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This is how Australia is consuming medical cannabis

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A new report shows record numbers of doctors are prescribing medical cannabis as the Australian market is expected to triple by the end of 2020. 

There will be around 30,000 active cannabis patients in Australia by the end of the year – according to the latest in-depth report on the country’s medical cannabis sector.

This is a significant jump from just over 10,000 in December 2019.

The market has also seen the greatest drop in product prices since the 2016 legalisation of medicinal cannabis, as the industry continues to grow in size year on year – equating to almost $95million in sales by the end of 2020.

Australia’s most comprehensive medicinal cannabis analysis of patients, products and pricing was published by FreshLeaf Analytics on Thursday 17 September.

Those behind the report believe that the coming year could be a turning point for the industry, with record numbers of products available, rapid price declines and new regulations coming into force to improve patient access.

“The number of new products entering the market, and the degree of price drop is probably beyond levels we would have forecast 12 months ago,” Cassandra Hunt, managing director of FreshLeaf told Cannabis Health.

“The report does not specifically track attitudes, however record numbers of doctors are prescribing, suggesting that acceptance of cannabis as a therapy is gradually increasing.”

The number of products available has also doubled to 150 in the last year and is expected to exceed 300 by the end of 2021. Oil and flower product formats are still the most common representing around 80 percent of the products in the market.

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This increase in competition has forced down prices. According to the report, patients buying legal cannabis products are now spending the same as those accessing it on the black market, putting Australia in line with more mature markets such as Canada.

Dr Mark Hardy, an addiction specialist and CA Clinics medical director said he hoped this would encourage patients to use legal routes, he commented: It’s encouraging to see the recent product price decline, bringing illegal and legal markets to parity. This will hopefully enable more patients to gain access to legal medicine pathways, with confidence in the contents and dose”.

However, medical cannabis prescriptions are not covered under the Pharmaceutical Benefits Scheme and so remain costly compared to conventional medicines.

Cassandra added: “Prices are now on par with the illegal market, but despite this, because medicinal cannabis products are not subsidized by the Government prices do appear expensive in comparison with subsidised medicine.”

But FreshLeaf believes this could be about to change, in what could be a ‘significant milestone’ for the industry.

In August, the Pharmaceutical Benefits Advisory Committee (PBAC) – the body that decides whether certain medicines can be subsidised by the taxpayer – deferred a decision to subsidise Epidyolex, a medicinal cannabis product used to treat children suffering from rare forms of epilepsy.

Regardless of the decision, FreshLeaf expects Epidyolex to be included on the Australian Register of Therapeutic Goods (ARTG) soon, meaning that doctors will be able to prescribe it freely.

Previous reports have shown that average dose increases over time, and this trend has continued with the average dose increasing to 92 milligrams per day – and more than three quarters of patients dosing at less than 100 milligrams per day.

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“Lower prices have led to a wider uptake and higher doses and we expect that trend to continue,” said Cassandra.

“There are now 150 products in the market fighting for a share, but scale is a second factor. “Some of the products being supplied now in Australia are derived from raw materials that are increasingly being cultivated and produced on a large scale bringing down cost per unit.”

Of the products now available, 20 percent are low-dose CBD, a category that is likely to move to over-the-counter under new regulations in 2021.

Experts believe the year will be significant in defining what a ‘healthy’ medical cannabis industry looks like, with the prescription market expected to reach more than $150million.

Cassandra added: “The last 12 months has seen huge change in the industry. Record numbers of new products, rapid price declines and new regulations that will improve access and reduce patient prices.

“In the next 12 months we expect the market to continue to grow. We also expect significant consolidation as the number of players and product companies in the sector is excessive for the size of the market.

“Some Australian players will start to report meaningful revenues from overseas sales, mostly to Europe.”

Interestingly, the report found that sales had not been significantly impacted by the coronavirus pandemic however, FreshLeaf has speculated that a need for new taxable revenues could lead to a discussion about the legalisation of cannabis for recreational use.

With New Zealand going to the polls on 17 October, many in the industry are watching closely and believe a positive could encourage Australia to follow in their footsteps.

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Advocacy

US Congresswoman speaks out about how cannabis helped her depression

Nancy Mace spoke out about using cannabis to help her depression after experiencing a traumatic event as a teenager

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Image credit: Nancy Mace/Instagram

A Republican congresswoman who has proposed a federal bill to legalise cannabis has spoken out about her experience using cannabis to combat depression.

Nancy Mace, a republican politician from South Carolina appeared on Fox Business’s ‘Kennedy’ show to talk about the bill which would legalise cannabis but would also focus on veteran access.

It also includes expungement for non-violent cannabis crimes and imposes a revenue tax that would support reinvestment into communities hurt by the war on drugs.

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The bill titled the States Reform Act would federally legalise and tax cannabis has been proposed ahead of competing Democrat proposed bills. While the bill was originally proposed in July, Mace shared her story after officially filing the State Reform Act in November.

At the end of the discussion, host, Lisa “Kennedy” Montgomery asked the congresswoman if she smoked cannabis.

Nancy replied: “When I was 16, I was raped. I was given prescription medication that made the feelings I had of depression worsen, and I stopped taking those prescription drugs and I turned to cannabis for a brief period of time in my life.”

She added that she believed her experience with cannabis made her more sympathetic to veterans who may use cannabis for conditions such as post-traumatic stress disorder (PTSD).

Bill protection for veterans

The congresswoman explained that the new bill is “particularity protective of veterans, ensuring they are protected, not discriminated against and that the US Department of Veteran Affairs can utilise cannabis for their PTSD.”

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She added: “When I talk to vets and I see that pain, it hurts because I felt that pain before in my life. Veteran suicide, we see every single day.”

One other provision in the bill is that cannabis would be under the Treasury Department’s Alcohol and Tobacco Tax and Trade Bureau (TTB) instead of the Food and Drug Administration (FDA). The FDA would have some involvement similar to its current control over the alcohol industry.

Bill history

Mace has already won an exception for rape and incest victims in a fatal fetal heartbeat bill. She mentioned her history when it came to proposing that bill in 2019.

She said: “I’ve had family that have overdosed from hardcore opiates and prescription drugs. And I’ve mentioned part of this in 2019, at the time I got the exception for rape and incest in the fetal-heartbeat bill I told my story about being raped when I was 16, but I’ve never said this part publicly before: I was prescribed antidepressants afterwards, and it made my feelings a lot worse. And so I started using cannabis for a brief moment, for a time in my life. It helped me. It cut down on my anxiety and helped me get through some dark periods.”

 

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Industry

Study: States with full legal access show fewer registered medical cannabis patients

“If true, this could have implications for public health and policy,” say researchers.

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Study shows U.S states where cannabis is legal for recreational purposes have experienced a decrease in patients registering for medical cannabis programmes.

The study on different US states, published in the International Drug Journal, revealed that numbers of registered and active medical cannabis consumers increased while it was not legal for recreational use.

Researchers in Arizona took data from the medical cannabis registry from two dozen states between 2013 and 2020.  These are mandatory registries that record the number of medical cannabis patients. They analysed the data to see if there were any changes around the times that recreational legalisation was introduced.

There are currently 19 states in the US that have legalised recreational cannabis including New Jersey, Vermont, Arizona and New York. However, more states have medical cannabis programs although some are still not operational. Some states such as Colorado have had recreational access since 2012, the year before the study was started.

Medical cannabis patients

The results confirmed that medical cannabis cardholders increased during times when recreational use was not legal. It then subsequently decreased when it became legal.

It also revealed an increase of 380 patients per 100,000 people per year when just medical cannabis was legal. This corresponded to a decrease of 100 patients per 100,000 after recreational cannabis was allowed. The researchers noted that active registered active male patients decreased faster than women. In states where only medical cannabis was legal, the older age groups (35 or older), increased faster.

They also found that in three states with medical-only use, the results showed significant increases in enrollment from 2016 to 2020 across white, African-American and Hispanic patients.

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The researchers wrote: “There is speculation that enrollment in U.S. state medical cannabis programs differs depending on whether adult recreational cannabis use is legal. If true, this could have implications for public health and policy.”

“Findings suggest that recreational cannabis legalisation is associated with decreasing enrollment in medical cannabis programs, particularly for males.”

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Fibromyalgia

Fibromyalgia and medical cannabis: “I find my pain is completely gone”

Natalie began experiencing fibromyalgia pain when she was a teenager but wasn’t diagnosed until her 20s.

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Fibromyalgia: An illustration of a woman in pain holding an umbrella

Natalie talks to Cannabis Health about living with fibromyalgia and how cannabis has helped her with pain relief.

Fibromyalgia can be a debilitating condition leaving patients with chronic pain, fatigue and increased sensitivity. Other side effects can include poor sleep, cognitive issues and headaches. It is thought to affect around 1.5-2 million people in the UK.

Natalie was diagnosed with fibromyalgia when she was in her first year of teaching. She had been experiencing some of the symptoms since she was in her early teens but doctors told her it was growing pains.

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“Since I was about 12, I had a lot of pain that came and went with a lot of fatigue,” she explains.

“The doctor’s put it down to growing pains. When I was I was in my first year of teaching, one day I woke up and couldn’t do anything. I was incredibly tired and in so much pain.

“I felt that way for months and I was really struggling. I got my formal diagnosis from a rheumatologist. I had a lot of blood and strength tests to make sure I didn’t have arthritis or lupus because of the similar symptoms.”

Life with fibromyalgia

Once Natalie had her diagnosis, her life began to change. She quit her teaching job as it became too much to cope with when her symptoms were bad. She took on jobs where she could choose her own hours or work part-time.

“I ended up working as a children’s entertainer because it was good money,” she says.

“I could do it over a few days a week and make an acceptable amount of money to cover my bills. I did retail work alongside it.”

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When it came to socialising, to stop herself from feeling isolated, Natalie turned to online communities to meet people and make friends.

“I’m not amazing at socialising, so I’ve always found it a struggle. I didn’t stay in touch with a lot of people from university or school because I also have mental health problems that held me back. This isolated me a lot so I did turn to online communities where I met a few people who I’m still friends with now,” says Natalie.

It wasn’t until she joined online fibromyalgia communities that someone suggested that cannabis may have benefits.

“I never really knew about its benefits, although I knew it would relax you,” she admits.

“People in my fibromyalgia groups said they used medical cannabis and found it helpful. It’s only really been the last few years where I’ve used it properly as a medicine.”

Fibromyalgia: An illustration of a woman using a laptop

Fibromyalgia pain

Cannabis may help with the pain experienced by fibromyalgia patients. A recent study on patients diagnosed with fibromyalgia and other inflammatory rheumatic diseases reported a reduction in pain levels following medical cannabis use. The study surveyed 319 patients about their use of medical cannabis products. Those with fibromyalgia reported a mean pain level reduction of 77 per cent while 78 per cent also reported sleep quality improvement.

Although Natalie has family members who use medical cannabis in legal states in the US, she hadn’t considered using it herself. Despite being open to the idea of a prescription, she says there was very little mentioned to her about pursuing it by her doctors.

“It’s weird because it’s almost like a whisper network. I would never have known about the private medical thing because it’s not really mentioned and the health sector doesn’t talk about it. They don’t actively tell you about prescriptions,” she says.

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Natalie has found that cannabis helps her most with the pain.

“A lot of the time, I get shoulder or lower back pain. If other people knew my pain level, they would have a different idea of what pain is, but I guess I’m used to it,” she says.

““Due to the way I work, I don’t use it until the evening. At the end of the day, I’ll use cannabis and I find my pain is completely gone. Sometimes, if I’m struggling then I’ll have a nice bath, have my cannabis and that’s the perfect combination.”

Cannabis Stigma

Natalie is guarded about her cannabis use because of the stigma but also due to her job. She is open with some of her friends but not her family. She chose to use only her first name to avoid being identified.

“My parents are from a different generation and they are quite conservative too. It’s very different for them so they don’t understand how it would help. My clients obviously don’t know, as some wouldn’t like it. [But] I have clients in the Netherlands who don’t drink but will go for a joint but it’s different for me,” she says.

“People still struggle to admit to taking medication because of the attitude. I’ve tried Tramadol, Xanax and all sorts of things that have more impact on how you feel, physically and mentally compared to cannabis. But that’s  acceptable because it’s prescribed by a big pharmaceutical company.”

Natalie feels that there is a lot to be changed in terms of education, so that people know the benefit of cannabis when it comes to conditions like fibromyalgia. She also highlighted that there should be more awareness of the options out there when it comes to accessing a prescription.

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“More people should be aware of the benefits of what it can do, rather than it being a niche internet topic or having a weird stigma around it,” she adds.

“Medical professionals need to be more aware of how it can help and the different avenues that people can go down to get prescriptions.”

 

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