Author: Bria Mastroianni

In this blog we explore some of the frequently asked questions, such as:
– who is able to prescribe plant-medicine in Australia,
– what is the current legal framework,
– who may be suitable, and
– what are the steps involved in getting started on your plant-based journey.

Who can prescribe plant-based medicines in Australia?

In Australia, any medical doctor can prescribe plant-based medicines upon receiving approval from the Therapeutic Goods Administration (TGA) and the respective Health Department of their State or Territory. 

It is important to note that the majority of plant-based medications fall into the category of “unapproved products” and are not listed on the Australian Register of Therapeutic Goods (ARTG). That means, the information on the efficacy and safety of the products has not been assessed. As a result, obtaining these medications isn’t as straightforward as picking up a prescription from your doctor and having it filled at a pharmacy, as you would with conventional registered medicines. Instead, the TGA has established specific avenues for medical practitioners to access these treatments when they are deemed clinically suitable.

For Australian registered medical professionals looking to prescribe unapproved products for particular conditions, two primary routes are available: the Special Access Scheme (SAS) and the Authorised Prescriber Scheme. 

Alternatively, general practitioners (GPs) can opt to refer their patients to specialised clinicians with expertise in plant-based medications such as Astrid Clinic. This approach ensures that patients can receive the care and treatment that best suits their medical needs, even in cases where the medications are not officially listed on the  ARTG.

Who may be suitable for plant therapies in Australia?

Australians with various medical conditions can be prescribed medicinal cannabis by a medical doctor, if clinically appropriate. However, there are two main criteria that need to be met:

1. A diagnosed chronic medical condition
   1. You need to have a diagnosed chronic medical condition, generally by a doctor (usually GP) that has been affecting you for longer than 3 months. 
2. Trialled conventional therapies
   1. Plant-medicine is not a first line treatment in Australia, and conventional therapies must have been trialled prior to being eligible. Often it isn’t a question of having trialled just one treatment, but numerous treatments (usually a combination of pharmacological (medication) and nonpharmacological e.g. physiotherapy, chiropractor, psychologists/psychiatrists, acupuncture, yoga etc.). If after trialling these, you are still struggling to manage your chronic condition, you have been suffering from ill-effects from these treatments or they are poorly tolerated, plant-based medicine may then be appropriate to trial. 
   2. It also may be acceptable that after discussing the option of trialling a traditional pharmacological treatment with your GP, you may have genuine concerns of potential side effects from medications, and decline commencement for this reason.

Which medical conditions may be appropriate to be treated with plant-based therapies? 

Currently, there is no official list of conditions that the TGA has approved for the use of plant-therapies, however there are over 100 conditions to date that medical practitioners have applied for the use of plant-therapies, through the Special Access Scheme pathway. 

The TGA have stated that the following conditions have some evidence to show that plant-therapies may be effective:

• Epilepsy in paediatric and adult patients
• Multiple Sclerosis 
• Chronic non-cancer pain 
• Chemotherapy-induced nausea and vomiting

According to the TGA, there is currently limited scientific evidence to support the use of plant-therapies in most conditions, and in many cases the evidence is for their use together with other medicines. Therefore, plant-based medicines should be considered only when approved treatments have been tried and have failed to manage conditions and symptoms. 

What are some of the steps involved in getting started with plant-based medicine? 

If you’re wondering whether plant-therapies might be right to help better manage your medical condition, the first step would be to have a conversation with your GP, or our team of clinicians at Astrid Clinic. 

Some patients may find this daunting at first but our team of friendly experts are here to support you each step in this journey.

When speaking with a doctor, we recommend the following steps: 

1. Be honest and open about your interest in exploring this as an option, whether it being due to you having researched this, or having previous experience. Explain why you think it may be a suitable treatment for your condition(s) and be sure to mention any side effects you’ve experienced with previous treatments. 

2. Ask questions! Prepare a list of questions to ask your doctor ahead of time. Some questions you might consider are:

• What are the potential benefits or risks associated with plant-based medications?
• Are there any specific plant-therapies you suggest for my condition?
• How may it interact with my current treatments or medications?
• What are some potential side effects or contraindications?
• How is this going to affect driving or what are the workplace regulations?
  

3. Discuss your expectations for the treatment, whether it be improved quality of life, symptom relief, or a reduction in side effects from medications.

Always remember that GPs are healthcare professionals who have your best interests in mind. However, sometimes traditional medical doctors may not have much experience or knowledge in plant-therapies as there still is a lack of education in the conventional medical curriculum. 
If your GP is not able to assist you, there are clinics which specialise in plant-based medicine. The team at Astrid Clinic are committed to ensuring a seamless patient experience, and are proud to provide a comprehensive approach to accessing plant-based medicines. 

At Astrid, we understand the process may seem overwhelming, but plant-based therapies are legal and hold many benefits for some patients throughout Australia. 

The first step is to discuss plant-based therapies further with your GP or book in for a free screening consultation with one of our friendly Astrid Clinic nurses here: https://astrid.health/screening-consultation 

References: 

https://www.sydney.edu.au/lambert/how-to-get-medicinal-cannabis.html

https://dashboard-data.health.gov.au/single/?appid=1066afbe-2b37-427d-8c47-2caa5082cccc&sheet=088f611b-10de-4d72-be68-ccf8d12c54e9&select=clearall

It has been studied for a number of years and there is evidence supporting its use in the treatment of certain childhood epilepsies.

What is Epilepsy? 

Epilepsy is a brain disorder characterised by unprovoked seizures, which are sudden and unpredictable bursts of electrical activity in the brain. These seizures can happen at least 24 hours apart or may occur even with a single unprovoked seizure if there is a high chance of more seizures happening. It’s quite common, being the fourth most common brain disorder after migraine, stroke, and Alzheimer’s Disease. In Australia alone, around 142,740 people are estimated to have active epilepsy, costing billions due to its impact on lives.

About one in three people with epilepsy continue to have seizures despite taking regular medication. The frequency of seizures in these individuals may vary in frequency and severity, however any uncontrolled seizure can severely impact quality of life. Medicinal cannabis treatments may be of benefit in these patients. 

What is the role of medicinal cannabis in the treatment of Epilepsy?

Cannabidiol (CBD), the non-intoxicating molecule from cannabis plants has been tried as an add-on treatment in young people up to the age of 25 who have epilepsy. 

Some studies showed it made life better for both kids and adults with epilepsy, but there aren’t many studies on how well it works for adults. Right now, doctors only suggest medicinal cannabis or cannabinoids along with regular anti-epileptic drugs, not on their own. 

If a doctor thinks about prescribing cannabis treatment, they usually use it together with other medicines, and then see if it helps. In Australia, there’s one approved liquid medicine with CBD(100mg/ml) that is prescribed for this purpose.

Is medicinal cannabis suitable for all patients with Epilepsy?

Medicinal cannabis or cannabinoids might help some people with epilepsy, especially children and young adults, by reducing how often they have seizures. However, this treatment doesn’t work the same for everyone, and it’s crucial to consult your doctor and neurologist before trying it. 

The main goal of epilepsy treatment is to decrease the number of seizures, ideally aiming for no seizures at all. If a patient experiences a 50 percent or more reduction in seizures with medicinal cannabis and doesn’t have significant negative side effects, it might be considered effective. 

Doctors usually suggest trying CBD for about twelve weeks to see if it helps, and ongoing research is being conducted to find out the best dosage and effectiveness of CBD in treating common types of epilepsy in adults.

What are some of the side effects of medicinal cannabis used in the treatment of Epilepsy?

All medications can have potential side effects. The majority of patients treated with CBD report it is well tolerated. Usually, adverse events (AEs) are mild and only observed in the first month. In patients being treated with CBD for the treatment of epilepsy, some of the reported side effects include:

• Diarrhoea 
• Drowsiness
• Changes in appetite (increased or decreased)
• Worsening of seizures
• Fever 
• Convulsion
• Fatigue
• Gastrointestinal problems 
• Irritability 
• Changes in weight (gain or loss)
• Nausea 
• Behavioural difficulties 
• Vomiting 
• Elevations of liver enzymes (can improve with continued use or dose reduction)

The most frequent AEs are drowsiness, reduced appetite, diarrhoea, vomiting, fatigue, and fever. More serious side effects have also been reported rarely. These include ‘Status epilepticus’, experiencing a seizure lasting more than 5 minutes, or having more than 1 seizure within a 5 minutes period, without returning to a normal level of consciousness between episodes.

Are all medicinal cannabis products suitable in the treatment of Epilepsy?

The cannabis sativa plant has been utilised since ancient times to treat seizures. The active ingredients of this plant include delta-9-tetrahydrocannabinol (THC) and cannabidiol (CBD). 

In more recent times, there have been studies that have demonstrated there is evidence  that supports the use of cannabidiol (CBD) in the treatment of some patients with epilepsy. Most of this evidence indicates that CBD alone is well tolerated and may be effective in reducing seizures in specific patient groups. 

There is less evidence to support the use of THC containing products. THC is generally not recommended in the treatment of epilepsy as the effect on seizure control is uncertain and they have psychotropic effects that CBD alone is not associated with.

In summary, Cannabidiol (CBD) is the substance in medicinal cannabis that has the most published evidence as an epilepsy treatment. Australian guidelines support using CBD as an add-on to treatment in certain patients when conventional treatments have not adequately controlled seizures. The strongest evidence for the use of CBD is in paediatric and young (under 25 years old) patients. In these populations CBD appears to be well tolerated and reduced seizures by 50% or more in over half the patients studied. Several studies have also demonstrated an improvement in quality of life for both paediatric and adult patients.  

Further research is needed to fully understand the role of other medicinal cannabis products and the role of CBD in the treatment of Epilepsy in adult patients. 

To learn more about the role of medicinal cannabis in the treatment of Epilepsy or ask any questions, please contact our team on (03) 9077 2446 or hello@astrid.health, or visit one of our dispensaries. 

References:

Devinsky O, Cilio MR, Cross H, Fernandez-Ruiz J, French J, Hill C, Katz R, Di Marzo V, Jutras-Aswad D, Notcutt WG, Martinez-Orgado J, Robson PJ, Rohrback BG, Thiele E, Whalley B, Friedman D. Cannabidiol: pharmacology and potential therapeutic role in epilepsy and other neuropsychiatric disorders. Epilepsia. 2014 Jun;55(6):791-802. doi: 10.1111/epi.12631. Epub 2014 May 22. PMID: 24854329; PMCID: PMC4707667.

https://pubmed.ncbi.nlm.nih.gov/24854329/

https://www.epilepsy.org.au/about-epilepsy/medicinal-cannabis/

https://www.tga.gov.au/resources/resource/guidance/guidance-use-medicinal-cannabis-treatment-epilepsy-paediatric-and-young-adult-patients-australia#role

https://www.hopkinsmedicine.org/health/conditions-and-diseases/status-epilepticus#:~:text=If%20you%20have%20epilepsy%2C%20you,episodes%20is%20called%20status%20epilepticus.

Zaheer S, Kumar D, Khan MT, Giyanwani PR, Kiran F. Epilepsy and Cannabis: A Literature Review. Cureus. 2018 Sep 10;10(9):e3278. doi: 10.7759/cureus.3278. PMID: 30443449; PMCID: PMC6235654.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6235654/

O’Brien TJ, Berkovic SF, French JA, et al. Adjunctive Transdermal Cannabidiol for Adults With Focal Epilepsy: A Randomized Clinical Trial. JAMA Netw Open. 2022;5(7):e2220189. doi:10.1001/jamanetworkopen.2022.201

https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2794028

https://www.tga.gov.au/resources/resource/guidance/guidance-use-medicinal-cannabis-australia-patient-information

https://epilepsyfoundation.org.au/wp-content/uploads/2022/06/Medicinal-Cannabis-Position-Statement-June-2022.pdf

https://epilepsyfoundation.org.au/wp-content/uploads/2020/02/Economic-burden-of-epilepsy-Final-Report-Feb-2020.pdf

While many associate them with Cannabis Sativa L., these aromatic molecules are found in various plants, giving them distinctive aromas and tastes. But here’s the mystery: terpenes aren’t just about smell; they’re vital for plant growth and protection. Now, picture this: what if these compounds held the key to powerful medicinal benefits, working in ways we’re only beginning to understand? Stay tuned to unravel the secrets of terpenes, exploring their diverse roles and potential therapeutic wonders.

What are Terpenes?

Terpenes are natural substances found in plants like Cannabis Sativa L., and they serve various essential functions for the plant, such as helping it grow, protecting it from pests, and more. 

In simpler terms, terpenes are what give plants, like Cannabis Sativa L., their distinctive smells. Different varieties of this plant have their unique mix of terpenes, which is sometimes called their “terpene profile.” You can also find terpenes in other things like tea, thyme, Spanish sage, and citrus fruits such as lemon, orange, and mandarin.

Terpenes are also noted to have various medicinal properties. So far only a small percentage of all 15000–20000 known terpenes have been researched. 

Some of the known terpenes with therapeutic benefits are among the more than 200 terpenes that are found in the Cannabis Sativa L. plant, these include:

• Myrcene (also known as 𝛽-myrcene)
• Limonene
• Pinene 
• Caryophyllene
• Linalool
• Ocimene
• Nerolidol

Myrcene

Myrcene is one of the most common terpenes. It is also found in basil, mangos, and its namesake, Myrcia sphaerocarpa, is a medicinal shrub from Brazil traditionally used to treat diabetes, diarrhoea, dysentery, and hypertension. Myrcene’s aroma is earthy, fruity, and clove-like. 

It is proposed that myrcene might increase the effects of other compounds in a variety of ways. One idea is that myrcene might affect how cell membranes work, especially the barrier that protects the brain. This could help substances like cannabinoids get into the brain more easily. But we don’t have enough good information yet to be sure. More research is needed to understand this. Myrcene has also been found to help substances pass through the skin more effectively.

Studies on animals have shown that myrcene has strong pain relief, calming, and anti-inflammatory effects. Scientists are currently studying myrcene in various ways to understand its potential benefits better

Limonene

Limonene is regarded as the second most commonly found terpene and is found in citrus, as well as a wide variety of other plant species. It’s an important part of oils found in citrus peels, dill, cumin, neroli, bergamot, and caraway seeds.

Limonene comes in two types: l-limonene and d-limonene. Even though they have the same chemical makeup, they look like mirror images of each other. L-limonene smells like pine and turpentine, while d-limonene has a nice orange scent.

Research has shown that limonene might have different health benefits. It can help fight harmful substances in the body, reduce inflammation, and protect against certain diseases. Scientists are studying how Limonene can be used to treat long-term health problems because it helps the body deal with stress and inflammation, and it also helps control cell death.

Also,scientists have done many studies on limonene to see if it can protect our brains from diseases like Alzheimer’s, multiple sclerosis, seizures, anxiety, and stroke.

Pinene

Pinene, commonly found in pine trees, comes in two forms—α-pinene and 𝛽-pinene. It is associated with the earthy, woody, fresh aromas of pine, and resin found in many non-edible parts of plants.

Many plants rich in pinene have been used in traditional remedies to address a range of ailments, such as gastrointestinal issues, seizures, inflammation, pain, snake bites, colds, fevers, hypertension, rheumatism, cancer, fungal infections, anxiety, and depression, among other conditions.

Many studies have shown that pinene might have a role in helping fight off infections, stopping blood clots, and even reducing pain and inflammation.

β-Caryophyllene (BCP)

The terpene BCP, found in black pepper, cloves, hops, rosemary, copaiba, and cannabis, is quite special. It’s different from the well-known substances in cannabis like THC(tetrahydrocannabinol) and CBD(cannabidiol). BCP is unique because it interacts with a system in our bodies called the endocannabinoid system in a special way.

Imagine your body has tiny locks, and the endocannabinoid system has keys to these locks. BCP fits into a specific lock called the CB2 receptor. This is different from most other compounds in cannabis.

Scientists have been studying BCP to see how it can help us with various health issues. They’ve looked into its potential for treating problems like colitis (inflammation in the colon), osteoarthritis (a type of joint pain), diabetes, cerebral ischemia (a condition where the brain doesn’t get enough blood and oxygen), anxiety, depression, liver fibrosis (scarring of the liver tissue), and diseases similar to Alzheimer’s.

There’s also hope that BCP could aid in cancer treatment. It might make certain chemotherapy drugs work better and even slow down the growth of tumours. 

Linalool

Linalool is a substance found in many fragrant plants. There are two types of linalool, each giving off a different smell. (R)-linalool, found in plants like lavender, sweet basil, and eucalyptus, has a fresh and woody scent. On the other hand, (S)-linalool has a softer fragrance with sweet and floral tones.

Scientists believe linalool could be really good for our brain. It might protect our brain cells, reduce inflammation (when parts of our body get red and swollen), and fight harmful substances called oxidants. Some studies with people have shown that oils with lots of linalool might help with problems like feeling very worried, sad, or having trouble sleeping. 

β-Ocimene

The name ‘Ocimene’ comes from the Greek word for ‘basil,’ which makes sense because basil plants contain this substance. It has a sweet and woody smell and can be found in things like mint, parsley, tarragon, kumquats, and mangos. It might have a role in stopping seizures, fighting fungal infections, and hindering the growth of tumours.

Nerolidol

Nerolidol is one of the common components found in the essential oil of various medicinal plants. The aroma is woody and reminiscent of fresh bark.

A majority of the studies reveal that nerolidol is the major constituent in many plants that have shown to exhibit antimicrobial, anti-parasitic, anti-biofilm, anti-oxidant, anti-nociceptive, anti-inflammatory, anti-ulcer, skin penetration enhancer, insect repellent and anti-cancer properties. The presence of nerolidol in these plants may be a contributing factor to these properties.  

Why are Boiling points important?

Boiling points are important because they help us understand how different natural compounds, like terpenes, behave when they are heated.

Now, imagine if you had a pot of soup on the stove. You know that the soup needs to be heated to a certain temperature for it to taste just right. Similarly, each terpene has its own specific temperature at which it starts to turn into vapour and disappear. We call this temperature the boiling point of the terpene.

So, knowing the boiling points of terpenes is like knowing the perfect temperature for your soup. It helps scientists and researchers understand how these compounds work and how they can be used in things like perfumes, medicines, or even tasty food recipes.

Different terpenes have different boiling points. Some might start evaporating at a lower temperature, while others need more heat to disappear. By understanding these boiling points, scientists can use terpenes effectively in various products, making sure they are not lost before they elicit their effects.

Terpenes are volatile, natural and complex bioactive compounds. Each terpene will have a different point at which they start to evaporate and the boiling point of a terpene is the temperature at which it completely dissipates. 

Boiling Points of Different Terpenes:

Different terpenes have different boiling points, below are some of the common terpenes and temperatures: 

Terpene	Boiling Point (°C)
α-Pinene	155
Camphene	159
Sabinene	163
β-Pinene	166
Myrcene	168
Carene	171
Ocimene	175
Limonene	176
Terpinolene	185
Linalool	198
Terpineol	217
Geraniol	230
β-Caryophyllene	263
Humulene	276
Nerolidol	276
Guaiol	290
Bisabolol	314

The ‘Entourage Effect’

The ‘entourage effect’ is the notion that the pharmacological effects of cannabis, as a whole extract, is greater than the sum of its individual chemical components. 

The terpenoids in the Cannabis Sativa L. plant may directly or indirectly interact with the plant cannabinoids, potentially contributing to the therapeutic value of plant-based therapies. This synergistic effect is sometimes referred to as the ‘entourage effect’ and is the subject of ongoing research. 

In summary, Terpenes are responsible for the smell of many plants. They play an important role in nature to protect the plant from pests and disease. However many terpenes also may have therapeutic benefits when taken as a component of plant-based medicine.

To learn more about plant-based medicines and terpenes or ask any questions, please contact our team on (03) 9077 2446 or hello@astrid.health, or visit one of our dispensaries. 

References:

Russo EB. Taming THC: potential cannabis synergy and phytocannabinoid-terpenoid entourage effects. Br J Pharmacol. 2011 Aug;163(7):1344-64. doi: 10.1111/j.1476-5381.2011.01238.x. PMID: 21749363; PMCID: PMC3165946.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3165946/

https://www.sydney.edu.au/lambert/medicinal-cannabis/the-cannabis-plant.html

Cox-Georgian D, Ramadoss N, Dona C, Basu C. Therapeutic and Medicinal Uses of Terpenes. Medicinal Plants. 2019 Nov 12:333–59. doi: 10.1007/978-3-030-31269-5_15. PMCID: PMC7120914. https://www.ncbi.nlm.nih.gov/pmc/articles

https://www.sciencedirect.com/topics/agricultural-and-biological-sciences/myrcene

https://www.sciencedirect.com/topics/chemistry/limonene

Eddin, L.B.; Jha, N.K.; Meeran, M.F.N.; Kesari, K.K.; Beiram, R.; Ojha, S. Neuroprotective Potential of Limonene and Limonene Containing Natural Products. Molecules 2021, 26, 4535. https://doi.org/10.3390/molecules26154535

https://www.mdpi.com/1420-3049/26/15/4535

Salehi B, Upadhyay S, Erdogan Orhan I, Kumar Jugran A, L D Jayaweera S, A Dias D, Sharopov F, Taheri Y, Martins N, Baghalpour N, Cho WC, Sharifi-Rad J. Therapeutic Potential of α- and β-Pinene: A Miracle Gift of Nature. Biomolecules. 2019 Nov 14;9(11):738. doi: 10.3390/biom9110738. PMID: 31739596; PMCID: PMC6920849.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6920849/

AUTHOR=Weston-Green Katrina, Clunas Helen, Jimenez Naranjo Carlos  

TITLE=A Review of the Potential Use of Pinene and Linalool as Terpene-Based Medicines for Brain Health: Discovering Novel Therapeutics in the Flavours and Fragrances of Cannabis 

JOURNAL=Frontiers in Psychiatry    

VOLUME=12     

YEAR=2021  

URL=https://www.frontiersin.org/articles/10.3389/fpsyt.2021.583211       

DOI=10.3389/fpsyt.2021.583211   

ISSN=1664-0640   

https://www.sciencedirect.com/topics/medicine-and-dentistry/caryophyllene

Chan WK, Tan LT, Chan KG, Lee LH, Goh BH. Nerolidol: A Sesquiterpene Alcohol with Multi-Faceted Pharmacological and Biological Activities. Molecules. 2016 Apr 28;21(5):529. doi: 10.3390/molecules21050529. PMID: 27136520; PMCID: PMC6272852.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6272852/

Raz N, Eyal AM, Davidson EM. Optimal Treatment with Cannabis Extracts Formulations Is Gained via Knowledge of Their Terpene Content and via Enrichment with Specifically Selected Monoterpenes and Monoterpenoids. Molecules. 2022 Oct 15;27(20):6920. doi: 10.3390/molecules27206920. PMID: 36296511; PMCID: PMC9608144.

https://www.sciencedirect.com/topics/agricultural-and-biological-sciences/ocimene