Medicinal and recreational cannabis vs synthetics: what’s the difference?

Cannabis use in Australia continues to spark the public’s imagination and gets a regular run in news and media outlets.

It was previously considered as a drug that was mostly illegal. Now, it is used medically around the world and even legalised for recreational use in some countries.

There are also synthetic drugs being promoted as ‘mimicking cannabis’ that have pushed their way on to the market.

With the continued evolution of cannabis and the changes to cannabis laws, it can be tricky to understand how each substance differs.

Here we explore the main differences between recreational cannabis, medicinal cannabis and synthetic cannabinoids (also called synthetic cannabis) to clear up any confusion.

Chemical differences between medicinal cannabis products, synthetic cannabinoids and recreational cannabis

Cannabinoids  are the chemicals in the cannabis plant which give it its medicinal or recreational properties. There are over 100 cannabinoids produced by the cannabis plant with the two main cannabinoids being THC (delta-9-tetrahydrocannabinol) and CBD (cannabidiol).¹ THC and CBD interact with different receptors in the body to produce various effects. THC acts on specific receptors in the brain known as cannabinoid or CB1 receptors, which gives cannabis its psychoactive effect (meaning it produces a ‘high’).^{2, 3} CBD on its own doesn’t connect to these receptors, so it doesn’t make someone high.³

Recreational cannabis comes from the cannabis plant and usually combines THC and CBD. The strength of its effects depends on CBD and THC levels. CBD makes the effects of THC less severe and reduces the likelihood of psychosis and seizures.^{4, 5} High levels of THC increase the effects of cannabis – a THC of 15% or above is considered high and makes negative effects more likely. ^{6, 7}

Medicinal cannabis  roducts also come from the cannabis plant – but they’re prescribed by a GP or specialist to relieve the symptoms of a medical condition, such as epilepsy. Some products only have CBD, some only THC, and some are a mixture of both. What a person is prescribed depends on what type of condition they have. In all products, the THC and CBD are altered to maximise the drug’s therapeutic benefits and minimise side effects.³

Synthetic cannabinoids are not derived from the cannabis plant and don’t contain THC or CBD. Instead, synthetic cannabinoids are made in a lab with a range of chemicals, which often vary between batches. This means different packets can produce different effects, even if the name and branding on the pack is the same, making them unpredictable and potentially more dangerous.^{8, 9}

Appearance and methods of use

Recreational cannabis usually comes as dried leaves or flowers of the cannabis plant which are smoked in a joint or bong. This is the most common form.

Other forms include:

• hashish: the dried plant resin that is added to edibles
• hash oil: highly potent liquid added to tip of joint or cigarette
• concentrates: in the form of dabs, wax or shatter.

Medicinal cannabis products are prepared and packaged like any other medicine or supplement and come in many different forms, including:

• capsules
• chewables
• creams
• crystals
• flowers
• lozenges
• oil (most common)
• tinctures.¹⁰

It is usually taken by either:

• vapourising (inhaling through a vaping device)
• swallowing oils or liquid capsules
• spraying under the tongue
• applying to the skin (topically).

Smoking medicinal cannabis products is not recommended. 

Synthetic cannabinoids are powdered chemicals that are usually mixed and dissolved, and then sprayed onto dried plant matter or herbs to give the appearance of cannabis.

They are usually sold in colourful, small-branded sachets or zip lock bags and smoked in a joint or bong. They can also sometimes come in liquid or powder form.^{11, 12}

Effects and side effects of synthetic cannabinoids, medicinal cannabis products and recreational cannabis

Recreational cannabis affects everyone differently. Even the same person may have a different experience on separate occasions or over their lifetime. Some people report feelings of relaxation and euphoria while others report anxiety and paranoia.¹³ The most commonly reported symptoms usually include:

• relaxation and euphoria
• spontaneous laughter and excitement
• increased sociability
• increased appetite
• dry mouth
• memory impairment
• slower reflexes
• bloodshot eyes
• increased heartrate
• mild anxiety and paranoia.^{13, 14}

Frequent and heavy use of cannabis can also lead to dependence for some people and cause problems in other aspects of their life.

Medicinal cannabis products are most commonly prescribed to treat or alleviate the symptoms of these conditions:

• chemotherapy-induced nausea and vomiting
• epilepsy in children
• chronic non-cancer pain
• multiple sclerosis (MS)
• palliative (end-of-life) care
• cancer-related anorexia^{15, 16}

Any other conditions which medicinal cannabis products have been prescribed for can be found on the TGA website.

Products that are CBD-only don’t have any psychoactive effects – so you can’t get ‘high’ or become dependent. But, like any other medication, people may still experience some mild side effects including:

• appetite change
• mood change
• diarrhoea
• fatigue
• irritability
• nausea
• weight gain or loss.^{17, 18}

For products that contain THC as well as CBD, side effects may include:

• confusion
• dry mouth
• anxiety
• fatigue
• headaches
• vertigo
• nausea and vomiting.¹⁵

Just like other prescribed medications, such as benzodiazepines and opioids, there’s potential for dependence and withdrawal with products that have THC. To minimise this risk, it’s important that medicinal cannabis products are always taken as prescribed and monitored appropriately by a qualified medical professional.

Read more about medicinal cannabis products here: Medicinal cannabis products - Alcohol and Drug Foundation (adf.org.au)

Synthetic cannabinoids are marketed as having similar effects to recreational cannabis and are often referred to as ‘synthetic cannabis’ – but this terminology is incorrect. Synthetic cannabinoids are completely different to plant-based cannabis and they should be considered an entirely separate drug group that has a greater risk of harm.^{5, 19}

While synthetic cannabinoids can produce some effects similar to cannabis, such as relaxation, euphoria and loss of co-ordination and attention,5 they impact our brain with much greater force than THC in cannabis does, making them capable of producing stronger effects. In fact, some of their effects are closer to a stimulant (such as ice or cocaine) than cannabis.^{8, 20}

No deaths have ever been recorded due to cannabis toxicity, but there have been several synthetic cannabinoid-related deaths.⁸ Synthetic cannabinoids can be 10 to 100 times stronger than cannabis and can cause acute cardiovascular events, such as heart attacks.⁸

Read more about the risks of synthetic cannabinoids here: Synthetic cannabinoids – the facts - Alcohol and Drug Foundation (adf.org.au)

Legal status of cannabis in Australia

Recreational cannabis is not legal in Australia – but decriminalisation, in different forms, is practiced in each state/territory. This means in some cases people who are found in possession of cannabis might receiving a warning, fine or diversion to education and/or treatment, rather than being charged with an offense and being processed through the courts.²¹ This differs between each state and territory, and isn’t always guaranteed.

Medicinal cannabis products are legal in every state and territory in Australia with a valid prescription from a qualified medical professional. It’s not legal to use medicinal cannabis products that are prescribed to someone else or to use recreational cannabis to self-medicate a condition.

Synthetic cannabinoids are not legal in Australia – despite attempts to sell and market them as ‘legal’ alternatives to cannabis.⁹ In fact, states and territories have continued to change their laws to ensure these products remain illegal.

Please note: The information given on this page is not medical advice. For medical advice please consult a health professional.

If you are interested in being prescribed medicinal cannabis products, speak with your GP or you can:

• find a cannabis clinic: Cannabis Clinics Australia | Prices, Locations & More | honahlee
• find a doctor who is a registered cannabis prescriber: Find Cannabis Doctors & Prescribers In Australia | honahlee.