What’s Happening with Medicinal Cannabis?

Dr Karen Hitchcock answers questions

Dr Karen Hitchcock is one of Australia’s first authorised prescribers of medicinal cannabis and a supporter of its benefits. The following is based on her informative and insightful responses at a Q&A at the December 2022 Entheogenesis Australis (EGA) “Garden States” conference.  

Q: What forms of medicinal cannabis are available in Australia?  

Karen: When medicinal cannabis first became legal, there were only a few ludicrously expensive cannabis oils available. There are now about 500 forms of medicinal cannabis — some are for eating; others are for inhaling — and more and more are becoming available.  

Inhaling is done using “flower” a.k.a. “bud”. You can vapourise it or smoke it. Vaping is the healthier option. There's also a range of oils that can be inhaled.  

If you want to inhale medicinal cannabis, I highly recommend that you don’t use a bong because it's bad for your lungs. There are dry herb vaporizers, that are TGA approved.  

The cannabis herb that is available medicinally now is mostly very high quality. Different strains have different effects. 

Eating it is done via oil or lozenge. You can swallow it or absorb it under your tongue. The oils range from pure CBD, to 50/50 THC/CBD, to pure THC. Other minor cannabinoids are also being promoted now, like CBG and CBN.  

Q: How can you get a prescription for medicinal cannabis?  

Karen: You can visit or call a doctor. A growing number of us will prescribe cannabis, where appropriate, as just one part of just one part of an overall treatment process. The patients we see have often gone to multiple specialists and they’re suffering things like insomnia, pain, fatigue, fibromyalgia, restless legs syndrome, anxiety, and depression.  

There are also a lot of telephone doctors now. In my observation, they may not be so holistic but will usually be happy to prescribe and tend to be working for a “vertically integrated clinic”. This means they will prescribe you products from the dispensary they have a relationship with. You can get a couple of ounces of weed delivered to your door every month. Some bulk bill.  

Any doctor can prescribe cannabis if they wish, but many still choose not to. Once you get a script, you can take it to a pharmacy and they can order it, or there are a bunch of independent dispensaries that specialise in cannabis.  

[Editor’s note: Call Peerline on 1800 644 413 for information on how to find prescribers and dispensaries.]  

Q: I found a strain that works for me but months later it was discontinued. How do you find consistent supply of a particular strain?  

Karen: There are currently about 150 different varieties of flower. The pharma companies and dispensaries give them brand-names like they would with any other product. They give them names like “Buttercup” — a bit more sanitised than the street names like “Death bubba” but it’s the same product! The supply issue has been difficult. It is a lot better now. If you know what kind of cannabis you like, talk to someone at the dispensary, they can offer you a replacement. When stock shortages happen, patients send me an email and I do a replacement, or the dispensaries call me, and we fix it. The small pharmaceutical companies tend to have more issues. 

Q: Cost has been a big barrier for many patients. Is medicinal cannabis affordable yet?  

Karen: The prices in Australia have come down by about 300%. Things that were $400 are now $100. The prices of flowers are now equivalent to good street weed. The oils are also getting cheaper. You can get prescribed bulk cannabis now that is cheaper, and maybe not as good. Other people pay more for organic certified premium ‘boutique’ cannabis. 

Q: It’s sometimes claimed there is little scientific evidence for medicinal cannabis. Is this true? What is the science? 

Karen: The evidence base for medicinal cannabis is pretty poor but cannabis is not dangerous. The lack of evidence is in part because of a lack of research.  

Cannabis is a plant that we only recently found out produces chemicals that our body also produces, called endocannabinoids. This is probably why humans have used cannabis for thousands of years, for all sorts of reasons, including healing physical and mental issues, for spiritual development, and for fun! But everyone has a different endocannabinoid system, so everyone’s reaction is going to be different. 

Cannabis can help people with anxiety. The evidence-based treatments for anxiety — anti-depressants and CBT— are all suppressive, they are about avoiding or suppressing certain thoughts and feelings. I have found from my personal experience of working with patients that cannabis can help you look at those thoughts and feelings that are making you anxious, without being overwhelmed.  

THC has a subjective effect that you can feel in an hour if you take it orally and almost instantly if inhaled. We know what THC does. Particular cultivars (types) tend to produce sleepiness. In the 100s of patients I've seen with insomnia, only 2 people haven't found it useful for sleep. It is good for restless legs syndrome, which is a horrific condition, and for people with MS suffering spasms and contractures.  

Cannabis has an effect that in time will wear off. It's not like anti-depressants that you have to take for 6 weeks before they “work”, and which tend to numb you and give you all sorts of negative side effects.  

CBD is more subtle than THC. It does have physiological effects. They give massive doses to babies that have various epilepsy syndromes. 

Q: What is meant by the term “cannabis use disorder” and what does this mean for medicinal cannabis? 

Karen: I think cannabis should be available not just for treatment. It’s a beautiful drug and a lot less toxic than alcohol (although I like alcohol too).  

DSM-5 has a criteria for “Substance use disorder”. It’s all about loss of function and relationships. So, I ask “Is cannabis a destructive thing in the patient's life, or a healing thing that is helping them be out in the world.” And it can go back and forth for some people too.  

I have patients who are dependent on using big doses of THC throughout the day who are living fulfilling lives, working, having good social and family relationships. Cannabis is working for them. They're happy.  

Then there are other patients, particularly from the forensic group who are referred to me from AOD (alcohol and other drug) counsellors or lawyers because they’ve been caught trafficking, growing, or in possession of cannabis. A number of these patients — usually young guys — have what would be considered a “cannabis use disorder”. Some are smoking more than 7 grams a day, sitting in their dark house and not leaving. They haven't got relationships or work. Maybe cannabis is the only thing keeping them alive, but it is also possibly holding them back. 

I tell them they have a choice. They can get bulk medical cannabis delivered and keep doing that legally. Or if they would like not to need a bong every half hour, I can help them just use it for pleasure, not because they’re dependent. Though, obviously, I'm not allowed to just prescribe it for “pleasure”. 

Q: Can cannabis cause a psychedelic trip? If so, does this have medical significance? 

I've had about 4 patients over the years who took an extra-large dose of THC oil accidentally and spent the night in a full-blown psychedelic trip, which was uncomfortable for them because they weren't expecting it. They were cannabis naïve before taking a far bigger dose of THC oil than I had prescribed them!  

All of them had profound lasting healing from that experience. One came back to my clinic and said, “Is there something about cannabis that can produce a reset? Because I took it that first night, I was awake most of the night and it was uncomfortable and then I woke up in the morning and I felt like myself again. I haven't felt this way in 4 years. It's amazing. That’s been sustained for a couple of months now.”  

Another, who was on 4 different benzos and anti-psychotics for his lifelong insomnia, had this massive trip overnight and then never had insomnia again.  

Q: What’s the deal with medicinal cannabis and driving?  

Karen: One of the main impediments to people getting benefits from medicinal cannabis is the fact that there is this ludicrous program of roadside saliva drug testing (aka RDTs / MDTs) for the presence of cannabis. In Victoria, there are 200,000 of these tests performed every year for about $100 million. [Editor’s note: there are also about 200,000 MDTs per year in NSW.] Even if you have a prescription for medicinal cannabis, there is at present no medical defence. If you test positive, it is up to the police officer to decide whether or not to charge you. If they decide to, you will be brought before a magistrate who is mandated to take your licence for 6 months, even if you’re just on a tiny dose of THC oil to get to sleep at night and feel perfectly fine the next day.  

Most doctors who prescribe cannabis give a “letter of authority” that people can put in their glove box. I hear anecdotally that some police officers who are shown that letter will just say “Ok fine, you’re obviously not intoxicated or impaired, go on your way”. But this is entirely up to the discretion of the individual police officer and a lot of people can’t risk their license or job.  

Q: How long does THC stay in your body in sufficient amounts to test positive? 

Karen: The Lambert Institute — which does a lot of cannabis research at Sydney University — did a study with 400 saliva tests to find out how long you’d be positive for. If it's urine or blood, you can be positive for weeks. But for saliva — which most roadside and workplace tests are — it's anywhere between never being positive or being positive for a max of 15 hours. If you swallow THC oil in a capsule you don’t get any mouth contamination, so you likely won't test positive. You can experiment with one of those saliva tests that people get online, although these may not be as sensitive to the presence of THC as the ones the police use.  

Q: I have a herb vape. Is it true that at lower temperatures you can still get some of the pain-relieving benefits from the herb without activating the THC, which the roadside testing is for?  

Karen: That doesn’t sound true to me. I'm not sure what temperature THC is activated at. I think it is about 120°C, which is really low, and most herb vapes don’t go less than that.  

Q: I’ve got older relatives, one who’s been on sleeping pills for insomnia for 20 years and another who’s been on opioids for back pain for 30 years. Both talked to their GPs about cannabis but were told to stay on sleeping pills and opioids.  

Karen: My oldest patient is 101! The older generation of doctors were educated to think that cannabis is a bad drug. Going to a younger doctor can be better.  

In my opinion, some of the things that GPs are prescribing for insomnia can be problematic. Benzos and anti-psychotic medications like Quetiapine can be very beneficial in treating many conditions, but I don’t think they should be first option for dealing with insomnia. These are very powerful drugs and I don’t believe they should be handed out like tic-tacs. They can have significant side-effects.  

Cannabis, because of its stigmatisation as an illicit drug, is still not completely accepted in mainstream medicine. I want to change this because in some circumstances it is a better and safer medication than the alternatives.