Cannabis Topicals and How They Work

 

Tens of millions of Americans are afflicted with chronic pain and many are seeking safe, non-addictive solutions to ease their suffering. So too in Australia, where 67% or 11.1 million people aged 15 years and over reported experiencing bodily pain in the previous month (2012). Around one in ten (9%) experienced severe or very severe pain, and many adults experienced chronic pain. Research suggests Cannabis topicals could provide relief for sufferers of ailments ranging from sports injuries and migraines to skin conditions such as acne, eczema and psoriasis. Image result for cannabis topicals

Topicals represent one of the fastest-growing segments of the legal Cannabis marketplace in the United States. Scientific bodies confirm Cannabis has pain-relieving properties. But to fully understand how topicals can relieve pain and other ailments, we need to take a quick tour of the human Endocannabinoid System (ECS). The ECS is a vast network of receptors throughout the body. It’s responsible for modulating many physiological systems involving the brain, endocrine, immune and nervous systems. Researchers have found the ECS is essential for maintaining homoeostasis, or balance, in these various systems.

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There are two main types of receptors or ‘message receivers’ in the ECS, classified as CB1 and CB2 receptors. CB1 receptors are predominantly located in the brain and central nervous system; CB2 receptors are primarily in the peripheral nervous system. The messages these receptors receive are actually chemicals that bind to the receptor and either activate it or shut it down, producing a corresponding effect within the body. 

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The chemical compounds in Cannabis that interact with the ECS are called cannabinoids, with the most well-known being neuroactive delta-9-Tetrahydrocannabinol (THC), which activates CB1 receptors in the brain to create euphoria. More than 100 cannabinoids have been identified in the Cannabis plant including cannabidiol (CBD) and others like cannabinol (CBN), cannabigerol (CBG) and tetrahydrocannabivarin (THCv), whose various medicinal properties are under escalating scrutiny.

When you apply a Cannabis topical to your skin, the cannabinoids interact with CB2 receptors in your epidermis and muscles. In a 2016 report in Cellular and Molecular Life Sciences, researchers found when CB2 receptors were the targets, the result was reduced inflammation, an immune response that plays a role in many ailments including skin conditions and chronic pain. Unlike anti-inflammatory medications, Cannabis topicals can be used without risking unpleasant potential side effects or overdose. Image result for cannabis topicals

Some Cannabis topicals contain THC, but when applied to the skin, the cannabinoids don’t actually enter the bloodstream. Instead, THC interacts with the ECS receptors outside the blood-brain barrier. A research review in Molecular Pharmacology concluded, “activation of CB2 receptors does not appear to produce … psychotropic effects”. Topicals allow consumers to localise and directly target an afflicted area to reduce inflammation. People can and do ingest Cannabis via smoking, vaping or edibles for generalised pain relief, but many prefer to single out that aching knee or sore neck by applying a topical directly. Image result for cannabis topicals

Some research even indicates cannabinoids may accelerate our bodies’ natural healing process. A 2005 study on CB1 and CB2 receptors in the gastrointestinal system found that cannabinoids can promote the healing of epithelial wounds. Our skin is composed of epithelial cells, which also line the surfaces of our organs and blood vessels. So, Cannabis topicals may also promote a quicker healing response for skin conditions and injuries. Perhaps best of all, Cannabis topicals offer consumers a simple, safe and low-stakes entryway into exploring the wellness benefits of Cannabis.

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Many people still harbour fears about Cannabis, but topicals are approachable and in many ways, the best ambassador for the Cannabis plant’s pain-relieving and healing capabilities. The emerging research is clear in showing the tangible ways Cannabis topicals work with our bodies. Just let that knowledge soak in.

Adapted from How Cannabis Topicals Actually Work: A Deep Dive into Your Body’s CB1 / CB2 Receptors (Author Dahlia Mertens is the founder and CEO of Mary Jane’s Medicinals)

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Cannabis for Seizures

A cutting edge paper published in early 2017, from three American physicians, Dustin Sulak, Russel Saneto and Bonni Goldstein, outlined case reports and the applications of Cannabis medicines for epilepsy and seizure disorders.

Highlights: 

  • Physicians have documented the efficacy of artisanal whole plant Cannabis preparations for seizure reduction.
  • In a study of 272 patients, 86% had some degree of seizure reduction while using artisanal Cannabis.
  • A combination of cannabinoids and terpenes, not just CBD, may be most effective for seizures.
  • These clinical findings challenge Big Pharma assumptions that favour single-molecule medications.

Cannabis clinicians treating epileptic patients in three American states, California, Washington and Maine, reported their findings in a peer-reviewed article that underscores the complex challenges and unique therapeutic potential of Cannabis oil concentrates. In this uncontrolled observational study involving 272 patients, some degree of seizure reduction was noted in 86% of cases; 10% (26 patients) experienced complete seizure remission. In addition to documenting the efficacy of “artisanal” (meaning not FDA-approved) Cannabis preparations for seizure reduction, the article highlights the need for flexible treatment protocols involving different cannabinoid ratios, an approach that implicitly calls into question single-molecule strategies favoured by Big Pharma. What follows are excerpts from “The current status of artisanal cannabis for the treatment of epilepsy in the United States” by Dustin Sulak, Russell Saneto and Bonni Goldstein in the journal, Epilepsy & Behavior:

“Of 272 combined patients from Washington state and California, 37 (14%) found Cannabis ineffective at reducing seizures, 29 (17%) experienced a 1-25% reduction in seizures, 60 (18%) experienced a 26-50% reduction in seizures, 45 (17%) experienced a 51-75% reduction in seizures, 75 (28%) experienced a 76-99% reduction in seizures and 26 (10%) experienced a complete clinical response. Overall, adverse effects were mild and infrequent and beneficial side effects such as increased alertness were reported. The majority of patients used cannabidiol (CBD)-enriched artisanal formulas, some with the addition of delta-9-tetrahydrocannabinol (THC) and tetrahydrocannabinolic acid (THCA)”.

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The authors maintain that artisanal Cannabis products should be considered for patients with refractory epilepsy that have a low likelihood of responding to FDA-approved anti-epileptic drugs (AEDs). Moreover, a combination of cannabinoid compounds, not just CBD, may be more effective for seizure reduction.

“The patient population that considers herbal Cannabis as a treatment for epilepsy is heterogeneous in etiology, currently predominantly paediatric and has seizures that are usually refractory to multiple conventional treatments. The cannabinoids may reduce seizures via numerous mechanisms of action that warrant further investigation including THC’s reduction of glutamate exotoxicity via the CB1 receptor, CBD’s modulation of numerous non-cannabinoid receptors and several proposed targets of THCA. Objective measurement of treatment response can be challenging and subjective reports of the efficacy of artisanal Cannabis can be strongly influenced by the placebo effect, especially in patients that have invested significant resources into securing access to these formulas”.

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Several other challenges are cited by the authors:

“Availability of a consistent supply of the medication is frequently interrupted due to horticultural, manufacturing and economic factors. Current market prices for artisanal Cannabis preparations observed in Maine, California and online range from 5 to 50 cents per milligram. Higher dosing ranges are financially unfeasible for many patients unless they grow and produce their own medicine, a complex process that presents many potential interruptions in treatment. Sudden loss of access to cannabinoids may result in rebound seizures. The potential for disruption of medical treatment or family structure related to child protective services and other legal agencies, even when the patient and medical provider operate within state laws, must also be carefully considered on a case-by-case basis”.

There are also serious issues of quality control with respect to artisanal Cannabis preparations used by epilepsy patients.

“Inaccurate product labelling is pervasive in this new and often-unregulated industry. A 2015 study of edible Cannabis products available in Seattle, San Francisco and Los Angeles found that of 75 products examined, 17% were accurately labelled for cannabinoid content, 23% were inaccurate with higher than labelled concentrations and 60% contained lower than labelled concentrations. Many patients purchase and use purportedly CBD-dominant “hemp” formulas that are sold online and shipped across state and international borders. Patients are led to believe that such products are legal, even in states without medical Cannabis laws, despite the fact that CBD remains classified as Schedule One. In 2015 and again in 2016, the FDA published analytical results of several commercial CBD products and issued warning letters to their manufacturers. Many products were under-labelled for  CBD content, contained no CBD, or contained significant amounts of THC”.

Image result for inaccurate product labelling california cannabisThe authors referenced the clinical trials of Epidiolex, a CBD isolate developed by GW Pharmaceuticals, evaluated at a dosing range of 2-50 mg/kg/day. Artisanal Cannabis preparations have a wider therapeutic window than Epidiolex (which has caused other drug poisoning) and are safe and effective at various dosages in clinical practice.  One of the authors, Dustin Sulak, observed anti-convulsive effects in patients at doses as low as 0.02 mg cannabinoids per kilogram per day. Ultra-low doses of cannabinoids have been shown to be physiologically active in pre-clinical models: a single application of 0.002 milligrams per kilogram of THC to mice induced long lasting activation of protective signalling in molecules in the brain. Cannabinoids trigger biphasic responses depending on dosage.

Low doses and high doses can elicit opposite effects and this should not be unexpected in clinical practice. The authors comment on the clinical implications of potential biphasic dose-response trends in the anticonvulsant of activity of THCCBD and other modulators of the endocannabinoid system. The extraordinarily wide dosing range of Cannabis is complicated by non-linear dose-response relationships. Clinicians are cautioned to avoid making the simple assumption that higher doses of cannabinoids will yield stronger therapeutic effects. If previous clinical improvements begin to diminish, especially after a dosage increase, clinicians may consider dosage reduction as a potential strategy to improve efficacy. The authors also discuss the use of tetrahydrocannabinol acid (THCA) for seizure reduction.main-cannabinoids

“Delta-9-THC acid is becoming a popular treatment approach for patients with epilepsy in legal states and is sometimes more readily available and/or affordable than CBDTHCA does not produce psychoactive effects in animals at relatively high doses and psychoactivity has not been observed in humans. Though most THCA-dominant preparations will contain at least trace amounts of THCTHCA does not convert into THC in vivo.

In one case, THCA-rich therapy proved effective when treatment with CBD and THC  failed to deliver satisfactory results. Specific terpenes, such as linalool (present in lavender and various Cannabis cultivars), may also confer anticonvulsant effects.

“Low-dose CBD at 0.05 mg/kg/day reportedly improved cognition, but higher doses of CBD caused an increase in myoclonic seizures. THC at 1 mg/kg/day reportedly produced a 4-day seizure-free episode, followed by recurrence of seizures. At 2 mg/kg/ day, THCA resulted in a reported overall 90% seizure reduction and improved tolerance to temperature fluctuations. At one point a new formula of THCA at the same dosage resulted in notably decreased efficacy. A terpenoid analysis of the previous formula demonstrated the presence of high levels of alpha-linalool, absent in the less effective formula. Returning to a THCA formula based on the linalool-dominant chemovar improved her response.

Whereas pharmaceutical companies focus on single-molecule compounds, clinical practice indicates that patients with seizure disorders are more likely to benefit if they have access to a range of whole plant artisanal Cannabis preparations, not just CBD. The authors concluded that despite the inherent challenges in the clinical use of artisanal Cannabis preparations, patients with refractory epilepsy do benefit. To avoid issues related to the variability of artisanal preparations, clinicians can measure serum cannabinoids levels and patients or their families should be advised not to rely on product labels, but to test every batch of medicine for cannabinoid potencies and potential contaminants at analytic laboratories using industry-standard methods. Clinicians can navigate the cannabinoid dosing nuances by providing patients with individualised, methodical titration instructions.

Read the entire paper, “The current status of artisanal cannabis for the treatment of epilepsy in the United States” (six page pdf)

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Adapted from Medical Marijuana for Seizures

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Higher Cannabis Education – Bridging the Clinical Gap

Cannabis and its role as a medicine is gaining prevalence, despite a distinct lack of governmental recognition of its true medicinal value. Isn’t it about time doctors, all those professionals with their knowledge purportedly rooted in science and reality, gain an adequate Cannabis education? How else can doctors possibly give their patients guidance? Every health expert should know about the Endocannabinoid System (ECS) and that almost every living creature with vertebrae has one. Named after the plant that led to its discovery, Cannabis, the Endocannabinoid System is one of the most widespread and powerful physiological control systems in the human body. It helps balance nearly every metabolic process in the body, from fertility to pain perception to emotion and so much more.
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Pointedly, several different chronic diseases and conditions are thought to be a direct result of an ECS imbalance or dysfunction. Understanding how the ECS works with respect to both our endogenous (from within) cannabinoids (endocannabinoids) and those exogenously (externally) produced, like in the Cannabis plant (phytocannabinoids), is undeniably vital to human physiology. Given its significance, most conventional health professionals know very little about Cannabis and ECS science. An independent survey by Dr David Allen, an American 30-year veteran heart and general surgeon, showed only 13.3% of the 157 accredited US medical schools taught or offered any type of endocannabinoid and/or Cannabis education. Dr Allen himself claims the ECS is the “single most important discovery in modern medicine since the recognition of sterile surgical technique”.Image result for ECS is the single most important discovery in modern medicineWith such little Cannabis education, it’s no wonder most doctors are so ill-equipped to effectively treat patients with Cannabis. The inability of physicians to guide patients in regard to Cannabis is essentially creating a “clinical gap” between patient and provider.  Cannabis is a versatile yet relatively safe and sophisticated living medicine. Millions worldwide turn to it for relief for numerous ailments every single day. Cannabis breaks the boundaries and limitations of single-molecule synthetic drugs and trumps other plant species with its intra-species diversity and vast clinical applications. For many patients however, navigating the waters of Cannabis therapy can be frustrating and difficult without expert, educated medical guidance on how to approach Cannabis treatment. While knowing that “CBD is good for inflammation” for example, educated Cannabis physicians will understand the lipophilic (“fat-loving”) nature of cannabinoids like CBD, and how they must be used consistently to allow for its “accumulation” in one’s body. The truth is, Cannabis is a complex and tricky plant.

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Sceptics continue to decry, “there isn’t enough research!” Yes, we do need more research around Cannabis. Yet, we already know more about it than most realise. Go to PubMed.gov (US repository for medical literature) and you’ll find over 28,000 studies published on Cannabis, whilst the likes of Ritalin will give over 8,600 results. Aside from this, Cannabis has been recognised as a medicine for thousands of years. Prohibition is fairly recent compared to that and is backed by zero science.  Prohibition also fails to account for the body’s own Endocannabinoid System and how Cannabis has proven to be an excellent supplement for this system, relieving many different types of ailments and conditions. Countries like Israel are light years ahead in their Cannabis research and clinical experience. Image result for israel cannabis researchCannabis has a lot of catching up to do when it comes to large-scale, double-blind, placebo-controlled trials. However, we know enough about the plant and the Endocannabinoid System that this shouldn’t prevent us from embracing it now. The only way we can begin to optimise cannabinoid therapy for patients is by breaking the mould and integrating Endocannabinoid and Cannabis education into the medical curriculum, as well as those in other sectors of healthcare (e.g. nurses etc). In the US, while the DEA continues to stonewall research attempts due to federally restrictive scheduling of Cannabis, there is absolutely nothing stopping allopathic medical schools from teaching future doctors what we do know about the Endocannabinoid System (which is a lot). American Osteopathic and Naturopathic medical schools have already begun, putting them at a clear advantage over their allopathic counterparts.    0000ECSandBodilySystems

The Endocannabinoid System is arguably involved in almost every physiological and biological process involving who we are and the status of our health. We can either pretend this incredibly significant element of the human body doesn’t exist (not recommended), or we can do something about it and start implementing evidence-based Cannabis education into healthcare curriculums around the world. Patients deserve the best, safest and most effective care medicine has to offer. Humanity deserves the opportunity to continue its pursuit of knowledge of the biomechanical and physiological workings of the human body. The mainstream medical community can no longer stand on the sidelines as they do in the US, simply authorising patients for a ‘medical cannabis’ card is not enough. The time to bridge this clinical gap is now; not just for the sake of the patients and physicians, but for all of us.

Adapted from Higher Education: Bridging the Clinical Gap in Medical Cannabis

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Therapeutic and Medicinal Uses of Six Cannabinoids

Cannabinoids are a diverse class of chemical compounds produced in plants like Cannabis, endogenously in many animals and, synthetically. Those produced in plants are known as phytocannabinoids, the most well-known source of which is the Cannabis plant. They are able to illicit physiological effects chiefly via their ability to act on receptors in the human Endocannabinoid System (ECS), primarily by their interactions with the CB1 and CB2 receptors. To date, 113 cannabinoids have been  isolated from the Cannabis plant, many of which have been linked to potential medicinal benefits, from killing cancer cells to reducing pain and anxiety. Cannabis contains a treasure trove of compounds with potential medical uses. Highlighted here are the medicinal uses of six of the more studied cannabinoids, offering a glimpse into the incredible potential of the Cannabis plant.


THC – Tetrahydrocannabinol

THCJuly2018

  • The FDA has approved THC for the treatment of: anorexia in AIDS patients, nausea and vomiting in cancer chemotherapy patients, muscular spasticity in multiple sclerosis (when combined with cannabidiol)
  • Clinical evidence supports the potential use of THC for the treatment of: muscular spasticity following spinal injury, fibromyalgia, peripheral neuropathic pain, glaucoma, post-traumatic stress disorder (PTSD)
  • Preclinical evidence supports the potential use of THC for the treatment of: multiple cancers, sleep disorders, opiate addiction, depression

CBD – Cannabidiol

CBDJuly2018

  • Clinical evidence supports the potential use of CBD for the treatment of: Epilepsy, Parkinson’s disease, pain, anxiety, inflammatory bowel disease (IBD), Crohn’s disease, schizophrenia, muscular spasticity in multiple sclerosis, glioblastoma (when combined with THC)
  • Preclinical evidence supports the potential use of CBD for the treatment of: Alzheimer’s disease, Huntington’s disease, hypoxic-ischemic injury, depression, multiple cancers, nausea, inflammatory diseases, rheumatoid arthritis, antibiotic-resistant bacterial  infection, cardiovascular disease, diabetes-related complications

THCV – Tetrahydrocannabivarin

THCVJuly2018

  • Preclinical evidence supports the potential use of THCV for the treatment of: Obesity, Type 2 diabetes, Alzheimer’s disease, osteoporosis, Parkinson’s disease, epilepsy, anxiety, PTSD

CBN – Cannabinol

CBNJuly2018

  • Clinical evidence supports the potential use of CBN for the treatment of: Sleep disorders
  • Preclinical evidence supports the potential use of CBN for the treatment of: Antibiotic-resistant bacterial infection, pain, allergic airway diseases, Crohn’s disease, rheumatoid arthritis, appetite loss, seizures

CBG – Cannabigerol

CBGJuly2018

  • Clinical evidence supports the potential use of CBG for the treatment of: Psoriasis, eczema
  • Preclinical evidence supports the potential use of CBG for the treatment of: Glaucoma, neuropathic pain, antibiotic-resistant bacterial
  • infection, IBD, ulcerative colitis, Crohn’s disease, multiple sclerosis, multiple cancers, autoimmune encephalomyelitis, appetite loss

CBC – Cannabichromene

CBCJuly2018

  • Preclinical evidence supports the potential use of CBC for the treatment of: Multiple cancers, osteoarthritis, inflammation (when combined with THC), acne, depression (when combined with THC and CBD)

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Is the Government Removing ‘Medical Cannabis’ Competition?

This man was arrested for giving patients Cannabis medicine for free. Despite purported legalisation, it remains extremely difficult to access ‘medical Cannabis’ in Australia. 

Prominent Cannabis Grower Tony Bower Is Arrested For Gifting Cannabis Oil To Patients
Tony Bower – If You Can, Please Support His Legal Fund

Mullaways-Medical-Cannabis

On 28th March 2018, police arrested prolific Australian Cannabis grower and founder of Mullaways Medical Cannabis (company registered 21 October, 2008), Tony Bower. His company develops Cannabis-based medicines to treat a variety of illnesses and conditions, including chronic pain, epilepsy (particularly intractable paediatric forms), cancer/s and the likes of multiple sclerosis. As a result of his arrest, over 150 individuals who rely on his Cannabis-based treatments will need to look elsewhere, at least in the short term. Tony’s wife, Julie, said the couple had only a relatively small amount of Cannabis oil left in stock at the time of Tony’s arrest. 

“A 62-year-old Crescent Head man remains in custody following his latest appearance in court on three drug-related charges. Police executed a raid on a property near Kempsey. Anthony Bower was charged by police from the Mid North Coast Police District after they executed a search warrant with assistance of the Dog Unit. Police facts allege they located a large amount of cash, Cannabis leaf and 280 plants. Bower was arrested and charged with cultivating prohibited plant, deal in proceeds of crime, possess prohibited drug and supply prohibited drug. He was refused bail and remains in custody. His next court appearance is on 20 June”.

Tony waits in the Mid North Coast Correctional Centre for a June bail hearing after bail was refused in Local Court as he was deemed a high risk of ‘re-offending’. Anyone who knows, or has heard of, Tony, ‘Mullaway’, knows he is anything but criminal. To even suggest such seems, in effect, criminal, as laws based on lies are ‘pretend laws’ after all! However, the authorities have been trying to stop him and his important, life-saving work for years. Tony’s first time in court for growing and supplying Cannabis was in 1998, charged for cultivation. In 2013, he was charged with possession. Sentenced to one year’s incarceration, he appealed and was released after only six weeks. The following year, caught with more Cannabis plants, he was charged once again.

“A pretend law, made in excess of power, is not and never has been a law at all. Anyone in the country is entitled to disregard it”, Chief Justice Sir John Latham, 1942, South Australia v Commonwealth.

Mullaways_Medical_Cannabis_Research_Crop
Tony has long experimented with plant breeding to cultivate safe cannabinoid medicines. From Mullaways’ website;

“The Research by Mullaways Medical Cannabis has made it possible for the first time to; Design, Cultivate, Trial and Evaluate Cannabinoid Treatments using SAFE Doses of Cannabinoids / THCA / THC. While the rest of the Medical Cannabis Research world tries to genetically engineer Cannabis without any THC or tries to produce a rich Blend of Cannabinoids / THC from low THC Cannabis Mullaway’s Research has already produced the Jewel in the Crown of Medical Cannabis Research”.

However, Tony’s plans have been put on hold as he once again sits behind bars. In February 2016, Australia officially legalised ‘medical Cannabis’. Since then, government has signalled its intention to expand its ‘medical Cannabis’ operations, stating it would approve exports, becoming the fourth country in the world to do so. The country’s health minister said his government aims “to give farmers and producers the best shot at being the world’s number one exporter of medicinal Cannabis”.

Mullaways

Without legal permits, Tony was an easy target for law enforcement. But many in the community see Mullaways’ independent operation as a necessary alternative to the government-run, overly bureaucratic program. Many patients report accessing ‘medical Cannabis’ in Australia remains difficult. According to some estimates, only roughly one in ten users has been granted permission to access Cannabis legally, regardless of the government streamlining the current convoluted process.


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Thank you for your interest.

Adapted from Prominent Cannabis Grower Tony Bower is Arrested For Gifting Cannabis Oil to Patients with Man remains in custody on cannabis charges, Patient Access to Medicinal Cannabis Products in Australia

Legal Status of ‘Medicinal Cannabis’ in Australia

‘Medicinal cannabis’ is usually prescribed to treat the effects of certain conditions such as pain management, epilepsy management, joint degeneration, improved movement, appetite stimulation for weight gain, reduce nausea and vomiting, slowing degeneration of neural pathways and mood.

Specific conditions treated include cancer, neuropathic pain, multiple sclerosis, HIV/AIDS, spinal cord injury, diabetes, end-of-life illnesses, treatment-resistant epilepsy, arthritis, Crohn’s disease, patients undergoing chemotherapy, Alzheimer’s disease, anxiety, depression and sleep disorders.

While the recreational use of cannabis remains illegal across all federal, state and territory laws, most jurisdictions permit the prescription of ‘medicinal cannabis’ under specific circumstances.

The following is the current legal status regarding the prescription of ‘medicinal cannabis’ in each jurisdiction:


act
Australian Capital Territory: Legal if prescribed by medical practitioner who is duly authorised under Commonwealth and territory law to do so. More information here.

Information regarding obtaining authorised prescriber approval from the TGA can be found on the TGA website at https://www.tga.gov.au/

Information regarding importation of ‘medicinal cannabis’ products can be found on the Office of Drug Control website at https://www.odc.gov.au/

Application for approval to prescribe medicinal cannabis

Follow the link for information on the ACT Medicinal Cannabis Medical Advisory Panel.


NSWHealth-logo
New South Wales: Legislation was passed in 2016 that makes certain cannabis-based products allowed for medicinal use in appropriate cases; for example, in treating chemotherapy induced nausea and vomiting. Under the policy, doctors have to apply to relevant authorities in order to prescribe cannabis-based products. These changes were made with the Poisons and Therapeutic Goods Amendment (Designated Non-ARTG Products) Regulation 2016 and came into effect on the 1 August 2016. More information here.

Further questions about the Medicinal Cannabis Compassionate Use Scheme should be directed to www.dpc.nsw.gov.au/contact

Fact sheet for adults and their carers (60.9 KB)

Fact sheet for NSW medical practitioners (59.7 KB)

Registration form (138.7 KB)


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Northern Territory: Not legal. Cannabis is listed as a prohibited drug. More information here.


QGovt
Queensland: Legal by prescription from a specialist for patients with a range of conditions including multiple sclerosis, epilepsy, cancer and HIV/AIDS. See Public Health (Medicinal Cannabis) Act 2016More information here.


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South Australia: Legal by prescription from doctors under certain conditions. More information here.

Patient Access to Medicinal Cannabis in South Australia overview (PDF 228KB)

Factsheet: Prescribing medicinal cannabis in South Australia (PDF 192KB)


Tasmanian-Government_logo
Tasmania: There is a Controlled Access Scheme which allows patients to access unregistered ‘medicinal cannabis’. This did not require legislative change. Commonwealth law means that Therapeutic Goods Administration (TGA) approval is still required to access ‘medicinal cannabis’ products approved under the scheme. More information here.


Victoria-Department-of-Health
Victoria: Legal for use by children with severe, treatment-resistant epilepsy, under the Access to Medicinal Cannabis Act 2016 . The legislation enables access to locally manufactured ‘medical cannabis’ products for a defined group of patients. More information here.

Fact sheet: Information for patients and carers

Fact sheet: Information for medical professionals

Victorian treatment permit


wa-gov-healthywa-logo
Western Australia: Legal by prescription from doctors under certain circumstances under the Misuse of Drugs Act 1981 [WA]. More information here.

Medicinal cannabis FAQs fact sheet (PDF 761KB)


 

Extract from Drug and alcohol policy – what about medicinal cannabis?

How Cannabis Works to Control Pain and Anxiety

Image result for the limbic system

The Limbic System

Cannabis is well known as a herbal painkiller, but is also increasingly being used in other conditions involving the limbic system, sometimes referred to as the mid or so-called reptilian brain. So, just how does Cannabis cause these effects? Cannabis contains over 500 compounds, 80 of which are cannabinoids. Many of these compounds have medicinal value and research continues to provide more knowledge about how they work. The medicinal effects of Cannabis are mediated by the Endocannabinoid System (ECS). The system includes two neurotransmitters (anandamide and 2AG) two receptors (CB1 and CB2) and two enzymes (MAGL and FAAH). The ECS is responsible for modulating neurotransmission and cannabinoids regulate the ECS. There are two types of cannabinoids, those produced by the human body, endogenous cannabinoids, and those sourced from the Cannabis plant, the phytocannabinoids. An increase in cannabinoids, either endogenous or phyto, increases the amount of the neurotransmitter dopamine to the brain.

endocannabinoids

Cannabinoids work differently to any other neurotransmitter. Instead of stimulating the next neuron on the pathway up the central nervous system, endocannabinoids actually double back to the presynaptic neuron from the post synaptic neuron they just stimulated and de-polarise the pre-synaptic neuron. This is referred to as retrograde inhibition. This depolarisation of the pre-synaptic neuron occurs by causing release of dopamine, which reverses the concentration of sodium and potassium inside and outside the cell. This depolarisation makes it harder for the pre-synaptic neuron to be stimulated by the next neural impulse being transmitted by the nervous system. The effect of this is a slowing down of neurotransmission which is ideal in pain management and control.

Image result for retrograde inhibition

Endocannabinoid Retrograde Inhibition

Migraines are caused by an overload of the electrical circuits in a certain part of the brain, so slowing down the speed of neurotransmission leads to fewer neural impulses. This in turn decreases the likelihood or severity of a migraine. That is not the only effect, CaImage result for reptilian brainnnabis is an anti-nauseant as well, but probably exerts that effect in some other manner. The same thing is true of people who have panic attacks, if the negative thoughts are moving to the brain at warp speed, the limbic system (emotional control centre of the brain), is overwhelmed and there is little or no time for the frontal cortex to override the more primitive mid or reptilian brain. This makes us more likely to act before we think. That is because the reptilian brain sees things in terms of black and white, life and death. This mechanism may have served our ancestors well in the time of sabre-toothed tigers, but in modern day it is more often not very helpful. Much in modern life is shades of grey and more nuanced than life and death.

Cannabis slows down the speed of neurotransmission, exposing the cerebral cortex to fewer slower moving neural stimuli. This allows the higher centres of the brain to more rationally assess relative danger or the negativity and put a more rational point of view on that sensory input, often taking the edge off anxiety or preventing a panic attack. In medical school, doctors are taught 70% of the brain exists to turn off the other 30%. Dopamine is one of the “off switches” that helps modulate sensory input. One suggestion is that Cannabis and cannabinoids increase the amount of free dopamine in the brain by preventing the dopamine from binding to another neurochemical dopamine transporter. The transporter and dopamine form an electrochemical bond that ties up the dopamine so that it is not free to act as an “off switch”. These cannabinoids replace the dopamine and the amount of free dopamine available to depolarise the presynaptic neuron also increases.

dopamine

And that’s just pain and anxiety. There are a host of conditions that appear to be tied to an endocannabinoid deficiency syndrome that has been postulated by such scientists as pharmacologist Danielle Piomelli, PhD and neurologist, Ethan Russo, MD. The possible cause of an endocannabinoid deficiency syndrome is most likely genetic and due to the fact that most, if not all, human characteristics are distributed on a bell shaped curve – some of us have less of the constituents of the ECS and some have more. It is not clear that is the explanation or the only explanation for Clinical Endocannabinoid Deficiency  (CECD), however, if there is a lower amount of free dopamine present in the brain, neural impulses will likely move more rapidly.

Image result for endocannabinoid deficiency syndrome

This mechanism of slowing the speed of neurotransmission, retrograde inhibition, contributes to the treatment of many conditions that respond to cannabinoids and Cannabis. Cannabinoids compete with dopamine for the binding sites on the dopamine transporter, and in sufficient quantity they win, which frees up more dopamine to slow down the speed of neurotransmissions. This, according to many cannabinoid researchers, is responsible for much of the therapeutic value of Cannabis in such conditions as migraines, seizure disorder, ADD, ADHD, Crohn’s disease, Irritable Bowel Syndrome (IBS), Social Anxiety and Autism Spectrum Disorder, to name some of the more obvious.

Adapted from How Cannabis Works to Control Pain and Anxiety by Dr David Bearman, with Granny Storm Crow’s List and Hemp Edification

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