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THE AUSTRALIAN FEDERAL GOVERNMENT LEGALISED ACCESS TO MEDICINAL CANNABIS IN 2016: MORE THAN 100 DIFFERENT CANNABIS PRODUCTS ARE NOW AVAILABLE TO PRESCRIBE. MOST ARE ORAL PREPARATIONS (OILS) OR CAPSULES CONTAINING DELTA-9-TETRAHYDROCANNABINOL OR CANNABIDIOL. DRIED-FLOWER PRODUCTS ARE ALSO AVAILABLE: AS MOST PRODUCTS ARE UNREGISTERED DRUGS, PRESCRIBING REQUIRES APPROVAL UNDER THE THERAPEUTIC GOODS ADMINISTRATION SPECIAL ACCESS SCHEME-B OR AUTHORISED PRESCRIBER SCHEME: SPECIAL ACCESS SCHEME CATEGORY B APPLICATIONS CAN BE MADE ONLINE, WITH APPROVAL USUALLY BEING GIVEN WITHIN 24–48 HOURS. HOWEVER, SUPPLY CHAIN PROBLEMS MAY DELAY DISPENSING BY THE PHARMACY: BY THE END OF 2019, OVER 28,000 PRESCRIBING APPROVALS HAD BEEN ISSUED TO PATIENTS, INVOLVING MORE THAN 1400 DOCTORS, MOSTLY GPS. MORE THAN 70,000 APPROVALS ARE PROJECTED BY THE END OF 2020: MOST PRESCRIPTIONS ARE FOR CHRONIC NON-CANCER PAIN, ANXIETY, CANCER-RELATED SYMPTOMS, EPILEPSY AND OTHER NEUROLOGICAL DISORDERS. HOWEVER, THE EVIDENCE SUPPORTING SOME INDICATIONS IS LIMITED: MANY DOCTORS ARE CAUTIOUS ABOUT PRESCRIBING CANNABIS. WHILE SERIOUS ADVERSE EVENTS ARE RARE, THERE ARE LEGITIMATE CONCERNS AROUND DRIVING, COGNITIVE IMPAIRMENT AND DRUG DEPENDENCE WITH PRODUCTS CONTAINING DELTA-9-TETRAHYDROCANNABINOL. CANNABIDIOL-ONLY PRODUCTS POSE FEWER RISKS:

BACKGROUND: In 2016, the Australian federal government passed legislation enabling a range of cannabis-based products to be prescribed to patients by registered healthcare professionals. An online survey conducted immediately prior to these legislative changes found that the vast majority of respondents at the time were illicitly sourcing cannabis plant matter, smoking was the preferred route of administration and mental health, chronic pain, and sleep conditions were the most frequently cited reasons for medical cannabis use. This manuscript reports the results of a follow-up survey conducted in 2018–2019, the Cannabis As Medicine Survey (CAMS-18). The goal of this second questionnaire was to examine patterns of use and consumer perspectives regarding medical cannabis use in Australia, 2 years after the introduction of legal access pathways. METHODS: Anonymous online cross-sectional survey with convenience sample, recruited mainly through online media between September 2018 and March 2019. Participants were adults (18 years or over) residing in Australia who reported using a cannabis product for self-identified therapeutic reasons during the preceding 12 months. The survey measured consumer characteristics, indications and patterns of medical cannabis use, routes and frequency of administration, perceived benefits and harms, experiences and preferred models of access to medical cannabis. RESULTS: Data were available for 1388 respondents. The main categories of condition being treated with medical cannabis were pain (36.4%), mental health (32.8%), sleep (9.2%), neurological (5.2%) and cancer (3.8%). Respondents reported using medical cannabis on 15.8 (11.2) days in the past 28, by inhaled (71.4%) or oral (26.5%) routes and spending AUD$82.27 ($101.27) per week. There were high levels of self-reported effectiveness, but also high rates of side effects. There was uncertainty regarding the composition of illicit cannabinoid products and concerns regarding their possible contamination. Few respondents (2.7%) had ...

Public opinion surrounding the recreational use and therapeutic potential of cannabis is shifting. This review describes new work examining the behavioural and neural effects of cannabis and the endocannabinoid system, highlighting key regions within corticolimbic brain circuits. First, we consider the role of human genetic factors and cannabis strain chemotypic differences in contributing to interindividual variation in the response to cannabinoids, such as THC, and review studies demonstrating that THC-induced impairments in decision-making processes are mediated by actions at prefrontal CB1 receptors. We further describe evidence that signalling through prefrontal or ventral hippocampal CB1 receptors modulates mesolimbic dopamine activity, aberrations of which may contribute to emotional processing deficits in schizophrenia. Lastly, we review studies suggesting that endocannabinoid tone in the amygdala is a critical regulator of anxiety, and report new data showing that FAAH activity is integral to this response. Together, these findings underscore the importance of cannabinoid signalling in the regulation of cognitive and affective behaviours, and encourage further research given their social, political, and therapeutic implications.