly regulated through the last century it has been more difficult to study. While medicinal cannabis has shown to be effective through anecdotal experience, the reality is that not many solid claims can be made about the substance. Medicinal cannabis is not a cure for any conditions, but may be a helpful tool for patients to cope with their illnesses and may give them a chance for a better quality of life.
Unlike many pharmaceutical drugs, the side effects of cannabis use may be minimal (see below), and experts say that it is likely impossible to consume a lethal dose of cannabis. While research has yet to confirm this, there have not been any cases of cannabis “overdoses”. However, like other prescriptions, patients have to take caution when using medicinal cannabis, as it may impair motor skills or judgment and pose a safety risk in that regard.
How can medicinal cannabis help to manage pain conditions?
Treating chronic pain is one of medicinal cannabis’ most popular uses. A growing number of people are turning to cannabis as a safer alternative to prescription medications, such as opioids, to treat their pain.
There are two compounds in the cannabis plant that focus on pain relief: tetrahydrocannabinol (THC) and cannabidiol (CBD). You may have heard of THC as the compound that gets you “high” and CBD as the pain-reliever, but both can work together or independently to relieve pain and relax the body. Depending on a person’s condition, they may want to focus on THC, CBD, or both to try to improve their condition. Medicinal cannabis may also serve as an adjuvant, meaning it may increase the effectiveness of other prescriptions or help to combat side effects or symptoms that other prescriptions do not.
How does medical cannabis help those who use it?
Medicinal cannabis has a variety of benefits that may help people with different disorders and conditions. While cannabis is not a cure for any of these conditions, it may be able to help in other ways, such as reducing pain and anxiety, increasing appetite, controlling nausea, and relaxing the body and mind. Research suggests it may even kill cancer cells and slow tumour growth, though the research is still in its early stages.
One of the more popular uses of medicinal cannabis is in palliative care. Medicinal cannabis can be used to ease the suffering and provide relief from the symptoms of the illness. Cannabis may be able to do this for a variety of conditions, including cancer, AIDS, multiple sclerosis (MS), Crohn’s disease, glaucoma, and epilepsy.
For example, cancer’s most common treatment is chemotherapy, but it comes with a barrage of side effects that make the process of healing much tougher for the patient. Many chemotherapy patients experience pain, nausea, and a lack of appetite. CBD might ease the nausea and relieve the pain of the chemotherapy and THC might help to increase a patient’s appetite. Anecdotal evidence suggests THC can also cause euphoria, relaxation, bliss, and comfort, which may relieve some of the mental pain, stress, and anxiety that can come with having cancer. This is due to the THC signaling neurons to release extra amounts of dopamine, creating the high that many people think of when they think about cannabis. .
What are the side effects of medicinal cannabis?
Like any substance that goes into the body, cannabis does come with the risk of side effects. Unlike traditional prescription drugs that can come with severe side effects, those of cannabis are anecdotally believed to be rather mild. They may include headaches, dry mouth and eyes, dizziness, drowsiness, fatigue, increased appetite, increased heart rate, nausea, disorientation, and hallucinations. The latter four are less common but still important to be aware of when consuming the substance. As always, patients should consult with a doctor before using any medicinal cannabis products, especially as a patient works out what dose is best for them.
How do Australians access medicinal cannabis products?
Through the Public Health Act of 2016, the Australian government gave doctors the ability to legally prescribe medicinal cannabis to patients whose conditions qualify through sound clinical evidence that cannabis could be an effective treatment for them. Eligible conditions include severe muscular spasms and other symptoms of MS, chemotherapy side effects (like nausea and vomiting), and epileptic seizures, among others Patients receiving palliative care for conditions like cancer and HIV/AIDS may also qualify if their symptoms indicate that cannabis may be a suitable treatment. Cannabis products prescribed by doctors must be approved by the Therapeutic Goods Administration (TGA), as well as the State.
The TGA hosts a programme called the Special Access Scheme (SAS-B), which grants doctors the capacity to prescribe medicinal products that aren’t available through general prescriptions, like those provided through the Pharmaceutical Benefits Scheme (PBS). First, a doctor must recommend medicinal cannabis to the patient, then they will help the patient fill out forms required to apply for access to cannabis. When the SAS-B forms have been approved, the doctor can formally prescribe medicinal cannabis.
Which medicinal cannabis products are approved for use in Australia?
The TGA has approved over 150 cannabis products for the Australian market. There are a variety of product types, from topical to inhalable. The most common products are creams, capsules, lozenges, sublingual oils (tinctures), flower, and chewables. Products with different forms of consumption allow patients to find what is most comfortable for them. Not everyone is keen or able to smoke, so they might prefer a chewable or a capsule. Different product types may also have different onsets, strengths, and durations. For example, inhaling cannabis smoke might affect the body more quickly, but oral and sublingual oils may produce a more intense and long lasting effect but with a slower onset.
Medicinal cannabis products come in a range of CBD and THC content; some only have CBD; some only have THC, and some are a balance of the two. Having a range of product types and cannabinoid content (ratio of CBD/THC) creates a wide variety of products with the goal that patients will be able to find the best product for them.
Do all medicinal cannabis products require a prescription?
The simple answer is no. In December 2020, the TGA down-scheduled some low-dose CBD products from a Schedule 4 listing to Schedule 3, which allows over-the-counter (OTC) purchasing of these products without a prescription. While this is a major milestone granting Australians access to cannabis products, the consumer still needs to ask the pharmacist for the product, who would then provide them with proper information to ensure that they can use it safely and effectively.
That being said, the ARTG (Australian Register of Therapeutic Goods), has not approved any cannabis products for OTC purchasing yet, which may take some time to do. This means that while they are coming, there are currently no CBD products available in pharmacies without prescriptions.
Are any products subsidised by the PBS?
As of January 2020, there are no cannabis products that are subsidised by the PBS. The medicinal cannabis product, Epidyolex, is used to treat seizures caused by Dravet Syndrome and Lennox-Gastaut Syndrome and was recently approved by the TGA for prescribed use. The medicine was considered for PBS subsidisation, as it can cost consumers thousands of dollars per month, however, they have decided to defer the decision on whether to subsidise.