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The Australian Opioid Problem and Solutions – A Role for Cannabis
As the distribution of vaccines becomes the focus for a battle against one pandemic, another epidemic continues to disrupt and destroy lives in the country of Australia. For most, the phrase “opioid crisis” conjures images of blighted rural communities in the United States. However, for Australians mourning the loss of a loved one due to opioid overdose, the problem hits much closer to home. A review of the impact that opioids are having in Australia is clearly in order, as is a thoughtful look at the available solutions.   The number of Australians killed by prescription opioid medications has grown every year since 2004. Additionally, as has been seen in America, there is another sickening consequence of so many prescription opioids in the community. Heroin is making a comeback. Every year since 2012 has marked an increase in deaths due to heroin overdose. In 2018, for the first time in many years, there were more deaths caused by heroin than prescription opioids. The problem is getting murkier and more deadly. (1)   However, a deep and despairing plunge into the statistics of opioid over-prescription and the rise of overdose fatalities is not the primary aim of this post. Instead, we will construct a simple outline of the current state of the opioid problem in Australia with an eye toward a particularly promising solution. To understand the problem, it is prudent to first review appropriate and inappropriate indications for opioid medications.  

The Good

  Of course, it is important to recognize the useful role that opioid pain medications can play in the management of several conditions. For example, opioids can be used to improve comfort at the end of life and to treat intractable cancer-related pain. In fact, the World Health Organization lists several opioids on its list of essential medications. These include codeine, morphine, fentanyl and methadone. (2)   At the end of life, opioids are on a short-list of medications useful in the treatment of air-hunger or dyspnea related to terminal illness. In one study, a 10 mg daily dose of sustained-release oral morphine was found to cause meaningful improvement in dyspnea symptoms for patients with advanced COPD. (3) Other studies have confirmed these findings. (4)   Additionally, there is ample evidence to support the use of opioid analgesics in the treatment of cancer-related pain. One influential paper called attention WHO’s guide for the management of cancer pain which favors the use of opioids when levels are at their highest. (5) A more recent paper from 2018 also cites the WHO Analgesic Ladder but mentions that stronger opioids such as morphine may be more effective than the weaker opioids (codeine) for moderate pain scores in cancer patients. (6)  

The Badh

  The truth of modern opioid utilization, however, is that the tremendous explosion in the usage of opioids has occurred mostly because of a push by pharmaceutical companies to expand the indications for which opioids can be prescribed. An examination of available literature on the rise in Australian opioid utilization reveals: “In the last two decades, various opioids (have been registered and marketed for the treatment of chronic non-cancer pain. These changes in registration have brought about dramatic growth in opioid prescribing despite uncertainties regarding effectiveness.” (7)   Indeed, the evidence to support the use of opioids in the treatment of chronic pain unrelated to cancer is disappointing at best. The most rigorous systematic reviews have found “that opioids were associated with similar improvements in pain and physical functioning compared with NSAID pain relievers, tricyclic antidepressants and cannabinoids.” (8)  

The Ugly

  The consequences of this explosive growth of opioid over-prescription are stark. In 2018, the most recent year for which we have data, there were 1130 deaths as the result of opioid overdose. For some perspective, there were 678 deaths from car crashes in the same period. (1)   It is helpful to put some actual figures to this explosion in opioid usage. This task can be challenging because there is sparce reporting of hard numbers when it comes to the filling of opioid prescriptions on a per-year basis in Australia. Nonetheless, diligent research paints a troubling picture of the decades-long increase in opioid utilization in Australia. One study reported that the yearly number of opioids being dispensed grew by 24% between 2002 – 2009. (9) Within the last decade things have worsened. Between 2010 and 2015 there was an increase of over 100% in prescriptions of oxycodone. (10) By 2016, 16 out of every 1000 Australian citizens were taking opioid medications every day—with 60% of those having long term prescriptions.  

Possible Progress?

  There is mixed evidence for incremental progress. For example, preliminary data seems to suggest a modest drop in the overall number of opioid related accidental overdose deaths in 2018 from the previous year. Perhaps the decline in opioid deaths comes due to improved regulation of codeine. After all, codeine is no longer available on an over-the-counter basis. However, another possible explanation belies the time spent cracking down on codeine. In almost every instance, the preliminary reported numbers of deaths due to opioid overdoses are eventually revised significantly higher. (1)   Are there any innovative ideas? Is there something that hasn’t been tried yet? Where exactly are all the people who had been relying on codeine supposed to turn?  

The Green Elephant in the Room

  Often dismissed by the more “sober” elements within the medical community due to its popularity among recreational users and its unfortunate association with “naturopathic medicine,” cannabis may yet have a key role to play in the future of Australian pain management.   Cannabis, ancient treatment that it is, is receiving renewed attention as a potential pain medication. And for good reason. Cannabis offers the opportunity as safe and effective alternative in the management of chronic pain, in particular when used responsibly and judiciously in a proper clinical set-up. My own clinical experience shows that about 50% of my patients were able to either reduce or even stop their other medications, in particular opioids.   Cannabinoid receptors and endocannabinoids are present in the primary afferent pain circuits to the brain. Cannabinoid and opioid receptors have similar signal transduction systems and are expressed in several parts of the brain involved in antinociception. Moreover, both mu-opioid receptors and CB1 receptors are present in the spinal cord at the first synaptic contact for peripheral nociceptive afferent neurons. (11)   Preclinical and clinical studies show that when co-administered with opioids, cannabis-based medicines may allow reduced opioid doses without loss of analgesic efficacy, so called an opioid-sparing effect. (11)   Some of pre-clinical studies showed that the median effective dose of morphine when administered in combination with delta-9-tetrahydrocannabinol was 3.6 times lower than the of morphine alone. Additionally, the median effective dose for codeine administered in combination with delta-9-THC was 9.5 times lower than the of codeine alone. (11)   Some controlled clinical studies showed beneficial effects on pain, sleep, and functioning in chronic pain patients when opioids and cannabinoids were administered together. (12)   Combinations of cannabinoids with opioids may be an effective way of reducing opioid doses, offering the potential for reducing opioid‐induced side effects and subsequent opioid physical dependence. (13)   In the light of the current crisis in Australia there are some significant decisions left to make. It is very important to expand and simplify access to
medicinal cannabis and educate physicians and patients about its use as an alternative as well as adjunct to opioid-based medications. For practicing physicians in Australia, one thing is clear: it’s time to start learning about cannabis.

References

 
  1. Penington Institute (2020). Australia’s Annual Overdose Report 2020. Melbourne: Penington Institute
  2. World Health Organization Model List of Essential Medicines, 21st List, 2019. Geneva: World Health Organization; 2019. Licence: CC BY-NC-SA 3.0 IGO
  3. Currow, D. C., Quinn, S., Greene, A., Bull, J., Johnson, M. J., & Abernethy, A. P. (2013). The longitudinal pattern of response when morphine is used to treat chronic refractory dyspnea. Journal of palliative medicine, 16(8), 881–886. https://doi.org/10.1089/jpm.2012.0591
  4. Barnes, H., McDonald, J., Smallwood, N., & Manser, R. (2016). Opioids for the palliation of refractory breathlessness in adults with advanced disease and terminal illness. The Cochrane database of systematic reviews, 3(3), CD011008. https://doi.org/10.1002/14651858.CD011008.pub2
  5. Plante, G. E., & VanItallie, T. B. (2010). Opioids for cancer pain: the challenge of optimizing treatment. Metabolism: clinical and experimental, 59 Suppl 1, S47–S52. https://doi.org/10.1016/j.metabol.2010.07.0106. Bruera, E., & Paice, J. A. (2015).
  6. Cancer pain management: safe and effective use of opioids. American Society of Clinical Oncology educational book. American Society of Clinical Oncology. Annual Meeting, e593–e599. https://doi.org/10.14694/EdBook_AM.2015.35.e593
  7. Karanges, E. A., Blanch, B., Buckley, N. A., & Pearson, S. A. (2016). Twenty-five years of prescription opioid use in Australia: a whole-of-population analysis using pharmaceutical claims. British journal of clinical pharmacology, 82(1), 255–267. https://doi.org/10.1111/bcp.12937
  8. Busse, J. W., Wang, L., Kamaleldin, M., Craigie, S., Riva, J. J., Montoya, L., Mulla, S. M., Lopes, L. C., Vogel, N., Chen, E., Kirmayr, K., De Oliveira, K., Olivieri, L., Kaushal, A., Chaparro, L. E., Oyberman, I., Agarwal, A., Couban, R., Tsoi, L., Lam, T., … Guyatt, G. H. (2018). Opioids for Chronic Noncancer Pain: A Systematic Review and Meta-analysis. JAMA, 320(23), 2448–2460. https://doi.org/10.1001/jama.2018.18472
  9. Blanch, B., Pearson, S. A., & Haber, P. S. (2014). An overview of the patterns of prescription opioid use, costs and related harms in Australia. British journal of clinical pharmacology, 78(5), 1159–1166. https://doi.org/10.1111/bcp.12446
  10. Roxburgh, A., Bruno, R., Larance, B., & Burns, L. (2011). Prescription of opioid analgesics and related harms in Australia. The Medical journal of Australia, 195(5), 280–284. https://doi.org/10.5694/mja10.11450
  11. Nielsen S, Sabioni P, Trigo JM, et al (2017) Opioid-sparing effect of cannabinoids: A systematic review and meta-analysis. Neuropsychopharmacology 42:1752–1765
  12. Narang S, Gibson D, Wasan A, Ross E, … EM-TJ of, 2008 undefined Efficacy of dronabinol as an adjuvant treatment for chronic pain patients on opioid therapy. Elsevier
  13. Chen X, Cowan A, Inan S, et al (2019) Opioid-sparing effects of cannabinoids on morphine analgesia: participation of CB1 and CB2 receptors. Br J Pharmacol 176:3378–3389
 
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Jun 2, 2021
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Worldwide Microbial Resistance And The Role Of Cannabis
The 20th century saw several critical discoveries that completely changed the face of health care. Among the most important discoveries was penicillin, one of the antibiotics that are still in use today. However, the emergence and spread of drug-resistant pathogens threaten to wipe out the gains made over the last century.   The discovery of penicillin in 1928 by Sir Alexander Fleming marked the beginning of the antibiotic revolution (1). But it’s the aptly named “golden era of antibiotics” period between the 1950s and 1970s that witnessed the discovery of many novel antibiotics. After that period, drug research changed to focusing on modifying existing antibiotics.   Antibiotics have had a success story like no other in the history of medicine. For example, the leading cause of death in the western world changed from infectious diseases to non-communicable diseases (1), and life expectancy increased by at least ten years due to antibiotic use (2).   That success didn’t last long as bacteria followed by fungi and viruses began developing resistance to antimicrobial agents (3). In fact, in 1940, before penicillin was introduced for therapeutic use, an enzyme from bacteria that could destroy penicillin had already been identified (4). Once antibiotics use became widespread, microbial capable of resisting the drugs became prevalent.   Today, The World Health Organization lists Antimicrobial resistance as one of the top 10 global public health threats facing humanity (5). And without drastic action, we could be heading to a post-antibiotic era due to the loss of effective antimicrobials. Experts say this would lead to “apocalyptic scenarios” in which common infections and minor injuries would kill (6) just like before the 20th century, and surgery would become too risky.   But what has led us onto this path?   Causes and Effects of Antimicrobial Resistance   Although antimicrobial resistance is a natural phenomenon, it is mainly fuelled by the inappropriate use of antimicrobial agents (1). For example, one report by the CDC found that between 30% to 50% of antibiotic use in humans was unnecessary or inappropriate (7).   Drug resistance is not limited to antibiotics. The World Health Organization has also expressed concern about antiviral drug resistance, especially in immunocompromised patient populations (7), including those using antiretroviral drugs (ARV).   Drug-resistant fungal infections are also on the rise, exacerbating an already difficult treatment situation. Antimicrobial resistance has led to the emergence and spread of untreatable infections, with some bacteria even developing resistance to multiple drugs. WHO estimates that over half a million treatment-resistant tuberculosis cases, including multi-drug resistant TB, were identified globally in 2018 (5).   K. pneumoniae, a common bacterium that can cause life-threatening infections, including pneumonia and bloodstream infections, is another drug-resistant bacteria spread globally. Other cases of resistance against antimicrobials have been recorded in STIs, including gonorrhoea, UTIs and some forms of diarrhoea.   How Covid-19 Could Be Accelerating Antibiotic Resistance   Antibiotic resistance was a health emergency long before the outbreak of Covid-19, but now, there are concerns that the coronavirus pandemic could be worsening the problem. The outbreak, which has overstretched healthcare facilities globally, has also led to misuse of antibiotics and may have increased drug-resistant infections.   For example, a recent US study found that more than half of hospitalised Covid-19 patients had received antibiotics in the pandemic’s first six months. In 96% of the cases, antibiotics were prescribed before confirming a bacterial infection (8). In Australia, 44% of respondents to a national online survey thought antibiotics effectively prevented or treated Covid-19 (9).   While hospitals in many countries had implemented antibiotic stewardship programmes, the burden of the pandemic disrupted this progress. It also may have led to more drug-resistant infections, common in overcrowded health care facilities.   Covid-19 could also hurt the efforts to curb antimicrobial resistance by interfering with the already “broken” antibiotics pipeline (10) as more resources are directed to Covid-19 vaccine research and management. Although some vaccines have already proven effective, the long-term effects of Covid-19 may be with us for a while.   Antimicrobial resistance is a disaster waiting to happen if it continues to increase unchecked. But what other options do we have?   The Role of Cannabis in The Fight Against Antimicrobial Resistance   Several cannabinoids have been shown to have antibacterial, antiviral, and antifungal properties in addition to their pain and anxiety-relieving properties. And with the microbial resistance reaching dangerously high levels, some studies suggest that cannabis may be the answer to today’s superbugs (11).   Antibacterial Properties of Cannabis   Several studies have shown that cannabinoids exhibit antibacterial activity against several bacteria. One study conducted by The University of Queensland and Botanix Pharmaceuticals found that CBD may kill the bacteria responsible for meningitis, gonorrhoea and legionnaires disease (12).   This is important because gonorrhoea is the second most prevalent STI in Australia, and it no longer has a single reliable antibiotic due to antibiotic resistance.   Other cannabinoids, including CBG, CBN, CBCA, and THC, also have potent antibiotic properties (13).

Antiviral Potential of Cannabis

  Several studies have suggested that some cannabinoids may have an antiviral effect against some common viruses (15). One study investigating the potential of CBD as a treatment for viral hepatitis C found that cannabidiol exhibited in vitro activity against the hepatitis C virus (14).   Cannabis can also be used alongside other antivirals for its anti-inflammatory and pain-relieving benefits that could boost the overall effectiveness of the treatment.   Although these preliminary results are encouraging, more research is still required before cannabis can be used as an antiviral.   Antifungal Benefits of Cannabis   There are indications that specific compounds in the cannabis plant may act as anti-fungal agents. These include cannabinoids CBD, CBC and CBG and terpenes, including beta-caryophyllene in its oxidised form (16).   One study reports that CBD, CBC and CBG have some antifungal properties. Still, most of the benefits could be due to the cannabinoids boosting the effects of caryophyllene oxide (16).   Caryophyllene oxide is an oxygenated terpenoid found in cannabis whose potent antifungal activity has been compared to Sulconazole – medication used to treat common fungal infections such as athlete's foot, jock itch and ringworms (17).   How Cannabis May Help Fight Resistant Microbial   Cannabis compounds have been shown to penetrate and kill a wide range of drug-resistant bacteria. This could lead to a new class of antibiotics for resistant bacteria after more than 60 years (12). CBD, for example, has been shown to be effective against antibiotic-resistant pathogens such as MRSA, N. gonorrhoeae and others.   Research conducted by the University of South Denmark found that CBD could also be used to boost antibiotics. By combining CBD and antibiotics, the researchers report observing a more powerful effect than treating with antibiotics alone (11). Cannabis compounds have also been shown to have potent antifungal and antiviral properties.   Antimicrobial resistance is already a global health threat. To avoid the dangers posed by drug-resistant pathogens, drastic actions including responsible use of antibiotics and the development of new classes of antimicrobials are required. Current research suggests that Cannabis may be effective in managing drug-resistant bacteria. However, more studies are still needed to understand how it works fully.   References 1.Treasure Called Antibiotics (2016) US National Library of Medicine, National Institute of Health
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5354621/ 2. Beta-Lactam Antibiotics (1988) The New England Journal of Medicine https://www.nejm.org/doi/full/10.1056/NEJM198802183180706 Microbial Resistance: Bacteria and More (2003) Infectious Disease Society of America https://academic.oup.com/cid/article/36/Supplement_1/S2/302113 4. Origins and Evolution of Antibiotic Resistance (2010) American Society for Microbiology https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2937522/ 5. Antimicrobial resistance (2020) World Health Organization https://www.who.int/news-room/fact-sheets/detail/antimicrobial-resistance 6. Antibiotic Resistance (2020) World Health Organization https://www.who.int/news-room/fact-sheets/detail/antibiotic-resistance 7. Antibiotic Abuse Report Media Release (2016) Centers for Disease Control and Prevention https://www.cdc.gov/media/releases/2016/p0503-unnecessary-prescriptions.html 8. Could Efforts to Fight the Coronavirus Lead to Overuse of Antibiotics? Pew Charitable Trusts https://www.pewtrusts.org/en/research-and-analysis/issue-briefs/2021/03/could-efforts-to-fight-the-coronavirus-lead-to-overuse-of-antibiotics 9. Examining Australian’s Beliefs, Misconceptions and Sources of Information for Covid-19: a national online survey BMJ Open https://bmjopen.bmj.com/content/11/2/e043421 10. Fix the Antibiotics Pipeline (2011) Nature https://www.nature.com/articles/472032a 11. Cannabis Helps Fight Resistant Bacteria (2020) University of South Denmark https://www.sdu.dk/en/nyheder/forskningsnyheder/cannabis 12. The Antimicrobial Potential of Cannabidiol Communications Biology https://www.nature.com/articles/s42003-020-01530-y 13. Uncovering the Hidden Antibiotic Potential of Cannabis BioRxiV https://www.biorxiv.org/content/10.1101/833392v3.full 14. Potential of Cannabidiol for the Treatment of Viral Hepatitis (2017) National Library of Medicine – Pharmacognosy Research https://pubmed.ncbi.nlm.nih.gov/28250664/ 15. Cannabidiol for Viral Diseases: Hype or Hope? Cannabis and Cannabinoid Research Vol.5, No.2 https://www.liebertpub.com/doi/10.1089/can.2019.0060 16. Taming THC: potential cannabis synergy and phytocannabinoid-terpenoid entourage effects British Journal of Pharmacology https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3165946/ 17. Use of caryophyllene oxide as an antifungal agent in an in vitro experimental model of onychomycosis Mycopathologia https://pubmed.ncbi.nlm.nih.gov/11189747/#:~:text=Caryophyllene%20oxide%2C%20an%20oxygenated%20terpenoid,as%20an%20antifungal%20against%20dermatophytes.&text=So%2C%20a%20new%20model%20has,unobtainable%20for%20in%20vitro%20tests
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Aug 3, 2021
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History of Cannabis Prohibition in Australia
For almost a century now, cannabis has been prohibited in Australia, and it’s the citizens who have paid the ultimate price. Today, cannabis legalization efforts are gaining traction worldwide, and Australians now realize what they have missed out on for the last 100 years (1).
  • Four countries have legalized marijuana for recreational use and forty-two including Australia, have legalized it for medical use (1). But how did we get here? Was Cannabis prohibition a mistake or an accident?
  • In this article, we attempt to shed more light on the history of cannabis prohibition in Australia.

Early Years – Where It All Began

  • Australia was neither the first to ban cannabis, nor was it the first to plant it. The first record of cannabis in the country was in the 1770s when hemp seeds from the United Kingdom made their way to Australia at Sir Joseph Banks’ request aboard the First Fleet (2).
  • The First Fleet comprised 11 ships transporting convicts from Portsmouth, England, to New South Wales, the penal colony that would become the first European Settlement in the country.
  • Joseph Banks, an English naturalist and botanist, marked the hemp seeds as “for commerce,” hoping that the plant would be produced commercially in the colony.
  • Historians believe that hemp cultivation was the main motive behind colonization. According to Dr. Jiggens, Australian historian and author of Sir Joseph Banks and the Question of Hemp, Britain’s colonization of New South Wales was never about finding a place to relocate convicts but to turn it into a hemp colony.
  • Hemp was very important for maritime countries as it could be used for making cables, sails among other uses. With Joseph Banks’ help, cannabis was introduced in Australia, where it flourished and was widely used during the 19th century. The government encouraged hemp farming for the next 150 years by giving grants and land.
  • Cannabis was used for both recreational and medicinal purposes. Cigars de joy (cannabis cigarettes) were sold over the counter well into the 20th century in Australia (3). These claimed to give immediate relief from asthma, shortness of breath, influenza, bronchitis, and cough.

Early 1900s – First Attempt at Prohibition

  • Like most developed countries, the Australian cannabis prohibition journey began in the 1920s. This is when the domestic implementation of international drug control treaties set off the eventual cannabis prohibition in the Commonwealth.
  • The first attempt at banning cannabis was in the 1912 International Opium Convention (4). Luckily, the United States attempt to include cannabis in the 1912 Convention signed at The Hague was unsuccessful. However, this wouldn’t be their last.
  • The 1912 Convention’s primary objective was to control exports and restrict opium, heroin, cocaine, and morphine to medical uses only. It didn’t make drug use or cultivation illegal. Like others negotiated by the League of Nations, this Convention was normative rather than prohibitive.
  • This led to the United States and China, who favored prohibitionist measures to withdraw from negotiations that led to the 1925 International Opium Convention signed in Geneva. (5)

1925 The Geneva Convention – Cannabis Prohibition in Australia

  • Cannabis banning was inevitable. A revised International Convention relating to Dangerous drugs was signed at Geneva. This treaty was designed to outlaw the recreational use of opium and cocaine. However, Egypt made a last-minute request to include cannabis as “it was causing widespread insanity.” The motion was backed by Turkey and voted in despite opposition from India. (6)(7)
  • While cannabis wasn’t a problem in Australia at the time, like other countries, it was not immune to the pressure to conform to those treaties. Furthermore, Australia was subjected to additional pressure from the British government, which represented its colonies and dominions in the international meetings and encouraged their compliance (3).
  • As a result, Australia became the first country to succumb to the pressure. In 1926, it proscribed the import and export of cannabis. However, that wasn’t enough to make it illegal. To do this, it required local jurisdictions to begin legislating and implementing laws consistent with the Geneva convention.
  • The country was also under pressure from the United States. In April 1938, Smith’s Weekly, an Australian newspaper, published an article titled ‘New Drug That Maddens Victims’ and subtitled ‘Warning from America.’ The article also informed the readers of the plant’s local availability (14)
  • This article marked the beginning of American-inspired ‘Reefer Madness’ style campaigns, including the outrageous claims that it was “a Mexican drug that leads men and women to the wildest sexual excesses.” The article also introduced the word marijuana to Australia in an attempt to change the public’s perception of cannabis. (14)
  • The states’ response was inevitable but was slowed down by the lack of a drug problem. Some jurisdictions didn’t see the problem as the prohibition model was applied with little research into how cannabis was used in Australia. (8). This meant that most laws enacted during that time were related only to opium.
  • However, with pressure from the UK, local jurisdictions started implementing laws related to cannabis. (2) Victoria was the first state to enact legislation outlawing cannabis in 1928, with other states slowly catching up over the next three decades. Cannabis cultivation for personal use remained legal in Western Australia until 1950 and in Tasmania until 1959.
  • Although the Commonwealth had in 1956 acted to introduce total cannabis prohibition, its use and cultivation remained uncommon, with the first illegal crop being reported as late as 1957. (8) This, however, changed dramatically in the 1960s.

The 1960’s – Weed Raiders and the Dramatic Rise of Cannabis Use

  • It wasn’t until it was banned that cannabis became the most used drug in Australia. The ’60s generally saw an increase in the use of mind-altering drugs, including cannabis, mainly by those opposed to the Vietnam War (2).
  • This led to more states gradually favoring the prohibitionist approach like in the US, with right-wing politicians like Robert Askin – New South Wales premier calling for crackdowns.
  • Although its recreational use had been banned decades earlier, it became widespread after it was introduced in Sydney’s hippie culture by US servicemen in respite from the Vietnam War in the mid-late ’60s. (6)
  • The discovery of about 30 square kilometers of marijuana infestation in the Hunter Valley ensured sufficient supply to satisfy the country’s demand. Bands of weed enthusiasts, later known as ‘Weed Raiders’ harvested the plants evading landowners and police. Much of the cannabis was smuggled to Sydney, where it was cured and illegally distributed. (9)
  • The eradication of the marijuana infestation took more than nine years.
  • The authorities reacted to this increase by trying to prosecute users. As a result, arrests rose by 1000% between 1966 and 1969, with the penalties also increasing.

Australia War on Drugs

  • Australia had a few notable events to curb drug use. In 1973, NSW premier Robert Askin allowed police to attempt arresting anyone smoking cannabis publicly at the Aquarius Festival in Nimbin NSW. This led to a riot of more than 6000 people.
  • In Queensland, police raided the Cedar Bar commune in an overwhelming show of force – a boat, helicopters, and four-wheel drives, for tiny portions of cannabis. The officers went as far as burning down houses and blowing up water tanks. Premier Joh Bjelke Peterson defended the police action as “tough on drugs.”

The 1970s The Beginning of the End

  • By 1970, all the states had enacted laws that separated drug use or possession offenses from drug supply offenses (10). In the late ’70s, reduced penalties for cannabis use were advocated for as arrests rose. Most advocated for the introduction of fines for possession offenses, while others advocated for the removal of all penalties. (11)
  • In 1985, a National Campaign Against Drug Abuse (NCADA) resulted from a meeting between the Prime Minister and all state premiers, adopted a mixture of prohibition and harm reduction policies in dealing with drug use, including cannabis.
  • This opened the way for South Australia to decriminalize minor cannabis offenses in 1987 and ACT in 1992 (6). In 2000, NSW introduced a cannabis cautioning scheme where police can issue a cannabis caution to adults found in possession of up to 15 grams.
  • In 2016, the Australian parliament passed new national laws legalizing medical cannabis products. Under the new federal scheme, patients with valid prescriptions can possess and use legally manufactured cannabis. (12)
  • Interestingly, one in five US residents lives in a jurisdiction with fully legal marijuana (13), although the country was the main architect and driving force behind global cannabis prohibition.
References   1. Legality of Cannabis Wikipedia
https://en.wikipedia.org/wiki/Legality_of_cannabis 2. Cannabis in Australia Wikipedia https://en.wikipedia.org/wiki/Cannabis_in_Australia#Early_history 3. Cannabis in Context, History, Laws and International Treaties chapter3 Druglibrary.org https://www.druglibrary.org/schaffer/Library/studies/aus/can_ch3_5.htm 4. International Opium Convention Wikipedia https://en.wikipedia.org/wiki/International_Opium_Convention 5. The UN Drug Control Conventions Transnational Institute https://www.tni.org/en/publication/the-un-drug-control-conventions#box1 6. The History of Recreational Cannabis in Australia Sydney Criminal Lawyers https://www.sydneycriminallawyers.com.au/blog/the-history-of-recreational-cannabis-in-australia/ 7. The War On Drugs: How Egypt was the First Country To Lead the Charge and the Last to Back Down Cairo Scene https://cairoscene.com/In-Depth/The-War-On-Drugs-How-Egypt-Was-The-First-Country-To-Lead-The-Charge-And-The-Last-To-Back-Down 8. Cannabis: The Contemporary Debate Parliamentary Library Research https://www.parliament.nsw.gov.au/researchpapers/Documents/cannabis-the-contemporary-debate-vol-1--text/Cannabis.pdf 9. Hunter Valley cannabis infestation Wikipedia https://en.wikipedia.org/wiki/Hunter_Valley_cannabis_infestation 10. A brief history of Australian drug laws Unharm.org https://www.unharm.org/a_brief_history 11. What does the history of Australian cannabis policy suggest about its likely future shape? Academia.edu https://www.academia.edu/2867399/What_does_the_history_of_Australian_cannabis_policy_suggest_about_its_likely_future_shape 12. Medical marijuana is now legal in Australia Business Insider, Australia https://www.businessinsider.com.au/medical-marijuana-is-now-legal-in-australia-2016-2 13. 1 in 5 Americans now has access to fully legal marijuana Business Insider, Australia https://www.businessinsider.com.au/marijuana-in-america-20-of-americans-can-now-access-legal-weed-2016-11?r=US&IR=T 14. The Origins of Marijuana Prohibition in Australia Dr Jiggens https://www.drjiggens.com/wordpress/the-origins-of-marijuana-prohibition-in-australia/
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Oct 5, 2021
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CBD And the Endocannabinoid System
CBD And the Endocannabinoid System

According to a 2019 study by researchers from the University of California and Johns Hopkins University, search rates for CBD (in the US) grew to 126% from 2016 to 2017, 160% the next year, and 118% the year after that (1). Closer home, Australia’s medical cannabis market is experiencing exponential growth.<? In 2017, only 457 patients on the entire continent had access to medical cannabis. By 2019, that number had increased by 34x to 15,556.

Data suggests that through 2019, active medical cannabis patients increased by an average monthly growth rate of 19%. By May 2020, the Therapeutic Goods Administration (TGA) had approved at least 18,000 medical cannabis applications (2).

It’s obvious the demand for cannabis extracts is on a steady rise. This merit understanding the mechanisms behind cannabinoids (chemical compounds found in cannabis) such as CBD and how they affect the human body. <p style="font-weight:bold;">Understanding the Endocannabinoid System</p> Cannabinoids in the cannabis plant, including CBD interact with many systems in the human body and among them, most importantly, the endocannabinoid system (ECS).

The endocannabinoid system (ECS) is a complex cell-signalling system responsible for internal regulation, cellular communication and homeostasis. It is universally found in all mammals (3).

This system was discovered in the 1990s by scientists exploring THC, a popular phytocannabinoid.

While there’s a long way to go to understand the ECS fully, we know the significant role it plays in regulating vital body processes, including:
  • Pain
  • Sleep
  • Immune system response
  • Metabolism
  • Memory
  • Mood
  • Appetite
  • Motor control
  • Reproduction health
  • Skin and nerve health, etc


POINT TO NOTE: The endocannabinoid system exists and is active in all mammals even if they don’t use cannabis. However, research suggests that cannabinoids such as CBD may help maintain a healthy ECS.

Components of The Endocannabinoid System



To understand how CBD may impact the human body, we need to understand how the ECS works. The ECS involves three core components: receptors, enzymes, and endocannabinoids.

Endocannabinoids



Endocannabinoids are the molecules internally produced within human body and are similar in function and structure to THC. These molecules are the chemical messengers of the endocannabinoid system.

So far, we know two key endocannabinoids: anandamide and 2-arachidonoylglycerol.

Anandamide, also known as the bliss molecule, is available throughout your ECS and is thought to impact appetite, pregnancy, memory, among other health benefits. It has also been associated with the ‘runner’s high’ (4) you experience after an intense exercise. On the other hand, 2-ArachidonoylGlycerol is involved with your emotional state, cardiovascular health, seizures, and even orgasm (5). Interesting, right?

Cannabinoid Receptors (CB Receptors)



; Cannabinoid receptors are found throughout the human body. These receptors are activated by endocannabinoids as well as some phytocannabinoids, for example THC.

When these molecules bind to cannabinoid receptors, the endocannabinoid system is triggered to take a specific action. We know two main CB receptors:

CB1 receptors

- Abundant in the central nervous system. Depending on their location in the brain, CB1 receptors can moderate mood, memory, pain perception, as well as motor function. Activation of these receptors in the brain by THC might trigger intoxicating effects on cannabis users.

CB2 receptors

- Mostly found in the immune system and associated structures. Scientists now believe that CB2 receptors are involved in the pharmacological effects of cannabinoids on immune function and inflammation.

Enzymes



Once the endocannabinoids have carried out their functions, they’re broken down by enzymes.

This helps prevent the endocannabinoids from continuing to stimulate the endocannabinoid system indefinitely.

The ECS contains enzymes involved in the synthesis and degradation of endocannabinoids.

The ones involved in degradation are

Monoacylglycerol acid lipase

- Breaks down 2-AG, and

Fatty acid amide hydrolase

- Breaks down AEA.

Function of The Endocannabinoid System in Maintaining Homeostasis

As mentioned, it will take a bit longer before we can explain exactly how the endocannabinoid system works or all its potential benefits. It is a very complex system and its main role is to maintain homeostasis. (6)

Homeostasis refers to a balance in the body’s internal environment. This means that when your body, for instance, produces too much of something, let’s say the stress hormone, or when external factors, e.g., anxiety or pain due to an injury, throws your body’s internal environment off balance, the ECS jumps into action to help return your body to its ideal operation.

How CBD Interacts with the ECS- (Effects Of CBD)



Now that we know what’s the ECS and its role in the human body, why do we need CBD? In other words, how does CBD interact with the endocannabinoid system?

As you probably already know, unlike THC, CBD doesn’t cause any mind-altering effects on users. This has to do with how the two cannabinoids impact the ECS.

Trying to explain this, research has shown that just like the endocannabinoid anandamide, THC can bind to CB1 receptors in the brain.

However, the difference here is that while endocannabinoid anandamide has a relaxing effect on the brain, THC might be intoxicating and lead to mind-altering effects.

FAAH is the enzyme responsible for anandamide degradation but at the same time it’s not very strong against THC. This is why THC users tend to remain high for longer.

On the other hand, CBD doesn’t bind directly to the CB receptors. Instead, it’s thought to impact the ECS by reducing the action of the enzyme linked to degrading anandamide.

This means a higher concentration of anandamide in the body. Since this endocannabinoid has a calming effect on the brain, by acting as a FAAH inhibitor, CBD may help control mood imbalance symptoms such as anxiety and stress.

In other words, instead of having a direct impact on the ECS, CBD helps potentiate the effects of anandamide (7).

It is also important to mention that CBD interacts with many other metabolic systems in the human body.

While more research is needed to ascertain the full potential of CBD in our bodies, doctors are already prescribing it to help manage some chronic conditions such as pain, nausea, stress, and anxiety.

Effects of CBD On the Endocannabinoid System- Wrapping Up



The ECS helps maintain a balance in the body’s internal environment (homeostasis).

Unfortunately, this balance may be disrupted, leading to what Dr Ethan Russo M.D., Director of Research and Development of the International Cannabis and Cannabinoids Institute, terms as clinical endocannabinoid deficiency.

In his theory, Dr Russo links clinical endocannabinoid deficiency to some chronic health conditions such as irritable bowel syndrome, migraine, fibromyalgia, and other treatment-resistant syndromes (8).

The fact that the endocannabinoid system is present in every major body system explains how an imbalance in the system can lead to many (and varied) health conditions.

More research is obviously needed to ascertain this, but given how CBD interacts with the body, it may help promote a balanced and healthy ECS.

References

1.Trends in Internet Searches for Cannabidiol (CBD) in the United States Jama Network Open
https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2753393

2. Australia’s Medical Cannabis Market: Lots Of Potential, Yet, Few Patients New Frontier Data https://newfrontierdata.com/cannabis-insights/the-ins-and-outs-of-australias-medical-cannabismarket/

3. Introduction To The Endocannabinoid System Norml.org https://norml.org/marijuana/library/recent-medical-marijuana-research/introduction-to-the-endocannabinoid-system/

4. New Brain Effect Behind The Runner’s High Scientific American https://www.scientificamerican.com/article/new-brain-effects-behind-runner-s-high/

5. Masturbation To Orgasm Stimulates The Release Of The Endocannabinoid 2-Arachidonoylglycerol In Humans The Journal Of Sexual Medicine https://www.jsm.jsexmed.org/article/S1743-6095(17)31443-1/abstract

6. The Role Of The Endocannabinoid System In The Human Body Cure Pharmaceutical https://www.curepharmaceutical.com/blog/the-role-of-the-endocannabinoid-system-in-the-human-body/#:~:text=The%20endocannabinoid%20system%20is%20a,metabolism%2C%20memory%2C%20and%20more

7. Cannabidiol Enhances Anandamide Signalling And Alleviates Psychotic Symptoms Of Schizophrenia Translational Psychiatry https://www.nature.com/articles/tp201215#Sec9

8. Clinical Endocannabinoid Deficiency Reconsidered: Current Research Supports the Theory in Migraine, Fibromyalgia, Irritable Bowel, and Other Treatment-Resistant Syndromes National Centre For Biotechnology Information https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5576607/
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Dec 2, 2021
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Recent Changes to Medicinal Cannabis Access in Australia
Medical Marijuana Products Will Now Be Prescribed on The Basis of Active Ingredient Content; Not Brand Name   As of the 22nd of November, The Therapeutic Goods Administration (TGA) has made changes to the process of applying for approval to prescribe medical cannabis - both via the Special Access Scheme (SAS) and Authorised Prescriber (AP) pathways. These changes have been introduced with the aim of reducing the administrative burden for prescribers who determine that an unapproved medicinal cannabis product is clinically suitable for their patient. This article will highlight some of these changes as we discuss their implications on medical cannabis prescribers, pharmacists, and consumers.

1. Active Ingredients to Be the Basis Under Which Cannabis Products Will Be Grouped for Prescriber Approval

In a move that aims to reduce the regulatory burden on prescribers, the TGA has announced that active ingredients, rather than specific trade names, will now be used for the purpose of prescriber approval. The current process for approval has often been described as long and arduous, with prescribers being required to wait up to 48 hours for the paperwork to be assessed & approval to be given to prescribe medicinal cannabis. Of course, this means that very few doctors were willing to undertake this time-consuming process. With the new changes, any unapproved cannabis products will be grouped together based on their cannabinoid content. Prior to these changes, General Practitioners were required to apply for a specific trade name and had to seek fresh TGA approval in the case of product discontinuation, name changes, or unavailability. With the new amendments, however, GP’s using the Special Access Scheme (SAS) will now be required to seek the TGA approval using one of the five categories of medicinal cannabis. This means that if you get approval for medicines in one category, you can switch between products with similar active ingredients without seeking approval from the TGA whenever there is a need. “The change means that prescribers can obtain approval for a category and then issue prescriptions for any product within that category without the need to reapply for TGA approval each time. And ultimately, our goal is to improve patient access for appropriate patients,” says TGA in a presentation. Here are the 5 general categories that the TGA will use to grant approval going forward:
  • Category 1- CBD products where CBD concentration is greater than or equal to 98%.
  • Category 2- CBD dominant products with a CBD concentration of between 60 and 98%.
  • Category 3- Balanced products, with CBD levels between 40 and 60%.
  • Category 4- THC concentration between 60-98%.
  • Category 5- Products with a THC concentration of more than 98%.
“We are also publishing on the TGA website a list of products which are available under each of those categories, just in recognition of the fact that there is some complexity there. So, sponsors will be declaring to us what category their products fall in, and we'll be publishing those products on the TGA website to assist prescribers and pharmacists,” says TGA representative Petra Bismire.

2. Certain Medicinal Cannabis Products Have Been Included in The Authorised Prescriber Established History of Use List

Following these changes, certain medicinal cannabis products have been included in a list titled the ‘Established history of use’ pathway with reference to active ingredient categories, dosage forms, and indications. This list features products up to Category 3 and suggests the use of oils and capsules only for people with chronic pain and anxiety.

3. TGA Has Published a List of Medical Cannabis Products on Their Website

The TGA, in a bid to make the new information available to everyone, has posted a list of licensed cannabis medicines on their websites. They’ve also highlighted what these 5 different active ingredient categories are and the prerequisites a product must fulfil to be placed under each category. Prescribers, pharmacists, and medical cannabis users are advised to go through this information and acquaint themselves with the new categories.

A Quick Summary of What This Means

  • Medical cannabis products will now be prescribed based on the active cannabinoid present rather than brand name.
  • Products with varying CBD and THC content grouped into 5 categories.
  • This move removes the burden on prescribers and medical practitioners to seek approval from TGA every time they need to switch brands.
  • Substitution between products is now permissible for products that fall under the same category.
  • This makes it easier to deal with product shortages and discontinuation without having to involve TGA on a case-by-case basis.
  • Pharmacists should continue to dispense prescriptions according to their relevant state or territory legislation.
  • Oils and capsules are mainly for patients with chronic respiratory pain or anxiety.
  • TGA requires prescribers to provide a 6-month report based on the number of patients they prescribe marijuana to.
  • For patients to receive these medicines, they will need to present their prescription plus a copy of the TGA approval letter.
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Dec 15, 2021
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Medical Cannabis and Driving: Can You Take Medical Cannabis and Drive?
Road safety is a top priority for road safety agencies, and there has been a great tussle over medical cannabis’ influence on driving. If traffic law enforcement officials find even prescribed THC in your body, you could face a penalty for the offense of Driving Under the Influence (DUI).

With the legalization of medical cannabis in Australia, there has been a debate on the influence of cannabis on driving. The debate has led to a rise in research on the subject, which could impact future laws.

What Is DUI?

When it comes to drug driving, Australia has a "zero tolerance" policy (1). As a result, any drug substance identified in the driver's system is considered a violation. This means that finding even a trace amount of alcohol or other illicit or licit drugs is deemed a crime even if it did not induce impairment.

So, what does a DUI offense entail? It occurs when a motorist is found to be unable to maintain reasonable vehicle control.

Opiates and antidepressants, for example, are medications designated under Poisons standards because they are suspected to impair psychomotor, cognitive, and driving skills (2). In general, they are thought to induce impairment or high crash risk.

Gauging Impairment



A DUI offense is assessed through a series of tests initiated by a police officer. The officer conducts a sobriety test, in which they may ask the motorist to do various tasks: they may assess their speech, response time, balance (by walking in a straight line), among other tests. Also, a urine or blood test may be conducted by the officer.

Some of the impairment effects tested on drugs that are legal or otherwise include:

Lowered reaction time Poor coordination and reflexes Poor concentration Alertness Impaired eyesight Drowsiness Therefore, if cannabis is to be evaluated on its impact on driving, these and other impairment effects have to be investigated. Extensive and conclusive research has been done on CBD and THC effects on driving impairment, and there are some interesting findings.

Research On Medical Cannabis And Its Effect On Driving

The Lambert Initiative carried out a study at the University of Sydney in collaboration with Tilray and Alfred Hospital. The study, conducted on 14 volunteers with mild cannabis use, explored CBD and THC's effects on simulated driving (3).

Research On Medical Cannabis And Its Effect On Driving

The Lambert Initiative carried out a study at the University of Sydney in collaboration with Tilray and Alfred Hospital. The study, conducted on 14 volunteers with mild cannabis use, explored CBD and THC's effects on simulated driving (3).

The participants were intoxicated with high THC cannabis. Interestingly, while THC appeared to cause impairment, the participants were found to be 'safer' drivers.

There was a shift in driver behavior to reduce potential crash risk. For instance, the drivers would leave more space between themselves and the car in front of them, and they weren't prone to speeding or overtaking.

Interestingly, adding CBD didn’t alleviate feelings of intoxication or lower driving impairment. In fact, CBD seemed to heighten THC- induced impairment.

The same institutions conducted a follow-up study to assess the accuracy of mobile drug testing devices (4). The gadgets were to detect vaporized THC with varying levels of CBD content. Fluid tests were performed on a similar number of healthy volunteers at timed intervals for three hours. The study discovered noteworthy false-positive and false-negative results.

The DrugWipe 5s and DrugTest 5000 were the devices that were tested. None of the devices performed as expected in specificity, sensitivity, and accuracy, with none exceeding 80%.

The Lambert initiative undertook a road study at Maastricht University in the Netherlands. CBD has been discovered not to affect driving; however, THC can induce minor impairment for up to four hours (5).

This development gives those who use CBD as a medication peace of mind when driving.

On the other hand, when using THC or a combo of THC with CBD, impairment didn’t persist after 4 hours. Therefore, a window was established to assist patients in understanding the duration of impairment, particularly with THC use.

Regulation On The Use Of Medicinal CBD

The Australian Therapeutic Goods Administration TGA granted over 100,000 approvals for medicinal cannabis products (6).

Furthermore, in Australian jurisdictions such as Tasmania and Victoria, there has been advocacy in the Australian Senate to revisit the ‘presence-based’ drug-driving crimes to enhance patient access to medical cannabis.

Road safety agencies continue to emphasize THC's incapacitating effects on driving, and their influence can be seen in South Australia (7). When a measure to reform the medicinal cannabis situation was introduced in parliament, the Police Minister expressed alarm, and the bill was not passed.

On the other hand, politicians and advocacy groups are emphasizing the need for change (8). According to road officials, patients who are legally prescribed medical cannabis-infused with THC are being lumped together with illicit drug users. The lobbyists are pushing for a reform that ensures that medical cannabis patients are treated fairly.

In January 2020, a Magistrate in South Australia had a patient charged with DUI (9). The medical cannabis patient was found to have been driving with a prescribed drug in his system. The magistrate dropped the charge on a lack of proof of impairment. However, she noted that the conviction would stand if the patient was prosecuted again.

The participants were intoxicated with high THC cannabis. Interestingly, while THC appeared to cause impairment, the participants were found to be 'safer' drivers. There was a shift in driver behavior to reduce potential crash risk. For instance, the drivers would leave more space between themselves and the car in front of them, and they weren't prone to speeding or overtaking. Interestingly, adding CBD didn’t alleviate feelings of intoxication or lower driving impairment. In fact, CBD seemed to heighten THC- induced impairment. The same institutions conducted a follow-up study to assess the accuracy of mobile drug testing devices (4). The gadgets were to detect vaporized THC with varying levels of CBD content. Fluid tests were performed on a similar number of healthy volunteers at timed intervals for three hours. The study discovered noteworthy false-positive and false-negative results. The DrugWipe 5s and DrugTest 5000 were the devices that were tested. None of the devices performed as expected in specificity, sensitivity, and accuracy, with none exceeding 80%.

The Lambert initiative undertook a road study at Maastricht University in the Netherlands. CBD has been discovered not to affect driving; however, THC can induce minor impairment for up to four hours (5).

This development gives those who use CBD as a medication peace of mind when driving.

On the other hand, when using THC or a combo of THC with CBD, impairment didn’t persist after 4 hours. Therefore, a window was established to assist patients in understanding the duration of impairment, particularly with THC use.

Regulation On The Use Of Medicinal CBD

The Australian Therapeutic Goods Administration TGA granted over 100,000 approvals for medicinal cannabis products (6).

Furthermore, in Australian jurisdictions such as Tasmania and Victoria, there has been advocacy in the Australian Senate to revisit the ‘presence-based’ drug-driving crimes to enhance patient access to medical cannabis.

Road safety agencies continue to emphasize THC's incapacitating effects on driving, and their influence can be seen in South Australia (7). When a measure to reform the medicinal cannabis situation was introduced in parliament, the Police Minister expressed alarm, and the bill was not passed.

On the other hand, politicians and advocacy groups are emphasizing the need for change (8). According to road officials, patients who are legally prescribed medical cannabis-infused with THC are being lumped together with illicit drug users. The lobbyists are pushing for a reform that ensures that medical cannabis patients are treated fairly.

In January 2020, a Magistrate in South Australia had a patient charged with DUI (9). The medical cannabis patient was found to have been driving with a prescribed drug in his system. The magistrate dropped the charge on a lack of proof of impairment. However, she noted that the conviction would stand if the patient was prosecuted again. References

1. ‘Zero Tolerance’ Drug Driving Laws in Australia: A Gap Between Rationale and Form?(2017) International Journal for Crime, Justice and Social Democracy
https://www.crimejusticejournal.com/article/view/876

2. The Role of Drugs in Road Safety (2008) Australian Prescriber https://www.nps.org.au/australian-prescriber/articles/the-role-of-drugs-in-road-safety

3. Cannabidiol (CBD) content in vaporized cannabis does not prevent tetrahydrocannabinol (THC)-induced impairment of driving and cognition (2019) Springer Link https://link.springer.com/article/10.1007/s00213-019-05246-8

4. An evaluation of two point-of-collection testing devices (2019) Wiley Analytical Science https://analyticalsciencejournals.onlinelibrary.wiley.com/doi/10.1002/dta.2687

5. Cannabidiol (CBD) in cannabis does not impair driving, landmark study shows. (2020) The University of Sydney https://www.sydney.edu.au/news-opinion/news/2020/12/02/Cannabidiol-CBD-in-cannabis-does-not-impair-driving-landmark-study-shows.html

6. Medical Cannabis Australia Department of Health https://www.tga.gov.au/medicinal-cannabis Medicinal cannabis driving plan inconsistent with road safety objectives, SA Police Minister says ABC news https://www.abc.net.au/news/2017-07-07/medicinal-cannabis-driving-plan-crazy,-sa-police-minister-says/8686688

7. Medicinal Cannabis Driving Laws Must Change Now (2020). Fiona Paten. Available from: https://fionapatten.com.au/news/medicinal-cannabis-driving-laws-must-change-now-fiona-patten-mp/

8. Magistrate dismisses drug driving charge for medicinal cannabis user (2020) Mondaq https://www.mondaq.com/australia/crime/887728/magistrate-dismisses-drug-driving-charge-for-medicinal-cannabis
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Jan 4, 2022
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Medicinal Cannabis and chemotherapy-induced nausea
Medications to manage nausea and vomiting associated with chemotherapy have been available for several decades, but despite their efficacy, many patients still experience persistent symptoms. This has led to increasing interest in the use of medicinal cannabis to manage chemotherapy-induced nausea. Medicinal cannabis contains a variety of compounds known as cannabinoids, which interact with the endocannabinoid system in the body to produce a range of effects, including the regulation of nausea and vomiting. The two main cannabinoids found in medicinal cannabis are delta-9-tetrahydrocannabinol (THC) and cannabidiol (CBD). THC is the main psychoactive compound responsible for the "high" associated with recreational cannabis use, while CBD is non-psychoactive and has been shown to have anti-inflammatory and anxiolytic effects. In clinical studies, the use of THC-containing medicinal cannabis has been shown to reduce chemotherapy-induced nausea and vomiting in patients who have not responded to conventional medications. THC is thought to act on cannabinoid receptors in the brain and gut, which regulate the release of hormones that control nausea and vomiting. CBD has also been shown to be effective in reducing chemotherapy-induced nausea and vomiting, although the mechanism of action is not yet fully understood. CBD is thought to act on a variety of receptors in the brain and body, including the 5-HT1A receptor, which is involved in the regulation of nausea and vomiting. In addition to its antiemetic effects, medicinal cannabis may also provide other benefits to patients undergoing chemotherapy. For example, it may help to improve appetite, sleep, and mood, and may also have pain-relieving properties. However, despite the potential benefits of medicinal cannabis, there are also some concerns about its use in this setting. For example, the long-term effects of THC on the developing brain are not yet fully understood. Additionally, medicinal cannabis is not regulated by the TGA, and the quality and potency of products can vary widely. In conclusion, medicinal cannabis is a promising treatment option for chemotherapy-induced nausea and vomiting.
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Jan 31, 2023