Let’s end the avalanche of THC imports – minor cannabinoids are where our focus should be

Heyday chief medical officer and co-founder Dr Jim Connell says cannabis has the potential to be a game changer for many patients – but the current focus on high-THC medicine is holding the industry back.

For the last seven years I have been prescribing cannabis as a medicine. It has profoundly affected the way I practice. It has instilled a new passion for learning, and has provided me with so many new treatment tools for people who are suffering.

We are only just scratching the surface of what can be achieved when cannabis is utilised to its full potential.

Patients deserve options to achieve strong, functional relief without intoxication. This can be achieved when we use the whole plant, creating an ensemble of cannabinoids to complement and support each other.

As a prescriber I want options and product differentiation. However, Australia has seen an avalanche of imported high-THC flower.

We are a dumping ground for the overflow of cheap flower out of Canada and other countries. The paucity of medicinally focused products and brands making their way onto our Australian prescriber’s formulary is hard to fathom in a medical market.

Does this really create better treatment options for our patients?

Shouldn’t there be a review system that assesses the clinical relevance of new products
entering our market and the ethical/health credentials of brands supplying these medicines? Otherwise, we run the risk of more vertically integrated companies with no or low-cost clinics, breaching advertising guidelines to push as much flower as possible on vulnerable patients.

This makes the medical cannabis industry look like the wild west and we run the risk of a political backlash, potentially delegitimising medical cannabis, with increasing restrictions around access.

In my view, the current free for all on imported THC flower needs a cap.

Canada, where most of these products come from, has rules that protect its local market, not allowing imported products to be sold in the country. Shouldn’t we be trying to support and grow our local industry?

Australia has the capacity to be a world leader in medical cannabis cultivation, formulation, manufacturing and research. We have engaged doctors who are passionate about medical cannabis.

However, our growers are continually undercut by products that are not held to the
same stringent standards as those we place on Australian operators.

The new GMP requirements are a joke, with many companies GMP-washing their products in Australia. A product that is irradiated and packed in Australia is not GMP.

Don’t get me wrong, THC flower has a role in the medical cannabis landscape, but does it need to make up 90% of the formulary?

As a stand-alone treatment, high-THC flower can provide profound relief. However, it is short acting, has possible side effects and the potential for an unhealthy relationship to develop with the medicine.

With appropriate guidance and education it can be used as part of a comprehensive treatment plan that includes long-acting options (oils, capsules, pastilles) and patient-centred functional goals.

However, many clinics providing low or no-cost appointments have limited capacity for education or support.

Cannabis care is more than just access.

The lack of advice and appropriate boundary setting can lead to overuse, with cannabis becoming a crutch rather than a tool to engage in the world in a more meaningful way.

We can do better than this.

Cannabis is a treasure trove of powerful bioactive compounds that provide an abundance of new medication options. Outside of THC and CBD, we have some wonderful minor cannabinoids like CBG, THCV, CBN, CBC and the acidic precursors THCA and CBDA.

When used in combination with THC and CBD they can be stacked to enhance effects,
modulate side effects and create specific and targeted outcomes.

They are non-intoxicating and provide strong functional relief. They are safely being utilised in North America. With selective breeding practices, plants can now be grown that express these previously minor cannabinoids in large quantities.

Because we are a relatively new market, local regulations make it difficult to get growers and manufacturers to champion minor cannabinoid-rich medicines, with increased costs and timelines associated with novel products and uncertain market demand.

To find solutions for our patients at Heyday, we have utilised compounding pharmacies for research and development.

These have actually been great and we have been able to develop a comprehensive, innovative range which showcases these minor and acidic cannabinoids.

We will continue working to improve access to these medicines because the results we have seen in our clinic have been extremely promising and patients deserve access to all of these powerful compounds.

Our current category system (category one CBD-predominant to category five THC-predominant) fails to recognise cannabinoids outside of CBD and THC.

Somehow these powerful non-intoxicating minor cannabinoids have been lumped in with THC for category determination. This makes all products with >2% minor cannabinoids category two or above, even if they contain 0% THC.

“We need to work together to take the industry in the right direction and not let the bad apples spoil the bunch.”

This is out of touch with the US hemp classification which has allowed minor cannabinoids to develop in North America.

For me the current category system creates problems with paediatric prescribing. It is now necessary for patients to get a letter from their paediatrician or specialist saying they endorse THC for these children for anything other than a category one product.

Many paediatricians are cautious about this and rightly so. However, without endorsement, medical cannabis prescribers can only use refined CBD products which are often less effective than more complex products as they lack synergy.

As many of these patients have complex needs and conditions like epilepsy, which require large doses of CBD to be effective, we should be able to add minor cannabinoids to boost the effectiveness of these products, mitigating the need to use THC, improving clinical outcomes and significantly reducing cost to patients because of lower doses.

As well as the problematic category system for some of these powerful minor cannabinoids, the Department of Veterans’ Affairs has also started refusing to fund cannabis medicine that contains minor cannabinoids in any significant amount.

To me this is a significant backward step and is pushing patients towards higher THC products because, unfortunately, CBD doesn’t cut it for those with more significant symptoms.

CBD is a great foundation to a treatment plan, but often needs help from the entourage for more significant results.

We have come a long way over the last eight years. There is huge potential with cannabis for producing diverse treatment options for those with difficult-to-treat symptoms.

We need to work together to take the industry in the right direction and not let the bad apples spoil the bunch.

I am excited for the future, with the right education and policies Australia can lead the world in the medical cannabis space.