The world swings towards Medical Cannabis -Martin Oliver uncovers it’s past, present and future
While cannabis was formerly associated with hippies and the counter-culture movement, mainstream public opinion has recent swung rapidly in favour of its therapeutic uses.
Across the world, growing numbers of countries are passing laws to permit medical marijuana. Today there is a greater awareness that medical cannabis offers many health benefits, with minimal harmful side effects, and often without any psychoactive effects.
It is believed in China that a man named Shennong, translated as ‘divine farmer’, discovered the healing effects of marijuana around 2700BC. His treatments later appeared in the world’s oldest pharmacopeia published in 1AD. Cannabis was known to many other ancient cultures, including the Ancient Egyptians (for haemorrhoids and sore eyes), the Indians (for insomnia, headaches, gastrointestinal issues, and pain), and the Greeks (for earache.)
William Brooke O’Shaughnessy, an Irish doctor working in Calcutta during the 1830s, first researched the Indian use of therapeutic cannabis, and then introduced it into Western medicine. From the middle of the 19th century until prohibition in the first half of the 20th century, cannabis appeared in a range of patent medicines.
In the early 1990s, researchers were excited to discover an endocannabinoid system in the human body. Receptors designed only for cannabis were located in the nervous and immune systems, raising the fascinating question of whether humans are physiologically designed for cannabis use.
For a range of health issues, scientific studies are showing encouraging outcomes for medical cannabis. Some are pain conditions such as fibromyalgia, migraine, rheumatism and arthritis. Others include cancer, multiple sclerosis, AIDS, epilepsy and autism. Numerous cancer patients use marijuana to curb nausea during chemotherapy.
In the main, epilepsy has brought medical marijuana to the attention of many Australians.
For several young Australian children having hundreds of epileptic seizures a week, harried parents have found that only cannabis oil would help them. Favourable mainstream media coverage has highlighted the unfairness of penalising parents wanting to do what they have found alleviates their children’s epilepsy, and has pushed politicians to take steps towards legalisation.
Only the medical mainstream is being slow to accept the therapeutic value of cannabis, arguing a lack of quality studies, and is looking for more evidence before taking a stronger supportive position.
Selecting the right type
Medical marijuana options include vaping (vapourisation by heating to below the temperature where smoke is produced), foods, juices, oil, therapeutic products, and smoking. Compared to smoking, vaping has the advantage of avoiding the irritating toxins such as polynuclear aromatic hydrocarbons found in cannabis smoke.
Cannabis nerds point out that marijuana has more than 80 cannabinoids, and that with a few exceptions we do not fully understand how they operate. Best-known are THC (tetrahydrocannabinol) and CBD (cannabidiol), but others include a range of terpenoids and flavonoids. It has been speculated that taking multiple cannabinoids has a beneficial synergistic effect.
The primary psychoactive ingredient of marijuana, THC, is found in most varieties in reasonably strong doses. Coming onto the radar more recently is CBD, and for lawmakers it has the advantage of a lack of intoxicating properties.
Both THC and CBD have medical benefits: THC is good for pain, nausea and inflammation, while CBD benefits psychosis, seizures and anxiety. A range of CBD-THC ratios can be adjusted by selectively breeding special varieties.
Proportions range from 18 parts of CBD to one of THC (18:1) to equal measures of 1:1. For most users, 4:1 is mildly psychoactive, and 1:1 has fairly marked psychoactive properties.
Don’t be confused with the hemp seed oil in the fridge at the local wholefood store. Therapeutic hemp oil is a very different liquid that is usually rich in CBD and low in THC, and is often referred to as ‘CBD oil’. An exception is a variety known as Rick Simpson Oil or Phoenix Tears that tends to be high in THC.
While hemp oil remains illegal in Australia, except under an import scheme, anyone obtaining the domestically produced item on the unregulated black market needs to be aware that the CBD content is extremely variable, and there may be contaminants. Reports indicate that the cost is about $250 for a 15ml to 25ml bottle. On his website, Rick Simpson states that the only way to produce something you can trust is to make it yourself. As this involves the use of high-proof alcohol as a solvent, it is wise to do it outdoors or a well-ventilated space, following all of the necessary safety precautions.
Villains or heroes?
In 2005, Dr. Andrew Katelaris became aware of the benefits of medical marijuana, and paid the price of being struck off the medical register in order to produce it in form of hemp oil.
As in a dodgy spy movie, Dr Katelaris processes it in a secret location hidden behind a wardrobe, and supplies it illegally. During the past few years, he has noticed encouragingly that the repetitive pattern of arrests and legal challenges has stopped.
Tony Bower from Mullaways Medical Cannabis near Kempsey continues to produce medical marijuana tincture illegally and free of charge to around 150 families who have supplied him with medical certificates. As with Katerlaris, most of his dealings involve families with epileptic children, and 15,000 people are on his waiting list. He has so far avoided being jailed, partly in recognition of the valuable benefits his products offer.
At the time of writing, medical marijuana is legal, or essentially legal, in 25 countries, including Australia. Considering that the first country to legalise it was Canada, as recently as 2003, there has been a remarkable shift in attitude in a short time. On this issue, the leading progressive regions are North America, South America, and Western Europe.
It has also been legalised in 24 American states, and in late 2015 US federal legislation was passed that allows the states to pursue their medical marijuana policies without interference such as raids on medical marijuana dispensaries. Each American state has its own rules and a list of eligible medical conditions.
Australian politicians have been slow to give medical cannabis the green light, perhaps because they were wary of being accused of being ‘soft on drugs’ by the tabloid press. But public opinion is overwhelmingly positive, with a 2015 Roy Morgan poll indicating 91 per cent support. Legalisation occurred in February 2016, with advocates viewing this move as an important first step on a long road towards deciding on a framework and setting up an industry here.
Later in 2016, Queensland will be voting on a Bill to set up a doctor-based system involving prescriptions through select pharmacies, and is hopeful of bipartisan support. If successful, these would be Australia’s most progressive laws. New South Wales is about to start trials of Epidiolex and CBDV for children with epilepsy, and Victoria is pursuing a goal of being the first state to establish a cannabis oil industry by 2017.
Too slow coming?
While NSW Health Minister Pru Goward recently stated that Epidiolex would be available within three years, critics see this type of progress as too little and too slow. Some question the use of trials when numerous countries have given medical marijuana the go-ahead. Is it a delaying tactic?
Much of the pressure for legalisation is coming out of Nimbin, where medical marijuana is always a hot topic for discussion at the annual Mardi Grass festival. The Greens and the Nimbin Hemp Embassy support a liberal regime, where those who are medically eligible are permitted to grow small quantities of weed at home.
Currently the Therapeutic Goods Administration (TGA) operates a Special Access Scheme (SAS), under which a few natural and synthetic cannabis products can be imported, but a lot of red tape is involved, including the need for support from a doctor. Compared to naturally derived products, users tend to find that synthetic alternatives have weaker therapeutic powers, possibly because they lack the full spectrum of marijuana cannabinoids.
More liberal laws would save affected families a lot of money.
Joelle Neville, of Perth, Western Australia, whose daughter is epileptic, was recently reported as paying a steep $180 a week for a product made by the US company Elixinol, imported under the SAS. Unfortunately she is financially unable to give her daughter the full dosage that could benefit her the most. Legalisation of hemp oil would bring down the price a long way.
The pharma angle
Medical cannabis has the advantage of avoiding the harmful long-term side effects often encountered with pharmaceuticals. Where legal, it is substituting some key pharmaceutical drugs for conditions such as depression, insomnia, ADHD, anxiety, and pain. According to a 2014 study in JAMA Internal Medicine, there has been a 25 per cent drop in opioid-related deaths in American states where medical marijuana is legal.
The pharmaceutical sector will lose out unless these billions of dollars are recouped through marijuana products, and an increasing number of players are positioning themselves for a slice of what looks like a very large pie. One interested market leader is G. W. Pharmaceuticals in the UK, which produces Epidiolex, and Sativex for multiple sclerosis spasms.
However, patented products come with a high price tag that dwarfs the simpler home made unbranded alternative. This expense will have to be shouldered by a patient’s family, or by the taxpayer if Pharmaceutical Benefits Scheme status is approved.
Medical marijuana supporters such as Michael Balderstone from the Nimbin Hemp Embassy see a risk of medical marijuana being introduced into Australia in a controlled fashion, with only pharmaceutical products permitted.
Medical cannabis and roadside testing
Australian states are running roadside drug testing programs that sound like a good idea on the surface, but become problematic under close examination.
Unlike alcohol, where the blood alcohol measurements are scientifically based on the risk of impairment, roadside tests target a select group of three drugs including marijuana. They are tested to the most sensitive level possible, under a ‘zero tolerance’ regime that is incompatible with the growing availability of legal medical marijuana in Australia.
Despite a global push to roll out this type of testing program, Australia is so far the only country to have introduced it, which raises further questions about its appropriateness. This ‘tough of drugs’ strategy will have to change for medical marijuana to become more widely available here.
Martin Oliver is a writer and researcher based in Lismore (Northern NSW).
Dr. Andrew Katelaris
Mullaways Medical Cannabis
Rick Simpson Oil
Special Access Scheme