UK Medical Cannabis: Everything You Need to Know

What does a Royal Marine Commando, a 66-year-old Arthritis sufferer, and a young professional plagued with anxiety all have in common?

They've all sought solace in the unfamiliar territory of medical cannabis.

Journey with us as we navigate the green sea of medical cannabis, we will tell you everything you need to know along the way.

Medical cannabis is legal in the UK, but only when it is prescribed by a doctor on the GMC’s specialist register for the treatment of a specific, eligible health condition. In order to be considered for cannabis-based treatments, patients must have previously tried at least two conventional treatment options that have been unsuccessful in meeting their needs, before meeting with a specialist doctor at a at a medical cannabis clinic like Releaf. If an expert doctor deems medical cannabis an appropriate option, and it is approved by the Multidisciplinary team, a medical cannabis prescription can be issued to be filled at a designated pharmacy, or in the case of Releaf, shipped straight to your door.

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Legalities and Regulations for Medical Cannabis in the UK

The legalities surrounding medical cannabis have been a topic of controversy in nations across the world for many years. However, it's essential to understand that the legalities and regulations relating to medical cannabis consumption in the UK are different from those surrounding recreational cannabis use.

In order for patients to receive a prescription for this type of medicinal product, they must have to have a health condition that is eligible for cannabis based treatments, that conventional medications or treatment options have been proven unsuccessful in managing or relieving. Only a registered specialist doctor can prescribe medicinal cannabis in the UK, and these products can only be obtained through regulated pharmacies.

Due to the relatively recent arrival of the legal medical cannabis industry in the UK, there are a lack of regulatory frameworks that cements the production or distribution flow of these medicinal products. This means that medical cannabis patients sometimes encounter issues with accessing a specific type of cannabis product due to supply constraints and drug regulations relating to imports, and higher costs when compared to unregulated sources.

Accessing Prescribed Cannabis Treatments

If you're suffering from a condition that could potentially benefit from medical cannabis, and you are interested in exploring this option further, the first step is to discuss this with a health care professional.

There are a number of private clinics in the UK that offer specialised consultations to assess a patients' eligibility and help them to discover if medicinal cannabis may be the right treatment for them. These clinics require patients to submit medical records and undergo a full consultation with a specialist clinician before any prescription decisions can be made.

Because the NHS is limited to prescribing only licensed cannabis based medications, the vast majority of access to medicinal cannabis products in the UK is through private clinics, which can be expensive. To combat this, a number of clinics like Releaf offer different subscription packages to make these products as affordable as possible for the patients that need them.

Specialist Doctors and Cannabis Clinics

Navigating the world of medical cannabis can be daunting, but specialist doctors and cannabis clinics are here to help. These experts have extensive knowledge of medical cannabis treatments and can guide patients through the entire process, from eligibility assessments to prescriptions.

In the UK, these specialist doctors can range in expertise, covering chronic pain, fibromyalgia, arthritis, endometriosis, palliative care, migraine, multiple sclerosis, insomnia, epilepsy, Parkinson's disease, anxiety, PTSD, depression, ADHD, and autism spectrum disorder.

 As these clinics typically operate online, patients can often check their eligibility by answering a short set of questions and sharing their relevant medical records at a time that is convenient to them, all without having to leave the house.

Once eligibility is confirmed, patients will be invited to book a virtual appointment with a specialist in their condition and a Multi-Disciplinary Team (MDT) of doctors and pharmacists will then assess whether medical cannabis is appropriate for the patient. If approved, the prescription will be sent to their nominated pharmacy and in the case of Releaf, delivered straight to their door.

Releaf have also made care administration simple with its patient portal that allows patients to book follow-up appointments, request repeat prescriptions, track reported health outcomes and access to their specialist Patient Support Team. A medical cannabis card is also included with Releaf subscriptions, which is intended to provide protection and peace of mind to their medicinal cannabis patients if they are ever stopped by the police.

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Benefits and Risks of Medical Cannabis Use

Medical cannabis has been gaining popularity recently as a therapeutic option. However, like any medication, it comes with both benefits and risks. Understanding these benefits and risks is crucial before considering medical cannabis as a treatment option.

One of the most significant known benefits of medical cannabis is its ability to provide relief for patients suffering from severe or chronic pain. In recent years there have been many studies into medicinal cannabinoids, including tetrahydrocannabinol (THC) and cannabidiol (CBD), which have suggested efficacy in managing neuropathic pain. [1] Medical cannabis can also effectively alleviate symptoms associated with conditions such as multiple sclerosis, epilepsy, anxiety, depression, and post-traumatic stress disorder. [2]

However, like all medicine, medical cannabis can have potential side effects. Some common side effects include decreased appetite, diarrhoea, feeling sick, weakness and mood changes [3]. It is important that patients report any side effects to their medical team because they may need to be monitored regularly, and long-term or chronic usage of marijuana has the potential to lead to dependency issues in some cases.

It is also important to note that while some may assume that “natural” treatments are inherently safe compared to pharmacological drugs produced through rigorous testing protocols, there are definitely some potential risks involved in self-medicating with unverified products bought online or on the street.

Many clinics specialise in prescribing individualised strains that contain different ratios of cannabinoid. This allows for the medication to be tailored to a specific patient's condition, symptoms and preferences, allowing patients the option of avoiding THC associated ‘highs’ while still achieving many of the medicinal benefits. In any case, a doctor's prescription is the best way to ensure that you are getting a safe and controlled dose of a medication, and medical cannabis is no different.

However, the legal restrictions on medical cannabis use in the UK can be quite strict. Currently, only specialist doctors registered by the General Medical Council are allowed to prescribe medical cannabis, and only for patients with specific conditions, such as rare forms of epilepsy or chronic pain that has not responded to conventional treatments. This makes accessibility difficult for many patients who may need it.

Overall, it is important to carefully weigh the potential benefits and risks of medical cannabis before making any decisions about its use. It's like owning a supercar: In the right hands, it can provide an unparalleled driving experience, but if used recklessly or improperly, it could potentially cause irreparable harm.

  • Medical cannabis can be an effective treatment option for severe or chronic pain and other symptoms associated with various conditions, but it also comes with potential side effects and risks.
  • It is crucial to consult a medical team, only obtain medical cannabis from licenced clinics, and consider all factors before using it as a treatment option.
  • Legal restrictions in the UK may make accessibility difficult for some patients who could benefit from cannabis-based treatments.
  • Making informed decisions about medical cannabis is essential like owning a supercar; when used correctly, it's helpful. However, if used carelessly, it can have adverse impacts on health.

Specific Types of Cannabis-based Medicines

Cannabis-based medicines come in various forms, including cannabis oils, sprays, capsules, and inhalers. Each form has its own advantages and disadvantages depending on the medical condition they are intended to treat.

One of the most researched cannabis-based medicine is Sativex, a mouth spray containing both THC and CBD that is primarily prescribed to treat spasticity in multiple sclerosis patients. Sativex has undergone a series of clinical trials [4], which have shown that it reduces muscle spasms and stiffness effectively. Upon the legalisation of medicinal cannabis, NHS England received a recommendation for this cannabis product from The National Institute for Health and Care Excellence (NICE) [5] for use in patients with multiple sclerosis.

Another type of cannabis-based medicine is Epidyolex, a CBD oral solution that can be prescribed to children and adults diagnosed with two rare types of epilepsy - Lennox-Gastaut syndrome and Dravet syndrome. Studies have shown it can significantly reduce seizure frequency when compared to a placebo [6].

There are other cannabis-based products available to eligible patients, however these products are not prescribed by the NHS because they do not hold a licence. There are a large variety of medicinal cannabis strains and cannabis oils that are unlicensed, but can still be prescribed by private clinics in the UK.

However, it is important to note, that unlicensed medications can also be purchased illegally online. These products may contain high levels of pesticides or heavy metals due to poor manufacturing practises. These contaminants can pose as a health risk to consumers, making it crucial only to use products that are prescribed by a specialist doctor. Furthermore, medical cannabis products should always be thoroughly tested for quality control before they are prescribed or dispensed.

Potential Side Effects and Interactions

Like many medications, medical cannabis has potential side effects that you should know before using it. As with any medication or supplement, check with your doctor before starting a medical cannabis therapy.

Some common side effects experienced when using medical cannabis include dizziness, dry mouth, fatigue, headaches, decreased appetite, diarrhoea, mood changes, weakness, and trouble concentrating [3]. There is also anecdotal evidence to suggest that strains high in THC can cause anxiety or paranoia in some people [7], however, it is important to note that not everyone responds the same way to a particular strain of cannabis.

It's also worth noting that while medical cannabis is generally well-tolerated, it may interact with other medications metabolised in the liver by the cytochrome P450 system [8]. This interaction can either increase or decrease the blood levels of those medications, leading to potential side effects. However, drug interactions with CBD oils or CBD products are rare and primarily occur when the doses taken are higher than the recommended amount.

It's essential to speak with a specialist doctor about any potential interactions specific to your situation if you are considering starting a cannabis-based treatment plan.

Medical cannabis treatments can provide relief for a broad range of conditions. Still, it's crucial to remain on the right side of the law and obtain your medication from a licenced pharmacy after it has been prescribed by a specialist doctor, such as those found at Releaf, and understand the potential side effects before beginning any treatment.

  • Approximately 1.4 million people in the UK are believed to be consuming street cannabis for medicinal use, according to a survey conducted by the Centre of Medical Cannabis in 2019 [9].
  • Recent data shows that between 2018 and 2022, in the UK a total of 101,355 prescriptions for unlicensed and licensed cannabis-based products were issued. Only 11,976 of these came from the NHS, and they were each classed as a licensed medicine [10].

The Role of Research in UK Medical Cannabis Policies

The use of medical cannabis rests heavily on scientific research. Its efficacy and safety are crucial for its regulation, prescription, and availability to the public. Research efforts are ongoing globally, especially in countries where medical cannabis is legal.

In the United Kingdom, medical cannabis is still considered a high-risk drug. However, the government has commissioned several studies to identify its potential benefits and side effects, which could pave the way for changes in current policies.

Additionally, two major studies are underway – one studying the effects of cannabis on many different health conditions using data from the UK medical cannabis registry called Project TWENTY21 [11], and a clinical trial focusing on Sativex's effects on people with glioblastoma is also currently taking place [12].

Conducting research in the field of medical cannabis can be difficult due to regulatory constraints and funding limitations. Locked behind strict drug regulations and misconceptions, research into the effects, risks and benefits of medicinal cannabis may take years before reaching a conclusive result.

One of the biggest challenge facing researchers today is how to find appropriate cannabis plant materials or extracts for clinical testing. This problem arises as different cultivars have differing chemical compositions that may affect their efficacy in treating specific medical conditions.

The lack of standardisation and consensus around dosage also complicates research efforts. It is through conducting clinical trials with standardised dosage recommendations that researchers gain trusted results regarding efficacy.

It is also important that research should not only focus on developing new therapeutic applications, but also identifying any adverse effects or long-term risks that may be associated with taking medical cannabis.

Think of these research studies as building blocks that contribute to a broader understanding of medical cannabis as a potential treatment option. Each new study adds a new block to the foundation upon which safe and effective treatments can be built.

Having said that, let's now explore the different medical cannabis products available in the UK.

Understanding Different Medical Cannabis Products in the UK

Due to current regulatory limitations surrounding the cultivation and processing of medicinal cannabis plants in the UK, patients must pass strict eligibility criteria that allow them access to clinical specialists trained to prescribe cannabis-based medicines, and then often find themselves relying on imports from other countries such as Canada or the Netherlands.

Medical cannabis can come in a number of forms including edibles, tablets, tinctures and oromucosal sprays, but in the UK it is typically prescribed in dried flower or cannabis oil form. Knowing what's in each product is crucial when it comes to choosing one that fits an individual's medical needs as best.

https://link.springer.com/article/10.1007/s11916-018-0658-8

And so, it is important to note how much cannabidiol (CBD) and tetrahydrocannabinol (THC) each product contains; to understand both the potential benefits and the risks involved.

Some products may have higher concentrations of THC that might better suit some patients' needs who require pain management, anxiety reduction or sleep improvement. Whilst CBD-dominant compositions that don't create mind-altering intoxication associated with THC use, but still have anti-inflammatory and anti-anxiety associations, may be more suitable for others.

For that reason, it is important always to consult a licenced medical professional. A specialist trained in cannabis medicine can help patients in navigating different strains and identifying the correct dosage that best suit the individual patient.

References

  1. 1. Lee, G., Grovey, B., Furnish, T. et al. Medical Cannabis for Neuropathic Pain, 2018. URL: https://link.springer.com/article/10.1007/s11916-018-0658-8
  2. 2. Releaf. Medical Cannabis 101, Education, 2023. URL:
  3. 3. Mayo Clinic. Medical Marijuana, 2021. URL: https://www.mayoclinic.org/healthy-lifestyle/consumer-health/in-depth/medical-marijuana/art-20137855
  4. 4. Wexler, M. Sativex eases MS spasticity, spasms in trials. 2021. URL: https://multiplesclerosisnewstoday.com/news-posts/2021/10/15/ectrims2021-sativex-eases-ms-spasticity-spasms-trial-data-analysis/
  5. 5. NICE. Cannabis-based medicinal products, 2019. URL: https://www.nice.org.uk/guidance/ng144
  6. 6. Abu Sawa, R., Scutt, B, Park Y. Emerging use of Epidiolex in epilepsy, 2020. URL: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7439947/
  7. 7. Freeman, D. Dunn, G. Murray, R. et al. How cannabis causes paranoia using the intravenous administration of ∆-9 Tetrahydrocannabinol (THC) to identify key cognitive mechanisms leading to paranoia, 2014. URL: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4332941/
  8. 8. Doohan, P. Oldfeild, N. Arnold, J. Anderson, L. Cannabinoid interactions with Cytochrome P450: Drug Metabolism: A full spectrum characterisation, 2021.URL: https://pubmed.ncbi.nlm.nih.gov/34181150/
  9. 9. Centre for medicinal cannabis. Left behind: the scale of illegal cannabis use for medicinal intent in the UK, 2019. URL: https://thecmcuk.org/wp-content/uploads/2022/02/Left-Behind012020.pdf
  10. 10. Prohibition Partners, International Cannabis Weekly: 282, 2023. URL: https://prohibitionpartners.com/international-cannabis-weekly/282/
  11. 11. Drug Science. The UK’s largest Medical Cannabis observational survey, 2023. URL: https://www.drugscience.org.uk/t21/
  12. 12. Cancer Research UK. A trial looking at Sativex for people with glioblastoma (ARISTOCRAT), 2023. URL: https://www.cancerresearchuk.org/about-cancer/find-a-clinical-trial/a-trial-looking-at-sativex-for-people-with-glioblastoma-aristocrat