By Dr Janelle Trees, BSC (HONS), MBBS (HONS), FRACGP
Australians began using recreational marijuana (and self-prescribing for medical conditions, because it made them feel better) in significant numbers in the 1970’s. People who smoked and ate marijuana were part of a counter-cultural movement in the western democracies, associated with opposition to the war against Vietnam and support for the Civil Rights and Women’s Liberation movements. For many ordinary people, the Cold War of the 1950’s was a period of regimentation in everyday life. People used marijuana as an expression of personal and political freedom.
Now that medicinal marijuana has become available in Australia, people want to know about the difference between recreational marijuana, known in the old days as dope, weed or pot, and the medical marijuana prescription a doctor might write for somebody for therapeutic reasons.
There are significant differences between medicinal marijuana and the buds of whole cannabis herb that might be smoked in a bong after dinner.
An important difference is that recreational marijuana is still illegal in Australia, even if small amounts for personal use result only in fines in some states and territories. Medicinal cannabis is still considered an experimental medicine, but is now available through strict legal channels, which your doctor can navigate with the help of an Australian medical marijuana centre.
Medical marijuana is a controlled substance. It has to meet regulatory requirements for purity and reliable dosage. These qualities are absent in marijuana sold illegally for recreational (or self-medicating) use. Unless you grow it yourself, which is still illegal in Australia, you have no way of knowing what’s in it. This can be true even if you do grow it yourself, if you are not a chemist or botanist with access to special equipment. Any marijuana smoker will tell you that different strains of cannabis and plants grown under different conditions are highly variable in their effects. Cannabis-based medicines are made to give predictable effects.
Medicinal marijuana has been developed in response to consumer demand—people have been using cannabis as medicine for centuries. Late last century, a major investigation into the scientific basis of cannabis as a medicine was commissioned by the US government.
The study involved contributors from many different disciplines. It was conducted by a committee of the Institute of Medicine in the US National Academy of Sciences and published in 1999. The book they produced is 288 pages long. It is fascinating reading.
In their conclusion, the researchers expressed concern about three barriers to marijuana’s use as a medicine: that it is a plant (and thus variable in its potency and not patentable), it was smoked (which has unhealthy side effects) and that it is a drug with potential for abuse. They identified a need for active constituents of marijuana to be isolated, purified (even, they suggested, synthesised) to facilitate further research and safe, controlled, medical use.
Two major active ingredients in marijuana, called cannabinoids, THC and CBD had already been isolated when that book was written. Medicines made from them were better understood and further developed in response to the report’s findings.
Natural marijuana has varying amounts of THC and CBD, as well as more than 110 other identified cannabinoids. Some of these other cannabinoids are under investigation as potential medicines, mostly still in animal studies.
THC and CBD are the chemicals we know something about. THC is known to cause the psychoactive effects of cannabis—the feeling of being stoned or high. It also relieves pain, nausea and depression. Some marijuana medicines are mainly THC.
CBD is known to counter some of the effects of THC, including the high. It is also an anti-inflammatory and pain reliever on its own. Most marijuana medicines have a degree of CBD, as THC and CBD work well together. Some medicines are almost entirely CBD. Patients who have had unpleasant side effects from THC, for example, feeling out of control or anxious, may prefer to avoid THC altogether or take it as only a minor proportion of their marijuana medication.
Medicinal marijuana is taken for different, but sometimes overlapping, reasons than recreational marijuana. People might use the herb for relaxation, to help with sleep, impotence, depression and anxiety or poor appetite. Medical marijuana is likely to be helpful for these problems. And cannabis-based medicines give the medical cannabis doctor and the patient much more control over the benefits they want from the medicine. They give reliable, repeatable results for the same dose.
They are also, with the correct forms and approval, legal. In that way, they are much less ‘experimental’ than accepting a cone at your friend’s barbecue.