What is it used for?

The death of a man with mental health issues prescribed medicinal cannabis by an online clinic has thrown a spotlight on the booming industry.

More than a million people have been prescribed cannabis products since it was first legalised for medical use in NSW in 2016.

Here’s what is (and isn’t) allowed.

What can medicinal cannabis be used for?

The Therapeutic Goods Administration (TGA) has approved only two cannabis products to treat specific conditions – one to treat muscle rigidity caused by multiple sclerosis and another to alleviate symptoms of a rare childhood epilepsy.

All other medicinal cannabis products are prescribed off-label as “unapproved” medicines, meaning they have not been assessed by the TGA for efficacy, quality or safety.

Doctors can apply to become an authorised prescriber, or apply on the patient’s behalf for approval to import and supply cannabis products under a special access scheme. They must also apply to their state or territory government for permission to dispense the medication.

Chronic pain, anxiety, and sleep problems are common reasons why a doctor might prescribe (or a patient might request) medicinal cannabis. Some products have shown mixed results in clinical trials but, so far, none have been approved by the TGA to treat these conditions.

“It’s up to the doctor – there is no list of approved or unapproved conditions,” says Professor Nick Lintzeris, an addiction medicine specialist at the University of Sydney. “Could a doctor prescribe it for some weird and rare condition? Maybe, if they wanted to give it a go.”

What is THC?

Tetrahydrocannabinol (THC) is the main psychoactive compound found in the cannabis plant.

It is responsible for the common effects associated with being “stoned”: drowsiness, red eyes, dry mouth and sometimes hallucinations. It also has some analgesic and anti-inflammatory effects.

“For some people it increases anxiety but, for most people, it reduces anxiety,” Lintzeris says. “It can also make you addicted to the stuff.”

What is CBD?

Cannabidiol (CBD) is the second most prevalent compound found in the cannabis plant. It is not psychoactive, not addictive, and doesn’t lead to withdrawals.

It has anti-inflammatory and anti-craving effects, and is also used to dampen symptoms of anxiety or psychosis.

“CBD balances a lot of the things THC can do,” Lintzeris says. “Indeed, in nature, most cannabis plants would have had both THC and CBD in them at roughly about a 2:1 or 1:1 ratio.”

Medicinal cannabis products sold in Australia range from those that are CBD-dominant to THC-dominant, or a mix of the two. Products grown and manufactured in Australia are tightly regulated to ensure they contain the amount of each compound indicated on the packet.

Can cannabis use cause mental health issues?

Recreational cannabis use, particularly as a teenager or young adult, has long been associated with elevated risk of developing a psychosis disorder. It is worth noting the risks are quite low: you’d have to stop 4700 young men smoking cannabis to prevent one case of schizophrenia.

A recent study found higher-strength users were more likely to report psychotic disorders. That is significant because legalisation has led to the increased availability of high-potency THC products.

The Royal Australian and New Zealand College of Psychiatrists (RANZCP) has previously raised concerns about people with psychotic disorders, including schizophrenia, not being adequately screened before getting high-potency THC products through online clinics.

Can I drive on my cannabis prescription?

It is currently an offence in all states and territories to drive with any amount of THC in your system. Tasmania is the only state where a medical defence can be used for an illicit drug that is prescribed, including THC.

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In May, the Victorian government and Swinburne University launched a trial to assess the effects of medicinal cannabis on people’s ability to drive a closed-circuit track.

Patients prescribed CBD-only medications are permitted to drive, but it’s worth noting they can cause drowsiness, fatigue and lowered blood pressure.

How easy is it to get a medicinal cannabis prescription?

This depends on the prescriber. More conservative GPs or family doctors may be reluctant to prescribe cannabis, but Lintzeris says most patients do not have any trouble securing a script through online clinics.

Lintzeris says patients often think they have to come up with a legitimate “reason” to get a cannabis script, but it is more important the doctor is across the patient’s full medical history. “It’s also a criminal offence for a patient to lie to a doctor in order to get Schedule A drugs,” Lintzeris says.

Concerned about the emergence of online super clinics that have caught the eyes of regulators, Lintzeris says medicinal cannabis is most safe and effective when it’s used alongside other medications, therapies and interventions. “In medicine, we never treat those things just with a pill,” he says.

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