Picture this; you, a sufferer of chronic pain as a result of an ongoing injury, hear that the Therapeutic Goods Administration has legalised the sale of low dose CBD oil over the counter in Australian pharmacies. After consulting your doctor to see if medicinal cannabis is an appropriate treatment option for you, you head towards your pharmacy to pick up some CBD oil. When you receive the bottle, you notice the label says "CBD Oil: Cannabis Sativa" and you think to yourself, "what on earth is a sativa?"

As the Australian medicinal cannabis (also known as marijuana) market hits its metaphorical puberty, there may be some additional confusion about what cannabis plant strains are and if it makes an overall difference to the quality of treatment and selection of products. The logical starting point for those looking to expand their knowledge of the cannabis plant's versatility is an understanding of the difference between indica and sativa strains.

Below is a crash course in the key differences between the two, but be warned; Like most topics surrounding the cannabis plant, these are general terms and each individual plant is truly unique.

Appearance

One thing is for certain, there are rudimentary differences in the appearances of the two strains. The cannabis sativa plant will grow tall and thin as a total plant, a trait that is complimented by the thin, light green leaflets found on each individual leaf. Conversely, the cannabis indica strain yields a short yet bushy plant with darker leaves growing broad. Sativa is also identifiable by its pointy leaves, along with two much smaller leaves (appearing to have nine leaflets rather than indica's seven).

Dominant Cannabinoids

A cannabinoid refers to any chemical compound found in a cannabis plant - they engage with the body's endocannabinoid system to effect one's mood, appetite, pain and stress levels. While the difference in appearance is interesting and one of the most obvious differences to a novice consumer, it is the physiological makeup of the plant that generates the most scientific interest and relevance to medical practitioners.

Across both indica and sativa strains, the most well known and prominent cannabinoids are tetrahydrocannabinol (THC) and cannabidiol (CBD), but their percentages tend to vary between strains and from plant to plant. 

The traditional wisdom is that sativa will be richer in THC while indica will report higher levels of CBD. It's important to note, however, as plants are crossbred to make new and exciting strains, the cannabinoid profile continues to evolve. As such, hybrid strains, where different variations of the cannabis plant are cross bred, contain differing dominant cannabinoids and varying percentages of both THC and CBD.

Information about which strain is being used in any given medicinal cannabis product should be available on the packaging or within the information leaflet. Having visibility over the type of strain used in medicinal cannabis products empowers both the authorised prescriber and the patient to make more informed decisions when it comes to receiving/giving treatment.

Type of “High” Delivered

Generally speaking, when the question of "Indica or Sativa" arises it's in relation to the high that is delivered, which is important because it determines what expectations the user has of the product. Furthermore, it also helps both medical practitioners and patients customise the cannabis treatment so it is tailored to treat their specific medical condition.

As a general rule of thumb, sativa is expected to deliver a more of a psychedelic, energising and stimulating high, perfect for daytime use to increase focus, boost energy and ease depression. Whereas the indica plant is more likely to produce a relaxing body high, ideal for pain relief or catching some z's for those suffering from insomnia. Even for CBD isolate products like CBD oil, it's good to have an understanding of which plant is being used so the authorised prescriber can determine the right dosage and whether any changes need to be made to the existing treatment.

Plus, categorising strains and understanding their differences also helps the Therapeutic Goods Administration put in place quality drug control measures, ensuring patients are receiving the highest quality cannabis-derived products.

Hybrids do provide an exception to the above rule of thumb, as when the plants are cross-bred there's no sure-fire way of determining how it will impact the patient. In this case, if a hybrid is recommended for a medical condition, the doctor may suggest a "start low, go slow" approach to test how the patient reacts to the treatment, then adjust the dosage accordingly.

Medical Conditions Treated

Because of the differing cannabinoid profiles of sativa and indica cannabis strains, the prescribing medical practitioner may choose one or the other depending on the condition being treated. Although more clinical trials are needed to determine exactly which strains should be used to treat which condition, research done by the Lambert Initiative is helping us get closer to fully understanding the medical potential of cannabis products. It should be said, however, that the research so far does support that indica and sativa strains can be used to treat different conditions.

Indica strains, commonly associated with producing a relaxing effect can be used to treat patients that suffer from conditions that are related to feelings of pain and/or tension. These include:

  • Chronic pain
  • Arthritis
  • Multiple Sclerosis
  • Parkinson's Disease
  • Inflammation
  • Insomnia
  • Anxiety

Since sativa strains are recognised as providing a more 'energising' high, and as such is used more commonly to treat the conditions below:

  • Nausea (often caused by treatments for cancer etc)
  • Depression
  • Anorexia, or other conditions requiring appetite stimulation
  • Migraines or chronic headaches
  • Chronic pain

Hybrid strains are also commonly used for medicinal purposes to produce the most ideal effects for a patient's condition, for example if a patient suffers from arthritis but doesn't want the sedative effect the doctor may recommend a hybrid product. Another instance where a hybrid product may be prescribed over a single strain is if a user suffers from a medical condition that can be treated by either cannabis strain, such as chronic pain.

Takeaway

As we develop our understanding of cannabis and its effect on the body's endocannabinoid system, so do we deepen our knowledge of how medicinal cannabis can be used to treat certain conditions. Part of this research and development is understanding how different strains produce different effects for patients, which allows each medicinal cannabis treatment to be truly unique to patient, condition and circumstance. The most important takeaway, however, is that medical cannabis isn't a one size fits all treatment, and may require that patients and doctors work cooperatively to determine what treatment is best for them.

If you're interested in incorporating cannabis into your treatment plan, consult a trained medical professional or speak to one of our SAS accredited doctors. All the doctors on the Canwell team have been specially trained in cannabis medicine and can help you or a loved one safely incorporate cannabis into your treatment. 

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