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In the 1960s, cannabis was banned in most of the world after the UN placed the plant in the same category as psychoactive drugs that have no accepted therapeutic value. Before this decision was made, cannabis had been used for thousands of years by several cultures as a medicine, a psychotropic drug, and for mind-expanding and religious ceremonies. In just a few years, the cannabis plant was banned from most of countries and its cultural heritage dissipated.

During the past 30 years, research has come a long way. It was actually the experimentation of cannabis as a drug by the 1970s youth that first sparked the interest of medical researchers, and when THC was isolated in the late 80s and the endocannabinoid system was uncovered in the early 90s, the research into the therapeutic value of cannabis really took off.

In spite of this, the debate on whether cannabis is a medicine or not is ongoing. Even among those that agree that the plant does have therapeutic properties, there is still dispute on which forms of cannabis might be considered medicinal. In this article, we will look at the debate surrounding medical cannabis, what medical cannabis is and whether it differs from cannabis oil with CBD.


What is Medical Cannabis?

There is no legal definition of medical cannabis or of how it differs from other cannabis products. However, the main difference between the two is that medical products have to be approved before they can be sold or marketed as such by the companies (and their laboratories) that have manufactured them. And before a product can be approved as a medicinal, clinical evidence has to prove that the product is safe, effective and without severe side effects.

Now you may be confused as to why cannabis is illegal then. After all, cannabis is both safe, effective and without severe side effects – this was confirmed by the WHO just over a year ago. You are not the only one confused, and the explanation is unfortunately only ground for immense frustration among the patients who use cannabis because of its medical properties:

In order for a product to be sold as medicine, it needs the approval of relevant authorities (in each country that the product is sold). And in order to be approved, clinical evidence has to prove the product works as intended and is safe for patients to use. However, clinical studies are not cheap In fact, the average cost of proving one drug’s efficacy and safety amounts to $67 million USD (£53 million GBP).

This means that it takes a large amount of money for a product to be sold as a medicine, which also places high expectations on the product from investors. This is because investors need a financial incentive to invest; they need some reassurance that their investment will pay off. After all, you would not buy shares in a company unless you expect to earn money on the investment you make. The same goes for medical investors, which is why they often only invest in products they can patent. This is their way to ensure a financial return on their investment.

And this is why there continues to be a “lack of clinical evidence” on the therapeutic effects of cannabis: you cannot patent a plant.


Approved Medical Cannabis

Some cannabis-based products have already been approved as medicine and are therefore called “medical cannabis” in a large number of countries. These products are Cesamet, Marinol, Sativex (also marketed as Nabiximols), and Epidiolex. While Cesamet and Marinol are based on synthetically produced cannabis (where the cannabinoid compounds are not derived from the plant, but rather artificially produced in laboratories), Sativex and Epidiolex are based on phytocannabinoids (the active compounds of the cannabis plant).

Because cannabinoids are either synthetically produced or developed for specific groups of patients, the manufacturer is able to patent these products – but not the plant from which the cannabinoids originated.


Money is the Reasion for the “Lack of Evidence”

Consequently, the few medical cannabis products that have been approved as a medicine are only produced by companies that have been able to patent their solution, and thereby secure their profit.

As such, substantial financial forces are needed, before any cannabis product can be defined as a “medicine”.

So it is not the lack of interest in cannabis as medicine that halts the clinical evidence for the medical use of cannabis. Rather, it is the fact that cannabis is not a lucrative source of profit for the companies that have the financial means to pay for the clinical trials needed for cannabis to be approved as a medicine.

Although the term “medicine” is protected by law, the use of cannabis as a medicine is not – at least not to the same extent. Thus, there are several ways to legally use cannabis as a medicine.


Cannabis-Based Products

When the UK Parliament in 2018 approved prescription use of medical cannabis, it was due to public pressure: for years, patients had been branded as “criminals” for simply using a plant to ease their pain and suffering. For some, cannabis represented their last hope for a normal life, when conventional medicines were no longer working.

However, it was the stories of children suffering that truly sparked a national uprising against the archaic laws on cannabis. Even though cannabis for centuries had been deemed as a psychoactive drug with “no medical value”, the UK Government finally decided to listen to the people and reschedule cannabis, allowing it to be used as a prescription medicine.

Although medical cannabis is still regulated under the Misuse of Drugs Act in the UK, CBD is not. This is because CBD is not a psychoactive compound, and since CBD oil contains less than 0,2 % THC (tetrahydrocannabiniol; the main psychoactive compound found in cannabis), it is legal in the whole of EU to purchase, carry and use CBD oil.

So when the UK Government rescheduled cannabis, the legality of cannabis and its derivatives was clarified and the access to cannabis as a therapeutic agents was eased.


Medical Cannabis or CBD Oil?

So what is the difference between medical cannabis and cannabis oil with CBD?

Well, it depends on whom you ask.

The EU and the UK Government only consider approved products to be “medical”, which means that there is only one product that can be defined as medical cannabis: Sativex. All other products are unlicensed medicines or “specials”, which can only be prescribed by medical specialists and only for patients who have exhausted all other conventional treatment options for their condition.

As such, the truth is that medical cannabis is limited to a smaller patient group than hoped for. However, the future holds much promise for all of us in this regard.


Cannabis in the EU

The European market for legal cannabis-based products is growing fast. In countries that have legalised medical cannabis (UK included), the number of ‘cannabis patients’ grows by 40 % each month, and today the medical cannabis industry in Europe alone is worth more than €150 million EUR.

However, in spite of more and more countries in the EU and the rest of Europe legalising medical cannabis, the market remains tightly regulated. There are strict rules on whom can grow it; sell it; use it; possess it; which products you are allowed to use; how much you can buy; who can authorise its use, manufacturing and exchange; as well as many other restrictions on the cannabis plant and any cannabis-derived product.

And not only are the EU’s rules on cannabis very strict, but the European market is also very fragmented: each country has its own set of rules, and even though there (more or less) exists a harmony between the laws of EU member states, then there is still great dispute between the states on what qualifies as being medical cannabis.

The same debate is happening in the US, where each individual state can make their own laws on cannabis, even though the United States of America still sees cannabis as an illegal substance. However, the US is a unique example of legal fragmentation, because even though cannabis is illegal on a national level, the US Government actually holds a patent on the therapeutic potential of cannabinoids and have for several years run a patient program where the Government provides citizens with medical cannabis as part of their health insurance policy.

The EU member states are currently debating whether to change the law on medical cannabis and here, terminology is at the centre of the talks. Many member states argue that medical cannabis is already available to patients, but this argument only concerns the 4 approved products (only one in the UK) – i.e. not the cannabis plant or its natural derivatives. The hearing on this potential legal change has unfortunately been postponed several times due to the busy agenda of the Committee on the Environment, Public Health and Food Safety, most likely due to Brexit.

The debate between member states on what constitutes “medical cannabis” and whether it differs from “cannabis-derived products” is taking place on both European and national level, and also includes whether terms like “natural medicine” and “hemp” are inappropriate to use about cannabis products meant for medicinal purposes. All the while patients are forced to wait for their choice of relief to possibly become legal.


The Answer from Medical Cannabis Patients

If you ask the many patients who regularly use cannabis to relieve their pain, nausea, cramps, anxiety, depression, and many other conditions, then cannabis oil with CBD is just as much a medicinal choice as is medical cannabis. Whether cannabis contains the psychoactive compound, THC, or not does not change the fact that a lot of British patients have chosen to use cannabis as a medicine.

The choice to use cannabis as a medicine has nothing to do with laws; it is about relief. This is why many patients do not distinguish between medical cannabis and cannabis oil with CBD, but simply view cannabis as a therapeutic option – as a way to ease their sufferings.

As such, cannabis oil with CBD can be a medicine to the same extent as cannabis products with THC can. Even though THC can have a psychoactive effect, this is not the intent behind using cannabis products containing THC. Patients are not chasing a “high”; they are looking to alleviate their agony. The same is the case for CBD oil, where patients are simply seeking a natural source of relief.

So even though laws may perceive medical cannabis and CBD oil to be two separate entities, we believe that both products are actually one and the same, and should therefore be equally accessible for any patient who wishes to use cannabis as a medicine.

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