Medicinal marijuana: a closer look

Posted on 6 August 2019

Dr Regina Hurley, a specialist anaesthetist at Mediclinic Newcastle, is one of only a handful of practitioners in SA with a permit to produce marijuana for medicinal use. She discusses the current state and future potential of this emerging field.

“My husband is also a doctor, and a few years ago, we started digging into the research around medicinal marijuana. We were amazed: the benefits are astounding.”

In the past two years, the topic of medicinal marijuana has exploded into mainstream discussion.

In part, the debate was sparked in 2018, when the Constitutional Court decriminalised the drug for personal consumption by adults in private. But it really caught on in May this year, when former Health Minister Dr Aaron Motsoaledi announced that preparations containing cannabidiol (CBD) would be excluded from being scheduled in terms of the Medicines and Related Substances Act of 1965 for the next 12 months.

Dr Regina Hurley, a specialist anaesthetist at Mediclinic Newcastle, has become a prominent voice in this discussion, having done a great deal of research into cannabidiol (CBD) as a potentially life-changing medication – and while we’ve come a long way in a short time, she says, there is more work to be done.

Cannabidiol is one of 80 chemicals found in the cannabis sativa plant, commonly known as marijuana, and the second most prevalent active ingredient – after delta-9-tetrahydrocannabinol (THC) – making up about 40% of extracts from the plant.

Unlike THC, CBD has no psychoactive or addictive properties. According to the World Health Organization, CBD “exhibits no effects indicative of any abuse or dependence potential … there is no evidence of public health related problems associated with the use of pure CBD.”

CBD has been studied extensively for its proposed benefits in treating a range of illnesses and conditions, from anxiety and insomnia to Dravet syndrome and Lennox-Gastaut syndrome (LGS), forms of epilepsy that in many cases do not respond to anti-seizure medications.

Medicinal marijuana could bring a range of benefits, says Dr Hurley, including economic upliftment and an increase in the range and cost of available medication. “We’ve seen in studies overseas that CBD can provide relief for patients who can’t find it elsewhere, and that for others, it can replace traditional medications: in many cases it is just as effective, without the side effects.”

Dr Hurley says she has worked with provincial departments of health, via the Cannabis Development Council of SA (CDC SA), to conduct further research into those benefits within a local setting. “We’re looking at answering questions like, How will it be grown in SA? Is there any economic benefit to growing it here, as opposed to importing the products from overseas? And can it be proven that there are tangible benefits for patients with no other options, here in SA?”

CBD oil is not yet entirely legal in SA, Dr Hurley clarifies: “It may be sourced from one of the rare specifically licensed practitioners, or from someone who makes sure to state it is not a medicine.”

To supply a registered medicinal CBD oil product, practitioners are required by the Southern African Pharmaceutical Regulatory Affairs Association (SAPRAA) to either import the item or hold a permit allowing them to produce it. “There are people who extracting CBD oil from hemp products in their kitchens and garages – but if they are selling that oil to others, and it has not been registered or even tested by SAPRAA, and they are representing it as having medicinal properties, that is illegal.”

The CDC SA is committed to working with SAPRAA to regulate CBD products, Dr Hurley says. “The consensus overseas is that CBD-related side effects are minimal and rare, but if a product is not tested, there is no way of knowing, for example, that it is free of any residual byproducts from the extraction process, or ensuring that it will provide the benefits it promises.”

Dr Hurley says the debate over medicinal marijuana has developed rapidly in a short space of time, to a point where experts are deep into discussions over control and regulation. “We’re digging into the specifics now: for a patient to see any benefits, they need to be prescribed CBD in the correct ratio. Someone with epileptic seizures might require 300 milligrams of CBD per day, whereas someone with chronic pain might need 25 milligrams, two or three times a day, with a small amount of THC as well. We’re not nitpicking – these are the kind of crucial details that could make or break this emerging industry.”