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What is Sativex, can we do better?


During all of my posts on Medical Cannabis, there have been may references to Sativex, the only LEGAL Medical Cannabis preparation in NZ, so I thought it was time to delve deeply into the product and explain it, and why it is an incomplete solution to the problem of Medical Cannabis in NZ.

Sativex, with the scientific name nabixomols, is essentially hash oil in a mouth spray designed and patented by GW Pharma. Grown in high quality conditions, mould (bud rot) and pesticide use is controlled,  just like at other high end medical Cannabis growing companies. Bedrocan from the Netherlands and Canada, and Tikkun Olam from Israel also grow the plants to similarly tight conditions, so firstly the growing phase is not particularly special or unique.  To quote Kevin Hague "If they can do it, there seems to be no reason why New Zealand, a country that prides itself on high-quality primary production, cannot."

In order for Sativex to have a reliable dose per spray, it is unique in that it is made from 2 Cannabis liquids, a High THC variety, similar to the plants grown for recreational purposes, and a high CBD Variety, similar to the famed "Charlottes web" strain.  By manufacturing the liquids separately, they can then factor in for variances in yield as the 2 oils are mixed, and get a more accurate dosing than if a single breed of plant was grown with an intended ratio from the start.

To make it seem more pharmaceutical and artificial (important for public perception), the typical amber or brown color of hash oils had to go, this is the magic sauce, a patented process is used to remove the chlorophyll and and much of coloration, that may normally be visible, for example, in "honey oil".

The additives used in extraction are anyhdrous ethanol and propylene glycol, many in the Cannabis Law reform community use the argument against processed medicines based on adding "harmful" chemicals, but in truth, if you don't have adverse reactions to a glass of wine and a scoop of icecream, both of which include these ingredients, you wont be having any adverse reactions to chemicals in this medicine. The last additive is of note, it affects the taste, Cannabis extracts don't taste all that great, so Peppermint oil has been added to make it more palatable.

The method of administration is sublingual, or under the tongue, this was fairly novel for Cannabis, the benefit of administering under the tongue, is that dosing is far more reliable, and it bypasses the metabolism by the liver. If it were a drinkable liquid, it would be very variable in dosing between patients, eg those with reduced liver function, or even the minor considerations of how full or empty the stomach is, etc. A liquid or a dissolvable tablet that is placed under the tongue and left there to be absorbed would perform identically, they go straight to the bloodstream in a reliable fashion.

The Spray bottle is novel, GW deserve full credit for this, each bottle has about 90 Sprays, a nice and portable method that can be done in public without raising eyebrows, but as discussed above, the same could be achieved with  measuring a liquid in a syringe, or having a tablet dissolve under the tongue.

Sativex is still a FULL PLANT extract, with the plethora of secondary chemicals, generating "the entourage effect". Despite being listed with only the 2 primary active ingredients, THC and CBD, it contains all of the minor terpenoids and cannabinoids in unmeasured and minute amounts, as it is still a WHOLE PLANT extract, this works in its favor, as CBD is well known to reduce the negative effects of THC, and the minor chemicals have been demonstrated to improve therapeutic effects, a cannabis oil will always beat a single chemical extract.

Sativex is vaguely psychoactive, from speaking to a patient I have blogged about, compared to Medical Cannabis liquids high in THC he had sampled in Canada, the psychoactivity is much closer to that of a quick acting antidepressant, similar in rapidity to the valium class of drugs, but his mood was lifted to what could be considered normal, his wife being tearful at the elevation of his mood and restoration of his personality to what it was pre-injury, a profound effect, and much less appealing to recreational users than would be expected, as the CBD effectively blunts any euphoria generated from the THC.

Another barrier to access is cost,  as a company that has patented certain aspects of production and manufacture, and taking a significant business risk in the UK trying to push forward with a Medical Cannabis preparation, it is only natural that GW Pharma demands to make good on its investments and risks that it has taken. There also seems to be significant price gouging in the distribution channels to NZ, I have heard from another Medical Cannabis supporter that the price is about 1/3rd of what we pay in the UK..... Currently in NZ, the starting price for a month of Sativex is approx $1300 NZ Dollars. It is estimated a similar amount of  product could be made for a fraction of that price if mass produced and ignoring the capital costs such as the acquisition of land.

Lastly, Cannabis based medicines are not a one size fits all approach, Sativex is good for pain and MS, but for nausea in cancer and HIV patients more THC is needed, and in epilepsy more CBD, or even the rarer CBDV is required,  more options need to be available, just as they are with the morphine family of medicines.

The access model for Sativex in NZ is broken, despite being available for over 5 years, somewhere in the vicinity of 130 people have used Sativex, at huge personal financial cost, and at last check, only 37 people were currently filling prescriptions.

We can do better, we must do better.

Shane Le Brun

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