Medicinal Cannabis

T The positive use of medicinal cannabis in palliative care has contributed significantly to the debate in favour of legal regulation and the end of global prohibition of cannabis. Over the last twenty-five years, public perception in many countries has moved away from viewing Cannabis as a harmful recreational drug, to an understanding that it has a variety of therapeutic benefits in the treatment of serious illnesses. International scientific research has formally recognised the medicinal value of cannabis in the treatment of illnesses such as Cancer, Alzheimer’s disease, Dravet’s syndrome, Glaucoma, Crohn’s disease, Tourette’s syndrome, Multiple Sclerosis, Anorexia and Fibromyalgia. For many people suffering from serious illness, medicinal cannabis is the only medicine that relieves pain and suffering, or treats the symptoms of their medical condition, without the debilitating side effects. Medicinal cannabis can be administered in several forms including: orally as a tincture or via oil-filled capsules; topically via skin creams and transdermal patches; infused into food products such as olive oil; or vaporised for respiratory delivery.

Conditions treated by Medicinal Cannabis


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    Alzheimer's Disease

    Regular, moderate use of cannabis helps to delay the onset and progression of Alzheimer’s disease and other neurodegenerative conditions.

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    Fibromyalgia

    There is strong evidence that demonstrates the efficacy and safety of cannabis in treating chronic pain.

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    Crohn's Disease

    Recent clinical trials have produced dramatic results with 50% of Crohn’s patients achieving complete remission and over 90% achieving substantial improvement. The evidence for the use of cannabis in Crohn’s and other forms of IBD is conclusive

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    Cancer

    A combination of tetrahydrocannabinol (THC) and cannabidiol (CBD) when used along side radiotherapy reduces the growth of tumours in brain cancer.

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    Multiple Sclerosis

    Strong medical evidence that cannabis is safe and effective as a palliative treatment for MS.

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    Dravet Syndrome

    Cannabidiol (CBD), has been determined to be a well-tolerated therapeutic treatment that can reduce or even eliminate seizures in a variety of childhood epilepsy disorders


Medicinal Cannabis regulations in Ireland

Article 4 (c) of the Single Convention on Narcotic Drugs 1961 as amended limits production, manufacture, export, import, distribution of, trade in, use and possession of Cannabis to Medical and Scientific purposes. This provision is implied within the Irish Misuse of Drugs Acts 1977-2015 and the accompanying regulations.

On the 11th of July 2014, Minister of State for Primary Care Alex White T.D. signed S. I. No 323 Misuse of Drugs (Amendment) Regulations to enable authorised cannabis-based medicinal products to be legally prescribed by medical practitioners and used by patients. The regulations removed legal impediments to the provision of cannabis based pharmaceuticals to ease the symptoms of spasticity for Multiple Sclerosis sufferers.

The Misuse of Drugs Regulations, made under the Misuse of Drugs Act 1977, are the primary legislative instrument regulating the import, export, manufacture, production, prescribing, supply, possession and administration of controlled drugs within the Irish health system.  The granting of approval enabling this product to be used in Ireland was dependent on changes to the Misuse of Drugs Regulations.

On the 18th July 2014, the Health Products Regulatory Authority granted a marketing authorisation for the cannabis-based medicinal product Sativex manufactured by GW Pharma to be marketed in this State. Sativex contains cannabinoids, which are extracted from cannabis sativa plants grown and processed under strictly controlled conditions. According to the manufacturer, its formulation is unique and standardised and, has undergone the corresponding research, clinical development, toxicology testing and regulatory approval processes. Sativex is administered as an oral spray (to be applied under the tongue or inside the cheek) enabling flexible dosage, always in accordance with healthcare professional’s advice.
In September 2014, the Health Service Executive received an application for inclusion of Sativex under the community drugs schemes high-tech arrangements. The HSE has statutory responsibility for decisions on pricing and reimbursement of medicinal products under the GMS (General Medical Service and community drug schemes in accordance with the provisions of the Health (Pricing and Supply of Medical Goods) Act 2013. Decisions on which medicines are reimbursed by the taxpayer are made the HSE on the advice of the National Centre for Pharmacoeconomics, NCPE.

A health technology assessment report on Sativex was completed by the National Centre for Pharmacoeconomics, however it did not recommend reimbursement of Sativex at the submitted price. Consequently as of May 3rd of 2016, Sativex is not available to the many patients suffering from MS who cannot afford the drug while it is not listed on the community drug scheme, however the listing of Sativex remains under consideration.

Global position regarding Medicinal Cannabis
The international drug control treaties have defined the parameters within which medicinal cannabis is permissible. It is worth noting that in 2014 the World Health Organisation’s expert committee on drug dependence, which is the designated body to develop scheduling recommendations observed the following.

“A review of cannabis and cannabis resin by the World Health Organisation is necessary for multiple reasons, the foremost being that the medical use of cannabis appears to have increased in recent years. Cannabis and cannabis resin has not been scientifically reviewed by the Expert Committee since the review by the Health Committee of the League of Nations in 1935. An increasing number of countries are adopting varying policies on cannabis and cannabis resin different from prohibition to mitigate the harm due to cannabis.”

Subsequent to that observation, The Expert Committee on Drug Dependence undertook to collect more evidence on medical use of cannabis and cannabis resin for a future comprehensive review. A point noted by the Commission on Narcotic Drugs which stated that “… looks forward to an updated report on cannabis by the Expert Committee, subject to the availability of extra budgetary resources”

The review is long overdue and the delay to date is highly questionable considering that there has been important medical and scientific breakthroughs such as the discovery made by researchers at the Department of Oncology, Division of Clinical Sciences, St George’s, University of London in 2014 that Cannabinoids have been shown to specifically inhibit glioma growth as well as neutralise oncogenic processes such as angiogenesis. In plain language what this means is that a combination of tetrahydrocannabinol (THC) and cannabidiol (CBD) when used along side radiotherapy reduces the growth of tumours in brain cancer.

At the time of writing, twenty-five of the fifty states in America have made provision for medicinal cannabis (medical marijuana) the first being California in 1996, and the most recent being Pennsylvania on April 17th 2016.

On the 4th May 2016 the German government announced that is was relaxing the rules governing medicinal cannabis enabling patients to purchase dried cannabis flower buds on prescription from pharmacies in 2017. In contrast to the position in Ireland, health insurance will cover the cost. Presently under German Federal Regulations, there are three-forms of medical cannabis available to patients: Dronabinol, Sativex and cannabis buds. Dronabinol which is taken orally and prepared by pharmacists from a synthetic Δ9-Tetrahydrocannabinol which is mixed in sesame oil giving it the appearance of a light yellow resinous oil. Dronabinol is used to treat patients with HIV and helps patients undergoing chemotherapy with the side-effects of nausea and vomiting.

Illnesses and cannabis based treatments
Internationally, there are a number of diseases which cannabinoids have been prescribed to treat and include Alzheimer’s disease, Dravet’s syndrome, Glaucoma, Crohn’s disease, Tourette’s syndrome, and Amyotrophic Lateral Sclerosis, Anorexia and Fibromyalgia. Nabilone although principally developed to treat the side-effects of chemotherapy has been used also been used to treat patients suffering from Fibromyalgia or chronic pain syndrome as it is also referred to. In research carried out by the University of Heidelberg in 2006 nine patients with fibromyalgia were treated with Nabilone over a 3-month period resulting in a significant reduction in daily recorded pain and electronically induced pain.

Conclusions
Research findings concerning medicinal value of cannabis in the treatment of illness and its positive use in palliative care has contributed significantly to the debate in favour of legal regulation and the end of global prohibition of cannabis. While cannabis and its derivatives remains a scheduled substance within the meaning of the Misuse of Drugs Acts 1977-2015 and it’s accompanying regulations, the Irish government has made some progress towards allowing for cannabis based treatments, most notably allowing Sativex, to be marketed in this jurisdiction.
On a critical note, the Irish Government’s approach to medicinal cannabis has been painstakingly slow, conservative and largely reactive. This is worth bearing in considering that other countries in the European Union and elsewhere are taking a more progressive approach towards regulation, instituting policies which allow patients the option to grow their own medication or at least acquire organic cannabinoids as opposed to purely synthetic versions. The German approach of allowing patients to purchase cannabis buds under prescription from pharmacies warrants serious consideration. At this juncture, the scientific and medical evidence is sufficiently strong to warrant significant reform of the law and accompanying regulations to allow for a more progressive approach to the production, use and supply of cannabis for medicinal purposes.

Pain Conditions
Mood
Nervous & Muscular System
STOMACH

Cannabinoids

There are approximately 470 known chemical constituents in the average cannabis plant which include compounds that have both medicinal as well as psychoactive use. Cannabinoids are unique chemical structures that can only be found in the cannabis plant. The main psychoactive constituent of cannabis is tetrahydrocannabinol or THC. However, it is not the only important cannabinoid found in the plant, which also includes cannabidiol (CBD) and cannabinol (CBL) respectively. Cannabinol (CBN) is a cannabinoid and an oxidation product of THC it is normally only found in aged samples of cannabis and cannabis resin. CBN is only very weakly psychoactive and not unlike CBD interacts with THC to reduce its effects. Cannabichromene (CBC) is the second most common phytocannabinoid in the cannabis plant. CBC is believed to have strong ant-bacterial and analgesic properties. Cannabigerol (CBG) is also non-psychoactive cannabinoid which is a precursor to THC and CBD. By virtue of an enzyme reaction CBG is converted into other cannabinoids such as the aforementioned THC, CBD but also CBC. In that respect, CBG it is often referred to as a ‘stem-cell’ cannabinoid. It its isolated form, it has enormous medical potential as an anti-inflammatory and antidepressant properties. Tetrahydrocannabivarin (THCV) is very similar to THC with the exception of some minor chemical constituents which are not present.

THC – TETRAHYDROCANNABINOL
CBD – CANNABIDIOL
CBC – CANNABICHROMENE
THCV – TETRAHYDROCANNABIVARIN
CBN – CANNABINOL
CBG – CANNABIGEROL

AERMED

Aermed is a Dublin based start-up that specialises in developing medical and electronic devices for the hemp industry. Eight of the world’s 10 largest medical device companies are located in Ireland. Examples of global companies with substantial operations include Abbott, Bayer, Becton Dickinson, Boston Scientific, Johnson & Johnson, Guidant, Medtronic and Stryker. The sector employs over 24,000 people in 160 companies and generates sales in excess of €6 billion. Recognising important developments in the field of medicinal cannabis globally, Aermed is developing products unique to that market treating patients with Crohn’s disease, Dravet’s syndrome and cancer.

Medicinal Cannabis Strains

Below is a selection of the most popular strains used for Medicinal Cannabis. Medicinal cannabis comes from two types of plants, Indica and Sativa which produce over 70 active compounds. The two important compounds (as noted above) are THC and CBD which provide the bulk of the known therapeutic effect. There are thousands of strains from which patients can choose from, which can be quite daunting for patients looking for therapeutic relief. Regulation of cannabis for medicinal and scientific use, would enable the establishment of a Cannabis Research Agency which can test and recommend the best strains for patients and allow medical practitioners access to the most up-to-date information in deciding which strain to prescribe.
Blue Dream
90%

Blue Dream is a sativa dominant hybrid originating from Santa Cruz in California and has been one of the most popular strains in North America since its introduction. Blue Dream is a cross-over between the Blueberry and Haze strains.

White Berry
89%

White Berry, often referred to quite humorously as Berry White is an Indica dominant strain. White Berry is great for relieving muscle spasms and helping with insomnia.

A-Train
90%

A-Train is a hybrid strain that helps enhance appetite, which is ideal for patients who have nausea, anorexia, AIDS, cancer, or other conditions that make it difficult to eat and keep food down. It’s also a good strain for relieving ocular pressure, which makes it a top choice for glaucoma sufferers.

Dr Grinspoon
95%

Named after a noted cannabis researcher, Dr. Lester Grinspoon. It’s a good sativa strain to try if you are looking to treat depression or nausea.

Canna Sutra
97%

Canna Sutra is a sativa strain that’s known to elevate and stimulate the mind. This type of cannabis may help in bronchial dilation, which makes it the perfect choice to alleviate the symptoms associated with asthma-related conditions.

G-13 Haze
81%

This hybrid strain offers sweet and spicy flavours that make the experience of treatment more enjoyable. In addition, it creates an uplifting high. It’s commonly used for treatment of ADHD, ADD, and depression.

Crimea Blue
92%

Patients suffering from muscle spasms caused by multiple sclerosis or pain from neuropathy due to HIV/AIDS often seek relief with Crimea Blue, a hybrid strain with scents of lemon and pine.

Jack Herer
93%

Jack Herer is a Sativa Strain. Patients suffering from fibromyalgia as well as some anxiety disorders have reported feeling relief with Jack Herer, named in honour of the late marijuana activist with the same name. Some of its related strains include Jackie White, Jackie O, Jack Candy, Jack’s Cleaner, and Jack Flash

Lavender
90%

This violet-coloured indica-dominant strain with dark-purple leaves and taste of pomegranate and plum offers a mellow feeling, making it very popular among medical marijuana patients. Because it provides a relaxing high, it’s best used a night, and is particularly helpful for those suffering from insomnia.

Nigerian
90%

Nigerian is used to energise patients. It’s a great treatment option for those suffering from psychological conditions, such as post-traumatic stress disorder, seasonal affective disorder, depression, and some forms of anxiety.

Satori
95%

A hybrid strain with a strong THC content, not recommended for patients with a low THC threshold. It has a variety of medical uses including relieving depression and anxiety.

Purple Kush
91%

This indica dominant strain is perhaps the most popular among medicinal cannabis patients. It’s helpful in treating conditions like depression and chronic pain.

Sage
82%

S.A.G.E. is a hybrid strain. S.A.G.E. is an acronym for Sativa Afghani Genetic Equilibrium believed to assist patients with hepatitis C, PTSD, and mood swings.

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