Cannabis-based products

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)
  • This is a non-psychoactive cannabinoid.
  • It does not seem to affect the mind or mental processes and does not have the ‘high’ like THC.
  • This is a psychoactive cannabinoid.
  • THC binds to cannabinoid receptors in the brain and causes most of the psychological effects such as elated mood (feeling ‘high'), fast heart rate, dizziness and slow reaction times.

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
  • Currently, the only product in New Zealand that falls into this category is Sativex, which is approved for use in people with multiple sclerosis to improve symptoms of moderate-to-severe spasticity (muscle tightness, stiffness or spasms). Its use must be endorsed by a neurologist and other standard treatment options must have been tried first.
  • Sativex is available as an oromucosal spray and is not funded, which means that you have to pay for it. It must be kept in the fridge.
  • These products do not require ministerial approval to be prescribed, supplied or dispensed if used for their licensed indication. ​
  • Learn more: Sativex® supply information for patients, prescribers and pharmacies.
Pharmaceutical grade medicinal cannabis products that DO NOT have consent for distribution in New Zealand
  • These products require ministerial approval and patient consent to be prescribed, supplied or dispensed.
  • Example of products that fall into this category are products that have been manufactured by a pharmaceutical company overseas.
Products that the Ministry of Health believes are of pharmaceutical grade or are GMP certified for at least part of the manufacturing process are Tilray and Bedrocan.
  • Tilray products are manufactured by a Canadian company. Tilray has oil and capsule products that have been produced to GMP standards for the cultivation and extraction of the active ingredients, but the Ministry of Health does not consider that the products are pharmaceutical grade.  
  • Bedrocan products are obtained from certified sites in the Netherlands. Bedrocan has a range of standardised plant (cannabis flowers, often called flos, and granulated plant material) products with different standardised concentrations of THC and CBD. The recommended method of administration for Bedrocan is via a medical vaporisation device.
  • Other cannabinoid-based medications include Marinol containing dronabinol (a synthetic THC), Cesamet containing nabilone (a synthetic analogue of THC) and Syndros, a liquid formulation of dronabinol. These are medicines based on cannabinoids but have been manufactured synthetically rather than derived from cannabis plant material. They are all pharmaceutical grade, FDA approved and can legally be exported from the United States. (note: this is different to not being allowed to take medicinal cannabis supplied under prescription out of the United States, as discussed in “Travelling with Cannabis” below).
  • Read more prescribing cannabis-based products (Medsafe)
Non-pharmaceutical grade medicinal cannabis products
  • These are products that are not manufactured to internationally recognised pharmaceutical manufacturing standards. They may, or may not, have been intended to be used as medicines.
  • These products require ministerial approval to be prescribed, supplied or dispensed.
CBD products
  • A CBD product is defined as a product that contains cannabidiol:
    • AND must have < 2% of THC (or any other psychoactive components within cannabis)
    • AND does not contain any other controlled drug
    • AND contains cannabidiol and does not contain a psychoactive substance.
  • These products do not require ministerial approval to be prescribed, supplied or dispensed. They are now regarded as prescription medicines.
  • As with all prescription medicines, patients must have a prescription from an authorised prescriber to import or use CBD products. 
  • Read more about CBD 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.

Dose

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.

Side effects

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)
  • dizziness
  • confusion
  • tiredness
  • 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.

Learn more

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

References

  1. Medicinal cannabinoids: current regulations for prescribing BPAC, 2018
  2. 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
  3. 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
  4. 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
  5. Newton-Howes G, McBride S. Medicinal Cannabis, moving the debate forward. New Zealand Medical Journal. 2016; 129(1445)
  6. Walitt B, Klose P, Fitzcharles MA et al. Cannabinoids for fibromyalgia. Cochrane Database of Systematic Reviews. 2016
  7. 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
Credits: Sandra Ponen, Pharmacist. Reviewed By: Emma Griffiths, Specialist Palliative Care Pharmacist, Mercy Hospice, Auckland; Angela Lambie, Pharmacist, Auckland Last reviewed: 06 May 2019