A Guide to
Medical Cannabis

What is Medicinal  Cannabis?

There is growing interest in the use of cannabis as a medicine as more people explore its healing benefits. It has been used for a variety of purposes for thousands of years, but the image of cannabis in western medicine is starting to improve.

Medicinal cannabis is any cannabis-based product prescribed to treat the symptoms of a medical condition. Most products are approved for use, under strict conditions, for the treatment of chronic non-cancer pain – arthritis, lower back pain, neck pain and various forms of neuropathic pain. In addition, there has been recognised benefit as a treatment option for endometriosis, anxiety, sleep disorders, chronic pain, multiple sclerosis, epilepsy and post-traumatic stress disorder.

While adult use (recreational) cannabis is illegal in all states and territories except ACT, medical cannabis is legal Australia-wide, however, eligibility requirements for patients do apply.

Medicinal cannabis is used as adjunct therapy. That means it is not considered a ‘first-line’ treatment for any health condition. A doctor will usually consider cannabis therapy for patients who have exhausted other options to manage their disease.

How does Medicinal Cannabis work?

The highly regulated landscape of medicinal cannabis is good news as it means that prescribed products have been tested, offer superior quality, and most importantly, are safe.

Safety is an important distinction to remember when understanding the difference between medicinal and recreational cannabis. Unlike the black-market products (illegal in Australia), with medicinal cannabis you have full transparency across the products pedigree.

The other important distinction is related to the cannabinoids. Cannabis contains chemicals called phytocannabinoids (commonly referred to as cannabinoids). There are more than 100 different types of cannabinoids found in cannabis plants. Cannabinoids can also be found in the human body, these are called endocannabinoids and they affect appetite, sleep, memory, pain and inflammation.

Cannabinoids

There are three general types of cannabinoids

Endogenous cannabinoids

known as endocannabinoids, which are produced naturally in the human body

Phytocannabinoids

such as those present in the cannabis plant

Synthetic cannabinoids

which are man-made chemicals synthesized to mimic the activities of a particular natural cannabinoid

Phytocannabinoids, such as THC and CBD – the primary active cannabinoids in the cannabis plant – have been shown to imitate cannabinoids that are naturally produced in the body (called endocannabinoids), leading to a therapeutic effect in patients with certain medical conditions. More than 100 cannabinoids have been identified in the cannabis plant, many of which have been shown to have medical value.

In addition to cannabinoids, the cannabis plant can contain up to 400+ additional chemical compounds, including terpenes – oils secreted in the same glands that produce cannabinoids, which are responsible for the aroma and colour of cannabis plants. Over 100 different terpenes have been identified in the cannabis plant, and every individual plant has a unique profile of terpenes and cannabinoids. The following infographic outlines the most commonly studied cannabinoids and terpenes in the cannabis plant.

Δ-9-tetrahydrocannabinol (THC) is a neutral cannabinoid, well known for being strongly psychoactive. Some studies have shown that THC has displayed therapeutic potential for the treatment of a variety of ailments and disorders including pain and nausea.

CBD has a very wide range of pharmacological actions but minimal intoxicating effects. CBD does not bind to CB1 receptors, so it does not have the same psychoactive effect. Early evidence suggests therapeutic actions of CBD at relatively high doses (300–1500 mg) in treating epilepsy, anxiety and psychosis. Numerous clinical trials are underway for other conditions such as neuropathic pain, drug and alcohol dependence and neurodegenerative disorders.

Cannabidiolic acid (CBDA) is a cannabinoid acid naturally produced in cannabis plants, most commonly found in raw hemp and marijuana plants. CBDA is the acidic form of CBD, meaning CBDA is the precursor to CBD. CBDA does not bind directly with cannabinoid receptors. CBDA interacts with the ECS by blocking the cyclooxygenase-2 enzyme from breaking down endocannabinoids. This may allow endocannabinoids to interact with cannabinoid  receptors more efficiently.

Cannabinol is a non-psychoactive cannabinoid that comes about from the oxidation of THC. It normally forms when THC is exposed to oxygen and heat. There is generally very little CBN in fresh cannabis plants.

Cannabichromene is a non-psychoative minor cannabinoid. Early research that has show potential as a treatment for anxiety and stress, inflammation, and pain.

Cannabicyclol is formed when cannabichomene (CBN) is exposed to light and degrades. Very little is known about its medical properties as it appears in much smaller concentrations than other cannabinoids.

Clinical Endocannabinoid Deficiency

Clinical Endocannabinoid Deficiency is a theory suggesting that certain health problems – migraines, fibromyalgia and irritable bowel syndrome – are directly connected to a lack of endocannabinoids.

The theory of clinical endocannabinoid deficiency suggests that in some cases the body does not produce enough endocannabinoids or enough receptors for the endocannabinoid system to function properly. As a result, the many functions aren’t regulated properly and the body becomes unbalanced, causing chronic illnesses.

Further research is required in this area, but some researchers believe that cannabinoids can help minimise disease symptoms by assisting the endocannabinoid system to function properly.

Stay informed