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What is Medical Cannabis

What is Medical Cannabis (Cannabis Based Medical Products)

What is Medical Cannabis? What is it used to treat?

Cannabis Based Medical Products (CBMPs) or Medical Cannabis are medications derived from the cannabis plant, containing cannabidiol (CBD) and/or Tetrahydrocannabinol (THC – which is the psychoactive substance in cannabis). In the UK medical cannabis has been legal since 2018 for the treatment of psychological, neurological, and chronic pain conditions as well as, palliative and/or end of life care: for sake of brevity a full list of conditions treated in the UK is highlighted in eligibility section of this website.

What’s the eligibility criteria?

With cannabis based medical products (CBMPs) being unlicenced, the census would be for patients to evidence unmet clinical needs i.e., their health is not improving despite having ongoing treatment or interventions via conventional healthcare services. It is important for all patients to recognise that due to cannabis containing a psychoactive substance, for the safety of potential patients, if you have any of the diagnosis listed in the exclusion criteria, you will not be eligible. We would advise these patients to liaise with their consultants at the NHS and explore an alternative treatment method to support their health needs.

Patients have a right to a second opinion, provided they do not have any counterindications listed in the exclusion criteria below. Patient’s must be over 18 years of age.

Exclusion Criteria?  

Like all medications, CBMPs is not advisable to use if you struggle from one of the following: –

  • Suffer with high BP (If this is not stable)
  • History of psychosis
  • Diagnosis of schizophrenia
  • Heart condition (Which has NOT been stable for 6+ months)
  • Pregnant or breast-feeding

What are the side effects of medical cannabis?

Side effects of CBMPs include:

  • Drowsiness
  • Confusion
  • Imbalance
  • Euphoria
  • Diarrhea
  • Dry mouth
  • Anxiety and/or Depression
  • Heart Palpitations
  • Psychological Dependence
  • Tolerance
  • Cannabis hyperemesis syndrome (CHS)

Adverse reactions include:

  • Headaches
  • Migraines
  • Nausea
  • Vomiting
  • Diarrhoea

If you experience an adverse reaction, it is important that you report your symptoms to the MHRA via yellow card, who are the medicines and healthcare products regulatory agency. To report a yellow card, please follow this link and fill out the form: Yellow Card | Making medicines and medical devices safer (mhra.gov.uk). It is also vital that you inform your clinic, to ensure this medication is not prescribed to you again in the future.

Cannabis dependence:

Cannabis dependence is known clinically as cannabis use disorder, and user’s of any form of medicines, including medical cannabis are prone to psychological dependency.

Signs of Psychological dependence include:

  • Not using medications as prescribed -> using more than required or larger dosages and/or more frequently
  • Withdrawal
  • Developed a tolerance and require more
  • Failed repeated attempts to control or stop use
  • Physical or psychological concerns related to use (i.e., respiratory concerns or fluctuation in mood)
  • Missing relevant appointments or work to use
  • Craving for purposes other than prescribed

If you experience any of the following, please get in touch with your prescriber, so that they may manage this concern accordingly.

Cannabis Hyperemesis Syndrome (CHS)

Cannabis hyperemesis syndrome, also known as cannabinoid hyperemesis syndrome, can affect people who are exposed to prolonged, high doses of cannabis: this can also occur with medical cannabis use.

Signs of Cannabis Hyperemesis Syndrome include:

  • Intense nausea and vomiting
  • Projectile vomiting (can happen without warning, up to 5x an hour)
  • Extreme Diarrhea
  • Lack of appetite
  • Weight loss

Although this is uncommon, if you experience any of the following, please reduce use or stop where possible and urgently alert your prescriber. If symptoms are uncontrollable, please seek urgent medical intervention as you are at risk of dehydration.

Monitoring BP / Warfin prescription

Medical cannabis can for some people cause heart palpations, it is important that people with a history of high blood pressure or a heart condition to be mindful of this, particularly those on warfarin as cannabis can impact the liver enzymes, interacting with other medications. It is important that you work alongside your GP and relevant health care professionals to adequately address your heart.

If you are someone who meets this criterion, regularly monitoring your blood pressure would aid in ensuring your safety and enables you to appropriately reach out for support.

Blood pressure guidance:

Low 90/60 or below Inform GP and clinic, if unwell seek medical attention
Ok 90/60 – 140/90 Continue to monitor – update clinic at FUP appointment
Raised 141/91 – 179/119 Raised, monitor and inform GP and clinic
High 180/120 or more Significant risk, needs urgent review – update GP and clinic

 

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Water Activity: A Guide for Medical Cannabis Producers

Water Activity: A Guide for Medical Cannabis Producers 

Introduction

As the global demand for medical cannabis continues to surge, the attention to quality control measures becomes increasingly critical. One such parameter gaining prominence in the cannabis industry is water activity (aw). This blog delves into the multifaceted role of water activity, extending beyond its conventional association with edibles and food safety. Specifically, we explore its impact on microbial stability, storage stability of harvested buds and extracts, its correlation to product quality attributes, and its implications for shelf life. Additionally, we discuss its current inclusion in state regulations and emphasise the need for a holistic understanding of water activity in the cannabis industry.

The Theory of Water Activity

Water activity is not a novel concept but is deeply rooted in the fundamental laws of thermodynamics, as per Gibb’s free energy equation. It represents the relative chemical potential energy of water in a system, measured by the partial vapour pressure of water in a headspace at equilibrium with the sample. This comprehensive understanding helps differentiate water activity from moisture content, with water activity providing a more accurate indication of microbial, chemical, and physical stability in cannabis products.

Water Activity and Microbial Safety

Microbial contamination poses a significant threat to cannabis products, leading to allergic reactions, respiratory complications, or food borne illnesses. Water activity serves as a critical control point for preventing microbial contamination, dictating the ability of microorganisms to grow and reproduce. While moisture content is an extensive property related to purity, water activity is an intensive property directly influencing microbial growth limits. Establishing water activity below 0.63 aw is crucial for ensuring shelf stability, preventing the growth of pathogenic bacteria and moulds that could compromise product safety.

Water Activity and Chemical Stability

Water activity is not only a guardian against microbial growth but also a determinant of chemical stability in cannabis products. Processing biomass and edibles to water activities below 0.63 aw mitigates the risk of microbial spoilage but doesn’t guarantee unlimited shelf life. Chemical degradation, such as tetrahydrocannabinolic acid (THCA) loss due to decarboxylation, becomes a pertinent concern. Water activity influences reaction rates, with lower water activity correlating with minimised chemical degradation. The hygrothermal time model is a valuable tool for predicting reaction rates and establishing the ideal water activity range for maximising shelf life while minimising chemical degradation.

Water Activity and Storage Stability

Harvested cannabis must be adequately dried to facilitate storage and transport. Water activity below 0.63 aw is essential to prevent mould growth, particularly in dried biomass. Adequate packaging, with good moisture barrier properties, becomes imperative to preserve water activity levels during storage and transport.

Water Activity and Regulations

While water activity is recognised for its role in ensuring the safety and stability of cannabis products, its inclusion in state regulations varies. States like Nevada, California, Oregon, and Washington have incorporated water activity testing requirements into their regulations. Additionally, ASTM standards have been established to standardise water activity testing in the cannabis industry, emphasising its importance in maintaining product quality and safety.

Conclusion

In the dynamic landscape of the medical cannabis industry, water activity emerges as a versatile and indispensable parameter. Its influence extends from microbial safety to chemical stability, storage stability, and overall product quality. For medical cannabis producers eyeing the UK market, understanding and controlling water activity is not just a standard to maintain but a strategic move to ensure the longevity, safety, and efficacy of their products. As the industry continues to evolve, embracing the multifaceted significance of water activity will undoubtedly set exporters apart, fostering a reputation for excellence and reliability in the global market.

References

  1. D.S. Reid, Water Activity in Foods (Blackwell Publishing and the Institute of Food Technologists, Ames, Iowa, 2007) pp. 15–28.
  2. A.J. Fontana, Water Activity in Foods (Blackwell Publishing and the Institute of Food Technologists, Ames, Iowa, 2007) pp. 155–171.
  3. M.S. Tapia, S.M. Alzamora, and J. Chirife, Water Activity in Foods (Blackwell Publishing and the Institute of Food Technologists, Ames, Iowa, 2007) pp. 239–271.
  4. L. Beuchat, J. Food Prot.46(2), 135–141 (1983).
  5. W. Scott, Adv. Food Res.7,83–127 (1957).
  6. National Cannabis Industry Association. https://thecannabisindustry.org/ncia-news-resources/state-by-state-policies/. (June 2019).
  7. H. Lueng, Water Activity: Theory and Applications to Food (Marcel Dekker, Inc., New York, New York, 1987) pp. 27–45.
  8. B.P Carter, R.M. Syamaladevi, M.T. Galloway, G.S. Campbell, and S.S. Sablani, Proceedings for the 8th Shelf Life International Meeting, U. Klinkesorn, Ed. (Bangkok, Thailand: Kasetsart University, 2017) pp. 40–45.
  9. H. Eyring, J. Chem. Phys.4, 283 (1936).
  10. The What, How, and Why of Water Activity in Cannabis. https://www.cannabissciencetech.com/view/what-how-and-why-water-activity-cannabis/ (December 2023).
  11. Water Activity And Cannabis. https://aqualab.com/en/knowledge-base/webinars/water-activity-and-cannabis/ (December 2023),

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