Medicinal Cannabis V Recreational Cannabis explained

Manx Radio looks at the difference between legal and illegal cannabis

The Isle of Man's first medicinal cannabis dispensing service has opened.

It means that patients with a private prescription for the drug can now get source it through Karsons Pharmacy in Onchan.

Cannabis is a naturally occurring plant which comes in a variety of different forms including; cannabis resin or hash, herbal cannabis and cannabis oil.

But what is medicinal cannabis and how is it different from “recreational” cannabis?

In short, the difference comes down to legality.

To put it simply - think of the word “medicinal” as interchangeable with “legal” and “recreational” as interchangeable with “illegal”.

What is recreational cannabis?

Around the world many countries have legalised or decriminalised the use of recreational cannabis.

It is legal, to at least some extent, in Canada, Georgia, Malta, Mexico, South Africa, Thailand, Uruguay and several states in the USA, amongst various other countries.

A common misconception is that cannabis is legal in the Netherlands - it is not. Instead the consumption and sale of cannabis is tolerated in licensed ‘coffeeshops’.

Cannabis is a psychoactive drug, which means its use changes functions of the nervous system, and results in alterations in perception, mood, consciousness, cognition or behaviour.

Alcohol, caffeine and nicotine are also considered psychoactive substances.

Essentially when you smoke, or eat, recreational cannabis chemicals called cannabinoids are released into your body - the main one being Tetrahydrocannabinol (THC).

THC is the main psychoactive compound in cannabis.

It binds with the cannabinoid 1 receptors in the brain and produces the ‘high’ or euphoric sensation people describe when having consumed it. 

The other main component with regards to cannabis is Cannabidiol (CBD).

CBD does not produce the ‘high’ sensation associated with cannabis as it does not contain the same psychoactive ingredient as THC. It can be extracted from hemp or cannabis. 

It is hailed by users to provide relief for anxiety, depression and post-traumatic stress disorder, as well as improving sleep.

Some products that claim to be medicinal, such as CBD oil or hemp oil, are available to buy legally as food supplements from health stores.

Here on the Isle of Man recreational cannabis is illegal.

​What is medicinal cannabis?

Medicinal cannabis and recreational cannabis actually have more similarities than differences.

Indeed, “medicinal cannabis” is a broad term for any sort of cannabis-based medicine used to relieve symptoms. As aforementioned, this basically means that medicinal cannabis is the legal form of the same drug.

However medicinal cannabis is cannabis consumed with the objective of reducing symptoms of a medical condition. This differs from recreational use where the purpose is to achieve a sensation of euphoria or relaxation, often referred to as a ‘high’.

Specific cannabis-based products are available on prescription as medicinal cannabis but very few people in the UK, and here on the Isle of Man, are likely to be able to get a prescription for it.

It must be prescribed by a specialist doctor and cannot be prescribed by your GP.

Currently, it is only likely to be prescribed for people with conditions such as rare, severe forms of epilepsy, those with multiple sclerosis (MS) and those with severe sickness whilst undergoing chemotherapy.

It would only be considered when other treatments were not suitable or had not helped.

According to NHS England there are three broad requirements that a product should satisfy to be considered a “cannabis-based product for medicinal use”:

• The product is or contains cannabis, cannabis resin, cannabinol or a cannabinol derivative
• It is produced for medicinal use in humans
• It is a product that is regulated as a medicinal product, or an ingredient of a medicinal product

Due to the limited evidence base, and their unlicensed nature, prescribing of cannabis-based products for medicinal use is restricted to only those clinicians listed on the Specialist Register of the General Medical Council.

Is medicinal cannabis safe?

Medicinal cannabis is showing promise for people with chronic or terminal illnesses who don’t get relief from other medicines.

This is because cannabinoids may reduce pain by altering pain perception pathways in the brain. It’s believed it alleviates stress, reduces nausea, and reduces inflammation.

The risks of using cannabis products containing THC are not currently clear. That's why clinical trials are needed before they can be used. "Pure" products that only contain CBD, such as Epidiolex, do not carry these unknown risks linked with THC.

The main risks of THC cannabis products are:

•  psychosis – there is some evidence to suggest that regular cannabis use increases your risk of developing a psychotic illness such as schizophrenia
• dependency on the medicine – although scientists believe this risk is probably small when its use is controlled and monitored by a specialist doctor

Generally the more THC the product contains the greater these risks are. 

A benefit of medicinal cannabis is the fact that it is regulated and therefore the patient can be sure they are getting the same product every time.

Enforcing the law

So how will the police enforce drug laws when medicinal cannabis is now available here?

Manx Radio asked Inspector Gavin Callow.

​One big concern is drug driving - which is not just confined to illegal drugs. It actually includes prescription and over-the-counter medicines, not just limited to medicinal cannabis.

The government website states: “Many drivers appear to be unaware of the dangers of driving under the influence of drugs and that the consequences can lead to serious and fatal injuries to the driver, passengers and other road users including pedestrians.

“Did you know that driving whilst unfit through drugs, whether illegal, prescribed or over-the-counter medicines, is an offence that carries the same penalties as drink driving?”

Ingesting cannabis can lead to impaired concentration - resulting in slower driver reaction times - and impaired steering control and co-ordination. It can also induce feelings of paranoia, drowsiness and disorientation.

A review into the harms caused by illicit drugs on the Island was commissioned by the Department of Home Affairs earlier this year.

It is expected to be completed by September 2023 with policy options being brought to Tynwald by January 2024.

Why is medicinal cannabis now available here?

On 1 November 2018, the scheduling of cannabis based medicinal products under the Misuse of Drugs Legislation changed. 

In 2019, the Department of Health and Social Care consulted Isle of Man residents on the introduction of medicinal cannabis here.

A total of 3,285 responses were received from residents and local organisations.

Only 0.8 per cent of respondents were not in favour of the introduction of medicinal cannabis.

The majority of respondents that were in favour would like to see it offered as a quality assured product direct to the public for self-medication through accredited dispensaries, and 62 per cent were in favour of restricting access to adults over the age of 18.

Ramsey MHK, Treasury Minister, and doctor, Alex Allinson was instrumental in getting the policy through Tynwald.

Where can you get medicinal cannabis?

Karsons Pharmacy was awarded the licence to dispense medicinal cannabis earlier this year.

And as of last week it has begun dispensing cannabis based products for medicinal use to patients with a private prescription.

It's part of a 12-month pilot scheme to collect data in order to shape future service provision on the Island. 

Upon the establishment of the service Karsons Pharmacy has taken to its website to answer some FAQ’s for patients seeking to fill their prescriptions.