Pharmaceutical Grade Cannabis Coming to a Pharmacy Near You

Written by BlackbirdGo January 11, 2019
The Industry

For medical cannabis patients, getting relief typically means going into a dispensary and purchasing smokable, vapeable, or edible cannabis products. But what if you could purchase cannabis-based medicine from your regular local pharmacy?

Critics of medical cannabis frequently question the legitimacy of a medicinal product that needs to be smoked. Doctors, too, often shy away from advising patients to smoke anything due to the potential respiratory damage that smoke inhalation can cause . Tinctures and extracts from the dispensary provide an alternative to smoking, but these products are typically extracted from cannabis flower; if they contain THC, they’re still technically illegal under Schedule-1 federal drug laws and, therefore, unregulated by the FDA.

But recent developments over the past year could change how both medical professionals and patients talk about cannabis.

Pharmaceutical Grade Cannabinoids

CBD (or cannabidiol) has been at the forefront of medical cannabis conversations in recent years. It’s fitting, then, that pharmaceutical companies have begun to offer an oral tincture that’s been extracted from non-psychotropic CBD . Sold under the brand name Epidiolex, the oral solution has shown promise in treating rare seizure disorders such as Dravet syndrome and Lennox-Gastaut syndrome. This product is considered safe to use for patients as young as two years old. It’s taken twice daily , and clinical studies suggest that Epidiolex may reduce seizures by 25-28% when compared to placebos .

Another potential cannabis pharmaceutical on the horizon involves extracts of the relatively rare cannabinoid tetrahydrocannabivarin, or THCV. Bay Area bio-pharmaceutical company Liposome Formulations Inc. is working to develop a pharmaceutical option that would offer patients a safe, effective way to ingest THCV without having to smoke flower with high-THCV genetics .

Preliminary studies suggest that THCV may be useful in treating anxiety and PTSD, lowering blood sugar levels in diabetics, managing the neurological effects of Alzheimer’s, and promoting bone growth in osteoarthritis patients. Researchers also hope that this new forthcoming medication may help reduce dependence on psychiatric medications and opioid pain medications. In the meantime, cannabis patients will have to seek out flower and extracts made from high-THCV strains if they want to explore the potential benefits of this cannabinoid. Researchers believe that African landrace sativa strains like Durban Poison may have higher concentrations of THCV.

It’s worth noting that one of the biggest differences between THCV and THC is that this emerging cannabinoid curbs appetite (THC, by comparison, is known to increase appetite). For this reason, experts recommend that anyone suffering from cachexia or appetite loss avoid using THCV .

How Do These Medications Compare With Cannabis?

Pharmaceutical medications made from lab-synthesized cannabinoids are nothing new; Marinol, which contains a synthetic form of THC called dronabinol, has been available to cancer and HIV/AIDS patients since 1985 . But cannabis patients have long had to contend with significant differences between pharmaceuticals and farm-grown cannabis. Here are the biggest differences between pharmaceutical-grade cannabinoids and the real thing.

  1. Activation Time
    Smokable cannabis is very fast acting. If you take a puff off a joint or a vape pen, you’ll feel the effects almost instantly. This makes it much easier for patients to regulate their medication intake and the effects that cannabis has on their particular symptoms. Many pharmaceutical pills like Marinol, by contrast, must be taken orally and can take upwards of an hour to take effect. But the pharmaceutical THCV being developed may offer faster absorption rates by incorporating other proprietary drug-absorption patents held by Liposome, the company developing this medication.

  2. Dosage
    Cannabis flower and concentrates can vary significantly between different batches or different growers, even when growing the same strain. These differences can affect the cannabinoid concentrations as well as the overall quality of your cannabis. On top of this, smokable cannabis can affect consumers in different ways. But with pharmaceutical cannabinoids, patients will always know exactly how potent a given dose is (whether it’s a pill or an eye dropper) and can anticipate any potential side effects. Precise dosing also lets doctors prescribe specific guidelines of how much to take and how often, and lets patients easily monitor how much medicine they’ve taken.

  3. What’s in Your Cannabis?
    Another factor in the conversation around pharmaceutical cannabis is product purity and quality assurance. Yes, the cannabis products that you pick up at your local dispensary undergo rigorous state-level regulatory testing, but the standards of cannabis testing may vary from one state to another and even from one batch of cannabis to the next. By contrast, pharmaceutical products are developed under strictly controlled laboratory settings. Pharmaceutical cannabinoids like Epidiolex must meet federal quality and purity standards in order to be FDA certified, which means that any two bottles you pick from the pharmacy will have uniform cannabinoid concentrations, effectiveness, and overall quality—just like you’d expect when you buy a bottle of aspirin.

  4. What Isn’t in Your Meds?
    The other major difference between cannabis and pharmaceutical cannabinoids is the entourage effect. When you smoke or vape cannabis, you’re getting more than just THC; you also get non-psychotropic cannabinoids like CBD, which studies suggest may have a mitigating effect on the intoxicating properties of THC. Pills like Marinol, by contrast, deliver only synthetic THC, which may be overwhelming for novice consumers. In fact, some patients consider the intoxicating psychotropic side effects of Marinol to be more extreme (and at times problematic) than smokable cannabis .

  5. Will Your Insurance Cover Your Medication?
    Unfortunately, since federal drug laws trump state-level cannabis legislation, insurance companies will not cover cannabis purchases at a dispensary. This won’t change any time soon, and it means that medical cannabis patients are forced to pay for their flower, edibles, and vape pens out of pocket. By contrast, pharmaceutical cannabinoids are more likely to be covered by insurance companies, meaning chronically ill patients don’t have to go broke paying cash for cannabis (and there’s no lofty state cannabis tax on pharmaceutical cannabinoids either!).

Currently, there is no uniformly “correct” way to consume cannabis. Talk to your doctor about which consumption method would work best for you and consider trying different methods to better treat your specific symptoms.

The Future of Plant-Derived Pharmaceuticals

Historically, pharmaceutical cannabinoids have relied on synthetic lab-created versions of cannabinoids to produce results that mimic the effects of real cannabis. For example, Marinol provides patients with a THC-like compound, but that compound is chemically synthesized in a lab.

Unlike Marinol, emerging products like Epidiolex are made using plant-derived cannabinoids. Patients argue that plant-based cannabis extracts are more effective than strictly synthetic medications. However, even plant-derived CBD in the form of Epidiolex will lack the additional cannabinoids that whole-plant extracts contain, like THC-A or CBN. It remains to be seen how this pharmaceutical product will perform compared with tinctures that contain a broad spectrum of available cannabinoids.

The emergence of plant-derived cannabinoids has raised questions about the continuing Schedule 1 categorization of cannabis flower, with many patients wondering why the federal government still believes that smokable cannabis flower has no valid medical applications. Pharmaceutical cannabinoids, by contrast, are typically listed as either Schedule 2 or Schedule 3 drugs—even those derived from the cannabis plant, like Epidiolex.

If nothing else, plant-derived cannabinoid pharmaceuticals may help legitimize medical cannabis in the larger medical community while pushing the conversation towards what cannabis offers that other pharmaceutical medications cannot currently deliver.

Disclaimer: Keep out of reach of children. For use only by adults 21 years of age and older.

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