Healthcare Professionals

What are cannabis and hemp?

Cannabis and hemp are two related but genetically different plants which are grown for different purposes. Cannabis is typically grown for its pharmacological effects, while hemp has traditionally been cultivated for industrial purposes and does not contain significant amounts of the hallucinogenic compound found in Cannabis.

What is medicinal cannabis?

Medicinal Cannabis is cannabis and phytocannabinoids (compounds from the cannabis plant), which are prescribed for use by a physician to treat a condition or symptoms of a condition.

What are Cannabinoids and the Endocannabinoid System?

Cannabinoids are active compounds which act on cannabinoid receptors in cells found throughout the body, including those that can alter neurotransmitter release in the brain. The endocannabinoid system is a group of receptors, ligands and enzymes which regulate a number of physiological processes generally maintaining homeostasis in the body. Source: De Laurentiis, A., Araujo, H. A., & Rettori, V. (2014). Role of the endocannabinoid system in the neuroendocrine responses to inflammation. Current Pharmaceutical Design, 20(29), 4697–4706.)

What is medicinal cannabis used for?

Medicinal cannabis is used to treat a variety of conditions including chronic pain, cancer, chemotherapy induced nausea/vomiting; appetite and weight loss; irritable bowel syndrome; epilepsy, spasticity related to multiple sclerosis, Tourette’s syndrome, amyotrophic lateral sclerosis, Huntington’s disease, Parkinson’s disease, dystonia, Alzheimer’s disease/dementia, glaucoma, traumatic brain injury/spinal cord injury, addiction, anxiety, depression, sleep disorders, post-traumatic stress disorder and schizophrenia. Source: National Academies of Sciences, Engineering, and Medicine, Health and Medicine Division, Board on Population Health and Public Health Practice, Committee on the Health Effects of Marijuana: An Evidence Review and Research Agenda. (2017). The Health Effects of Cannabis and Cannabinoids: The Current State of Evidence and Recommendations for Research. Click here to view full paper.

What is the evidence for the efficacy of medicinal cannabis?

Due to the history of prohibition on the medicinal use of cannabis, the evidence in this area is not as comprehensive as other areas of medicine. For a review of the evidence by the US National Academies of Sciences Engineering and Medicine please click here. Since this is a rapidly evolving area, new evidence is constantly being generated. Pubmed is another excellent source of up to date literature, Creso is working to develop an automated Journal Alert service to collect clinical evidence in the last week for distribution. If you would like to receive these notifications please contact us at info@cresopharma.com.

Are medicinal cannabis products safe?

As medicinal cannabis covers a broad variety of products, it’s difficult to make a single statement about safety. It has been noted that there has not been a documented death due to overdose of smoked cannabis (not recommended for medicinal purposes). Elevated levels of THC which are found in some products may assist with efficacy, but also cause side effects. There is some evidence that high levels of CBD may be able to counteract these side effects. CBD based products are very safe with an extensive literature review finding that doses up to 1500mg in humans were tolerated. At the lower doses currently used outside of epilepsy CBD is well tolerated. Source: Iffland and Grotenhermen, 2017. Click here to view full paper.

What does the WHO think of CBD?

A World Health Organisation (WHO) pre-review report published in November 2017 found that Cannabidiol (CBD) is generally well tolerated with a good safety profile. There is also preliminary evidence that CBD may be a useful treatment for a number of medical conditions. Source: 39th ECDD, Cannabidiol (CBD), 2017. Click here to view full paper.

What is the difference between THC and CBD?

Both Δ9-tetrahydrocannabinol and Cannabidiol are cannabinoids, in particular phytochemicals from the cannabis plant. THC was identified as the agent responsible for the hallucinogenic effects of cannabis but also acts directly on the CB1 and CB2 receptors of the endocannabinoid system providing therapeutic effects. CBD is non-hallucinogenic, and acts like an allosteric modulator (changing the effect that natural ligands for the receptor have) on the CB1 and CB2 receptors. CBD does have numerous other effects on both the endocannabinoid system (reducing endocannabinoid breakdown) and other systems such as adenosine, and receptors such as serotonin, glycine, GPR55 and TRPV1. CBD has been shown to have anti-depressant and anti-anxiolytic effects in animal models and therefore should not be referred to as “non-psychoactive”. Sources: 1. Bridgeman, M. B., & Abazia, D. T. (2017). Medicinal Cannabis: History, Pharmacology, And Implications for the Acute Care Setting. P & T: a Peer-Reviewed Journal for Formulary Management, 42(3), 180–188. Click here to view the full paper. 2. Blessing et al, 2015. Click here to view the full paper.

What difference does the form medicinal cannabis is administered make?

The most common administration of cannabis worldwide is smoked. This is not recommended for medicinal cannabis due to its obvious health implications, as well as variable dosage. Some products are vaporised allowing for a rapid onset of action but currently the most common form is orally via an oil or tincture. The disadvantage of oral administration, particularly for CBD products is that 80%+ are broken down in the first pass through the liver after absorption resulting in less bioavailability. Alternatively, you can administer medicinal cannabis products through the cheeks (buccal). Source: Huestis, M. A. (2007). Human cannabinoid pharmacokinetics. Chemistry & Biodiversity, 4(8), 1770–1804. Click here to view full paper.

What are the advantages of buccal administration?

Blood vessels in the mouth including gums and cheeks are very close to the surface. This allows access directly from the product to the blood stream through diffusion avoiding the first past liver metabolism. This allows for a much greater bioavailability of cannabinoids compared to oral administration. Source: Huestis, M. A. (2007). Human cannabinoid pharmacokinetics. Chemistry & Biodiversity, 4(8), 1770–1804. Click here to view full paper.

How does my patient get access to medicinal cannabis products (Australia)?

In Australia the process for prescribing medicinal cannabis is detailed on the TGA website. Click here.

How does my patient get access to medicinal cannabis products (rest of world)?

Unfortunately, regulations vary significantly from region to region in the world. For assistance in identifying your local regulations please contact us at info@cresopharma.com.