Medicinal cannabis: pharmaceutical vs herbal

What is the difference between pharmaceutically produced medicinal cannabis and whole-plant cannabis?

Pharmaceutical vs herbal cannabis

A conspiracy theory often floated about NCPIC, by those people who advocate for cannabis legalisation, is we are ‘pro big pharma’ (big pharmaceutical companies), or even funded by big pharma. While our recent blog, ‘Where do we stand on medical cannabis?’ aimed to put those accusations to rest, we were still left wondering how we could be more clear about where we stand on pharmaceutical cannabinoids vs herbal cannabis.

Let’s start by making it simple – we can’t report on something that doesn’t exist. We generally aim to only use the most high-quality research available. There is little-to-no high quality research on human use for therapeutic purposes of whole-plant cannabis to-date.

Maybe this will change.

Maybe upcoming research will provide life-changing insights. Maybe it won’t. But for the moment, we report mainly on pharmaceutical products because that’s where the research evidence has been derived. If we have missed any high-quality research on whole-plant, we welcome links to studies so we can assess them.

So is there really any danger in using whole plant cannabis?

Cannabis is still illegal in Australia, so using it does continue to pose legal risks. Some may argue that this factor, among others, has meant most recent research has been focused on harms – and in some cases this is true (though like tobacco, it is still important not to miss possible public health risks).

Despite this, the results of many high-quality studies provide a significant body of evidence suggesting there are physical and mental risks associated with heavy cannabis use. Inevitably there will be more-and-more research conducted in the future, but until the results start flying in, the current evidence and unknowns present risks – especially to young people.

Is pharmaceutical cannabis less risky than whole-plant cannabis?

Given there are no high-quality studies on whole-plant cannabis as medicine, saying pharmaceutical cannabis is definitely less dangerous is a little inaccurate. It’s like saying the banana in your left hand is better than the mystery food in your right, after only taking a bite of the banana.

But what we can say is we know more about, and have a better control of, pharmaceutical products than whole-plant cannabis – and more knowledge and control decreases risk.

There are many different chemical compounds that make up the cannabis plant, those that are unique to cannabis are called cannabinoids. Two of the main cannabinoids are THC (delta-9 tetrahydrocannabinol) and CBD (cannabidiol).

Different cannabinoids affect the brain in different ways. For example, THC is the part of the plant that gives you a ‘high’, and it can also cause unpleasant side-effects like anxiety, paranoia or even psychosis. 

CBD on the other hand has an anti-psychoactive and anti-psychotic effect, possibly even relieving anxiety.

Both THC and CBD have the potential to relieve pain, and CBD also has anti-inflammatory properties.

The trouble with plant cannabis is we cannot control the levels of the different cannabinoids, like THC and CBD. It is also very difficult to ensure the quality of the plant and make certain it is free of harmful contaminants. (Many cannabis plants contain contaminants like heavy metals. This has even been a recent problem with legal cannabis in Colorado).

Also, as with almost all plants in nature, each plant is slightly different, meaning there isn’t a consistent ‘dose’ or strength between each plant. This would make it difficult for doctors to prescribe as a medicine, as they are not sure exactly what strength they are prescribing and whether their patient would even receive the exact same ‘medicine’ between each dose. They also don’t have clinical evidence to support how to prescribe and for how long for a particular condition – information that will help protect them should a patient claim malpractice.

Pharmaceutical products allow scientists to manipulate the levels of cannabinoids within a drug so patients get more of what they need and less of what they don’t, and dosage is regulated and consistent. This hopefully results in a medicine with benefits that are greater than any potential negative side-effects.

But isn’t ‘natural’ cannabis best?

Some people think because something is ‘natural’, it can only be beneficial and that the natural form of the product is the ideal product to use as a medicine. On one hand, this makes sense – it seems pure and not manipulated by science, with additives and elements we can’t read or pronounce.

But on the other hand, nature provides the fault in this logic. If you think about it, there are many things in nature that can harm you: poison ivy and hemlock, for example. There are also many commonly produced medicines that are derived from natural substances, but produced using a pharmaceutical method to optimise medicinal benefit and control the quality and dosage of the product. Some of these products include morphine (which is derived from opium poppies), penicillin (derived from a fungus) and aspirin (from willow bark).

So what are you really saying?

We aren’t your GP, so we’re no more going to recommend you try pharmaceutical cannabinoids or plant cannabis, than we’ll recommend aspirin or cough mixture. That’s not our job.

The reason many of our medicinal resources talk about pharmaceutical cannabinoids is because that’s where good, solid research currently exists. Taking that and spinning it into the ‘you’re funded by big pharma’ slogan is like saying Gov-funded cancer research centres are funded by companies that produce chemo drugs. We’re scientists, we read, we analyse and we share. As more high-quality research becomes available – whether about plant or pharmaceuticals – we’ll evaluate  it and keep you posted.  

If you’d like to read more about medicinal cannabis, check out our medical cannabis resource centre on our website.

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