Module 1: Geriatric and palliative medicine
This module briefly revisits the history of cannabis use and its legislation in Australia in 2016. Two main cannabinoids are distinguished: THC (Tetrahydrocannabinol) and CBD (Cannabidiol). The module describes common and rare side effects, results and varied responses of patients to medicinal cannabis. Medicinal cannabis does not work equally for everyone – dosages vary and outcomes are different for each patient. The module describes the use of cannabinoids to relieve pain in patients with malignant diseases compared to placebos. Four case studies demonstrate how medicinal cannabis can be considered for geriatric and palliative care treatment. In conclusion, medicinal cannabis may have a legitimate role for certain patients in certain circumstances and each patient’s management is to be individually considered.
Module 2: Medicinal Cannabis and Epilepsy
This module studies the symptoms of Epilepsy 101, medicinal cannabis treatment options and modes of transmission. Several ways of application are outlined, as well as different products: artisanal preparations, unapproved products and approved medication of purified CBD. Dravet syndrome (DS) is explained, including treatment options, side effects and efficacy are discussed. A section describes Lennoz-Gastautsyndrome (LGS) and reviews research and treatment options including side effects. Tuberous Sclerosis Complex (TSC) symptoms are explained and studies and treatment options are discussed. Other potential applications of CBD are outlined including childhood epilepsy, next generation cannabis-based medicines, biosynthesis of cannabinoids in the plant and anticonvulsant effects.
Module 3: PTSD – Treatment in clinical practice
Module 3 assesses the use of medical cannabis for PTSD, including dosage and treatment in clinical practice. It describes what PTSD is and what the signs, symptoms and characteristics are. The conventional treatment of PTSD (e.g. sleeping medications or antidepressant medications), is being compared to the cannabinoid treatment options. The current position of the Department of Veterans Affairs (DVA) on PTSD is that compensation for PTSD treatment with medicinal cannabis is not allowed. However, research into medicinal cannabis is rapidly evolving and DVA will continue to monitor the developing research and published evidence. Two case studies look into symptoms, current medications, treatments using CBD, and provides reviews and results of these studies.
Module 4: Advanced mental health
This module commences with the importance of understanding the science of medicinal cannabis and the role it can play when treating mental health. Advantages and side effects are outlined. When managing complex mental health issues, the module describes treatment and techniques for schizophrenia, bipolar disorder, severe anxiety and depression. PTSD patients, often in military and first-responders frequently utilise medicinal cannabis. A comparison is made between THC-dominant (street cannabis), to CBD-dominant (hemp) or balanced (e.g. nabiximols). The module summarises studies of the use of medicinal cannabis and mental disorders. The module also addresses the use of medicinal cannabis in conjunction with conventional medications, potential toxicities, most common symptoms treated and side-effects. Larger trials on the use of medicinal cannabis for treating mental health are in progress.
Module 5: Cancer: A creative approach – where to beyond symptom relief
This module assesses cancer research for potential treatment with medical cannabis leading to a curative approach that goes beyond symptom relief. The module evaluates treatment options for breast and pancreatic cancer patients with medical cannabis and evaluates the use of medical cannabis to mitigate the side effects of cancer and its treatment. It looks into early diagnosis, treatment, defining and aetiology of cancer as well as defining and targeting the hallmarks of cancer. Clinical and side-effects of CBD and Δ9-Tetrahydrocannabinol (THC) are listed. Outcomes of studies into cannabinoids in pain management and palliative medicine are included.
Module 6: Treatment resistant patients and patients with high cannabinoid needs
Module 6 is about planning the management of complex chronic disease including poly pharmacy, multiple system disease and evaluate the challenges of effectively integrating cannabis medicines, including liver metabolism considerations and drug interactions. The results of a study into patients with chronic diseases (conditions that last one year or more and require ongoing medical attention, long lasting conditions with persistent effects), are included where patients have at least two conditions and were prescribed a minimum of four drugs. When choosing a cannabis product, the preferences of the patient, age and clinical condition are to be considered. The module describes dosing of THC and CBD and minimum/ maximum doses. A case study looks into current medications, past treatments, clinical history, treatment options, progress and life quality.
Module 7: Endocannabinoid support – advanced techniques for maximising ECS efficiency
This module evaluates clinical endocannabinoid deficiency (CED) and plan support to maximise the efficiency and function of the endocannabinoid system including diet, supplements terpenes and therapies. Migraine, fibromyalgia, IBS and related conditions display common clinical, biochemical and pathophysiological patterns that suggest an underlying clinical endocannabinoid deficiency that may be suitably treated with cannabinoid medicines. This module concludes that the adverse effects of UCMS-transferred microbiota were alleviated by selectively enhancing the central ECB or by complementation with a strain of the Lactobacilli genus. The findings provide a mechanistic scenario for how chronic stress, diet and gut microbiota generate a pathological feed-forward loop that contributes to despair behaviour via the central ECS. Finally, a case study of a patient with a long history of migraine headaches, insomnia and anxiety is described, looking at past treatments and treatment options.
Module 8: Complex chronic disease
This module looks at the planning of clinical treatment and dosing for conditions with medicinal cannabis. General rules of dosing with cannabis medicines are given, noting that doses of cannabis medicines should be administered with consistency and regularity. Minimal doses that are clinically effective should be a principle aim. Each person is individual in their response to cannabis medicines. Patient age and previous cannabis use/ experience must be taken into consideration. Initially, conventional medications should be maintained at current dosing rates. Cannabis medications should be titrated slowly and conventional medications reduced as symptoms lessen. Treating of rheumatoid arthritis, neuropathic pain, fibromyalgia, headaches and migraine, multiple sclerosis, Parkinson’s (tremor and dystonia), Chron’s disease and ulcerative colitis, chemotherapy induced nausea and vomiting, anxiety and depression, insomnia, PTSD, epilepsy, ASD, ADHD, OCD and Tourette's, diabetes, hypertension, glaucoma, geriatric/palliative care and complex mental health issues are reviewed in this module.