With June 2020 marking a record-high for Special Access B (SAS-B) approvals of patient-prescribed cannabinoid medicines, many are asking how they can access cannabis products, especially the non-psychoactive element of marijuana, CBD.
The Devil's Lettuce, Mary-Jane, Ganja, Jamaican Herb, or reefer does a hell of a lot more than just get you high. Cannabis contains over eighty individual molecules, with early studies showing the effectiveness of cannabinoid-based medicines across a range of different applications from chronic pain relief to anti-nausea.
One of the more peculiar compounds is Cannabidiol or CBD as it is more commonly referred to. Unlike it's more popular comrade THC, it is a non-intoxicating molecule, allowing products that contain CBD to be utilised for medicinal purposes without stimulating intense psychoactive effects.
While the drug has been approved for use in the treatment of a few diseases by the US Food and Drug Administration (FDA), in addition to a growing number of legal states, the compound is yet to receive the same exact treatment in Australia.
Cannabis is quite clearly illegal in Australia, with over A$2 billion spent on dealing with the illicit consequences. However, in 2016 legislation to enable the cultivation of cannabis for medicinal and related research purposes in Australia was passed by Parliament. While cannabis is its own kettle of fish, the Office of Drug Control (ODC) currently permits the consumption of certain hemp seed products, with extracts from the remainder of the plant considered a drug.
Hemp seed oil products are only legal if the total CBD levels do not exceed 0.0075% (75mg/kg), and the THC content is 0.005% (50mg/kg) or less. For example, a capsule containing 1000mg of hemp seed oil would need to contain less than 0.075 mg of CBD. Because the ODC views both hemp and cannabis as terms used to describe a plant in the genus Cannabis, "all extracts of cannabis are drugs, regardless of specific cannabinoid levels."
This legal grey area of hemp seed oil allows for the extraction of cannabinoid compounds like CBD, while also increasing the prevalence of overseas sellers with questionable legality.
Several American-based companies saying yes to international shipping into Australia, with the caveat to customers to make sure they check local laws regarding hemp products before making a purchase. Let the buyer beware indeed.
"We are not held responsible for any laws breached once the item has been shipped," is a common phrase seen on these websites.
Where Do I Get CBD Oil in Australia?
Medicinal cannabis is legally prescribed through the Special Access and Authorised Prescriber Scheme as outlined in the Narcotic Drugs Amendment Act 2016.
One way of simplifying the process of prescription is by allowing healthcare professionals the option to refer patients to more experienced Doctors if they feel their own cannabis knowledge is insufficient.
Cannabis clinics are a popular avenue for prescribing CBD products. Companies like Compass Cannabis Clinics employ teams of doctors who specialize in cannabis-derived medicines. These teams offer a pathway for patients to learn more about medicinal cannabis products and potentially gain access to them, in addition to educational services for healthcare professionals who are interested in learning more themselves.
There is a growing range of cannabis clinics throughout Australia, with prominent players such as Cannvalate, Emerald Clinics, and Cannabis Access Clinics, who each aim to simplify the process of being prescribed cannabinoid medicines.
Cannabis Doctors Australia (CDA), is a patient-focused service providing legal access to medical cannabis Australia-wide. Making it simple to find out if your eligible for medical cannabis, CDA offers a free test for the treatment of your chronic condition. Because CBD is a scheduled 4 medication, an application by a prescribing Doctor to the TGA is needed to access it.
The process can take as long as two weeks from the time you pay for your consultation until you hear from a pharmacy. During this time, Doctors liaise with the government on the patient's behalf. Approvals usually last for periods of 3-12 months, with a review of your treatment plan and progress required when completed.
Because the cost of medicinal cannabis products is not currently subsidised, patients will need to fund the cost of treatment themselves, with price depending on the type of product prescribed and the dose recommended.
While there still remains a lot of red tape around CBD, doctors are legally allowed to prescribe medicinal cannabis to patients with specific medical conditions through the Therapeutic Goods Administration (TGA).
Currently, the TGA will consider approval for any condition that has not responded to conventional medical treatment and has persisted for at least 3 months.
A recent Senate inquiry investigating 'barriers to prescription' within the Pharmaceutical Benefits Scheme (PBS), which allows patients to access 'alternative' cannabinoid medicines, found that the efficacy of the scheme: "is limited by the health professionals prepared to prescribe medicinal cannabis and negotiate the online application process."
Speaking at the inquiry, the head of the Australian Medical Association, Dr Tony Bartone, "requested the government consider providing public funds to educate doctors on medical cannabis."
Describing the level of detail that goes into an application, a health professional described that "to prescribe this treatment to a single patient (one who could afford it) would require at least four hours of my time." Since every medication or medical device must be approved by the TGA, which can cost millions in order to undergo the necessary R&D, there is limited choice and availability for patients.
A recent poll of over 1,300 Australians revealed that just 2.5% of respondents sourced their cannabis legally. A figure that attributes to the A$4.4 billion in direct tangible cannabis costs from policing, healthcare and productivity in 2016. The inquiry estimated roughly 100,000 Australians still using the black market to self-medicate.
One patient described her experience with the cost as, "highly expensive on the black market," at about $20 per gram. "Under the SAS the gram price I have heard is about $40 per gram," she said.
Dr Richard Di Natale who instigated the inquiry took aim at the "confusing" and overlapping nature of state and commonwealth law, saying that "patients are losing out."
"This unanimous report has recommended a range of changes to the current system to give patients access to these treatments and to give Australia's burgeoning medicinal cannabis industry a fighting chance," said Di Natale.
The inquiry views that "the information currently provided on the TGA's website in relation to these pathways does not appear to be meeting the needs of practitioners who wish to use them," since "the majority of patients acquiring the medication via SAS B are not 'exceptional' but rather, represent common illnesses and conditions being approved in rapidly increasing numbers,"
CBD medicines make up 40% of the total prescribed cannabis products, with the inquiry revealing that over 1400 different doctors have prescribed cannabis at least once to a patient.
At the public hearing in January, the TGA did note the question of down-scheduling CBD could possibly be put out for public consultation. Acknowledging that there "will be hundreds and hundreds of submissions with a wide diversity of views," such an extensive consultation would be "a couple of months away".
There are approximately more than 7.6 million Australian cannabis users, according to the 2019 National Drug Strategy Household Survey (NDHS). Coupled with a fluctuating legal status around the world, medicinal cannabis in Australia is becoming more widespread.
Before you start blazing glory, you have to remember that you can't use it to treat the common cold (although a recent study did show CBD could help to prevent extensive lung damage from COVID-19).
Clinical trials and medical research has shown medicinal cannabis can assist in the treatment of symptoms for conditions including but not limited to: chronic pain syndrome; neurological conditions such as epilepsy; multiple sclerosis and motor neuron diseases; inflammatory bowel diseases, Crohn's disease and ulcerative colitis; chronic cancer pain and malaise; chemotherapy-induced nausea and vomiting; arthritis; and dementia.
Speaking on the effects of medicinal cannabis in treating chronic pain, Medical Advisor to Little Green Pharma, Dr Joe Kosterich said the plant "has a legitimate role in treating certain conditions in certain people."
"It is important patients seek advice from their doctor who can provide more information about qualifying conditions for medicinal cannabis treatments, and products legally available for prescription."
Another study performed by Southern Cannabis Holdings (SCH) in conjunction with Little Green Pharma (LGP) found that medicinal cannabis is sufficient treatment for chronic pain. The total number of chronic pain sufferers is expected to increase to 5.23 million by 2050, creating greater potential for CBD treatment to take over from the more commonly prescribed opioid-based pain killers.
According to Dr Adie Wilson-Poe, a neuroscientist and advisor to WeedMaps, "when patients have access to cannabis, they fill fewer opioid prescriptions, consume fewer opioids, overdose less and stay alive. No other policy, clinical intervention, law or pharmaceutical therapy has the kind of impact that cannabis does when it comes to opioid use."
Considering that more Australians had a negative perception of pain-killers/ pain-relievers and opioids in 2019 than in 2016, coupled with 2019 being the first time more people supported the legalisation of cannabis than opposed it (41% compared with 37%) now is a good time to pull the trigger.
The current forecast for cannabis prescriptions is 140,00 by the end of 2020. Combined with an expected cannabis market value of US$1 billion by 2023, and the construction of a secret $50 million cannabis cultivation facility currently underway (seriously, we can't tell you where it is), the answer to the how should be easy. But until the TGA re-schedules CBD, the answer is going to remain, with difficulty.
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