do i need a script for cbd oil

2021 is giving us over-the-counter medical cannabis

Low-dose CBD cannabis oil can be sold in pharmacies from next year.

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From early 2021 you’ll technically be allowed to buy low-dose cannabis oil from pharmacies without a prescription.

However, while the laws have been changed so you can buy CBD oil over-the-counter, there are currently no products approved for sale.

Firstly, these products won’t get you high. This is only low-dose CBD oil we’re talking about and products won’t be allowed to have more than 1 per cent THC (which is the psychoactive part of the plant).

When the changes come in on February 1 next year, the maximum dose for adults will be limited to 150mg per day, which is why it’s considered low-dose. It’s expected patients would use this to help them sleep, reduce anxiety or depression and treat pain, although there’s currently not much evidence the oil is effective at this strength.

The decision from the Therapeutic Goods Administration (TGA) changes low-dose CBD oil from a schedule four drug, which doctors have to prescribe, to a schedule three drug, which chemists can hand out over-the-counter without a prescription.

Cassandra Hunt, the managing director of cannabis industry consultancy, Fresh Leaf Analytics, told Hack the change is significant.

"It’s the biggest milestone since legalisation in 2016 and it’s going to dramatically change access for patients in Australia."

She says this will make life much easier for people who want to use this drug.

“Previously, they’ve had to go to a GP and they’ve had to talk to the GP about what they’re trying to treat, and then the GP has had to get special permission in order for them to be able to access a prescription.”

There will be a wait for products

While the changes will come into effect in early 2021, it could be years before there’s actually a product to buy.

Cassandra Hunt from Fresh Leaf Analytics told Hack that it’s unlikely anything will be on the shelves in February.

“In order for companies to get these products registered or available over-the-counter in pharmacies, they have to be registered as an S3 medicine,” she said.

“What that requires is quite significant data about the safety and efficacy and quality of the products.”

According to Cassandra, because the Australian cannabis industry is still so new, they don’t know how effective their low-dose CBD products are and it could take years to get that data.

She says it’s not clear what info the TGA wants, but if it’s expecting companies to run clinical trials then it could be a five-year wait for products.

“That data, given the industry is so young, isn’t easy to come by.”

Medical Association “surprised” by down-scheduling

The Australian Medical Association (AMA) doesn’t support the TGA’s decision to down-schedule low-dose CBD oil.

In a statement to Hack, the AMA said it isn’t confident pharmacists have the education to properly advise patients, and that side effects could go unchecked.

“Medical practitioners have only been prescribing CBD products for a few years, the evidence is still emerging, more education around its use is required,” the AMA said.

When it comes to possible side effects, the medical association fears doctors won’t be able to properly monitor patients when the CBD oil is sold through pharmacies.

“There is a risk that patient conditions that are associated with CBD use (e.g. anxiety, psychosis, chronic non-cancer pain, and epilepsy) will go unchecked and cause further harm to the patient,” the AMA told Hack.

The TGA told Hack the decision to make low-dose CBD oil available over the counter wasn’t based on how well it works, just that it isn’t harmful.

“The scheduling decision was made on the basis of the safety profile of CBD at this dose,” a TGA spokesperson said.

Cassandra from Fresh Leaf Analytics admits evidence of how well these products work is hard to come by but agrees they’re not harmful.

“There is good safety data to show that at the types of doses we’re talking about CBD is very safe.”

The illicit silver lining

According to Cassandra Hunt from Fresh Leaf Analytics, the TGA could also be trying to move CBD users away from the black market.

“I think one of the other motivations of the TGA is to make it easier for people to access these products where they might otherwise be using illicit channels,” she told Hack.

"The problem with some of the illicit channels is that the quality of the products is not always good."

“Sometimes those products say they have something in them and that’s not in there, so you can’t really rely on the fact that you’re getting a good product.”

She also says that for the first time, as the cost of medical cannabis production comes down, legal products are reaching price parity with the illegal market.

“If you couple that with making it more easily accessible through pharmacies, that should hopefully make a big difference for people who’ve been getting relief through those channels, but maybe can’t rely on those products being good quality.”

How to Talk to Your Physician About Medical Cannabis: 10 Points to Guide You

Living with chronic pain is challenging, especially when opioids may be less available. If you are wondering about other pain relief options—including medical cannabis—here’s a guide discussing alternatives with your doctor.

There are many ways to start a conversation with your doctor If you feel awkward bringing up the topic of medical marijuana. If you suffer from a chronic medical condition and have not found adequate relief from pain and other symptoms using traditional medicines, you may be thinking about trying medical cannabis (also commonly referred to as medical marijuana) as part of your treatment strategy.

A growing number of states (currently 31 plus the District of Columbia) have approved cannabis use for medicinal purposes to treat a host of serious and chronic medical needs from nerve pain to nausea and anxiety. (Note: the conditions which qualify for its use vary from state to state.) According to proponents, medical cannabis can relieve pain, reduce inflammation, lessen nausea/improve appetite, control epileptic seizures and more. Also of note, in a Fall 2018 PPM online patient poll, about half of respondents said they had tried medical marijuana to help alleviate their pain or pain-related symptoms.

Getting Started

If you have a medical condition that qualifies for medical cannabis use in your state, you can start by talking to your primary care physician about the options, benefits, and risks of using it therapeutically for your specific situation, says David Bearman, MD, a physician with 40 years of experience in the substance abuse field and author of the recent book, Drugs Are NOT the Devil’s Tools: How Greed and Discrimination Led to a Dysfunctional Drug Policy and How It Can Be Fixed.

10 Key Considerations

Before broaching the subject, It is helpful to know the basics about medical cannabis and some of the issues and concerns involved in its usage. Here are some points to help guide your conversation with your physician:

#1. Not all medical cannabis is the same.
Photo courtesy Robin R. Buckallew, hosted by the USDA-NRCS PLANTS Database Medical cannabis comes from the Cannabis sativa plant, and there are hundreds of different strains out there. “Cannabinoids are the molecules in the cannabis plant matter that have a medical value and perform certain actions in the body,” explains Sharmilla K Patil, MD, CAS, FDM, who serves as the CMO of Divine Balance Medical Group and CEO of Greentech Laboratories, Inc.

Two of the best-known types of cannabinoids contained in most strains are THC (delta 9 tetrahydrocannabinol) and CBD (the name for cannabidiol). THC causes the psychoactive effect that people typically associate with cannabis use; CBD offers many therapeutic applications without the psychoactive properties.

Most people use a strain that contains a mixture of both compounds. Experts say low doses of THC can be effective for treating anxiety, attention deficit disorder (ADD) and post traumatic stress disorder (PTSD). Higher doses are typically required for pain relief.

#2. Medical cannabis can be used to treat a variety of conditions.
“Some of the more frequent reasons for cannabinoid medicine specialists [or other physicians] to recommend cannabis is to treat pain and to treat anxiety,” Dr. Bearman says. “Other common conditions that cannabis can address include [but aren’t limited to] migraines, epilepsy, ADD/ADHD, PTSD, depression, Crohn’s disease, nausea, appetite stimulant, Parkinson’s Disease, multiple sclerosis, fibromyalgia, complex regional pain syndrome (CRPS), rheumatoid arthritis, lupus, and autism.” (Keep in mind that the conditions cannabis is approved to treat will depend on the state in which you live.) Your doctor may be able to discuss your condition and explain how medical cannabis can be used to address your symptoms.

Some people are not good candidates for this form of treatment. Your practitioner should be able to tell you if this is true for you. As with any medication, pregnant women should consult a doctor before use and those with schizophrenia should use cannabis only under the supervision of a psychiatrist.

In addition, Dr. Bearman points out that the US Food and Drug Administration (FDA) offers a warning for users of Marinol (prescription synthetic THC) and other psychoactive drugs, which is not to drive, operate heavy equipment or engage in dangerous activity until the substance’s affects are evaluated in them. Something to keep in mind when using medical cannabis as well.

#3. Medical cannabis comes in several forms.
Dr. Bearman suggests you ask your physician to recommend the best ratio of THC to CBD to look for in a marijuana strain, as well as to offer a suggested dosage and route of administration. Medical cannabis can be taken in a variety of forms, including being smoked, vaporized, sublingually (under the tongue), ingested, and used topically. When you visit a dispensary with your doctor’s recommendation, if the staff there is experienced and well-informed, they can also help guide you to identify the best option for the type of results you are seeking. Some patients prefer to grow their own cannabis. You can also talk to your doctor about going this route, too.

#4. Side effects are usually minor but do exist.
“While cannabis does have a few side effects, they are generally dose related and occur more frequently in novice users, and in most cases nonmedical recreational consumers,” Dr. Bearman points out. “These side effects include paranoia, panic attacks, and dysphoria [a feeling of deep uneasiness or dissatisfaction]. Therefore, the best advice with medical cannabis is to “start low and go slow,” he stresses.

#5. You don’t need a prescription for medical cannabis but you do need a physician’s recommendation.
If you are an appropriate candidate for medical cannabis treatment, your physician can provide a medical cannabis recommendation that can be used in your state. Since medical cannabis is classified as a Schedule 1 drug, doctors don’t formally prescribe it; they recommend usage. A physician’s recommendation is needed to purchase the substance at a medical marijuana dispensary.

You may also want to use the recommendation to apply for a formal medical marijuana card, which enables you to be a registered medical cannabis user in your state. (Note: The card is an optional step in many states, but be sure to find out the laws where you live.) Dr. Bearman points out that the benefit of having a medical cannabis card is to offer protection in the event you need to prove to law enforcement that you are using it for a valid medical reason. Law enforcement may ignore the doctor’s letter (the courts will recognize it, however) but the card is an official state document and can help you avoid unnecessary hassle.

#6. Cannabis use laws vary by state.
To learn the medical cannabis laws in your state, several online resources are available. Sites such as the National Organization for the Reform of Marijuana Laws (NORML), the Marijuana Policy Project, and the United Patient’s Group provide information about regulations in each state. You can also call your state legislators for more information about local regulations.

It’s also important to understand that medical marijuana is prohibited under federal law but in states with controlled medical cannabis laws, patients with physician’s recommendations don’t generally need to be concerned about this. In 2014, Congress budgeted no money to enforce the federal anti-marijuana law (the Controlled Substances Act of 1970) in states where cannabis is legal. The US Drug Enforcement Agency (DEA) points out that the laws are meant to protect against drug rings and aren’t meant to target individual people using cannabis for approved therapeutic reasons.

“No patient should be worried. The states that have medical marijuana usually have amendments that protect patients and physicians from federal laws,” stresses Philip S. Kim, MD, CEO and founder of the Center for Interventional Pain Spine, LLC, in Newark, Delaware.

Dr. Kim also points out that for people in states that don’t have medical cannabis laws, they can ask their doctor about dronabinol, a synthetic THC and the generic form of Marinol, which is FDA approved and available nationwide.The National Institute on Drug Abuse (NIDA) website reports that medications containing THC that are approved by the FDA can help with nausea control, improved pain, reduced inflammation and improvements in muscle control issues.

#7. There’s more than one way to start the conversation with your doctor about using cannabis therapeutically.
If you’re unsure how to bring up the subject of using medical cannabis with your doctor, Dr. Bearman has a few possible openings. Try talking about someone else you know (“a friend”) who is using medical cannabis effectively; mentioning a book on the subject that you have recently read or a documentary or news show you’ve watched or asking about research you’ve discovered on the Internet. “Any of these tactics can kick off a conversation with your doctor,” he says.

#8. Not all doctors are up on the latest research on medical cannabis.
You shouldn’t assume that your doctor is well versed in the current medical cannabis literature. One way to find out his level of knowledge is to inquire if he or she has attended any continuing education programs or workshops about cannabis recently. Dr. Bearman says that you shouldn’t be surprised if the answer is, “no.”

“Most physicians have not even been taught about the endocannabinoid system [the neurotransmitter system that cannabis affects for results], let alone the medicinal value of cannabis [the plant matter] and cannabinoids [the molecules]. Even physicians who make cannabis recommendations may be unfamiliar with its value, dosing, and/or strain in treating a less common condition that may respond favorably to cannabis,” Dr. Bearman explains. So, be sure to do your homework and understand the options and issues involved in using medical cannabis.

#9. If your physician doesn’t recommend cannabis for you, you can still find a doctor who specializes in this treatment.
If your condition qualifies you to use medical cannabis in your state and you don’t have any contraindications that make usage risky, but your primary care physician isn’t comfortable making a cannabis recommendation, ask him or her for a referral to another clinician. Medical cannabis practitioners can also be tracked down online through resources such as the Medicinal Marijuana Association.

#10. Medical cannabis use can negatively impact your career and finances.
While the majority of states have some type of medical cannabis law in place to make it accessible for patients who qualify, there are still some important implications that people should think about before they decide to use it. For instance, regular usage could impact life insurance premiums and could also put you at risk on the job in some circumstances if your employer performs drug testing and is not willing to recognize the medical benefits of this drug. (Dr. Bearman notes that the use of synthetic THC [dronabinol] will be reported as a negative test result, so this could be worth considering.)

Your best bet is to ask your doctor about the benefits and risks associated with any options you are considering so you can determine what makes the most sense for your specific symptoms and circumstances.