This is a snapshot of the event on Medicinal Cannabis presented by Associate Professor Kylie O’Brien from the National Institute of Integrative Medicine in Melbourne:
- Cannabis is a complex plant with over 400 chemical constituents. These include the cannabinoids, terpenoids and many other plant nutrients.
- There is a difference between recreational and medicinal cannabis. Medicinal cannabis is the judicious use of the plant medicine to treat and prevent illness. Ideally, it is prescribed and individualized to the patient and their condition by a practitioner trained in its use.
- There are many strains of cannabis (‘cultivars’), with varying amounts of the two main active constituents (both cannabinoids), tetrahydrocannabinol (THC) and cannabidiol (CBD). THC is the active constituent that produces known psychoactive effects including euphoria, and the strains grown for the ‘adult use’ or ‘recreational use’ market are high in THC. In contrast, CBD and the other cannabinoids do not produce the typical euphoria and other psychoactive effects. Many cannabis cultivars grown for the medicinal cannabis market are bred to contain high amounts of CBD and little or virtually no THC, whilst others may be bred to contain a balanced ratio of THC and CBD, and others high amounts of THC and lower amounts of CBD. There are over 140 different cannabinoids which probably have specific therapeutic effects.
- Forms of medicinal cannabis include: oils (which are ingested orally as a liquid or in capsule form or vaporized using a vaporizer), suppositories, external ointments and the raw form which may be smoked. Some people juice the leaves of the plant.
- Scientific evidence exists for the positive effects of medicinal cannabis. A major report published in the US in 2017 by the National Academies of Sciences, Engineering and Medicine found substantial or conclusive evidence that cannabis or cannabinoids were efficacious in the treatment of chronic pain, spasticity associated with multiple sclerosis and chemotherapy-induced nausea and vomiting, and moderate evidence for sleep disorders associated with a range of conditions. Other research suggests it may be efficacious in the treatment of range of diseases including epilepsy, Dravet Syndrome (severe form of childhood epilepsy), Parkinson’s Disease, Post-Traumatic Stress Disorder, inflammatory bowel disease, anxiety, depression and many others.
- The WHO (World Health Organization) published a series of reports in 2018 on cannabis, cannabis resins, CBD and THC. Currently cannabis and cannabis resins are listed in Schedules 1 and IV of the Single Convention of Narcotic Drugs (1961), which are the strictest schedules for substances with little or no recognized therapeutic value. The WHO recently recommended that CBD should not be scheduled and this recommendation will be considered by the United Nations at the end of this year.
- In Australia, access to medicinal cannabis by patients is difficult. In Australia, CBD is contained in Schedule 4 and THC in Schedule 8 of the Standard for the Uniform Prescribing of Medicines and Poisons. This means only a medical practitioner may prescribe it.
- There are main two pathways by which a medical practitioner may access and prescribe medicinal cannabis. The first is via the Special Access Scheme, whereby the medical practitioner must apply to the Therapeutic Goods Administration (TGA) for approval to prescribe a specific product for a specific patient. The doctor must also gain approval from their State or Territory Health Department. The second pathway is via the TGA’s Authorised Prescriber Scheme. Under this scheme, the medical practitioner may apply to prescribe specific products for a particular class of patients or conditions eg. chronic neuropathic pain. They must first be approved by a specialist college or human research ethics committee (HREC) then apply to the TGA for final approval. They must also gain approval from the State/Territory Health Department. The National Institute of Integrative Medicine’s HREC are accepting applications from medical practitioners who wish to be approved as Authorised Prescribers of medicinal cannabis under the TGA Authorised Prescriber Scheme. The paperwork involved is extensive and onerous for busy doctors.
- In the US, 31 states have legalized the use of medicinal cannabis. Canada has recently legalized adult use cannabis, the law coming into effect on the 17th October 2018.
- Australia is lagging a long way behind. Access to medicinal cannabis, a plant medicine, is a human rights issue.
- What can we all do to help? “It’s all about education”, says A/P Kylie O’Brien who has been an advocate for Medicinal Cannabis for the past 10 months and has been very involved with doctor and public education about medicinal cannabis. She has been scheduled to speak in the Victorian Parliament on this issue near the end of October and encourages all supporters to talk to their local MP to bring to her/his attention this most important issue. She believes that in light of the good safety profile of CBD, the findings of the WHO report and their recommendation that CBD should not be scheduled, there is no logical reason why CBD products should continue to be Schedule 4 medicines in Australia. She believes that the regulation of CBD could be handled under the TGA’s world class, stringent system for regulating complementary medicines. This would open up access to, at least, CBD products.
Medicinal Cannabis is a very safe, effective herbal medicine that has been made legal in Australia since 2016 BUT is virtually inaccessible to the millions of Australians who could benefit from it.
If you are interested in keeping up to date with this topic, Medicinal Cannabis Education www.medicinalcannabiseducation.org.au runs practitioner training events as well as public events. In addition, United in Compassion is a patient advocacy group set up by Lucy Haslam www.unitedincompassion.org.au which provides information to the public also.