Heyday Help Centre

Research has found that the cannabis plant produces between 80 and 100 cannabinoids and about 300 non-cannabinoid chemicals. The two main cannabinoids that are known to have therapeutic benefits are delta-9-tetrahydrocannabinol (THC) and cannabidiol (CBD). 

Cannabinoids have been found to influence, and where used appropriately, upregulate, the endocannabinoid system, or the ECS. The ECS is a bridge between the body and the mind. It regulates the release of neurotransmitters that make us think fast or move slow, cry tears of laughter or tears of pain. It directly regulates the physiological systems that control pain, inflammation, appetite, thermoregulation, intraocular pressure, sensation, muscle control, metabolism, sleep, stress response, motivation/reward, mood and memory. It maintains bone density and immune response.

Changes in the ECS have now been directly linked to conditions such as depression, anxiety, IBS, arthritis and migraines. There are more cannabinoid receptors in the brain than there are for all neurotransmitters put together.

Delta-9 Tetrahydrocannabinol (THC) is one of two major cannabinoids found in the Cannabis sativa plant. Many people commonly think of THC as the recreational component of cannabis as it is the component that can produce intoxication and a “high” sought after by recreational users for euphoria, relaxation and altered thinking patterns. It can also cause anxiety and paranoia in certain individuals.
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When used appropriately, THC can be a powerful medicine, associated with positive health benefits. It is not necessary to experience intoxication or feelings of being “high” to enable these benefits. Often, if significant intoxication occurs, this indicates that the point of maximal therapeutic benefit has been passed. 
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If used appropriately and under the guidance of an experienced healthcare provider, THC is a powerful:

• Analgesic 
• Anti-inflammatory 
• Muscle relaxant 
• Immune modulator 
• Neuroprotectant 
• Antioxidant 
• Antiemetic (anti-nausea and vomiting)
• Anticonvulsant 
• Antispasmodic 
• Appetite stimulant 
• Antidepressant 
• Sleep aid 
• Reducer of visceral hypersensitivity and GI motility 
• Traumatic memory reducer 
• Positive memory promotor

THC has such wide ranging therapeutic effects because it has a similar structure and mimics our body’s own Anandamide (AEA), an essential endocannabinoid.

It is a partial agonist which directly stimulates the body’s cannabinoid receptors, CB1 and CB2, modulating the activity of cellular and neurotransmitter function in many parts of the body.
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If used appropriately, THC can supplement and support the ECS, leading to improved homeostatic functioning (internal balance). 
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If used excessively and in high doses, THC can overwhelm the body’s natural endocannabinoid system (ECS) function, leading to down regulation of this essential system.

For this reason, THC must be used with caution. It is also responsible for most of the side effects associated with cannabis.

The most common side effects of cannabis are usually attributed to THC, and may include:
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• Dry mouth
• Red eyes
• Reduced coordination 
• Impaired balance 
• Dizziness 
• Fatigue 
• Anxiety/paranoia 
• Euphoria/dysphoria 
• Reduction in blood pressure 
• Transient increase in heart rate 
• Nausea/vomiting 
• Short term memory impairment 
• Difficulty focusing

Caution and potential contraindications are needed for:
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• Schizophrenia and previous psychosis 
• Anxiety disorders
• Unstable heart disease
• Arrhythmia
• Falls risk 
• Previous drug use disorder
• End stage renal failure 
• Pregnancy and breastfeeding 

Cannabidiol (CBD) is another major cannabinoid in the cannabis plant. 
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CBD is often thought of as the medicinal cannabinoid as it is non-intoxicating and non-impairing. CBD is like a well tolerated therapeutic shotgun, hitting multiple targets and often leading to unintentional benefits, especially in patients with multiple comorbidities.

CBD is a promiscuous molecule, acting on many neurotransmitters, receptors and enzymes within the body. In fact, over 60 different mechanisms of action have been noted to date.

CBD also upregulates the body’s own endocannabinoid system by inhibiting the breakdown of anandamide and competing for fatty acid binding proteins.
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Traditional medicines that activate multiple pathways are often associated with significantly increased side effect profiles. However, CBD is generally well tolerated, with some studies using up to 9,000mg in a single dose without significant adverse effects.

Potential therapeutic applications of CBD include:

• Anti-inflammatory 
• Analgesic 
• Anxiolytic (anti-anxiety)
• Antidepressant 
• Antioxidant 
• Neuroprotective 
• Anticonvulsant 
• Antiemetic (anti-nausea) 
• Antipsychotic 
• Immune modulation 
• Anti-cancer properties

Side effects from CBD are generally mild, but may include:

• Dizziness 
• Irritability/restlessness
• Drowsiness 
• Nausea
• Diarrhoea 
• Sleep disturbances 

Most commonly prescribed products are full spectrum oil based tinctures with varying ratios of CBD and THC. Also cannabis flower is prescribed for inhalation when appropriate. Multiple products can be prescribed in combination.

The cannabis medicine marketplace is continually developing and other delivery methods are becoming more widely available like soft gels, capsules, sublingual wafers, sprays and topicals.

Our doctors will consider all options when prescribing for patients and will make appropriate changes when necessary.

Cannabis medicines involve highly complex compounds that exert effects across multiple physiological systems, including the endocannabinoid system.

Therefore, cannabis medicines have the potential to interact with multiple common medicines. Because of this, it is crucial that any doctor prescribing cannabis medicines has intricate knowledge about the pharmacological actions of various cannabinoids.

Cannabis is a bio accumulator, meaning the plant’s long tap roots will suck up potential toxins and contaminants in the soil and sequester them in the plant.

Cannabis from unregulated sources can be contaminated with heavy metals, pesticides, plant growth retardants (PGRs), bacteria and fungal elements which can have negative health impacts.
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Strict manufacturing and agricultural standards are adhered to when going through legal routes. Because of these strict regulatory practices, medicinal products are assessed to ensure patients are receiving consistent, high quality and safe products.

As medical cannabis is such a complex medicine, it is important to be able to achieve reproducible results, which can only be achieved through a regulated market.

It is important we understand a patient’s past experiences to help us tailor our approach.  There is vast interpersonal variability between people’s response to cannabis.

Side effects are dose related and some people who are more sensitive to THC might have a narrow therapeutic window, meaning they have limited effective dosing range.

This doesn’t mean that we can’t use cannabis medicines but THC predominant treatments need to be used with caution.

To manage this we will start at very small doses and increase slowly, allowing the body time to acclimatise to the extra cannabinoids.

You should never drive or operate heavy machinery whilst under the influence of intoxicating substances, including some cannabis medicines. However, the answer to this question depends on a few factors.
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Cannabis medicines that do not contain THC are non-impairing and are thus legal to drive on. Cannabis medicines containing THC can result in impairment and are associated with potentially slower reaction times, impaired decision making and confusion.

The level of impairment resulting from cannabis medicines can depend on a variety of factors, including:

• Delivery method (oils/flower/edibles)
• Concentration and dosage of THC 
• Time since ingestion 
• Body mass
• Metabolism
• Sex
• Previous experience with plant-medicines

Varying delivery methods can result in differing levels of impairment and intoxication. It is worth noting here that the psychoactive effects of THC medicines can vary substantially from person to person. Thus, it’s crucial to take into consideration personal experiences and responsiveness to medicines containing THC.

Under Australian drug-driving laws, driving with THC in your system is strictly prohibited, even if you aren’t impaired. Current drug tests only test for THC presence, and do not test for levels of impairment.

If your medicine contains THC, a positive mouth swab test may result in a loss of license. THC products are the only prescription medicines that are illegal to drive on in Australia.
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These laws present significant social and economic burdens to cannabis medicine patients. Dr. Connell through his position as President of the Society of Cannabis Clinicians is actively involved in the Drive Change campaign, formed to help establish more appropriate laws for sensible medical cannabis use by educating politicians and advocating for patients.

To summarise: driving with any presence of THC in your system is illegal, regardless of levels of impairment. CBD-based medicines that contain no THC are legal under Australian law.

www.drivechangemc.org.au

Access to cannabis medicines can only be arranged through an Australian registered healthcare provider. Approval is granted on a case by case basis by the Australian regulator, the Therapeutic Goods Administration (or TGA).

The TGA does not have an official list of approved medical conditions for cannabis medicines. In many cases, more research is required to fully establish the efficacy of cannabis medicines in various therapeutic areas.

However, cannabis medicines have previously been approved for the following conditions:

• Anorexia
• Anxiety
• Autism symptoms
• Cancer pain
• Chemotherapy-induced nausea and vomiting
• Chronic infection 
• Chronic pain
• Chronic Regional Pain Syndrome
• Depression
• Dystonia
• Epilepsy/Seizure management 
• Fibromyalgia 
• Migraines
• Neuropathic pain
• Opioid dependence
• Palliative care
• Parkinson’s Disease
• Polymyalgia Rheumatica
• Post CVA Neuropathy
• PTSD
• Radiculopathies 
• Rheumatoid / inflammatory Arthritis 
• Spasticity from neurological conditions 
• Tremors 
• Insomnia
• Restless leg syndrome
• Endometriosis
• Irritable Bowel Syndrome
• Inflammatory Bowel Disease
• Dementia
• Huntington’s disease
• Motor neurone disease
• Cerebral palsy 
• Gastroparesis 
• Tinnitus 
• Cancer related symptoms, including pain and chemotherapy induced nausea and vomiting

It is worth noting that although the TGA has previously approved cannabis treatments for these conditions, more research is required to establish cannabis as an approved treatment. 
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Whilst research into the efficacy and effects of cannabis medicines for certain treatments is increasing, it is currently in its early days. Patients should always talk to a healthcare provider for advice on their unique requirements before making any decisions about their treatment options.

For the latest and most accurate information on how to prescribe, and be prescribed cannabis medicines, please head to the TGA website.
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TGA website

Yes. We encourage patients to speak to their regular GP first. However, there is a high degree of complexity with cannabis medicines. Due to their known and unknown interactions with traditional medications, the potential risks associated with their use and challenges with patient monitoring, very few doctors feel comfortable or confident in prescribing cannabis medicines themselves.
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If your regular doctor would like to learn more about prescribing cannabis medicines, we are able and willing to help. If you have previously been prescribed cannabis medicines but you have experienced suboptimal results, we can help. Heyday is doctor led, and we like to work closely with a patient’s primary care provider wherever possible.

Any doctor in Australia can legally prescribe cannabis medicines. However, cannabis is a complex medicine, and some doctors feel uncomfortable prescribing and or monitoring cannabis medicine treatments.
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Here is the process for accessing prescription cannabis medicines:

1. Book a consultation with an experienced cannabis doctor, whether it be your regular doctor with experience in cannabis medicine, or a Heyday doctor.

2. The doctor will assess your eligibility and develop a personalised treatment plan based upon your needs and goals.

3. The doctor will submit an application on your behalf to the Australian regulator, the Therapeutic Goods Administration (TGA) through the Special Access Scheme (SAS-B) pathway for unapproved medicines.

4. If approved, the doctor will arrange for a prescription to be written for you.  If you work with a Heyday doctor, our doctor will forward your prescription to one of our partner pharmacies who will ship your medication to your door. Otherwise, we can forward your prescription to a pharmacy of your choice for fulfilment.

The TGA is responsible for regulating all medicinal cannabis products, applications and prescriptions, and ultimately decides whether a patient is granted access.

As medical cannabis is categorised as an unapproved medicine, doctors must first submit an application to the TGA if they are not already Authorised Prescribers.

This application is done through a specific pathway for unapproved medicines known as the Special Access Scheme (SAS-B).

We have completed thousands of applications with no submissions being refused to date. However, it is ultimately up to the TGA to approve or deny applications.

An authorised prescriber (AP) is a doctor who is able to prescribe certain cannabis medicines for certain conditions independently, without needing to submit an application to the TGA.

They have proven their knowledge in the field of cannabis medicine, allowing them to prescribe without approval. 
This can significantly reduce the time it takes for patients to receive their medicine.

Heyday doctors are authorised prescribers, resulting in reduced delays and efficient, streamlined access.