Medical cannabis is standardised cannabis that has been grown for medicinal use. It is the unfertilised female flowering top of the cannabis plant, that has the highest quantities of the desired medicinal compounds and it can be in the form of dried whole flowers (buds, cannabis flos) or in the form of a standardised granulate.
In Europe it is prescribed by doctors/specialists and is only available via prescription in pharmacies. There are several varieties or cultivars of medical cannabis that are available, which mainly vary by the levels of the active compounds (cannabinoids, terpenes).
Currently there are 3 main types of medical cannabis flowers that are available for prescribing:
High-THC – flowers have higher ratio of delta-9-tetrahydocannabinol: cannabidiol (THC : CBD), available in with high-range (17-22% THC) and mid-range (12-16% THC) flowers. CBD is usually less than 1 %
Balanced – flowers have an about equal ratio of THC : CBD, usually somewhere in the range of 6-10% for both cannabinoids.
High-CBD – flowers have a higher ratio of CBD compared to THC, with THC usually under 1%. The levels of CBD are in the range of 11-20 %.
Examples of each type of medical cannabis flowers, from Bedrocan (a European licensed producer):
High- THC – Bedrocan (THC 22%, CBD <1%), Bedica (THC 14%, CBD <1%)
Balanced – Bediol (THC 6.3%, CBD 8%)
High-CBD – Bedrolite (THC <1%, CBD 9%)
You will often see cannabis categorized as “sativa” or “indica” dominant, which vaguely indicates the effects of these varieties, sativa being a more day-time, more energetic compared to indica which has more relaxing, night-time effects. These old classification is more for reference as nowadays the majority of medical cannabis flowers are hybrids.
Cannabinoids
Phytocannabinoids or “plant” cannabinoids are the main active ingredients produced by the cannabis plant and while more than a 140 have been isolated, currently the focus is just on a few of them.
The two main phytocannabinoids used therapeutically are delta-9-tetrahydocannabinol (THC) and cannabidiol (CBD). They both have therapeutic effects and usually work best when combined in different ratios. THC is intoxicating, can cause the so called “high”, while CBD is not and can counter some of the potential undesired effects of THC.
There are other phytocannabinoids that are currently being investigated for their therapeutic use, such as cannabigerol (CBG), cannabinol (CBN) and tetrahydrocannabivarin (THCV), but unfortunately they are not widely available, like THC and CBD.
Cannabinoid base preparations
The female flowers of cannabis can be used also to make a variety of cannabinoid base preparations (products) such as macerates, tinctures, capsules, salves, balms, and suppositories. Different methods are used to extract the active compounds form the cannabis flowers. The cannabinoid extract is the base for making all the other products, usually by diluting it in various carrier oils (olive, MCT, coconut).
For oral use, patients often use “oils” or “drops” in with standardized cannabinoid content, in 10/30/60 ml bottles with a dropper, for accurate dosing. Capsules with standardized doses are less popular, due to their fixed cannabinoid content.
For external use, different salves and balms can be used for alleviating various symptoms of the skin and mucosa.
For internal use, suppositories can be used, both rectally and vaginally, for targeting specific conditions/symptoms.
Both salves/balms and suppositories work mainly locally as the systemic absorption is very low in these methods of use.
Cannabinoid pharmaceutical drugs
Several cannabinoid base pharmaceutical drugs are also available to patients. Their availability varies by country and are made from natural and synthetic cannabinoids.
Epidiolex – is a CBD oral solution indicated for the treatment of seizures associated with Lennox-Gastaut syndrome or Dravet syndrome.
Sativex – is an oromucosal spray, made from plant cannabinoids, with approximately equal levels of THC and CBD (2.7 mg THC and 2.5 mg CBD per spray). It is indicated for the relief of multiple sclerosis symptoms and the treatment of severe neuropathic-related cancer pain. The carrier is ethanol, which enhances mucosal absorption, but can have unwanted side effects and limited usability in certain groups (children).
Marinol (dronabinolo) – synthetic delta-9-THC in the form of capsules.
Nabilone – a synthetic analogue of delta-9-THC in the form of capsules.
Cannabinoid wellness consumer products
Consumers can find a wide variety of cannabinoid based products in specialised shops all over Europe. CBD is the main cannabinoid found in the majority of these products, with CBG products slowly coming to market. While some consumers may utilise these products for health related issues, these are not medical cannabis preparations. They are not standardised and don’t need to have all the analysis done on them, so consumers cannot know what is actually in the product. Testing of some consumer products have shown discrepancies in the advertised and actual cannabinoid content, as well as other irregularities. Consumers should be very careful when buying these products, avoid unknown internet cheap products and only rely on trusted brands