Complete Guide to Medical Cannabis (Medical Marijuana) & CBD Oil
First of all, what is cannabis?
Cannabis is a flowering plant which has existed for thousands of years. Humans have used the plant for recreational, medicinal, nutritional and other practical purposes (such as for clothing, rope or even as building material.
Depending on the location, cannabis may be permitted for medical reasons or potentially adult recreational use. Many people also use cannabis for treating medical conditions in their pets. In North America this is common, however in Australia, this requires a prescription from a veterinarian.
So, what is ‘medical’ cannabis?
Medical cannabis is any product of the marijuana plant that has been prescribed by a doctor to treat a medical indication. These medications are pharmaceutical preparations that include flowers, oils, tinctures, vaporisers, capsules, and other various formats.
How does medical cannabis work?
Cannabis contains ‘cannabinoids’ that interact with our bodies through an internal system called the endocannabinoid system (ECS). Our ECS helps balance various bodily functions including our regulation of pain & inflammation, our sleep cycle & memory, the way we process food, our immune response, our general cognitive ability, and more.
What are cannabinoids?
Cannabinoids are chemical compounds that are both produced by our bodies (known as endocannabinoids) and plants (known as phytocannabinoids). Phytocannabinoids work with our body’s ECS where it helps regulate our endocannabinoids. Over 100 phytocannabinoids are known to exist within cannabis, and this list continues to grow with more research. THC and CBD are the most well known cannabinoids and most products available are made from either one or a combination of these two.
What is THC?
Tetrahydrocannabinol (also known as THC) is the compound responsible for the intoxicating and euphoric effects associated with cannabis. Research has shown that THC plays a role in human therapy and may potentially reduce various symptoms of various diseases. See the TGA website for more information.
What is CBD?
Cannabidiol (also known as CBD) is a non-intoxicating compound that has therapeutic applications in humans. Research has shown that CBD may help with certain medical conditions and may also be able to reduce certain unwanted effects associated with THC. See the TGA website for more information.
Cannabis vs. marijuana vs. hemp?
Marijuana is the word most people use to refer to cannabis when used for recreational purposes. It has psychoactive, euphoric and relaxing properties that may be desired for pleasure. Often, people use marijuana to get ‘stoned’ or ‘high’ and experience a mildly dissociative sensation. In non-adult use markets, marijuana is typically unregulated, which results in a lack of consistency, quality or safety. This can lead to undesired side effects in some people.
Hemp
Hemp is a type of cannabis that contains very low levels of THC and is usually grown for more industrial and nutritional purposes, such as to produce hemp seed oil, rope and fabrics.
How do I access medical cannabis in Australia?
All Australian patients must speak with a doctor about whether medical cannabis is appropriate for their health needs. Doctors can only prescribe medical cannabis if the patient has tried a ‘first line’ therapy first and has been unsuccessful (either due to being ineffective or due to negative side effects). If a healthcare professional believes medical cannabis would be appropriate for your condition, they will either need to be an authorised prescriber of cannabis or alternative seek approval from the Therapeutic Goods Administration (TGA) in order to prescribe it. They will then be responsible for monitoring your treatment. A typical access pathway for medical cannabis may look like the following:
If eligible, book a consult
Choose a time to speak with a doctor about your personal circumstances. There are three necessary factors that enable patients to qualify for medical cannabis. These are:
- You must have a chronic condition (suffering for more than three (3) months).
- You must have tried traditional first line therapies (eg. pain-killers, benzodiazepines, etc).
- These first line therapies either did not work, or resulted in unwanted side effects.
Discuss your options for medical cannabis with the doctor
The doctor will assess your individual situation by investigating your medical and mental health history. They will consider any other treatments for your condition that have failed or resulted in undesired side effects.
Receive your medical cannabis product
If the doctor approves your condition for treatment with medical cannabis, he/she will write you a prescription. The doctor is then able to send your approval and prescription to the pharmacy, which will dispense your medical cannabis.
Monitor your progress
It is important to check back in with the doctor at regular intervals to see how your treatment is progressing, discuss any potential side effects or see if there might be a better medical product for your circumstances.
How do I consume medical cannabis?
Medical cannabis can be consumed in a variety of ways, including:
- By swallowing an oil, tincture, capsule or tablet
- By spraying a mixture into the mouth or under the tongue
- By heating a raw, dried cannabis flower and inhaling the vapour (vaporising).
Cannabis oil products have the active ingredients THC and/or CBD content measured as a ratio of the total oil. This is usually expressed in milligrams per millilitre (mg/mL). Depending on the condition, medical cannabis is prescribed at various dosages of CBD and/or THC. Always speak to a doctor when determining the dosage and frequency of medical cannabis medicines.
What are the side effects of medical cannabis?
Medicinal cannabis can have side effects, similarly to any other medication. These effects vary from person to person depending on their body, risk-factors and the type and dose of the medication. Side effects are more often associated with THC over CBD, but both have various symptoms reported.
Some known side effects of medical cannabis include:
- Confusion
- Fatigue
- Sedation
- Dizziness
- Nausea
- Vomiting
- Increased heart rate
- Changed appetite
- Dry mouth
- Diarrhoea
Products containing THC have been associated with:
- The feeling of being ‘high’
- Paranoia
- Anxiety
- Depression
- Confusion
- Hallucinations
- Psychosis
Dosing
As there is a risk of side effects associated with medical cannabis it is important to always listen to the doctor’s recommendation regarding dosage. Many adverse events occur due to improper dosing. Always tell the doctor as soon as possible when negative side effects have been experienced.
Is Cannabis legal in Australia?
Yes, cannabis is legal in Australia, provided it is prescribed by a doctor for medical purposes. This is true in all States and Territories in Australia, though the legislation varies slightly in each state.
Cannabis for recreational purposes is still illegal in almost every State and Territory, with the exception of the ACT, which passed laws that allow adults to grow a small amount of cannabis at home from late 2019. This is limited to a maximum of two (2) plants per person and four (4) per household. Further, each person is only allowed to possess a total of up to 50 grams of dried cannabis flower.
Legal vs. illegal cannabis
All cannabis obtained on the street or ordered online or without a prescription is illegal in Australia. Cannabis prescribed by a doctor and dispensed by a pharmacy is legal. This includes THC and CBD.
Risks of illegal cannabis, include that the products may:
- Be fake or never arrive, putting individuals at risk of being scammed.
- Contain different amounts of THC or CBD than advertised – which could cause it to be too strong or not strong enough this could either not work or end up too strong.
- Contain unknown contaminants, such as mould or pesticides.
- Have passed their expiry date, causing them to degrade or decay.
Legal medical cannabis medicine accessed in Australia:
- Is regulated for quality and safety against Australian pharmaceutical standards.
- Must contain accurate amounts of THC and CBD.
- Is prescribed by practitioners who are responsible for the patient’s health.
- Is not allowed to contain any mould, fungi, bacteria, pesticides, or substances that may be harmful to your health
What is CBD oil?
CBD oil is a tincture that contains CBD suspended in a fatty carrier oil (such as MCT or olive oil). This oil is different to hemp-seed oil, as it is produced from the cannabinoids containing flowers of the plant and not from its seeds.
Are all CBD oils the same?
CBD oils are not all the same. Different oils contain differing ratios of THC and CBD as well as the presence of other cannabinoids and/or terpenes and flavonoids depending on the genetics of their original strain. CBD oils can also have different carrier oils such as MCT oil, sesame oil or olive oil. The amount of cannabinoids and whether the extract contains the ‘whole plant’ defines whether the medicine is considered full spectrum, broad spectrum, or an isolate.
Purified CBD Isolate Oil
CBD isolate oil is made from purified CBD, which is the only active ingredient. Isolate is created by extracting CBD only and removing all other compounds found in the cannabis plant. This is then added to a carrier oil to create a tincture. CBD isolate oil is generally cheaper and contains no THC, which allows patients to continue driving while on the medication. The downside of CBD isolate oil is that it may not benefit from the ‘entourage effect’ like full spectrum oils, as all the other cannabinoids, terpenes and flavonoids are removed.
Full Spectrum CBD Oil
Full spectrum CBD oil contains all of the naturally occurring chemical compounds in that cannabis plant strain, including terpenes, flavonoids, and other cannabinoids. Studies have shown that all these compounds have a synergistic effect that increase the efficacy of cannabis, known as ‘the entourage effect.’
Broad Spectrum CBD Oil
Broad spectrum CBD oil is very similar to full spectrum CBD oil, with one key differentiator, the THC component is removed. This is an ideal option for patients looking to engage the entourage effect, without taking THC. Patients will not get high from this medicine, and may even still be able to drive.
Can I Drive on medical cannabis?
It is illegal to drive with any detectable amounts of THC in your body. Many patients use CBD isolate oil to ensure they do not have any THC in their body
What are terpenes?
Terpenes are aromatic chemical compounds found in the cannabis plant. They are similar to the chemicals found in essential oils and are thought to play a role in activating the ‘entourage effect.’ Terpenes help identify each cannabis strain by contributing to their smell and taste. They are predominantly found in female cannabis flower resin.
What are flavonoids?
Similar to terpenes, flavonoids are chemical compounds found in cannabis plants responsible for the colours, odours and flavours of different cannabis strains. Studies suggest that flavonoids may have advantageous effects on consumers, such as assisting patients with anti-inflammatory, anti-spasmodic and anti-emetic properties. It is thought that flavonoids may also contribute to ‘the entourage effect.’ There are hundreds of flavonoids in all plants, fruits and vegetables. Some flavonoids are only found in cannabis and are referred to as ‘cannaflavins.’
What is the entourage effect?
The ‘entourage effect’ is a hypothesis describing the interaction between cannabinoids, terpenes and flavonoids when consumed. It is thought that these chemical compounds work together to provide better therapeutic outcomes. It is thought that these interactions might explain why certain strains provide certain effects (both recreational and medicinal), such as feeling sleepy, euphoric or hungry (Russo 2011).
What are the other common cannabinoids?
Beyond THC and CBD, there are over 100 cannabinoids which have been identified in cannabis. Some of the more notable ones include:
- Tetrahydrocannabinolic Acid (THCA)
- Tetrahydrocannabivarin (THCV)
- Cannabidiolic Acid (CBDA)
- Cannabidivarin (CBDV)
- Cannabigerol (CBG)
- Cannabigerolic acid
- Cannabigerivarin (CBGV)
- Cannabichromene (CBC)
- Cannabichromenic acid (CBCA)
- Cannabichromevarin (CBCV)
- Cannabinol (CBN)