Hard News by Russell Brown

24

I tried Sativex: it was no fun at all

Sativex, an oromucosal spray, is the only pharmaceutical-grade medical cannabis product approved by Medsafe for use in New Zealand. It can't simply be prescribed by doctors – even after promised changes to regulations, prescriptions will have to be approved by an expert panel. The only use approved by Medsafe is in the treatment of pain associated with multiple sclerosis, but approval can be sought for other uses.

So there are hoops. But the main reason for the low uptake of Sativex in New Zealand is that it's not subsidised by Pharmac – and thus costs patients up to $1300 a month. One of the reasons that Sativex is not subsidised by Pharmac is the finding by the agency's Pharmacology Therapeutics Advisory Committee that:

 … the risk of diversion in the New Zealand setting, should Sativex be funded, is high due to the inherent nature of its active substances and the ease of administration.

Is that really the case? Would Sativex be diverted for recreational use if it was funded? Does a 50-50 mixture of the two main cannabinoids, THC and CBD (which is typically found at far lower levels in recreational weed), even get you high? Trying some seemed one way to find out more, so I said yes when a patient friend offered me a day's worth of sprays. Given the nature of the ingredients, there was no real harm that could come to me and I would not be able to overdose.

The only time my patient friend and I could get together was Sunday morning. She dropped off the small bottle of spray with instructions to take 12 sprays altogether – seven and then a top-up of five sprays some hours later.

At 9am, I had five sprays, each containing 2.7 mg of THC and 2.5mg of CBD (yes, I got it the initial dose the wrong way around). The liquid in the spray is greenish and smells like weed, or maybe bongwater – but to make it more palatable it's strongly flavoured with peppermint. Effects started about 20 minutes after administration. It did not get me high. It did make me feel fuzzy-headed and tired, but I was able to go about my business.

I had the second dose of seven sprays at 12.30pm, so I could complete the experiment before handing the bottle back. This was a different matter.

The 12 sprays recommended by my friend turns out to be the maximum recommended daily dose (much higher doses have been administered in trials). Tolerance to THC builds quickly in users, but I'd dropped right in on the top. And because I'd taken the two doses only three and a half hours apart, my doses overlapped (the duration of the effect is comparable to eating cannabis).

I'm not sure if I'd call what happened next getting high, but there was certainly a psychoactive effect.

The two cannabinoids in Sativex have quite different impacts. THC produces the euphoric effect we associate with marijuana, while CBD, which is not psychoactive on its own, mitigates the effects of THC (this isn't why it's there in Sativex – it appears that CBD itself has a crucial role in easing MS symptoms and nerve pain).

Effectively, CBD seems to take the top off the THC high, especially at the concentration in which it's present in Sativex. So while I experienced perceptual effects and the odd short-term memory lapse, it was a weird feeling and I really did not like it. It wasn't any fun. The more so given that it took the top off my thinking in general. I felt dull-witted and couldn't send a text without wondering if I was saying the right thing.

I can only guess that had I consumed the same amount of THC alone – just over 32mg, or two or three times the recommended edible dose for casual recreational users – I'd have been high as a kite. And I think I would have preferred that.

Eventually, I figured I should do something and went for a ride down to the Big Gay Out. The bike-riding felt great – my legs were pumping and it was the highlight of the day – but I wasn't happy with the level of my attention to the road and felt the need to concentrate very hard. The scene down at Coyle Park was nice enough, but I didn't feel like staying long.

I got home and couch-lock set in while I watched the Brisbane Tens on TV. I felt not only tired, but anxious, a little nauseous and still oddly troubled by the absence of euphoria. I fretted about various things and felt frustrated at the slowness of my thinking. The blind pimple under my nose throbbed constantly.

I eventually felt better, but cancelled plans to go and see friends. I ordained takeaways for dinner, demolished a Cajun fish burger and chips, watched some TV with Fiona and had an early night. But when I got up to go to the toilet a couple of hours after going to bed, I noticed there was still a minor effect on my visual perception.

The comparison that occurred to me was to when someone gave me a tablet of epilepsy medication at a party 30-odd years ago, assuring me it was a great buzz – and I wound up feeling really awful and foggy-headed and having to find somewhere to lie down. Sativex wasn't nearly that bad, but it also wasn't my idea of fun.

There was one thing that potentially mucked up my experiment, and that was that on Sunday morning I was feeling pretty jaded on account of having vigorously celebrated a friend's Significant Birthday party the night before. THC is metabolised in the liver and it's possible my liver was a bit overworked and that that contributed to both the way I felt and the duration of the effects.

So … would anyone divert Sativex for recreational use? Well, I can tell you that I wouldn't. The dose of CBD that I'd been led to believe would make me feel relaxed paradoxically made me anxious. (The warning in the official Sativex FAQ that "Some people may also feel depressed or confused" seemed more on the money.) As Fiona pointed out, it seemed to have put me off my stride. "It's interrupting my flow," I agreed.

It's quite likely that other people in other circumstances would feel differently and clearly the impact would have been different had I spaced out my doses, or had the big dose before bed.

But the main thing is that for my friend (and others like her), it makes the nerve pain associated with MS manageable and allows her to get by with a low or no dose of the more-readily-prescribed opioids that leave her too zonked to function. I'm also not certain Sativex would be as useful as a high-THC-ratio product for general pain (notwithstanding that the Ministry of Heath was very keen for the late Helen Kelly to apply for it for her cancer pain).

But what it came down to is this: at some point, I realised that this didn't feel like getting high. It felt like I'd taken somebody else's medicine.

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