Lately, cannabis oil is on (or under) the tips' of everyone's tongues. As the Australian government works to make the drug legally more accessible medically, states in the US move to increase its legality, too. Meanwhile the hemp industry (a completely different product derived from the same plant family) booms, producing everything from fashion to houses.
It's fascinating the rapid developments that are taking place worldwide. Sometimes its decriminalisation, (Mexico, Colombia, Israel) sometimes it's for medical purposes (Norway, Czech Republic, Peru) and sometimes it's a free for all, (Canada, Uruguay, South Africa).
In NSW, any person who thinks medicinal cannabis would be of use to them should speak to their doctor, as that's the only legal way to access it - get a medical script.
SPINAL CORD CONDITION
Ben Saunderson lives at Point Frederick in East Gosford on the Central Coast. After dealing with a spinal cord condition for the last three years, he's been legally using cannabis for the last 14 months. He has had only positive results, so he's considering a stronger dose with less applications.
"It's really changed my life," he says of cannabis. "I've got a condition called Arachnoiditis; (previously) we were throwing a lot of meds at me and getting frustrated with what pharmaceuticals weren't able to do."
Arachnoiditis is a pain disorder caused by the inflammation of the arachnoid, one of the membranes that surrounds and protects the nerves of the spinal cord. It is characterized by severe stinging, burning pain, and neurological problems.
Saunderson takes a Canadian product, an oil called CanniMed 10:10 with an even ratio of THC and CBD. He got a script for the product through Dr Hasher Kadavil of Northern Integrated Pain Management clinic.
Saunderson started using the oil and also dropping his opioids by 90 percent, as he was previously on methadone and then Endone.
"We allowed 12 weeks to start priming my cannabinoid system, so you just introduce the product slowly. It was at the end of last year. Now the opioids are gone, and it's just cannabis," he says.
CanniMed comes in a 60ml bottle. Starting from first thing in the morning, Saunderson places the oil on his tongue approximately three times a day.
With his doctor's approval, Saunderson has also recently started using ketamine in conjunction with cannabis.
In a video interview with the Newcastle Herald, Saunderson says he'd sell his house if he had to in order to keep buying cannabis oil to give him pain relief.
Understanding the Cannabaceae family and its genera and species takes a bit of research. Humans have been using the highly versatile genus of cannabis plant for thousands of years.
The Cannabaceae family has 170 different species. Some varieties are known for their medicinal and recreational benefits.
As more patients get access to cannabis products in Australia, a woman in Newcastle is on the forefront of medicinal cannabis research.
Jennifer Martin is a professor, a clinical pharmacologist and also the director of the Australian Centre for Cannabinoid Clinical and Research Excellence, (ACRE). ACRE is Australia's first federally-funded research centre in medicinal cannabinoids, funded in 2017 by the National Health and Medical Research Council (NHMRC).
Martin explains the two main active molecules of the cannabis plant.
"The two main components we know of have both effectiveness and side effects in humans. The two we know most about are THC (the compound that makes people feel high) and there's cannabidiol or CBD that doesn't seem to cause psychosis but it can make people feel sedated and not quite functioning mentally as well as they usually do. In that regard it's a bit like Valium or other benzodiazepines," Martin says.
For the last two years the Therapeutic Goods Administration (TGA) have been regulating the medicinal varieties of cannabis. Unapproved medicinal cannabis products imported into and supplied/manufactured in Australia must conform to Therapeutic Goods (Standard for Medicinal Cannabis) (TGO 93), a standard that specifies minimum quality requirements.
The demand is growing. Martin says the process is getting faster, but the TGA regulations aren't always easy to understand.
"The Government has done quite a bit; they have tried to facilitate a research framework for better. Also the approval (for patients to get cannabis) now only takes a couple of days.
"Now that it's a more efficient process for doctors to use, and we have some research data on how to use it, doctors can more easily choose the best product and dose for them," Martin says.
Thirteen years ago Ben Kasteel of Laguna was diagnosed with a rare nerve disease.
"I get really bad tremors," Kasteel says. "I got put onto a lot of different pharmaceutical pain killers. It's neuropathic pain, [so they] didn't do anything for me."
He started reading research from Israel and the US that pointed at cannabis for neuropathic pain. He found microdosing with CBD oil (which also contained THC) was a relief for his tremors, but it also has adverse reactions with pharmaceutical drugs.
His medicine use is always monitored, including his attitude and headspace. He gauges his mental health, and his pain levels. He documents the side effects, which have been minimal - bar a bit of reflux as it's quite an oily product.
To avoid the reflux he started putting the oil in a capsule.
Since he's switched to cannabis, he says his the tremors have virtually disappeared. The pins and needles have gone from a 7 to a 1, and the pain is down to 70 percent of what it was.
"[I learnt] mainly through research," he says. "I used to smoke pot as a teenager in my early 20s. I stopped for 15 years until my regular doctor recommended getting it as well."
Public pressure on doctors to provide cannabis medicine is growing, which is why Martin says she thinks now is the perfect time for ACRE. Helping the community get quality, consistent products is vital.
"What I mean by consistent is, when you grow it in your backyard, it might not be the same consistency or chemical make up as what medical grade products can guarantee. People growing at home wrap their cannabis themselves and store it. Over time the chemicals in the plant break down and may not work as well, and be less effective.
"Growing it commercially, we know how much water and sunlight (the plant has), the exact type and amount of chemicals in the plant and how the plant breaks down over time.
"We can also easily and reliably test how long the components of the plant last, particularly in different temperatures, humidity and sunlight, and stop parasites and fungus getting to the plants.
"There are other benefits from having a standardised product. We can say to patients, the prescribed cannabis medicines won't be active in 12 months, or keep them in the fridge or freezer," Martin says.
ACRE imports the cannabis it uses from Holland, from a Dutch company that meets the legislation order 93 from the TGA. Some of these Dutch-origin products are being trialled in clinical trials. Outside of clinical trials, federal and state legislation only allows patients to access medicinal cannabis products through an Australian registered medical practitioner through the SAS or the Authorised Prescriber Scheme, and from a pharmacy who is supplying the product.
But not everyone is thrilled about the medicinal regulations and the research Martin and ACRE are doing.
"Because theoretically you could grow it in your own backyard, (some people) say 'I don't know why you want to research it. We don't see why you need to do a dose-finding study, you just smoke it until you feel good.' There's a lot of trust in that," Martin says.
"However some patients get side effects before they get any benefit and we do not want to make people more sick, particularly the elderly or people with lot of medical conditions and on multiple medicines."
She wants her colleagues writing prescriptions to be confident they won't harm patients.
"I'm a clinical pharmacologist; what I do is look at how we can use drugs better, seeing if they're as safe as people think they are or what doses or combinations start to make people sick. What happens when people who are different to those studied in clinical trials use these?" she says.
"We're saying 'let's have a look at it before we expose a whole population to side effects or to the wrong dose. Do some better clinical trials and share our data.'"
Cost is also an issue for patients, as cannabis isn't covered by Medicare.
"Cannimed is $350 for 60ml. That lasts 20 days, and there's not a pharmaceutical out there that gives you the same benefits," Saunderson says of the Canadian product he is using.
"Anyone interested in any kind of cannabis treatment has to pay it for themselves; that's what I want to change. It's terrible," he says.
Kasteel is only on a CBD, THC blend. His script comes in a one-to-one formulation, prepackaged.
He was paying $360 for a 25ml bottle, which lasts him 28 days. Tilray, the Canadian distributor of the product he uses, have recently reduced the cost to $195 a bottle.
Australian-grown medicinal products are on the horizon and will likely be on the market by next year.
Martin finds herself and the work that she does are sometimes placed in the polarising debate around recreational cannabis advocates and those who want medical autonomy.
Even if recreational cannabis is legalised ACRE will do the studies. ACRE are sticking to the patient issues and making sure they have appropriate evidence to guide the products.
"I think it would be good to know how to use it properly, minimising the risk or intensity of side effects," Martin says.
"I have looked after people who have not had a good death. I have seen people with anxiety and paranoia at the end of their life; it's not very nice for them nor their carers.
"Trialling cannabis outside of an ethically approved clinical trials framework is not a good thing without knowing more about which product, which route and which dose."