What is Sativex, can we do better?

Sativexpack

During all of my posts in Medical Cannabis, there has 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.

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 “harmfull” 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 effects 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 anti depressant, 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 distrubution 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 60 people have used Sativex, at huge personal financial cost.

We can do better, we must do better.

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9 Comments

  1. Being one of the 48 currently prescribed Sativex, it is viewed too much as a “last alternative” after many other harmful drugs. I take it for a neurological disorder that leaves me with spasticity, neurological pain, many sleepless nights and chronic pain and lack of appetite. It is too expensive and restricted to 12 sprays per day, as per the medsafe data sheet guidelines for MS. A different ratio of THC to CBD and different terpenes would be much more effective, even if they used the same process of extraction.

    Reply
  2. Another good post.. I’m no expert, just an interested person. BUT I find the following issues:

    1) the Govt. is ‘shit scared’ of allowing natural cannabis to be grown & prescribed, because they fear actually addressing the real issue.. Cannabis is already widely available in Aotearoa/NZ & they don’t want to be seen to be legally regulating it; medicinal or otherwise

    2) they allow Sativex, because it is less likely that it will find its way onto a black-market, BUT many of the synthetic cannabinoids (already out there) came from this sort of pharm. research eg ‘Marinol’

    3) the ‘joke’ being that Sativex is not covered by Govt. subsidy (Pharmac) & is more expensive that buying black-market cannabis & making your own ‘oils’

    4) Sativex is a ‘generic’ product that contains cannabis extracts/compounds (THC, CBD etc.) BUT is not suitable for Epilepsy in Children (which needs higher levels of CBD). I read that in other countries (Canada, USA, EU etc.) they are growing strains of cannabis that have more suitable levels of these compounds eg. ‘Charlottes Web’

    5) IF cannabis was grown under license here. in Aotearoa/NZ (specifically for medicinal purposes) it could create a whole new industry; jobs, income etc. BUT this Govt. seems unwilling/fearful to look into this ! 😦

    6) Cannabis is not the ‘Demonic, weed with its Roots in HELL’ that many were led to believe. Whilst no drug is harmless, much of this propaganda in B-S & this drug DOES have genuine medicinal/therapeutic value, even though the USA still has it on their schedule #1 list (most open to abuse & NO medicinal value).

    7) Canada, USA, Australia, many EU countries are all in various stages of legally regulating NATURAL cannabis (‘marijuana’) for medicinal use.. Aotearoa/NZ is really lagging behind.

    YES, we can do better than this narrow-minded approach : ‘Sativex’ !!!! :/

    Reply
  3. I also read that cannabis was used to make skin creams & balms.. used to treat cold sores, herpes & other viral skin infections. I don’t think Sativex is suitable for any such treatment ?

    I have heard the biggest criticism is that many people smoke the raw plant (buds) for its pain killing effects, BUT it can also be vapourised instead (this does not create the same potential for carcenogens etc.) This is faster acting too. 🙂

    Methinks that there are still groups/corporations looking for any excuse to continue prohibition & any further block on R&D into the vast potential of this ancient plant, used for 1000s years prior to 20th century, for both medicinal & personal uses :/

    Reply
  4. Peter Reynolds

     /  31st May 2015

    Well done. It is very rare to see anything published about Sativex which is accurate. This is on the button from beginning to end.

    Reply
    • Wow, Thanks, I had to google you as the name was familiar, Sativex is great, but its almost impossible to qualify for it, doctors are ignorant/scared of it, and it is to expensive here in NZ, a 3 month trial for pediatric epilepsy costs 50k, and its not even the most appropriate solution, just the only one available. We are too small for GW Pharma to bother with Epidolex yet. I am part of a team starting a charity in NZ, unitedincompassion.org.nz trying to follow Australia’s lead, but hope we can be more nimble on the issue as we are a smaller government without the issue of federalisation Australia has. Feel free to get in touch formally if you can offer any support!

      Regards
      Shane Le Brun

      Reply
  5. Celeste Jones

     /  1st June 2015

    wow loved all this information as I am looking at it for my son

    Reply

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