MEDICINAL CANNABIS AND PERSISTENT PAIN


Key points | Is it marijuana or cannabis? | The power of cannabinoids | How is it taken? | Is there any evidence for its use? | Side effects | How do I access it? | Driving and medicinal cannabis | Interactions with other medications | Conclusion | Where to get help | How we can help | More to explore | References | Download PDF

Key points

  • There’s a lot of interest in the use of medicinal cannabis for many health conditions
  • Medical cannabis products usually contain THC, CBD or their combination and are usually in the form of an oil, spray or capsule. CBD does not cause intoxication
  • Evidence for its use in treating pain related to arthritis and musculoskeletal pain is still sparse
  • More research is needed and many clinical trials are currently underway

In 2016 the Australian Government legalised the use of medicinal cannabis for people who have a prescription from their doctor. Since then it’s been prescribed to thousands of Australians with a range of health issues.

And on 1 February 2021 the Therapeutic Goods Administration (TGA) approved over-the-counter sales of low dose cannabidiol (CBD) products from pharmacies.

So what does this mean? Can you just walk into a chemist and ask for cannabis? Should you ask your doctor for a prescription? And is cannabis the wonder drug that many people claim it to be?

This information sheet will answer these questions and explore the use of medicinal cannabis in Australia – specifically in relation to musculoskeletal conditions and pain.

Let’s start with some basics.

Is it marijuana or cannabis?

It’s both. Marijuana and cannabis are different names for the same plant. Marijuana is a colloquial term used to refer to cannabis but it carries a fair bit of historical baggage. Cannabis is the scientific name for the plant and is generally preferred. It can refer to both ‘medicinal cannabis’ where the plant is used for medical purposes and ‘non-medical cannabis’ use where it is used recreationally for relaxation and euphoria.

It’s important to note that medicinal cannabis – unlike any old backyard plant – is grown, cultivated and processed under strict guidelines similar to other pharmaceutical products. When used for medical purposes, cannabis is typically taken orally rather than being inhaled via a joint or bong.

The power of cannabinoids

Cannabinoids are chemicals found in the cannabis plant. Some of them bind onto specific receptors (CB1 and CB2) on the outside of our cells and can affect things such as our appetite, pain-sensation, inflammation, mood, and memory.

Cannabis has more than 100 cannabinoids; the two major ones are tetrahydrocannabinol (THC) and cannabidiol (CBD). THC is the cannabinoid linked with the ‘high’ or ‘euphoria’ associated with non-medical cannabis use.

Cannabinoids also occur naturally in our body (endocannabinoids) and can be created artificially (synthetic cannabinoids).

Cannabinoids are the chemicals that researchers are studying for their potential therapeutic effects.

How is it taken?

Medicinal cannabis, both plant-based and synthetic, can come in a range of forms including oils, capsules and sprays. Cannabis plant material is also sometimes prescribed but for ‘vaporisation’ rather than smoking.

Depending on the product and the condition being treated, it may contain CBD, THC or a combination of the two. If you’re using medicinal cannabis it’s important that you know the active ingredients involved.

Is there any evidence for its use?

Evidence for the use of medicinal cannabis to treat pain associated with arthritis and musculoskeletal conditions is slowly emerging, but is still sparse.

Cannabis has been an illegal drug for a long time. This has caused difficulties in conducting high quality studies into its therapeutic effects in people with a variety of health conditions.

So at the moment, we are still accumulating the scientific evidence around beneficial effects, side effects, dosages, and whether THC, CBD or both are best for treating a specific condition. A lot of research is underway and we will know much more soon!

The Australian Rheumatology Association does not currently support the use of medicinal cannabis for musculoskeletal conditions. Their concern is the lack of evidence from high quality research trials that cannabis is safe and effective for people with musculoskeletal conditions. They have stated that: “there is currently not enough supportive evidence to recommend medical cannabis as a clinical intervention for chronic musculoskeletal pain outside of a clinical trial setting”.(1)

More research is also needed to determine the risks associated with long term use of medicinal cannabis.

While CBD is generally considered safe and without serious side effects, THC can have significant side effects in vulnerable individuals. We are still accumulating the information around the risks and benefits people may experience with medicinal cannabis products, particularly on a long term basis.

As with any treatment or intervention, you and your doctor will weigh up the risks and benefits for your specific situation.

Side effects

Medicinal cannabis is a medication, and like all medications it can have side effects.

Side effects can vary greatly with the type of medicinal cannabis product, the active ingredients (e.g. CBD, THC or combination) and between people.(2)

Products containing THC can cause sedation, anxiety, dizziness, appetite stimulation and impairments in driving and cognitive function. In extreme cases THC can cause hallucinations and psychosis. Doctors will tend to prescribe very low doses of THC when people start treatment.

CBD is generally without serious side effects by itself, but may interact with other prescription medications to alter their effects.

How do I access it?

If you think medicinal cannabis is something you’d like to try, it’s a bit complicated.

Low dose CBD products are available over-the-counter (OTC) for adults as of 1 February 2021, however the TGA has not yet approved any for sale. This is likely to change in the coming months.

Once they’re available, CBD products will be behind the counter and you’ll need to discuss your needs with the pharmacist. Products sold at the pharmacy will only be those taken by mouth. Creams applied directly to the skin and other preparations such as vapours have not been approved for OTC sale at this stage.

As far as getting a prescription from your doctor for higher doses or different preparations of medicinal cannabis, we aren’t at the stage where a doctor can just write a prescription that you can fill at a chemist.

Medicinal cannabis is an unregistered medicine, which means your doctor must be an Authorised Prescriber or must apply for you to have access to it through the TGA’s Special Access Scheme.

It’s important that you note that medicinal cannabis is not on the Pharmaceutical Benefits Scheme (PBS), so if you can access it, you’ll need to pay all the costs.

Another option for gaining access to medicinal cannabis is to consult a doctor at a specialised cannabis clinic. This also comes at a price, however it may be an option if your doctor isn’t an Authorised Prescriber or they’re not well-informed in the use and prescribing of medicinal cannabis.

Driving and medicinal cannabis

If you’re using medicinal cannabis it’s important that you know exactly what’s in it. If you’re taking a product that you’ve obtained through legal prescribers or a pharmacy, and that only contains CBD, then you are good to drive. However if you’re using a product that has any THC in it, whether on its own or in combination with CBD, you can’t drive. It’s currently a criminal offence to drive with any THC in your system. This situation is currently under review in Victoria and it may be that exemptions for patients with a legitimate medicinal cannabis prescription will be granted in the future.

Talk with your doctor and/or pharmacist for more information.

Interactions with other medications

As with any substance you take into your body, there’s the potential for both THC and CBD to interact with other medications and supplements you’re taking. So before prescribing or supplying you with medicinal cannabis, your doctor or pharmacist will review your current medications to reduce the risk of any negative effects.

However if while using medicinal cannabis you experience any unusual symptoms, discuss these with your healthcare professional.

Conclusion

For most people the use of medicinal cannabis may be quite a long way off. And unlike the way it’s often portrayed in the media, it won’t necessarily be a panacea or magic bullet that will cure all ills. Experience shows that some people will benefit greatly, many will benefit modestly, and some not at all.

It also won’t necessarily work in isolation – you’ll still need to do all of the other things you do to manage your condition and pain, including exercise, managing your weight, mindfulness, managing stress, pacing etc.

The important thing is to be as educated as you can and be open in your discussions with your doctor. And be aware that cannabis for non-medical purposes is still illegal in Australia.

Where to get help

  • Your doctor
  • Musculoskeletal Australia
    MSK Help Line: 1800 263 265

How we can help

Call our MSK Help Line and speak to our nurses. Phone 1800 263 265 or email helpline@msk.org.au

Watch our webinar

Medicinal cannabis in Australia: Weeding out the facts

Dr Richard di Natale, outgoing Senator and former leader of the Australian Greens, and Prof Iain McGregor, Lambert Initiative for Cannabinoid Therapeutics, University of Sydney discuss the use of medicinal cannabis in Australia – what it is, available forms, access issues in Australia and the current evidence for use.

More to explore

Download this information sheet (PDF).

References

  1. Australian Rheumatology Association. ARA Position Statement on the use of medicinal cannabis for musculoskeletal pain. 2016.
  2. Therapeutic Goods Administration. Medicinal cannabis products: Patient information. 2018.


Musculoskeletal Australia (or MSK) is the consumer organisation working with, and advocating on behalf of, people with arthritis, osteoporosis, back pain, gout and over 150 other musculoskeletal conditions.

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