Is the Grass really Greener on the other side?

Australians have been dabbling in their fair share of cannabis since it first hit our shores. Having a knack for taking the edge off and inciting an infectious giggle, it's no wonder nearly 1/3 of adult Aussies have tried the little green plant at least once in their lives¹. However, with negative stereotypes portraying users as lazy, dull or even at risk of “developing schizophrenia”, the media has created a cocktail of conflicting messages about marijuana’s safety… or lack thereof. Perhaps the plant was associated with a threat to the rigid social and corporate expectations of modern Australia? It's crazy to think older generations were told that cannabis was as on par with heroin and cocaine! Fortunately, we now know that marijuana offers great potential to ease pain, induce sleep, manage epilepsy, depression and anxiety (to name a few). So, you may find yourself asking: what’s the truth? Well, as usual, it's not that simple. Like many therapeutic drugs, marijuana has strong remedial capabilities (recognised a fair bit quicker by smokers than healthcare professionals). But it also has some obvious drawbacks, including dependence and undesirable lifestyle changes. With an ever-growing market for medicinal cannabis, we are called to grapple with a nuanced issue that impacts thousands of everyday Australians.

Australia federally approved marijuana for medicinal use in 2016, allowing authorised prescribers to provisionally prescribe cannabis in all its forms (I’m talking oils, gummies and the plant itself)². As a relatively new, emerging domain of healthcare, it is one overlooked in community pharmacy. Often, the medical rationale requires the benefits of cannabis to outweigh the risks posed by existing treatments- think benzo substitution. In reality, prescribers are not as discerning as the TGA would like. Upon medicinal marijuana legalisation, independent business has boomed. As a pharmacy assistant, I am grateful to work in an in-person clinic that genuinely emphasises holistic health and provides services beyond cannabis treatment. But this isn't the case with many online-only providers. Their shared vision? Prescribe. Dispense. Cannabis. This is probably because their sole service is cannabis and are realistically quite profit driven. A consultation is a brief call, often free, encouraging a seemingly flexible (and astonishing) 60-gram limit of flower per person, per month- a very large quantity indeed! Due to the quick and easy consultation process, seemingly anyone can be prescribed. Because of this, a recreational market is quietly catered for. There’s no question that undesirable effects may be associated with long term cannabis use³. For instance, many report an impairment in memory recall and formation, negative personality changes, poorer impulse control and a decline in cognition. When immersed in a recreational culture of cannabis use, people unsurprisingly engage in riskier behaviours, including further substance abuse³. I have seen incredibly agitated patients, desperately begging to dispense beyond their monthly limit. These situations are threatening and scary! Without greater monitoring and discretion in prescribing, these issues will continue to fly under the radar. It seems online dispensaries are exploiting legal loopholes to continue maximising their profits in lieu of genuine healthcare.

This is not to say that medical marijuana is not without tremendous benefit and incredibly valuable in modern medicine. Majority of my experiences with patients have been overwhelmingly positive. For instance, I had an elderly lady rave on about how much her life has improved now that she is managing her chronic pain with THC:CBD oil instead of opioids. I also recall fondly a conversation with a man in his mid-30s, simply ecstatic about finally experiencing relief from crippling social anxiety after managing it with a sativa strain of cannabis. In fact, many who suffer from dependence to other drugs can treat their underlying addiction and psychological disorders with cannabis- another overlooked advantage in pharmacy and which should be celebrated!

Truthfully, the evidence is murky and inconclusive as to whether there are serious, long-term harms from regular use⁴. Considering highly addictive opioids and benzodiazepines are still being prescribed, it only makes sense to have cannabis as a potentially safer and more effective medicine. But with the current online market for marijuana, how can we ensure that prescribing is being done judiciously?

References/Links:

1. https://www.penington.org.au/cannabis/cannabis-in-australia-2022

2. https://www.tga.gov.au/news/blog/introduction-medicinal-cannabis-regulation-australia

3. https://www.sciencedirect.com/science/article/pii/B9780443154898000116

4. https://link.springer.com/article/10.1186/s13643-019-1243-x

More about the Author:

David Narvaez is currently in their third year of a Bachelor of Science degree, majoring in Pharmacology. With a deep passion for healthcare, biomedical science, and public health promotion, they are committed to advancing in the field of clinical pharmacy. Their ultimate goal is to specialize in emergency medicine pharmacy, where they hope to make a significant impact on patient care in high-pressure environments.

In addition to their academic pursuits, David Narvaez works part-time as a pharmacy assistant, gaining hands-on experience and developing a strong foundation in the practical aspects of pharmacy practice. Outside of their professional interests, they are an avid music enthusiast, engaging in music production as a creative outlet. They also enjoy attending live music gigs with friends, and when time permits, they love exploring the outdoors through traveling and camping adventures.