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Medicinal Cannabis

Patient Pamphlet about Medicinal Cannabis

You may not know this, but the body makes its own cannabinoids. The body has an endo-cannabinoid system (ECS) and is an important body regulator. This is the reason why medicinal cannabis (MC) can help and enhance the body’s regulatory mechanisms.

Your doctor has prescribed you Medicinal Cannabis (MC). Depending on your individual situation, the doctor will decide which form of MC is appropriate. 
There are five choices that can be prescribed.

1/ CBD only
2/ CBD dominant
3/ Balanced: THC equal dose to CBD  
4/ THC dominant,
5/ THC only.

Cannabidiol (CBD) and tetrahydrocannabinol (THC) are the two main naturally occurring cannabinoids in the cannabis plant. 

CBD oil contains cannabidiol only and does not make you “high”! 
The doctor may start you off with a CBD only product but if the effects are inadequate, preparations with THC may be added.

Unlike CBD oil which only contains cannabidiol, a combined product is a mixture of CBD and THC. The THC is the portion of cannabis that has the psychoactive effect, i.e., it is the portion of cannabis that makes you “high”. Note that doctor-prescribed MC is much different from smoking street cannabis. The differences being the quality, the purity, and the known quantity in the prescribed product. 
With street bought illicit cannabis you do not know what you are getting! 
Medically prescribed cannabis is much safer especially when supervised by a trained cannabis prescribing doctor. THC only preparations may cause significant psychoactive effects on the brain, however it should be pointed out that the addition of CBD can have a modifying action, reducing the psychoactive effects.

CBD and THC are similar but there are some differences.
•    THC has psychoactive properties while CBD does not.
•    THC has a stronger pain-relieving property.
•    THC can aggravate anxiety, while CBD can relieve it.
•    There are more side effects with THC
•    THC can increase appetite (marihuana “munchies”) while CBD can reduce appetite.


What can be treated with MC.
In one study 3,000 MC participants were surveyed regarding the reason for using MC. The top reason were 1/ pain, 2/ anxiety, 3/ back pain, and 4/ insomnia. 
This study also showed that the people who were using opioids and started using MC were able to use less or had even stopped taking opioids. 

There is a long list of conditions that can be helped with MC.  
1/ Inflammatory conditions – e.g., arthritis, pain, autoimmunity
2/ Immune conditions – e.g., autoimmune diseases – rheumatoid arthritis, lupus (note the over-lap with inflammatory conditions)
3/ Metabolic conditions. e.g., diabetes, oxidative stress
4/ Neurologic conditions e.g., pain syndromes, epilepsy, neuro-degenerative diseases such as Alzheimer, Parkinson’s, Huntington’s
5/ Behavioural conditions e.g., anxiety, depression, PTSD, OCD
6/ Proliferative conditions e.g., - cysts, tumours, cancer, chemotherapy, radiation support, pain.
7/ Others – These are conditions, often genetic, with no current, effective treatment, such as autism, cystic fibrosis, Huntington’s. Note MC does not necessarily treat the named disease but may treat the symptoms of that disease. For example, MC may not treat autism, but MC can treat the symptoms such as agitation, anxiety, insomnia, inflammation etc.  

CBD oil alone has been shown to be safe, however the addition of THC can cause side effects which is largely based on dosage.

The most common side effects of CBD oil include drowsiness (take at night to help sleep!), gastrointestinal issues, dry mouth, reduced appetite, and nausea. These are generally mild and self-limiting. The addition of THC may increase the incidence of side effects, which can include,
•    Increased heart rate
•    Dizziness
•    Impaired concentration and memory
•    Slower reaction times
•    Negative drug interactions
•    Increased risk of heart attack and stroke
•    Increased appetite
•    Potential for addiction
•    Hallucinations or mental illness
•    Withdrawal symptoms

While CBD can be used in the younger age group in treating most conditions, the use of THC has been shown to cause long-term problems with depression and mental health issues.
THC should not be used in adolescents; some even suggest should not be used in under 20-year age group.
THC should not be used where there is a past history of psychosis, or even a family history of psychosis.
MC should not be used during pregnancy and breastfeeding.
THC should not be used after recent heart attack.

However, beware of drug-drug interactions with high doses. These drugs include - Antihistamines, antiretrovirals, antipsychotics, beta blockers, benzodiazepines, calcium channel blockers, cyclosporine, haloperidol, macrolides, opioids, sildenafil, statins (atorvastatin and simvastatin but not pravastatin and rosuvastatin), SSRIs, tricyclic antidepressants.  

Low doses seem to be safe but still needs regular monitoring with your doctor. 

CBD oil is non-toxic and doses up to 1,500 mg per day (15 mls of CBD oil) a day are well tolerated in humans. However, they may be issues with high doses and liver enzyme inhibition.

CBD is metabolised by the liver and so are pharmaceutical medication. CBD, especially in high doses can interfere with the breakdown of pharmaceuticals, therefore levels of pharmaceutical drugs can rise to toxic levels. This needs to be monitored by your doctor and doses may need to be adjusted.
For example, if you are on blood pressure medication – you may start to feel dizzy as the blood pressure drops due to the medication not being metabolised (higher doses in the blood). The dose may need to be adjusted downward.
If you are on any of these drugs and start taking CBD oil – then care must be taken. Drug doses may need to be reviewed regularly. You must work closely with your medical practitioner.

Everyone is different so there is not a standard dose – so the general policy is to - “Start low and go slow”.

Starting dose is 0.1 ml daily. This dose is slowly increased by 0.1 ml every 3 - 4 days until the desired effect is reached. Taking more may not necessarily be better! If there are any concerns, any possible side effects; contact your doctor immediately. 
I would prefer to review the person after 2 weeks of starting MC. This is to make sure all is going well and there are no issues.
Note that everyone is an individual and different people react differently to different doses. We cannot predict what dose is needed for everyone – therefore “Start low and go slow” … and “stay low”.
After about 2-3 months of positive benefit, a reduction of dose can be done without loss of benefit.

Also please note – It is very important to let the doctor know if you are a regular heavy cannabis user – as the doses needed in this situation needs to be much higher than in non-cannabis users.

MC and Driving
Police can randomly test you for THC. Driving in Tasmania with THC is only permitted with a valid doctor’s prescription. However, you can still be prosecuted if the police deem you to be driving erratically or “under the influence. 
CBD oil contains no THC, this is not an issue with driving. 
If you do go interstate and drive, the laws are different. You can be prosecuted with THC in your system if tested and a valid script is not a defence. 


Medicinal Cannabis in anxiety disorders.

MC is useful in treating anxiety and related conditions, e.g., PTSD.
CBD oil only is used in a majority of anxiety conditions, as added THC may increase anxiety. 
Depending on specific situations, THC may be added but this would need careful monitoring. 
Detailed above, CBD oil needs to be started in a low dose, e.g., 0.1 ml daily and to increase by 0.1ml every 3-4 days. Depending on when the anxiety is worse, the dose can be taken in the morning, or the evening, or if the anxiety is continuous, there can be a split dose.
Extra doses of 0.1 ml can be taken as needed if anxiety is worse. After a while, the dose can be reduced, or even stopped and as needed doses used.

Where to get it?
Davey Street Discount Pharmacy
Epic Pharmacy New Town
Terry White Rosny
Huonville Pharmacy
Green Dispensary Adelaide for compounded products

This will be discussed. Prices do vary – and they have been coming down recently. Some Private Health Insurances will cover compounded prescriptions to some degree.

CBD Oil: The Gift of Nature. Dr Peter Baratosy self-published 2021
Reiman, A., Welty, M. & Solomon, P. (2017). Cannabis as a Substitute for Opioid-Based Pain Medication: Patient Self-Report. Cannabis Cannabinoid Res, 2(1), 160-166. doi: 10.1089/can.2017.0012

Bergamaschi, M., Queiroz, R., Zuardi, A. & Crippa, J. (2011). Safety and side effects of cannabidiol, a Cannabis sativa constituent. Curr Drug Saf, 6(4), 237-49. doi: 10.2174/157488611798280924

Berger, M., Amminger, G. & McGregor, I. (2022). Medicinal cannabis for the treatment of anxiety disorders. Aust J Gen Pract, 51(8), 586-592. doi: 10.31128/AJGP-04-21-5936

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