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The legalization of recreational cannabis in Canada is just around the corner. So what will this mean for medical cannabis? Once cannabis is legal, the temptation to self-medicate could increase. It is important that the stewards of our health care and patient care remind us that there is a big difference between “recreational weed” and cannabis as a medicine.
A big part of that difference between recreational marijuana and medicinal cannabis comes down to the importance of ensuring that a given medical cannabis product, be it an oil or a concentrate, provides a consistent dose of its active pharmaceutical ingredients (meaning those with proven therapeutic effects) every time it is consumed. The natural complexity of cannabis, however, makes this difficult.
“Cannabis is a natural product produced by a plant, which means that there are a number of compounds present,” explains Dr. Lakshmi P. Kotra, aSenior Scientist at the University Health Network, Professor of Pharmacy at theUniversity of Toronto and the consulting Chief Science Officer at Scientus Pharma. “A typical pharmaceutical product may only have one or two active compounds, whereas a natural product can have hundreds of compounds, and a lot of them can be active, making it quite complex. Scientus is bringing consistency and reliability to these products.”
This requires more than just careful measurement. It also requires that the desirable compounds in the cannabis be activated in a complete, controlled fashion through a process called decarboxylation, and that a desired dose is delivered when the patient takes the medication.
“In layman’s terms, the cannabis plant produces a number of compounds that are not fully active. Heat is required to activate these compounds (seen in compounds such as THC or CBD), a process known to many as decarboxylation. When we are looking at medical cannabis products, we want to see 100% activation every time, allowing the patient to experience 100% of the health benefit,” says Dr. Kotra. “Every time someone consumes a medical product we want them to get a consistent and well-defined amount of the activated compounds, dose after dose after dose. In short, patients who have a migraine take one or two pills of ibuprofen in order to alleviate their symptoms. Patients taking cannabis for their symptoms should expect the same quality product from their medication, every time.”
An innovative and patented process
In pursuit of this consistency, Scientus Pharma, a Toronto-based biopharmaceutical company, has worked with Dr. Kotra to develop a new, patented decarboxylation process, which is giving them an unprecedented level of control over the precise amounts of each active pharmaceutical ingredient in their products. “Most of the industry has adopted the idea of using ovens for decarboxylation or other in efficient methods, and the product consistency is a major challenge,” says Dr. Kotra. “The technology that Scientus Pharma has developed is a very precise, industrial-scale method of accomplishing decarboxylation to derive effective and activated extracts. It’s like pumping a litre of gas at the gas station. You pump one litre, you always get a litre with the same quality and consistency.”
This is the level of precision and attention to detail that must be demanded from the pharmaceutical and medical sector for patient care. When we are talking about cannabis as a medicine, the industry must stick to these exacting standards, even if we are less demanding of similar non-medical products in the post-legalization world.
“Post-legalization, nothing is going to change when it comes to the needs we have in the medical cannabis products nor should patients take all the burden of experimenting,” says Dr. Kotra. “We’ll still need consistent, reliable products, coming from pharmaceutical-grade manufacturers that the patient can trust to provide the relief they need. Legalization of cannabis is not intended to be a method for people to seek out their own cures. Medical cannabis products still need to be distinct, separate, and held to pharmaceutical standards.”
It’s also vital that health care providers continue to educate themselves about cannabis products for medicine as legalization grows nearer and this conversation naturally becomes more common. This is not something that can reasonably be passed off to the patient. When people are prescribed medicine, they trust their doctor to be knowledgeable about it and cannabis medicine should not be any different. “A typical patient doesn’t have time to educate themselves about the hundreds of different strains of cannabis,” says Dr. Kotra. “They just want to go to the pharmacy, buy the product, and use it. We shouldn’t expect patients to take on a learning burden before they get treatment.”
D.F. McCourt