In our final episode of This Month In Cannabis (TMIC) for 2020, we give you a recap of some of the most important things that have happened in legal medical cannabis in the past year. We published our first TMIC episode in July 2020 with an overview of the market.
In this article you’ll learn about the following topics:
- 00:34 | Legal medical cannabis patient growth and trends in 2020
- 01:53 | Medical cannabis products
- 04:28 | Impactful Australian cannabis research
- 08:10 | Final results of the TGA down-scheduling of CBD
- 09:42 | Timeline for CBD appearing over the counter in pharmacies
- 11:05 | Major injustices in the Tasmanian medical cannabis system
- 15:55 | Changing cannabis and drug driving laws
- 20:23 | UN Reclassification of CBD
- 22:46 | NSW & ACT drug law reform
Legal medical cannabis patient growth and trends in 2020
There are two main measures in which patient numbers are often stated:
- Number of approvals
- Number of active patients
We like to talk about the number of active patients because that gives a better picture of how the industry is growing. In January 2020, there were roughly 15,000 medical cannabis patients. As of December 2020, there were about 35,000 active medical cannabis patients in Australia.
However, the actual number is becoming more difficult to track for two reasons. Firstly, the number of Authorised Prescribers (APs) has increased from 63 in January to 149 in December. Because APs don’t need to apply to the TGA for each patient and report to the TGA a couple of times a year, the numbers aren’t always up to date. Secondly, the compounding of medical cannabis is becoming increasingly popular. Compounded cannabis products don’t need TGA authorisation to be approved and are therefore not counted in the patient numbers reported by the TGA.
Note: While compounding is becoming more popular from certain clinics, there are limited reasons you would need a compounded product over one available on the SAS or via the AP programs. To learn more about compounding and the questions you may want to ask your doctor, please read the compounded medical cannabis article.
One thing that has not changed, and likely will not change, is that medical cannabis is most often prescribed for chronic pain. However, this year we saw a rise in the number of patients who have been prescribed medical cannabis for mental health conditions. The top categories for prescription of medical cannabis are:
- Chronic Pain
- Neuropathic Pain
We’ve also seen a rise in prescribing for depression, insomnia and PTSD. And, for Veterans, medical cannabis can be reimbursed via the DVA. Entoura, a medical cannabis product company, also created a DVA application tool to help streamline the doctor and patient process.
Medical cannabis products
We now have over 150 legal products for doctors to prescribe. And, as mentioned, doctors are prescribing compounded products too. Products can come in various forms including oils, flower, lozenges, sprays and more.
The thing that the market needs most, however, is more local product. In 2020 we saw an increase in numbers of locally cultivated and manufactured products. While the list is still short, having some local products is better than nothing. As of December 2020, the following companies make local products:
- ANTG – flower and oils
- Canndeo* – oils
- Entoura – 2 x local products: EMC 10:15 oil & EMC THC 26 oil.
- Little Green Pharma* – oils
*Sometimes these companies supplement local products with foreign raw materials.
Impactful Australian cannabis research
In 2020 there were two very impactful cannabis-related pieces of research published in Australia:
- Impact of cannabis on driving
- An analysis of CBD accessibility and impact on health (worldwide)
Lambert Initiative – the impact of cannabis on driving.
The Lambert Initiative For Cannabinoid Therapeutics’s Tom Arkell went to the Netherlands to research cannabis and driving. The test looked at the way inhaled cannabis impacts driving performance. Participants were given a placebo or CBD and/or THC in combinations or isolation. The subjects inhaled 15mg of cannabis and then drove on a highway with a researcher.
The results were as follows:
- Impairs driving abilities.
- Inhaled, impairment lasts for about 4 hours.
- With oral consumption, impairment lasts longer.
- Does not impair driving abilities.
- Does not stop the impairing effects of THC.
Cannabidiol with no prescription paper
Another piece of research spearheaded by the Lambert Initiative had a significant impact on the recent down scheduling of CBD. The paper, which reviewed the CBD policies in multiple countries worldwide, was quoted by the individual responsible for making the down scheduling recommendation.
In the study, the Lambert Team including Rhys Cohen, reviewed the USA, Canada, Germany, Ireland, United Kingdom, Switzerland, Japan, Australia, and New Zealand’s access to CBD as of May 2020.
The results were that not only were CBD products quite accessible across the board; they were also not well regulated. But what was most important in helping with the decision was the risk level of these products. Rhys said, “ Despite that (the lack of regulation) we have yet to see any obvious signs of population-level risks or harms that may be caused by these products. “
To learn more about the research, you can read the PubMed article.
Final results of the TGA down scheduling of CBD
Earlier this year, we heard about the interim decision on the down scheduling of CBD. However, in early December we received the final decision which recommended that as of Feb ‘21, CBD will now be a schedule 3 drug down from schedule 4.
It means that as of February 2021 CBD may be sold, legally, over the counter in pharmacies from a pharmacist. The rules will be as follows:
- Products must be 98% CBD.
- Can contain no more than 1% of THC.
- No more than 150mg a day.
- Must be ARTG listed.
The tricky bit about this is the ARTG listing. ARTG listed products have gone through clinical trials and been clinically proven to treat some sort of illness or disease. Rhys said:
“What companies will need to do, first of all, is to make sure that they have an appropriate product. Then those companies will probably need to run reasonably large placebo-controlled clinical trials using those drugs. And then, of course, those clinical trials will need to produce a compelling result. The products will need to prove to be more effective than a placebo. And then there are all of the application processes. This is not a small task. So, by the end of 2022, there’s a chance we’ll see some of these products become available.”
Injustices in the Tasmanian medical cannabis system
When it comes to medical cannabis, Tasmania is a place we should all be talking about. The Tassie government often talks about how excellent their medical cannabis framework is because it covers the cost of medical cannabis for patients. In theory, this is great. However, less than 20 patients have been approved for medical cannabis by the Tasmanian government since 2016.
We asked Rhys if he had any idea as to why this was happening and here’s what he said:
“I have no idea why this is happening. I think their process made sense initially. In the early days, in 2016 and 2017, when medicinal cannabis was brand new, every state and territory had their own restrictions on who could get access to what and which doctors could prescribe and the paperwork. And, that was completely unworkable.
In 2018, Greg Hunt the federal health minister, through the Council Of Australian Governments (COAG) process, managed to get all of the States and Territories to agree to collaborate in order to streamline the patient access processes to make sure that access barriers were reduced.
All of the States and Territories agreed, except Tasmania. So you have a situation where patients, and in some cases quite seriously ill patients, who’ve been seen not just by a GP but also by a condition specialist. For example, as an epileptologist.
And that specialist has submitted an application to the Tasmanian government saying, “As a specialist medical practitioner, that my patient would benefit from medical cannabis.” And, the Tasmanian government said no.”
This is a huge problem for Tasmania patients and, in many ways, a human rights issue. The Tasmanian government can’t say that it’s to protect the community from harm because patients are going to clinics on the mainland and getting scripts.
This is an issue that needs more airtime. We need people to speak out. If you’re a Tassie local, please call or email your local member of parliament and let them know that you’re not going to stand for this kind of treatment.
If you’d like to learn more about what’s happening in Tassie or want to be a part of the movement to improve these laws, please visit Cannabis Awareness Tasmania’s site.
Cannabis and drug-driving laws
Since early on in medical cannabis legalisation, the fact that it’s illegal to drive with any amount of THC in your system (mouth) was a big concern. Fiona Patten in particular began working to change the drug-driving laws to be fair and equitable for medical cannabis patients.
Earlier this year, Fiona managed to get the Victorian government to agree to put together a working committee. This committee would look at how the drug-driving laws operate in relation to medical cannabis patients who are both legally prescribed THC based products and are not impaired when tested. While the committee was scheduled to deliver a result on the 18th of December, this committee’s recommendations will be pushed back to February ‘21.
The Drive Change Campaign
What’s important for readers to know is that the current drug driving laws, related to legal medical cannabis, are discriminatory, quite literally. Currently, individuals are tested via a mouth swab at the roadside. If any driver comes back positive for the presence (not impairment) of THC in their oral fluid, the driver can lose their license on the spot.
All other prescription medications, even those that impair, have a legal defence for presence (when the driver is not impaired). Cannabis is the only legally prescribed medication that has no defence.
Not only is it discriminatory, but these laws are also failing to make roads safer. And, probably even more importantly, they are hurting public health outcomes. Many doctors won’t prescribe patients medical cannabis, and many patients won’t take it due to its impact on driving.
Because of these unjust laws, a group of advocates and political figures have come together to create the Drive Change campaign. If you’d like to learn more about how you can help right these injustices in your local community or become part of the nation-wide campaign to help reform drug driving laws concerning medical cannabis patients, please visit drivechangemc.org.au.
UN Reclassification of CBD
The Commission on Narcotic Drugs, a body within the UN recently voted on the WHO’s recommendations regarding the international control of cannabis and cannabis extracts. The WHO had recommended removing cannabis from Schedule IV of the 1961 Single Convention on Narcotic Drugs. Cannabis was listed alongside opioids, including heroin, and was recognised as having little to no therapeutic purposes.
This was the first time these laws have been reviewed in decades. And, while from a UN perspective, cannabis consumption for non-medical or non-scientific purposes will remain illegal, this vote recognises the medicinal and therapeutic potential of cannabis.
While this likely won’t impact Australia much as we already have a legal medical framework, the benefits of this change are already being seen internationally. A politician in Switzerland has cited this change in fighting to improve medical access expansion.
It also means that more countries around the world will likely legalise medical cannabis. Because Australia’s such an export-focused country and has some of the most strict regulations for locally produced cannabis, it should help the Australian cannabis industry grow internationally.
To learn more about the international rescheduling of cannabis, you can visit the UN article on the rescheduling of cannabis.
NSW & ACT drug law reform
In the past couple of months, we’ve seen some positive steps toward drug reform locally.
New South Wales drug reform proposal
The NSW cabinet is considering a proposal to de-penalise the possession of small amounts of all illicit drugs. This is not, however, decriminalisation where there would be no penalties. Depenalisation is a reduction in the punishment attached to a particular drug charge.
They have proposed a three-strike system. It would have escalating fines and penalties until you move through the courts for possessing drugs. It’s an extension of our sort of drug diversion programs that we have in New South Wales already.
Rhys also said that he didn’t feel it was good enough. “It doesn’t go far enough, in my opinion. For example, it won’t stop the incentive for police to strip search children at music festivals, which is happening quite a lot still.”
ACT drug decriminalisation proposal
In the ACT, a member of parliament has proposed the true decriminalisation of the possession of small quantities of all illicit drugs.
“This is recognising that drug consumption and drug use is a social and a health problem. It’s not a criminal problem. Your criminal syndicates are responsible for manufacturing and international transport of illegal drugs, yes. But, when it comes down to everyday people who use drugs personally, that’s a health issue.”
This is similar to the policies we see in places like Portugal and some parts of America now. If this does get implemented, ACT would be the first place in Australia to go this far with drug reform. All the evidence that we have from every jurisdiction that has decriminalised possession of small amounts of illicit drugs has found that it has improved public health and reduced costs for police and prisons and courts.
While 2020 has been a difficult year for most, in the cannabis space we see some positive momentum. More people are learning about cannabis, and we’re seeing a shift from illicit medical cannabis to legal medical cannabis which is good for everyone in the long run.
The team at honahlee would like to thank those of you who have joined us for our This Month In Cannabis series in 2020, and we hope you’ve found all of our content beneficial. We look forward to sharing more educational information in 2021.
Best wishes to you and your family and friends.
See you in 2021!