Getting a medicine to market in Australia, even a non-prescription one, requires extensive research and investment. It might be too much for small cannabis producers to take on, and a turn-off for big pharmaceutical companies if that investment is at the expense of upcoming blockbuster drugs. And the process might not be worth it if research shows the benefit of cannabinoids is small compared with other therapies.
Catherine Lucas does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.
With some high-profile proponents including basketballer Lauren Jackson, there are increasing calls in many countries for patients, particularly those with chronic pain, to legally use cannabinoids. There are also claims low-dose CBD could help people with anxiety, insomnia, arthritis or inflammatory issues, but this has yet to be backed by research into effectiveness or safety.
Setting high standards
Since early 2021, the Therapeutic Goods Administration (TGA) has allowed the sale of low-dose cannabidiol (CBD) preparations over the counter at Australian pharmacies. But you won’t find any at your local chemist.
Already there’s countless overseas companies taking an interest in selling to Aussies. “They see it as perhaps the fastest growing market in the world, even though it’s a small population the numbers add up,” says Dr Iain.
After Grace was diagnosed with cancer, she turned to medicinal cannabis. But getting it legally was a challenge, so she’s sticking with the black market — and experts say her experience is common.
FireFox NVDA users – To access the following content, press ‘M’ to enter the iFrame.
How do you actually get CBD oil?
“CBD got caught up in the whole medical cannabis legalisation thing that happened from late 2016,” Dr Iain explains. As part of that, there was a “torturous process” set up for Australians to access CBD, whereby you had to go through a doctor, hope said doctor is educated about CBD and is in favour of its use, then persuade them that CBD is right for you, then they would need to write a complicated application and send that off to Canberra to the TGA who would then decide either way.
“CBD is obviously pretty important. Its anti-inflammatory capacity and its ability to protect the brain is evident in almost every study that you pick up.”
'Green Light': New doco reveals story of two Aussies breaking the law to supply medicinal cannabis
A growing demand for cannabidiol to ease pain and anxiety issues in pets leads to new products.
She finds these anti-inflammatory effects, even in low doses of cannabidiol, especially exciting since inflammation kind of underlies everything. “Low levels of inflammation are involved in body weight gain, if you pull a muscle. there’s such wide ranging benefits to anti-inflammatories.”
And it's jumping through the efficacy hoop that will be the tricky part.
"The TGA has said anyone who proves their CBD product is effective for an appropriate indication, up to this specific dose [of 150 milligrams per day], may be allowed to sell it over the counter," Mr Cohen said.
"The problem is it's probably too low to be effective for most symptoms and diseases," Professor Martin said.
"The honest answer is we don't really know how all the cannabinoids exert their activity," said Jennifer Martin, director of the Australian Centre for Cannabinoid Clinical and Research Excellence.
ABC Science on YouTube
Claims for CBD's benefits can be broadly split into two, although they are connected: general pain relief and more specific neurological effects.
And — being a promiscuous molecule — CBD doesn't just work its magic on cannabinoid receptors. It can activate others, such as serotonin receptors.
What's more, some cannabinoids can also act on non-cannabinoid receptors, such as opioid receptors.
Here's a first look at how many Australians are taking medicinal cannabis
Plus there are plenty of gaps in the research, he added.
CBD's purported effects there — such as calming us down and helping us nod off at night — are all controlled by evolutionarily ancient brain systems that regulate vital functions such as appetite, emotion, fear and sleep.