Medical Cannabis and Its Myths: An Australian Pharmacist's Perspective
Article Written by Kultej Verma
The conversation around medical cannabis has gained significant momentum in recent years. In 2023 alone, the average number of medicinal cannabis prescriptions issued was approximately 20,000 per month. As a pharmacist involved in the medical cannabis field, I have written an article regarding some of the myths I’ve encountered from other professionals – the goal is to provide a clear, evidence-based perspective on its use.
Myth 1: Medical Cannabis is Just for Getting Stoned
Medical cannabis is utilised to manage a variety of health conditions, leveraging its therapeutic properties rather than its psychoactive effects. In my practice, I've observed that most patients seek treatment for chronic pain, anxiety, depression, insomnia, and arthritis.
However, medical cannabis has many more primary indications, including Chemotherapy-Induced Nausea and Vomiting, Multiple Sclerosis, Epilepsy, PTSD, and others.
Myth 2: Medical Cannabis is Just a Way to Legalise Recreational Use
Medical cannabis is prescribed and used under strict regulations, ensuring its application is for therapeutic purposes only. It's essential to differentiate between recreational and medicinal use, as the latter involves careful dosing and monitoring by healthcare professionals.
In my practice, I've noticed that dosage forms vary by age group and gender. For ages 20-40, flower and liquid vapes are most common, followed by oral oils. Ages 40-60 prefer oils or capsules, then vapes. Those 60+ and in palliative care favour oral oils, followed by gummies. Men generally use more flower than women, while women prefer vapes and oils.
Interestingly, CBD has shown remarkable results for ADHD and Autism patients. I have multiple testimonials where parents reported significant behavioural improvements in their children after just 1-2 weeks of initial doses.
Myth 3: Cannabis is a Gateway Drug
The notion that cannabis use leads to the consumption of more potent and dangerous drugs lacks substantial evidence. Research indicates that most people who use cannabis do not progress to using harder substances[1]. In a medical context, cannabis is often used as an alternative to more addictive pharmaceuticals such as opioids.
Myth 4: All Cannabis Strains are the Same & Dosages are the Same
Cannabis strains vary in cannabinoid and terpene levels, making certain strains more suitable for specific conditions. Dosages differ based on age, weight, and indications. For instance, a young chronic pain patient might use up to 1.5g of cannabis flower (20%+ THC) twice daily.
Here is a quick guide for health professionals based on observations in the pharmacy:
For CBD
Safest option to start at any age as young as 8 months.
Non-psychotropic - Schedule 4
Start: 5-10mg bd dose (consider 2.5mg in the elderly)
Titrate: increase 5mg/day every 4to5 days
Max dose: 200 to 800mg
Stop further dose increase once the therapeutic benefit
Common s/e: Nausea
For THC
Safest option to start in 18+
Psychoactive/Psychotropic - Schedule 8
Safe in high doses
Good option for sleep, appetite
Start: 2.5mg nocte (consider 1.25mg in elderly)
Titrate: increase 2mg/day every 4 to 5 days
Max dose: start 2.5 to 40mg Oral & 800mg inhalation (1 inhalation every 10 mins) to a maximum of 5 a day
Stop further dose increase once the therapeutic benefit
Common s/e: Nausea, sedation, dizziness, dry mouth, paranoia, cognitive distortion
Characteristics: Sativa (activating) vs. indica (calming)
The following products are the most commonly requested at our pharmacy:
CanMED CBD 100mg/ml
CanMED CBD/THC 10/10mg/ml
ANTG Rocky El Jefe flower 30% THC <0.1%
Cannatrek /Urban Leaf Mcart Petra Vapes
INDIMED TEMPO 19 (INDICA BK) DRIED 19%/<1%, 15g
Patients commonly use the above products for the treatment of chronic pain, insomnia, and arthritis.
Myth 5: Medical Cannabis Has No Scientific Backing
Contrary to this belief, there's a growing body of research supporting its efficacy for various conditions:
Chronic Pain Management
Study: Cannabinoids for Chronic Pain Management: A Systematic Review and Meta-Analysis
Summary: Examines the effectiveness of cannabinoids in treating chronic pain, showing significant relief for various conditions.
Link: https://jamanetwork.com/journals/jama/fullarticle/2673974
Chemotherapy-Induced Nausea and Vomiting (CINV)
Study: Cannabinoids for Nausea and Vomiting in Adults with Cancer Receiving Chemotherapy
Summary: Assesses the efficacy of cannabinoids in reducing CINV, indicating they are effective compared to placebo.
Link: https://pubmed.ncbi.nlm.nih.gov/26561324/
Multiple Sclerosis (MS)
Study: Cannabinoids in the Treatment of Spasticity in Multiple Sclerosis
Summary: Evaluates the use of cannabinoids for spasticity in MS, supporting cannabis extract for symptom relief.
Link: https://n.neurology.org/content/82/10/976
Epilepsy
Study: Trial of Cannabidiol for Drug-Resistant Seizures in the Dravet Syndrome
Summary: Investigates the efficacy of CBD in reducing seizure frequency in Dravet syndrome patients, showing significant reductions.
Link: https://www.nejm.org/doi/full/10.1056/NEJMoa1611618
Anxiety and PTSD
Study: The Effectiveness of Cannabidiol Oil for Pediatric Anxiety and Insomnia as Part of Posttraumatic Stress Disorder: A Case Report
Summary: Discusses the effectiveness of CBD oil in treating anxiety and insomnia in a pediatric PTSD patient, showing significant symptom improvement.
Link: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5101100/
Sleep Disorders
Study: Cannabidiol in Anxiety and Sleep: A Large Case Series
Summary: Explores the impact of CBD on anxiety and sleep, indicating benefits for anxiety-related disorders and sleep quality.
Link: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6326553/
Inflammatory Bowel Disease (IBD)
Study: Cannabis Use in Patients with Crohn's Disease
Summary: Investigates the effects of cannabis in Crohn's disease patients, showing clinical improvement and reduced medication need.
Link: https://academic.oup.com/ibdjournal/article/19/13/665/4634540
Palliative Care
Study: Medical Cannabis and Pain Management in Palliative Care
Summary: Discusses the role of medical cannabis in palliative care, particularly for pain management and improving quality of life.
Link: https://www.jpsmjournal.com/article/S0885-3924(20)30207-1/fulltext
Myth 6: Using Medical Cannabis Leads to Impaired Cognitive Function
When used appropriately in controlled doses, medical cannabis can manage symptoms without significantly affecting cognitive abilities. THC can be detectable in blood for up to a week in regular users, with impairment typically lasting 1-3 hours after ingestion. CBD is non-psychotropic and generally detectable for 2-5 days in blood.
THC (Tetrahydrocannabinol)
Duration in Body: THC can stay in the body for varying lengths of time depending on the frequency of use, dosage, and individual metabolism.
Occasional Users: It is typically detectable in blood for up to 24 hours and in saliva for 1-3 days.
Regular Users: It can be detectable in blood for up to a week or more and in saliva for up to 30 days.
Impairment: THC is psychotropic and can impair cognitive and motor functions.
Duration of Impairment: Impairment typically lasts 1-3 hours after ingestion but can extend up to 24 hours or longer with higher doses or chronic use.
CBD (Cannabidiol)
Duration in Body: CBD is non-psychotropic and does not impair cognitive function.
Detectable in Blood: CBD can remain in the blood for 2-5 days after use.
Detectable in Saliva: Saliva tests for CBD are not commonly used but generally detectable for up to 72 hours.
Impairment: CBD does not cause impairment. It is known for its therapeutic effects without the psychotropic effects associated with THC.
Factors Affecting Detection and Duration
Dosage: Higher doses of THC and CBD will generally result in longer detection times.
Frequency of Use: Regular users may retain THC and CBD in their systems longer than occasional users.
Metabolism: Individuals with faster metabolisms may process and eliminate cannabinoids more quickly.
Key References
THC Detection:
CBD Detection:
The Role of the Pharmacist
As pharmacists, we play a critical role in the safe and effective use of medical cannabis. Our responsibilities include educating patients about proper usage, potential side effects, and interactions with other medications. We also work closely with other healthcare providers to ensure a comprehensive approach to patient care.
Medical cannabis holds significant promise for treating a variety of conditions, but it's essential to approach it with an informed and evidence-based perspective. Dispelling myths and understanding the true therapeutic potential of cannabis can help integrate it more effectively into modern medical practice.
[1] Fergusson, D. M., Horwood, L. J., & Swain-Campbell, N. A. (2002). Cannabis use and other illicit drug use: testing the cannabis gateway hypothesis. Addiction, 97(4), 505-520. https://onlinelibrary.wiley.com/doi/full/10.1046/j.1360-0443.2002.00107.
[2] https://academic.oup.com/jat/article/40/7/479/2210885
[3] https://www.sciencedirect.com/science/article/abs/pii/S0376871 607000455
[4] https://www.liebertpub.com/doi/full/10.1089/can.2016.0034
[5] https://journals.sagepub.com/doi/full/10.1177/2045125320918292
Kultej Verma is a multifaceted healthcare professional serving as the Managing Partner at Custom Compounding Chemist in West Lakes, SA, and CanMed Clinics. With over 16 years of experience in the pharmaceutical industry, Kultej brings extensive knowledge in commercial, sales, and marketing aspects of pharmacy. He holds a diverse educational background, including a Certificate IV in Mental Health, a Bachelor of Pharmacy, an MBA, and a Graduate Certificate in Applied Pharmacy Practice. Kultej's expertise spans pharmacy management, customer service, mental health counseling, immunization, and prescription drugs, with a special focus on alternative therapies based on medical cannabis. As an advocate for safe and effective treatments, he is dedicated to ensuring access to innovative therapies while upholding regulatory standards. Kultej's mission is to deliver high-quality pharmacy services, prioritize customer satisfaction, and promote informed healthcare decision-making, all while staying committed to ongoing professional development in pharmacy and mental health care.
Disclaimer: This information is shared with a global readership for educational purposes only and does not constitute medical or business advice. All patient-related information has been de-identified OR fictional to protect privacy. Nothing in this article is intended to promote the use or supply of medical cannabis to members of the public.
