History of research
The many healing properties of medicinal cannabis have been studied worldwide for thousands of years*. It is believed that the earliest use of medicinal cannabis was in Asia around 500 BC, followed by Africa, Europe and the Americas.
Most ancient cultures – like ancient China, Greece, Italy and India – grew cannabis for medicinal purposes to help ease a number of health conditions.
Centuries later, in the 1800s, doctors were still using cannabis to cure a range of ailments. Scientists would later discover that Tetrahydrocannabinol (THC) was a key component of cannabis’ medicinal properties – a breakthrough that would lead to using the plant for a number of modern treatments.
History of legislation and legalisation
In response to the growing criticism of the opium trade in the early 20th century, the League of Nations signed a multilateral treaty restricting the use of drugs like cannabis to scientific and medical use only. Around the same time, countries like the United States and the United Kingdom began to criminalise cannabis during the prohibition era.
Today, governments worldwide are beginning to change their stance on cannabis and embrace its medicinal possibilities. Studies are finding that medicinal cannabis is an effective, affordable and natural treatment for a variety of illnesses. As such, legal cannabis markets are evolving rapidly around the world.
The growth has largely been driven by Canada and in the United States where recreational consumption has been legalised. Other countries like the United Kingdom and Germany are also beginning to make great advancements in the use of plant-based therapies.
In 2016, the Australian government established a licensing and permit scheme for the lawful research, cultivation and manufacturing of medicinal cannabis products. With superior climate conditions and high green standards, Australia has positioned itself to be a key supply centre for the rest of the world.
Research studies are finding that medicinal cannabis can be an effective, affordable and natural treatment for a variety of illnesses.
Types of cannabis plants
It is widely believed that there are many different types of cannabis which can each be differentiated by their phenotypes (visual appearance) and typified by their different chemotypes (chemical composition). However, this is no longer accurate.
Historically, there were two main species of cannabis, Indica and Sativa, which were identifiable by their different phenotypes and chemotypes. Their individual make-ups had different effects and were therefore used for different medicinal uses. This information is no longer accurate, though you may continue to see this information distributed. Over time, the various species of cannabis have become so hybridized that taxonomically, or scientifically, they have become the same thing.
How medicinal cannabis works: explaining the endocannabinoid system
The endocannabinoid system plays a role in regulating a range of body functions including:
- and many other functions.
These functions contribute to finding homeostasis, or the balance of your internal system.
The endocannabinoid system is made up of three main parts:
- receptors; and
Endocannabinoids are the body’s own version of cannabis compounds. There are two key endocannabinoids – anandamide (AEA) and 2-arachidonoylglycerol (2-AG). Your body creates these as needed in order to keep internal functions running smoothly.
AEA is a long chain polyunsaturated fatty acid and has homeostasis regulating properties, playing an essential role in many of our biological functions and emotions. AEA influences homeostasis by binding with endocannabinoid receptors.
2-AG is a signalling lipid found in the central nervous system. It is a key regulator of neurotransmitter release, and activates the cannabinoid CB1 receptor. It is associated with bodily functions such as emotion, pain sensation, cognition and energy.
Endocannabinoids are neurotransmitters that modify the activity of other transmitters, binding to the receptors of other cells.
Typically, neurotransmitters are released from a presynaptic cell, travel across the synapse and attach to a receptor on a postsynaptic cell. They then send that receiving neuron into action. The endocannabinoid system behaves differently. When the postsynaptic neuron is activated, cannabinoids are created from fat cells that are already present in the neuron. Once released, they travel back to the presynaptic neuron and attach as cannabinoid receptors. They are then in control of how chemical messages are sent, received and processed to the body.
2. Endocannabinoid receptors
Endocannabinoid receptors are found all over the body. The receptors mediate the effects of cannabinoids and endocannabinoids. It is believed that they are connected to physiological and pathophysiological roles in the body such as regulation of appetite, mood and immune functions.
Studies have currently identified two cannabinoid receptors: CB1 and CB2.
CB1 is mostly found in the gonads, glands, organs, connective tissue and central nervous system.
CB2 can be found in the peripheral nervous system, particularly in immune cells.
Endocannabinoids can bind to either receptor. The resulting effect depends on the location of the receptor and which endocannabinoid it connects with. Once bound the endocannabinoid system is kicked into action relieving pain, inflammation or other ailments.
Enzymes control the breakdown of the endocannabinoids after they have completed their function. There are two main enzymes: fatty acid amide hydrolase (in charge of breaking down AEA) and monoacylglycerol acid lipase (in charge of breaking down 2-AG).
Endocannabinoid deficiency is a theory in which researchers believe that underlying cause of ailments – particularly those related to inflammation and the immune system – occur when the body’s endocannabinoid system is not functioning correctly. This upsets the body’s homeostasis, leaving the body more susceptible to diseases.
It is believed that a deficiency in endocannabinoids can be linked to disorders like migraine, fibromyalgia, Alzheimer’s disease and Parkinson’s disease. More studies are needed in this area, but some researchers believe that cannabinoids can help minimise disease symptoms by assisting the endocannabinoid system to function properly.
Cannabis and the endocannabinoid system
Cannabis contains over 60 compounds, but the main cannabinoids that interact with the Endocannabinoid System are Tetrahydrocannabinol (THC) and Cannabidiol (CBD).
Tetrahydrocannabinol (THC or delta-9-tetrahydrocannabinol) is known as the ‘one that gets you high’ and is the psychoactive cannabinoid. It binds to both CB1 and CB2 receptors which makes it very useful for medicinal purposes.
THC binds to the receptors in three main places in the brain: the cerebellum, basal ganglia and hippocampus. These control short term memory, learning, problem-solving and coordination. THC mimics anandamide and binds to the receptors to activate the neurons that affect the mind and body.
THC can be used to combat:
Cannabidiol (CBD) does not seem to react the same way as THC. Instead, researchers theorise that it prevents endocannabinoids from being broken down, thus having a greater effect. It does not cause a ‘high’ and is therefore considered ‘non-psychoactive’. That means it counteracts the effects of THC, reducing memory impairment and paranoia. Even though CBD alone is not known to cause drowsiness as a side effect, if CBD is used together with other medication, drowsiness may result.
CBD can be used to combat:
- psychosis disorders
- neurodegenerative disorders
- tumor growth; and
- cancer cell growth.
The entourage effect
There are hundreds of phytocannabinoids - like Cannabidiol (CBD) and Tetrahydrocannabinol (THC) - in a plant which affect the endocannabinoid system. When used separately, each will have a different effect on your system.
The entourage effect suggests that when these are taken together with other organic compounds found in cannabis – like terpenes or terpenoids – the health outcome is greater than taking each individually.
What is the difference between medicinal cannabis and street cannabis?
In Australia, medicinal cannabis products are controlled drugs, regulated by the Commonwealth Department of Health’s Therapeutic Goods Administration (TGA) and the Office of Drug Control (ODC).
Medicinal cannabis products in Australia are approved pharmaceutical products and include a range of preparations for therapeutic use. The quality and purity of medicinal cannabis (also known as medical marijuana) is carefully controlled and regulated by the Federal government, unlike street cannabis that is grown and sold illegally. The formulation and dose of medical cannabis, and therefore the effects, are more predictable and consistent, distinctly different to street cannabis which is uncontrolled, and can be contaminated with mould or solvents.
To learn more about medical cannabis products in Australia, please visit NPS MedicineWise’s Medicinal Cannabis, Explained
Who is eligible to use medicinal cannabis in Australia?
Medicinal cannabis is legally available to buy and use for medical purposes in Australia for patients who meet specific eligibility criteria and if the correct process is followed by the prescribing doctor.
The prescribing doctor needs to justify to the government’s Therapeutic Goods Administration (TGA) why the person needs medicinal cannabis. TGA approval is dependent on each patient’s unique set of circumstances, subject to various eligibility criteria through the Department of Health’s TGA approval framework.
Access to medicinal cannabis by way of TGA approval is not limited to a specific list of conditions or symptoms. Eligibility depends on a person having had the condition for at least three months and having tried conventional medical treatment, which was ineffective or resulted in unbearable side effects.
Who can prescribe medicinal cannabis in Australia?
In Australia, all medical practitioners are permitted to prescribe medicinal cannabis but approval is required by the Department of Health’s Therapeutic Goods Administration (TGA) and state or territory health departments (if required).
Prescribing doctors in Australia can prescribe medicinal cannabis for patients who have not responded to conventional medicine or if their current treatment has intolerable side effects.
Through the TGA framework, the TGA considers each patient’s prescription of medicinal cannabis via the Special Access Scheme (SAS) application. The SAS application is submitted by the prescribing doctor on the patient’s behalf which includes clinical evidence and reasons for treatment, dosing routine, and length of treatment. Other pathways to access medical cannabis within the TGA framework is the Authorised Prescriber Scheme (APS) which allows doctors to prescribe medicinal cannabis for a specific condition and Clinical Trials.
For the most up-to-date and accurate information on cannabis medicine and prescribing medicinal cannabis in Australia, please visit https://www.tga.gov.au/medicinal-cannabis-guidance-documents
Format and administration
There are a number of medical cannabis formats including, dried flower (bud), vape concentrate, oil, oral spray and softgels.
Prescriptions can therefore be taken in a variety of ways:
- Inhalation: Dried flower and vape concentrate are inhaled. The effects are typically felt immediately, however it can take up to 30 minutes to reach full effect. Effects last anywhere from 2 to 4 hours.
- Ingestion and sublingual: Oil, oral spray and softgels can all be ingested or administered sublingually (under the tongue). Their effects are typically felt in the first two hours of administration, lasting anywhere from 6 to 8 hours.
- Topical: Oils can also be added to lotions, gels or creams that can be applied topically. The effects are typically felt immediately depending on the application site. Effects last for 1 or 2 hours and need to be applied frequently.
Dosage, concentration, individual biological factors and method of consumption will all affect your response time to feeling the effects of medicinal cannabis.
How is medicinal cannabis delivered in Australia?
Any pharmacy in Australia can dispense medicinal cannabis products as long as they meet the Department of Health’s requirements – but a doctor’s prescription is required. This prescription is only possible after the doctor receives approval for the patient from the TGA through the Special Access Scheme (SAS-B Application) or if the doctor is a TGA approved authorised prescriber.
How much does medicinal cannabis cost in Australia?
The Australian government does not fund medicinal cannabis products under the Pharmaceutical Benefits Scheme (PBS). This means that Australian patients need to pay the full cost of products themselves which will vary by patient depending on the type of product prescribed and dosage. Patients also need to pay for related medical costs and appointments.
Even though there is no government funding for medical cannabis under the PBS, from May 2021, Australians living with Dravet syndrome, a rare form of epilepsy, have access to Epidyolex® (CBD), the first medicinal cannabis drug to be subsidised by the Australian Government under the PBS. Epidyolex® as well as Sativex® (nabiximols; THC and CBD), which treats moderate to severe spasticity in multiple sclerosis, are two cannabis medicines which have been registered on the Australian Register of Therapeutic Goods (ARTG).
To make pain management treatments more accessible and affordable for Australian patients, Cannatrek has a number of initiatives in place with general practitioners, health professionals, and pharmacists. For a small number of patients, Cannatrek may be able to reduce costs through clinical trials or concession-based discounts. Although this is often not the case. To find out more, make contact with the Cannatrek team.
Medicinal cannabis: clinical trials
In recent years there has been growing interest globally and in Australia into the benefits of cannabis for medical purposes. Although research is in its infancy and well-designed clinical trials are limited, there have been some studies focused on the following key areas: epilepsy in children and adult patients, multiple sclerosis (MS), chronic non-cancer pain, chemotherapy-induced nausea and vomiting in cancer (CINV), and palliative care. For more information about these studies, please view the TGA’s Medicinal Cannabis Fact Sheet for Consumers.
Accessing medicinal cannabis in Australia
To find out whether medicinal cannabis is an appropriate treatment for you, the first step is to speak to your doctor or healthcare practitioner. If your doctor is willing to pursue this option, but is unsure about the process, your doctor (or you) can contact Cannatrek for more information.
If you believe you may be eligible to access medicinal cannabis, but your doctor is not willing to investigate this option, you can contact Cannatrek and we can connect you with a doctor who has experience in prescribing medicinal cannabis.
If you are already eligible for medicinal cannabis treatment and get in touch with us, we can streamline the process for you – from initial consultation, through TGA approval, to delivery of the prescribed product.
If you’re in Melbourne, Victoria, Sydney, NSW, Perth, Hobart, Brisbane, South Australia, Northern Territory, Tasmania, Western Australia, or Queensland and want to learn more about your eligibility or how to get started, speak to your doctor or make contact.