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Patients, along with their medical supervisory team, which includes their GP, specialists and pharmacist are the best combination to make a decision regarding the role of cannabinoid-based products in their care plan.
Healthcare professionals and patients need to be certain that the cannabis-based products that they are using are safe, of a certified high quality and effective in their treatment plan.
The Therapeutic Goods Administration (TGA) has not currently approved Cannabis and cannabinoid products as a medicine except for Sativex. Patient access to cannabis based products is currently provided through the established TGA systems of the Authorised Prescriber and Special Access Schemes.
Cannabinoid based pharmaceuticals are a relatively new treatment option and many physicians may not have yet experienced the best way to administer these products within their patients care plan. To date, most cannabinoid products have been used adjunctively (used with other treatments) or as a second line treatment where other standard treatments are ineffective or the side effects are poorly tolerated.
By providing access to products with known quality, purity and standard formulations medical practitioners can be sure the product they are recommending is safe and manufactured under the stringent conditions of the Australian Commonwealth regulator, the Therapeutic Goods Administration.
Medical practitioners who have the patients best interests in mind will help decide the balance of benefit and any potential side effects to the patient by the use of this course of treatment.
A patient care plan for cannabinoid therapy should cover items such as, but not limited to:
To date cannabinoid therapy has been most effective in alleviating symptoms and conditions associated with cancer treatment (appetite stimulation and pain relief), HIV/AIDS wasting, MS muscle spasticity and some forms of epilepsy in some patients. Preliminary research has shown promise in alleviating symptoms associated with conditions such as chronic pain, neuropathic pain, Alzheimers, inflammation, depression and Tourette syndrome.
Age, gender, physical and mental health, pharmacogenetics and medical and illicit drug abuse history can all have an impact in determining the best course of treatment.
The patients GP, specialists and pharmacist should all be aware of other medication they are taking, and factor this into the care plan. We encourage patients using illicit sources of Cannabis or cannabis products to discuss their current use with their team in order to take this into account.
Cannabis plants have over 70 cannabinoids, the two most well studied are cannabidiol (CBD) and Δ9-tetrahydrocannabinol (THC). It is important to know both the composition of the individual cannabinoids as well as the concentration of the cannabinoids in any product. Only through having access to products produced in sterile facilities to exacting standards which have been quality certified can physicians have confidence that the products they are recommending will be suitable for their patients with consistent outcomes.
The effect of cannabinoids, the time of onset and metabolism are all influenced by the administration form. In many other countries raw cannabis flowers are permitted to be smoked. In Australia this is not encouraged due to the potential for cancer risks associated with smoking. As a general rule, when inhaled through vaporisation or taken an oral-muscosal spray the onset will be much quicker compared with ingestion. Furthermore the administration method affects the bioavailability of the target compound.
Identifying the right dosage for alleviating symptoms without inducing unwanted side effects is paramount to the effectiveness of cannabinoid therapy. Many practitioners advocate the “go low and slow” approach to self-titration for maximum benefit. The process of recording this in a diary is often useful for understanding the optimal dose and timing for a particular patient. Cannabinoid based treatment is most often used in situations where the symptoms are subjective to the patient, therefore self-reporting of the outcomes of various dosage and timings are crucial to monitoring the efficacy and potential side effects of the treatment. Which is similar to the process for determining the optimal regime for other therapeutic agents such as antidepressants.
As part of establishing the correct dosage and frequency for a particular patient, the patient and medical team should be aware of, and monitor, any side effects or complications. Like many other drugs, the use of cannabinoids can be associated with unwanted side effects including outcomes such as increased heart rate, dizziness or feeling light headed, confusion, changes in mood, the feeling of being ‘high’ and drowsiness. Persons with a family history of schizophrenia, cardiovascular disease or who are or are planning to become pregnant or are nursing, suffer from paranoia or have low blood pressure should be closely monitored during treatment. It is recommended that during the first stages of treatment and when changing doses that the patient is closely monitored by direct supervision.
A scientific review of 40 years of data on the use of Cannabis and cannabis-based products found that the adverse effects associated with cannabis use for medical applications were not serious or unexpected (1). Furthermore the side effects of cannabinoid treatment are similar or less severe than those associated with many other medicines such as opioids or anti-epileptics that may be used to treat the same conditions.
It is important that like all drugs, cannabinoid products are kept out of the reach of children and pets. After taking cannabinoid products patients should not drive or operate heavy machinery whilst under the influence of the product.
1Wang, T, Collet, J-P, Shapiro, S, Ware MA (2008) Adverse effects of medical cannabinoids: a systematic review. CMAJ. 178(13): 1669-1678.
Please note that the information provided above does not constitute medical advice and should not be relied upon in this way. The information is correct at the time of publication. People wanting medical advice should consult with their medical advisory team.