The term cannabis-based products encompass several types of products that may be prescribed to treat various medical conditions.
What is the difference between medicinal cannabis and recreational cannabis?
Medicinal cannabis is the use of cannabis-based products for medicinal purposes, to relieve the symptoms of a medical condition. Recreational cannabis is the use of cannabis without medical justification for the purpose of getting ‘high’.
Cannabis-based medical products
- The NZ Government prefers to refer to ‘cannabis-based products’ rather than ‘medicinal cannabis’ because the majority of the products available do not meet the criteria normally associated with a medicine.
- That is, the products are not all manufactured to international good manufacturing practice (GMP) standards for pharmaceutical-grade products. Evidence of the composition of these products, the consistency of the composition from batch to batch and the stability of the products in use is not available.
- Evidence of the safety and efficacy of most of the individual products from clinical trials is lacking.
- However, an evidence base for the use of cannabis for medicinal purposes is developing and for some products, it is considered there is strong evidence of a moderate effect.
Read more prescribing cannabis-based products (Medsafe)
What are cannabis-based products?
Cannabis-based products generally contain two main ingredients – cannabidiol (CBD) and tetrahydrocannabinol (THC). They may also contain other chemicals called terpenes.
Cannabis-based products either come from the cannabis plant (marijuana) or they can be synthetic. Synthetic products are man-made chemicals that have the same chemical structures as CBD and THC.
|Cannabidiol (CBD)||Tetrahydrocannabinol (THC)|
Medicinal cannabis products in New Zealand
Currently, the New Zealand Ministry of Health defines four categories of medicinal cannabis products.
Categories of medicinal cannabis products
|Pharmaceutical grade medicinal cannabis products that HAVE CONSENT for distribution in New Zealand
|Pharmaceutical grade medicinal cannabis products that DO NOT have consent for distribution in New Zealand
|Non-pharmaceutical grade medicinal cannabis products
Formulations of medicinal cannabis
Medicinal cannabis is NOT usually smoked. It is usually available as:
- oral drops, lozenges, capsules
- oromucosal spray (mouth spray)
- inhaled via a medical vapourisor device (non-combustion)
- gel or patches that are applied to the skin.
Do cannabis-based products work?
Overall the scientific evidence for effectiveness and safe use of cannabis-based products is not considered strong and in general there is not yet enough information to fully recommend its use. One of the main issues is that there are limited pharmaceutical grade cannabis-based products available for use. Certain cannabis-based products may provide some moderate improvements in symptoms for people with:
- multiple sclerosis-associated spasticity
- seizures associated with refractory epilepsy such as Dravet syndrome or Lennox-Gastaut syndrome
- chronic pain, specifically nerve pain
- nausea and vomiting caused by cancer therapy.
Trialling a cannabis-based product is only a suitable option for people who have ongoing symptoms after trying available conventional treatments. Evidence is lacking to support the use of cannabis-based products for depressive disorders, post-traumatic stress disorder (PTSD), Parkinson’s disease, anxiety, obsessive-compulsive disorder, autism, ulcerative colitis, Alzheimer’s disease, glaucoma and Crohn’s disease.
The recommended dose is difficult to be sure of due to the large range of products tested in studies.
- Some are synthetic and some are natural (plant-based and have different strengths from different parts of the plant).
- Different products have different amounts of cannabinoids, so until there are more reliable products available, it is difficult to know the right dose.
- There are side effects and dangers of using smoked cannabis for medicinal use because it is impossible to know what doses are being inhaled.
- The general advice for any medicinal cannabis product is to start with low doses and increase slowly to assess for beneficial effect.
Cannabis-based products are known to cause many side effects and these differ between products. Common mild side effects include:
- nausea (feeling sick)
- indigestion, stomach upset
- stomach pain or cramps
- diarrhoea (runny poos)
- dry mouth.
No studies have yet assessed the long-term adverse effects of cannabis-based products. The THC component of cannabis-based products is not appropriate for people who have a personal or strong family history of psychosis, concurrent active mood disorder or anxiety disorder.
Travelling with cannabis
New Zealand law allows people arriving in New Zealand to bring up to one months’ supply of a controlled drug, as long as they have been lawfully supplied in the country of origin for the purpose of treating their medical condition. Cannabis-based products supplied in the United States are not considered lawfully supplied under federal legislation and cannot be carried into New Zealand from the United States. Some other countries also have limitations in place restricting people from leaving the country with cannabis-based products. For further information on bringing medicines into New Zealand, see bringing-medicines-New-Zealand.
Sativex® Oromucosal Spray Medsafe, New Zealand
Savitex (Nabiximols) Multiple Sclerosis NewZealand
CBD products Ministry of Health, New Zealand
Prescribing cannabis-based products Medafe Prescriber Updates June, 2017
Summary of approvals required to prescribe cannabis-based products Ministry of Health, 2017
- Medicinal cannabinoids: current regulations for prescribing BPAC, 2018
- Committee on the Health Effects of Marijuana. The National Academies Press. The Health Effects of Cannabis and Cannabinoids: The Current State of Evidence and Recommendations for Research, The National Academic Press, 2017
- Allan MG, Finley CR, Hauptman R, Beahm NP. Missing ‘high’ quality evidence for medical cannabinoids for pain? Alberta College of Family Physicians, Tools for Practice. 2017
- Whiting PF, Wolff RF, Deshpande S et al. Cannabinoids for medical use; a systematic review and meta-analysis. Journal of the American Medical Association 2015;313(24):2456-73
- Newton-Howes G, McBride S. Medicinal Cannabis, moving the debate forward. New Zealand Medical Journal. 2016; 129(1445)
- Walitt B, Klose P, Fitzcharles MA et al. Cannabinoids for fibromyalgia. Cochrane Database of Systematic Reviews. 2016
- Mouhamed Y, Vishnyakov A, Qorri B, et al Therapeutic potential of medicinal marijuana: an educational primer for healthcare professionals Drug Healthc Patient Saf. 2018;10:45-66. Published 2018 Jun 11. doi:10.2147/DHPS.S158592