Canna-blitz: Underground medicinal cannabis use storms ahead of science
Robbie Mason investigates Australia’s evolving medicinal weed landscape.
Diagnosed with testicular cancer while overseas in France, Australian Jonathan Ly used both tetrahydrocannabinol (THC) and cannabidiol (CBD) dominant weed during his chemotherapy. “My experience was positive in every sense”, he says.
Confined to his home and physically unable to work, weed softened the relentless jabs of nausea, increased his appetite, reduced the pains in his body and helped him to disconnect from the trauma of battling cancer. “It’s a crime that other chemo patients aren’t being offered this alternative”, Ly explains.
Cannabis is one of the rare drug cases where anecdotal evidence and public support in Australia seem to outstrip academic consensus.
Press coverage of medicinal cannabis tends to be glowing, and the vast majority of Australians support changing legislation to permit access to medicinal cannabis – 85 percent according to the National Drug Strategy Household Survey 2016. It’s no surprise then that the Legalise Cannabis Western Australia Party won two seats in the upper house in the recent WA state election. Even far-right figures such as Tony Abbott, Pauline Hanson and Alan Jones have publicly expressed support for medicinal cannabis.
Weed use spans every corner of the Australian map and fills every row, column and section of demographic charts. A 2018 survey by researchers from The Lambert Initiative for Cannabinoid Therapeutics at the University of Sydney revealed that 61.5 percent of Australian general practitioners had been asked by at least one patient about medicinal cannabis in the three months prior to the investigation.
Elderly Australians attempting to ward off arthritis, children with epilepsy and stay-at-home parents searching for effective pain relief medication are all experimenting with cannabis, often for the first time. It’s estimated that 2.7 percent of Australians (600,000) use medicinal cannabis. Imagine the entire population of Luxembourg consuming weed medicinally – that’s the situation in Australia.
Correspondingly, marijuana shows some promise in supporting chemotherapy patients and treating certain health issues such as multiple sclerosis and anorexia. CBD specifically – a non-intoxicating cannabinoid found in the cannabis plant – seems to help children and adults under 25 with epilepsy but appears less practical for older patients.
But the academic jury is still out. Rhys Cohen, editor-at-large for Cannabiz and a freelance consultant for the medicinal cannabis industry, says that public support is “at odds with the clinical evidence that we have available at the moment. The prohibition of cannabis did not stop its use but it did stop its research.”
Among researchers, general practitioners and specialist doctors, debate rages over the more generalised uses of medicinal cannabis for mental health disorders and non-cancer-related pain relief. In recent years, staff at the National Drug & Alcohol Research Centre at UNSW and the Lambert Initiative for Cannabinoid Therapeutics at the University of Sydney have released a slew of research and review papers underlining medicinal cannabis’ limitations. Analysing 83 studies and accounting for the experiences of 3000 people, researchers asserted in one 2019 paper that there is “scarce evidence” to indicate medicinal cannabis improves the symptoms of mental health disorders, for example.
As Cohen explains, it takes “a leap of faith” for doctors to prescribe medicinal cannabis. Many professional medical organisations in Australia therefore remain conservative voices. In late March this year, the Faculty of Pain Medicine at the Australian and New Zealand College of Anaesthetists published advice recommending against the prescription of medical marijuana for chronic non-cancer pain. Meanwhile, WA Dr Matty Moore, expressed caution about the therapeutic benefits of CBD oil in an ABC radio interview on 13 May, suggesting more research is required before enacting widespread legalisation. According to statistics from the Therapeutic Goods Administration (TGA) – the regulatory body for the supply and advertising of medicines within Australia – Moore is one of only 279 “authorised prescribers” of medicinal cannabis in the country as of the end of April this year.
Issues of only modest benefits, conflicting results and inconclusive evidence have created a minefield for weed advocates to traverse.
Unable to await a catch-all minesweeper in the form of greater funding and government support for clinical trials, many desperate Australians opt for self-medication without adequate medical consultation.
However, illicitly-obtained weed is often a problematic substitute. Jane*, 25, used THC resin obtained from a local drug dealer almost every day during Sydney’s COVID-19 lockdown to manage her chronic pain but remains divided on its benefits. “When I used it too much it built up in my system and made my mental health issues worse”, she says. The weed was “super helpful” for pain relief but it caused her anxiety and paranoia to spiral, forcing her to take months-long tolerance breaks from the weed between periods of prolonged use.
While CBD has almost no harmful side effects, THC – the ingredient in weed that gets you ‘high’ – can cause dependency (estimated at one in ten users), subtle cognitive impairment in those who smoke weed daily for over a decade and psychotic symptoms and disorders among heavy users, particularly those with a family history of such disorders. Researchers have also linked THC to anxiety, paranoia and low levels of energy and motivation.
If it’s not illicitly-obtained weed, suspect advertising is sucking in desperate Australians. The wellness industry has bought into the cannabis craze by marketing hemp seed oils with near negligible amounts of CBD as nutritional supplements and occasionally as genuine medicines. Early evidence indicates that CBD has certain therapeutic possibilities at high daily doses between 300 and 1500 milligrams but little use at lower dosages. Owing to recent TGA approval, low-dose CBD products (below 150 milligrams) can technically be sold over-the-counter at pharmacies, although they are yet to hit shelves. According to a Pedestrian TV report, however, low-dose CBD, which some weed advocates have pointed out are of questionable benefit, can be ordered online in Australia with a simple, seven minute, free conference call – a reflection, more than anything, of unrestrained capitalist forces exploiting demand.
As Jack Revell’s exploration of the political-economy of Australia’s medicinal cannabis industry in Rolling Stone Australia illustrates, the open-mindedness of the TGA and conservative politicians to medicinal weed is motivated not by public health concern but the promise of dollars.
Like many in the industry, Cohen is cautious about the availability of low-dose CBD, labeling it “a small step in the right direction” but one “rife for exploitation.”
When the Food and Drug Administration in the US tested a wide sample of CBD products last year in response to a Congress demand, the results illuminated persisting issues of product quality control. Of the 147 products tested, two advertised as containing CBD in fact contained none at all. Of the 102 products labeled with specific CBD quantities, 18 contained less than 80% of the indicated amount, while many contained more THC than is legal in the US. Academic studies have illuminated similar issues of mislabeling.
In other words: Australians who illegally source medicinal cannabis products online may not be receiving the product they expect. In May this year, the TGA issued a warning about this very phenomenon.
It’s not all bad news, however. There is one simple explanation for why panacea thinking dominates research spaces and the public sphere. Compared to other prescription drugs, the side effects of weed, even THC-rich weed, are relatively minor. Drawing on the life-changing experiences of medicinal cannabis users, the Vice documentary Stealthcare: Victoria’s Underground Medicinal Marijuana Growers has reframed weed not as a dangerous gateway drug – a revolving door trapping people in a cycle of drug to experimentation and dependency – but as something more benign – an unlocked gate on the path to recovery.
As Cohen suggests, the weed legalisation campaign has accelerated ahead of the scientific research precisely because it has a “pretty good safety profile as a medicine when you compare it to opiates or benzos or anti-psychotics or antidepressants.”
Ly, for example, disliked the prescription drugs he was taking during chemotherapy. “There were a lot of steroids to handle the inflammation, which made me feel puffy and really yuck.”
“Weed did the job of five of the pharmaceutical drugs I was given. By the end of my chemotherapy, I had a giant bag of prescription medicine that I didn’t even touch.”
But he is also realistic in his outlook: while it did help, weed was not a curative treatment for his cancer. Still, Ly is “1000 percent a big advocate”.
For Jane, the hardest realisation was that weed was no magic pill.
It may not be the solution to all our ills but, that being said, it is a solution. “There’s nothing worse than some balding doctor telling you to eat well and exercise and ‘she’ll be right mate’”, she says.
* Name changed to protect this person’s identity.