Patient Access
The Narcotic Drugs and Psychotropic Substances (NDPS) Act specifically prohibits the utilization of cannabis plant flower and resin, creating an exemption for hemp plants as well as the leaves and seeds of the cannabis plant. Since these parts of the plant also contain cannabinoids like CBD and THC, the main psychoactive compounds known for their therapeutic benefits, this allows for the production of cannabis medicine products within an existing regulatory framework for medical cannabis. As cannabis is recognised as a potent plant ingredient in Ayurveda, cannabis medicine has earned ratification from India’s he Ministry of Ayurveda, Yoga, Naturopathy, Unani, Siddha, Sowa-Rigpa and Homoeopathy (AYUSH).
For these reasons, patients in India can currently obtain access to cannabis medicine via a prescription issued by a licensed health care provider, just as they would in the case of any other controlled medication. This prescription is then fulfilled by a pharmaceutical grade manufacturer of cannabinoid medicine products.
The Process
Step 1 – Eligibility Screening
It is always important to begin by screening patients for possible contraindications and to identify those belonging to vulnerable patient groups. In a cannabinoid treatment specific medical practice, patients will typically answer a set of standardized eligibility screening questions as part of their general intake. It is also important to note that even if a patient is likely to be denied a prescription due to certain risk factors, they should still receive a full consultation so that they can be educated about these risk factors and to help discourage them from seeking access to cannabis from other sources.
Step 2 – Medical Consultation
An overall medical assessment of the patient is performed by a qualified health care provider to determine if cannabinoid treatment is appropriate for the patient’s specific symptoms and condition, based on potential benefits, risk factors, and available alternative treatment options. If deemed appropriate, the patient will then receive guidance/recommendations regarding cannabis product dosage, effects, and potential side effects.
Step 3 – Receive Prescription Document
Following a consultation, if cannabis medicine is deemed appropriate the patient will be provided with a prescription/authorization document specifying the name/brand of an approved cannabis medicine product as well as the recommended dosage. The patient can then provide their prescription to the corresponding product manufacture for fulfillment. In some cases, in order to reduce possible wait times the prescription/authorization documents may also be sent directly to the product manufacturer on the patient’s behalf.
Step 4 – Product Fulfillment & Educational Services/Resources
Once received, patients will provide their official prescription/authorization document to an approved manufacturer of pharmaceutical grade medical cannabis products (if this document has not already been provided on their behalf by their HCP). Additionally, patients will often have an opportunity to receive supplementary product specific education resources as needed.
Step 5 – Follow-Up Consultation & Prescription Renewal
Patients are encouraged to schedule follow up appointments with their health care provider in order to assess their treatment progress and overall condition. If the patient has been successful in achieving improved symptom management, they will likely receive a repeat prescription/authorization document. Alternatively, patients may also be advised to change products and/or dosage, or to discontinue medical cannabis treatment entirely if noted benefits do not outweigh side effects.
Methods Of Administration
Cannabis products can be consumed using a variety of different delivery methods. The onset time and duration of a cannabis product can be strongly influenced by the intake method(s) recommended for a patient’s treatment.
Cannabis medicine products currently available to patients in India can be consumed via the following methods:
Ingestion
Infused Oils/Capsules – Created by decarboxylating or ‘activating’ cannabis and infusing it with a fatty- oil/fatty-acid to increase the bio-availability.
- Onset of Effects – Typically 60-90 minutes. Up to 2 hours.
- Duration of Effects – Typically 6-10 hours. Peak effects 2-3 hours following consumption.
- Ideal for preventative treatment or symptoms that persist throughout the day/night.
Sublingual / Buccal
These methods of delivery allow cannabinoids and terpenes to avoid the digestive system which can decrease overall effectiveness.
- Typically found in the form of an oral spray or strip/film, these products are applied directly under the tongue or between the gums and cheek.
*NOTE: With the exception of product formulations utilizing nano-emulsion technology (not yet available in most jurisdictions), traditional formulations of infused cannabis oil are best consumed via ingestion, rather than sublingual absorption.
Product Selection / Recommendation
Different formulations of cannabis medicine products can be more effective for the management of certain symptoms and conditions.
THC Products:
- Chronic Pain
- Depression
- IBD
- Insomnia
- Muscle Spasticity
- Nausea
- Poor Appetite
- Sleep Disorders
CBD Products:
- Anxiety
- Depression
- Fatigue
- Inflammation
- Migraines
- Seizures
- Sleep Disorders
THC & CBD Products:
- Anxiety
- Chronic Pain
- Depression
- Fatigue
- IBD
- Inflammation
- Insomnia
- Migraines
- Muscle Spasticity
- Nausea
- Poor Appetite
- Seizures
- Sleep Disorders
CBD has been shown to help limit the intensity of the intoxicating effects of THC. Thus, it is commonly used alongside THC in order to limit side effects.
It is important to note that full spectrum products, when available, can influence appropriateness for either daytime or evening use.
Daytime – Products with a terpene profile dominant in pinene, limonene, and/or terpinolene.
Evening – Products with a terpene profile dominant in myrcene, linalool, and/or caryophyllene.
Dosage & Titration
There is a common saying amongst cannabis patients and health care professionals. When using cannabis oils, it is important to ‘start low, and go slow’. Cannabis affects patients in different ways, and thus some patients are more sensitive to the effects of THC than others. For this reason, patients need to be careful when using cannabis oils as it can be difficult to predetermine an ideal dosage, and it can be easy to accidentally consume a larger dose than needed. It is recommended that patients use titration in order to help identify the dosage best suited to your needs. It is also important to note the biphasic nature of cannabis medicine. Research has shown that low and high doses can result in opposing effects experienced by patients.
THC & CBD PRODUCTS:
Low Potency
- Patients should begin with a dose of approximately 2.5mg THC and 2.5mg CBD.
- If needed, dosage can be increased in increments of an additional 2.5mg of THC and 2.5mg of CBD, once per day.
Moderate Potency
- Patients should begin with a dose of approximately 5mg THC and 5mg CBD.
- If needed, dosage can be increased in increments of an additional 5mg of THC and 5mg of CBD, once per day.
High Potency
- Patients should begin with a dose of approximately 10mg THC and 10mg CBD.
- If needed, dosage can be increased in increments of an additional 5 – 10mg of THC and CBD, once per day.
- Immediately reduce dosage if patient begins experiencing unwanted effects such as dizziness or nausea.
* NOTE: When using full-spectrum products, the terpene profile should be considered when recommending products for either daytime or evening use.
