Medical Cannabis in Australia: What is Legal?

Australia legalized medical cannabis in 2016, but it took a number of years before the medical cannabis program was eventually rolled out. With the program being relatively new, many Australian GPs feel ill equipped to answer questions on available products, access pathways, and evidence based medical cannabis claims. 

The good news is the legal access to medicinal cannabis is now increasing as most countries relax their restrictions. This is mostly due to heightened community interest, strong patient demand, and commercialisation of cannabis products. 

This article will shed light on the basics of medical cannabis and outline the opportunities it presents for both patients and clinicians. 

Overview of Medicinal Cannabis in Australia

Australia legalized the growing of cannabis for scientific and medicinal use in 2016. In 2017 medical cannabis was rescheduled by the TGA (Therapeutic Goods Administration) to schedule 8 of the poisons standard. This made access to certain medical cannabis products legal.

A bill was passed by the Australia Capital Territory in 2019 that allowed Australians to grow and possess small quantities of cannabis for their personal use. This however is still in conflict with federal laws that prohibit use of cannabis for recreational purposes. 

A lot has happened since the legalization of cannabis. The Australian “medical cannabis market” now hosts more than 150 legal “medical cannabis products” under the TGA (Therapeutic Goods Administration) access pathways. The TGA approval is required because most of the medical cannabis drugs are unregistered. 

TGA’s approval is obtained through the Authorised Prescriber Scheme or Special Access Scheme-B (which can be accessed online) and is necessary for all prescribed medicinal cannabis products. 

Though the use of medical cannabis has made great strides in the recent years, several challenges still exist such as:

• Some clinicians are still not confident enough to prescribe medicinal cannabis to their  patients as it was not part of their medical training
• Patients in need of medical cannabis do not know how to access it
• It is not always easy to know which medical cannabis products exist, and which are best under certain circumstances

By the close of 2019, more than 28,000 prescribing approvals for medical marijuana had been given to patients. These involved over 1,400 doctors, who were mostly GP’s. These figures are set to triple in the coming years as the use of medical cannabis becomes more widely accepted. 

What Is Medicinal Cannabis?

Medicinal cannabis is a product of a plant species called Cannabis Sativa L. This species includes both hemp as well as marijuana, which is commonly known for its intoxicating effects. Medicinal cannabis is the use of the cannabinoids and other therapeutic compounds found in cannabis to treat or manage various medical conditions. 

In Australia, approval for the use of medical cannabis has been given for the treatment of more than 40 conditions, many of which are chronic. That said, medical cannabis is still heavily regulated and requires prescription by a registered doctor as an authorised prescriber (AP) or one operating under SAS (Special Access Scheme).

Medical cannabis can either be hemp-derived or cannabis-derived. The major distinction between these two is how much tetrahydrocannabinol (THC) it contains. “Hemp-derived” medicinal cannabis will usually have negligible THC amounts which will generally be less than 0.03%.

“Cannabis-derived” medicinal cannabis usually has much higher amounts of THC. To better understand the difference, let’s take a closer look at THC and CBD.

The cannabis plant has hundreds of molecules that are bioactive. The two most dominant and therefore best studied are THC (delta-9-tetrahydrocannabinol) and CBD (cannabidiol).

THC is the compound responsible for the intoxication associated with cannabis as it induces psychoactive effects by binding to CB1 cannabinoid receptors. Though it is often intoxicating, especially in higher doses THC has also been found to be useful in the treatment of conditions such as chronic pain, Tourette’s syndrome, anorexia, chemo-therapy induced nausea, spasticity in multiple sclerosis, and cachexia. Trials are still being conducted to further study its efficacy as a therapeutic drug for these and other conditions. 

CBD on the other hand does not have psychoactive or intoxicating effects. From preliminary studies, it promises to have a wide range of pharmacological and therapeutic actions. In relatively high doses (300–1500 mg), CBD has indications of treating epilepsy, psychosis, and anxiety. Numerous other clinical trials are currently being carried out for conditions like drug and alcohol dependence, neuropathic pain, and neurodegenerative disorders.

Though CBD is readily available over-the-counter in nutraceutical ‘wellness’ products in many countries, this is not yet an option in Australia. 

What is The Difference Between Street Cannabis and Medicinal Cannabis?

While medical cannabis is used to treat and manage health conditions, street cannabis is often high in THC and used for recreational purposes due to its intoxicating effects. In Australia, street cannabis is often referred to as Mary Jane, smoko, bud, dope, ganja, green, sesh, spliff, weed and many other such names.

While medical cannabis is legal, street cannabis remains illegal in most provinces.

How does Medicinal Cannabis work?

The Endocannabinoid System (ECS)

In the human body, the endocannabinoid system’s main responsibility is to maintain a state of “physiological balance” known as homeostasis. The endocannabinoid system (ECS) has three components: endocannabinoid receptors, endocannabinoids, and metabolic enzymes.

The ECS regulates many functions in the body, some of which are:

•  Pain
• Sleep
• Hunger
• Reproduction
•  Hormones
• Memory
• Immunity
• Moods

Endocannabinoid receptors are found all over the body in areas such as the skin, brain, heart tissue, brain, immune cells, gastrointestinal tract, and muscles among others. 

The ECS is regulated by endocannabinoids binding to these receptors.

The two main ECS endocannabinoids are anandamide and 2-AG. It’s two main types of receptors are CB1 receptors whose main location is the brain and CB2 receptors that are mainly located in immune cells as well as other areas of the body.

Medicinal Cannabis And The Endocannabinoid System

Phytocannabinoids such as CBD and THC act in a similar way to the body’s endocannabinoids thus further promoting a state of homeostasis. As we mentioned earlier, THC binds to the CB1 receptors found in the brain. This not only causes psychoactive effects through mind-altering euphoria, it also has therapeutic benefits. 

Though CBD does not directly bind to the CB1 and CB2 receptors, it interacts indirectly with the ECS to bring about therapeutic effects.

Therapeutic Applications

Medicinal cannabis could contain THC, CBD, or both. THC induces psychoactive effects, unless under extreme circumstances, it is not recommended for anyone below 18 years of age. CBD can however be prescribed for minors for example in treating intractable childhood seizures.

THC however also has numerous health benefits as well. The prescribing doctor will be able to make judgement on what to prescribe to a certain patient.

Medical cannabis can be used to treat:

• Cancer
• Neuropathic pain
• Multiple Sclerosis
• HIV/AIDS
• Diabetes
• Multiple Sclerosis
• Epilepsy
• Crohn’s disease
• Alzheimer’s disease
• Joint degeneration
• Nausea and vomiting associated with terminal illness
• Anxiety
• Depression
• Sleep disorders
• Mood disorders

Medicinal cannabis is also helpful as adjuvant therapy in improving the efficacy of other drugs. An example is the reduction of use of opioids in patients suffering from chronic pain.  In such cases, medicinal cannabis also reduces the side effects of the opioids. 

What Medical Cannabis Products Are Legal in Australia? 

There is a vast range of medicinal cannabis products one can access legally in Australia via prescription. They can be broken down into:

• Full spectrum
• Broad spectrum
• Isolates

Under these, you can get subscriptions of medicinal cannabis products that contain:

• CBD only
• CBD & THC
• THC only
• A defined mixed ratio of CBD & THC
• The full profile of cannabinoids and terpenes found in the original plant. (CBG, CBC, and CBN as well as other popular cannabinoids) 

Unfortunately, it is often very difficult to determine the exact terpene content of a good number of these products. As such, your doctor might need to find this out from the product suppliers.

These medicinal cannabis products can be found in the form of:

• Capsules
• Chewables
• Cream
• Crystals
• Flower (which includes granulated flower)
• Lozenges
• Oil
• Spray

It is important to note that the different types of products will have different effects based on onset and impairment windows. This is mainly because of the method of use or ingestion which will have some directly hitting the bloodstream while other ingestible products will have to go through the digestion process. While some products hit faster, their effects may not last as long as others.

An example is oils which may take longer for the effects to be felt, which is referred to as long ‘onset of action’, the duration of the impact, also called ‘duration of action’ will last longer. While smoking and vaping hit fast, they are not only harmful to your lungs, their effects wear off quickly. This is why doctors do not generally prescribe these methods. Oils and other edibles offer more prolonged relief.

Getting TGA Approval And Filling The Prescription

As mentioned earlier, in Australia, patients cannot directly get access to medicinal cannabis. This necessitates a prescription from a doctor. In order for this to happen, the patient must get approval from the TGA (Therapeutic Goods Administration) as well as other relevant territorial or state authorities.  

The first step in the process is getting a doctor to provide a clinical basis with the support of documents as to why the patient needs medicinal cannabis treatment. Once this has been done in a clear way, approval is usually granted. 

Once the patient gets the necessary approvals, a medicinal cannabis prescription can be written out by the doctor. This prescription can then be filled out at any pharmacy which works in conjunction with legal medicinal cannabis producers. 

Cost, Dosage, And Side effects

Because everybody has a unique endocannabinoid system which responds differently to cannabinoids, the dosage of medicinal cannabis differs from that of other drugs. A patient can therefore not “copy-paste” a dosage which worked for someone else and expect the same results, even if they may have similar physical characteristics.

The prescribing doctor usually determines an appropriate medicinal cannabis dosage to start with which is then adjusted according to the patient’s response.

As standardization is yet to be achieved, the cost of medicinal cannabis products varies according to the seller. This cost is also affected by the fact that medicinal cannabis is not covered under the “Pharmaceutical Benefits Scheme”, which pushes the entire cost to the patient, making it expensive. 

CBD-based medicinal cannabis rarely causes negative side effects. On rare occasions, it might cause mild headaches or drowsiness.

THC-based medicinal cannabis may cause several negative side effects including mental alteration, dry eyes, and cottonmouth. Your prescribing doctor should be able to help you navigate through these side effects in case they occur.  

Will Australia Legalize Recreational Cannabis?

Recreational cannabis is currently illegal in Australian states and territories, other than the Australian Capital Territory (ACT). However, marijuana is the most abused illicit compound in the country and has at the same time received massive support for legalization from the grassroots.  The Australian National Drug Strategy Household Survey in 2019 found that over 40% of Australians support the legalization of cannabis for recreational use. Unfortunately, there isn’t much going on in regards to this in the political arena. This implies that there’s still some work that needs to be done before Australia legalizes recreational cannabis.