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UK’s “broken” system needs urgent repair

Dr Frank D’Ambrosio has advised the UN on medical cannabis and prescribed it to 10,000+ patients. Here’s his take on the UK’s failure to provide access to the medicine.

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“It’s a dire situation”, says Dr Frank D’Ambrosio of the current plight of UK families struggling to access medicinal cannabis.

It’s also indicative of a “broken system”, he believes, since the UK is the biggest producer and exporter of legal cannabis on the planet, “yet the citizens have no access to it”.

As one of the world’s leading campaigners for policy reform on medical cannabis, D’Ambrosio is well placed to comment on the UK picture.

He spent 30 years as an orthopaedic spine surgeon in California, witnessing thousands of patients in chronic pain.

After 20 years in the field, he realised he had an office full of patients addicted to opioids.

Six years ago he stopped prescribing opioids and convinced 90 per cent of his patients to move to the cannabis plant. He’s since treated over 10,000 patients with opioid addiction and successfully transferred them over to the use of cannabis.

Last year he addressed the World Health Organisation – which directs international health within the United Nations’ system – telling its drug dependence committee not to fear cannabis.

He says: “In the UK we’ve essentially had the legalisation or allowance of medical cannabis prescriptions as approved by Parliament. This was then given over to the medical societies which actually formed a roadblock. So it has really did nothing and the NHS has so far issued no prescriptions.

“The only way people can get access cannabis is to go to private clinics where they are paying between £1000 and £2000 a month. If you’re very rich that’s fine but this is ultimately a two-tiered medical system with regards to cannabis.

“There are plenty of families with children with epilepsy who can’t afford £2000 a month. They’re essentially doing fundraising every month, just to get their children medicine. I can’t imagine that this was what they hoped would be the result of allowing medical cannabis to be available to citizens in the UK, or if it was, then it was a pretty duplicitous experiment.”

The situation is all the more bewildering for families given that the UK produces and exports more cannabis medicine than any other country, according to the UN.

A report published last year showed that the UK produced 95 tonnes of legal cannabis in 2016, putting it ahead of Canada in top spot. That UK production accounted for 44.9 per cent of the world total at the time is largely down to production of GW Pharmaceuticals’ cannabis-based medicine, Sativex.

D’Ambrosio says: “If you have a country that’s exporting so much, why can’t patients get access to it? And why can’t you have other companies come in to lower the cost and make it more accessible? It seems incredibly hypocritical that it’s okay for people in the countries you are exporting to to access it but not the citizens of the UK.”

Some argue that the jackhammer to the medical profession’s “roadblock”, might be yet more research into cannabis medicine’s efficacy. For all the existing studies and anecdotal evidence that exists, the Department of Health and other official bodies continually point to the need for an improved “evidence base”.

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D’Ambrosio says: “I think the move by Parliament last November to legalise medicinal cannabis was smoke and mirrors. They punted it from their lap into the lap of the medical societies knowing full well that they would stop it there.”

In August, the National Institute for Health and Care Excellence (NICE) said it was “unable to make a recommendation about the use of cannabis-based medicines for severe treatment-resistant epilepsy because there was a lack of clear evidence that these treatments provide any benefits”.

On the same day, NHS England and NHS Improvement issued a report setting out a series of measures to help remove barriers to the appropriate prescription of medical cannabis on the NHS.

Among them were several steps aimed at speeding up the generation of research linking cannabis with various conditions.

Aside from research,  pricing is also an issue that needs to be addressed, says D’Ambrosio.

“I think there’s enough evidence out there already, if you take evidence from other countries. But also, the cost is just so prohibitive. If you only have one producer of medical cannabis in the country, the price is going to essentially be fixed.

“Over time, if you had two or three more companies come into the UK, to be able to compete, that would lower the price and then all of a sudden, you’ve got the studies that will fulfil the requirements of what is a medicine according to the NHS, and you bring the price down.”

In September, D’Ambrosio visited 10 Downing Street to deliver his report on the UK’s medical cannabis landscape as it has emerged over the last two years. This follows two visits to MPs and patients in the UK last year. He will also soon be releasing the full results of an online survey of patients he has conducted.

The study is ongoing but based on responses from the 4,700 patients questioned to date, the top five reasons for using medical cannabis are for: anxiety, depression, headaches, sleep problems and as an alternative to opioids. A further 15,000 to 20,000 people will be surveyed in the coming months.

“One of the big negatives aimed at cannabis is that it’s addictive. The reason people say it’s addictive is because when you stop using cannabis, you may become anxious, depressed and unable to sleep. But that’s not really addiction, because the top three reasons for using cannabis in the first place are because you’re depressed, anxious and you can’t sleep.”

Despite the current lack of access to medical cannabis in the UK, the Californian does see some signs of positive change – but not nearly enough.

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“Children with severe epilepsy are slowly starting to be treated via Great Ormond Street which is admirable. However, a whole host of other patients are being left by the wayside.

“The UK’s spiralling opioid addiction can be handled by the adoption of non-addictive medical cannabis as an alternative to opioids. Domestic supply is the way forward for people as a way of beating the prohibitive cost from profiteering pharmaceutical companies.”

Raising medical cannabis awareness on both sides of the doctor/patient divide might also help to improve access.

Most doctors have had little to no formal training in cannabis medicine, while many are also understandably influenced by somewhat restrictive guidelines from official bodies such as the Royal College of Physicians and the British Paediatric Neurology Association.

An added complication is the fact that cannabis is an unlicensed medicine, meaning that the doctor, rather than the manufacturer, must take full responsibility for it should something go wrong.

“GPs are getting more and more comfortable with cannabis medicine because they know the science behind it. As well as educating GPs, it’s about educating patients. They will then go back to their MPs and say ‘this is what we want, how can you make it happen? Open up the doors for the GPs to play their part’ – and don’t hang the threat over them of losing their medical licence if they use cannabis.”

In California, D’Ambrosio’s patients have been able to legally access medical cannabis for 23 years, while recreational cannabis was legalised there in late 2016.

“Has it been a resounding success? It depends who you ask. In my practice, I’ve seen medical cannabis help so many people that I could not be a stronger advocate for it. But there are different agendas, for example taxes are being attached to cannabis, because you can get it both from a medical facility and in shops recreationally.

“The problem with taxation is that there are some people who are so against taxation that they’re turning back to the underground black market. So it’s a work in progress.

“I always tell people that I live my life beta, because I am always going through changes. And I think that’s exactly what cannabis is going to be going through for the rest of our existence. It is always going to be in beta, we’re always going to keep tweaking and figuring out what the next move is.”

The UK medical cannabis model is certainly a work in progress, as is Britain’s burgeoning cannabis wellbeing products sector.

The UK CBD market will be worth almost £1bn per year by 2025, the Centre for for Medicinal Cannabis (CMC) predicts. Does this help or hinder the cause for better access to medical cannabis prescribed by doctors?

D’Ambrosio says: “In an ideal world, accessibility to CBD which is non psychoactive and has well documented beneficial effects to health, wellbeing and recovery, is good. I think what’s going to be a problem, just from speaking to some of the law enforcement officials I met in the UK, is that a lot of the CBD products are not considered THC free.

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“The definition of CBD oils sold on the High Street is that they have less than 0.2 per cent THC and that’s why they can sell it. I can see the National Crime Agency cracking down and saying if it has any THC in it at all then this is a dangerous drug and you’re going to get into trouble. I wouldn’t be surprised in the next one or two quarters if you saw CBD products being taken off the shelves.”

Such drastic action has been speculated in the past, although the pace of growth in the sector – and the sheer weight of resistance from consumers and trade bodies – would make it a hugely divisive and controversial move.

While D’Ambrosio is following the UK situation closely, his mission to liberate access to medicinal cannabis goes beyond these shores and his native US.

He is the chief medical officer of London Stock Exchange (NEX) listed Block Commodities, which holds medical cannabis growing licences in Africa.

“The company’s plan is to build cannabis economies on the African continent. The first country we’re working in is Sierra Leone.

“We’re not only looking to create a cannabis economy where we can export cannabis oil from, to countries that are willing to accept the product; but more importantly it is to grow cannabis so that the residents can use the cannabis as medicine. There’s been an enormous increase in the importation into Africa of Tramadol.

“It’s quite addictive, and it can be lethal so we want we want people to be able to grow the medicine and create an economy to not only build the financial welfare of the family, but also the medical welfare of the people.”

Hear more from Dr Frank D’Ambrosio in the next print edition of Cannabis Health. Click here to sign up for your entirely free, no strings subscription.

Cannabis Health is THE UK magazine covering cannabis medicine and wellbeing from every angle. It is affiliated with the Medical Cannabis Clinicians Society and lists campaigner Hannah Deacon, leading expert Professor Mike Barnes and prominent doctor Dani Gordon on our editorial panel. For a limited time only, we are offering a free – absolutely no strings – annual subscription to the quarterly print title. You will  receive four issues, delivered with discretion to your address – with no hidden fees or obligation to pay beyond that. To repeat, this is a 100% free promotion available to the first 100,000 sign-ups.

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Advocacy

Emigration: “I tried cannabis again and I noticed that I was in less pain when I took it.”

In a new series, we speak to Irish cannabis patients about their decision to emigrate in search of easier, safer cannabis access.

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Emigration: A stack of suitcases against a window revealing a sunset and a plane

In a new series, Cannabis Health News talks to people who have experienced emigration in search of safe, legal cannabis access.

Our previous stories have focused on the difficulty of packing your entire life into boxes and emigrating with your family to a new country for access. However, there is another side to emigration: the potential for return.

What happens once you are a medical cannabis patient in another country and need to travel home?

The returning Irish from emigration in the past few years has hit record numbers. As people settle into life away from home, it gets harder to return. Travel options have never been easier with several flights to and from Ireland daily from all over the country, ferry options and failing that, zoom calls are a vast improvement on Skype.

COVID lockdowns meant that it’s been a difficult year for travel. Families who have experienced emigration may not have seen in their families since the beginning of the crisis. Now thanks to vaccines, travel is starting to become a possibility again.

This leaves medical cannabis patients in a confusing situation. What do you do if you have a prescription in one country yet need to go to another?

Joe’s story

This is the situation *Joe is in. This is not his real name but he has asked to remain anonymous due to the persisting negative attitudes towards cannabis which he is prescribed for debilitating arthritis.

“I have since the age of 14 suffered from debilitating rheumatoid arthritis. I also suffer from sciatica. I played rugby six days a week for my school, worked on the family farm and lived a full and normal life. My body then changed and while initially my shoulders were affected but then my knees. It felt like someone was trying to tear my arms from their sockets and that I had broken glass in my knees. That was 36 years ago.”

Arthritis is a common condition that causes pain and inflammation in a person’s joints. Osteoarthritis and rheumatoid arthritis are the two most common forms of the condition. It can start when a person is between 40 and 50 years old although it also affects children and teenagers.

In rheumatoid arthritis, the body’s immune system targets affected joints causing pain and swelling. The outer covering of the joint is the first place to be affected before it spreads across the joint leading to further swelling and a change in shape. This may cause the bone and cartilage to break down. People with rheumatoid arthritis may also develop problems with other tissues and organs.

The Irish Children’s Arthritis Network (iCAN) estimates there are over one thousand children and teenagers currently diagnosed with juvenile arthritis.

Emigration return

Emigration in Ireland soared in the 1980s as a result of a harsh recession and lack of jobs. It is estimated that during the ten years of the 1980s, 206,000 more people left Ireland.  Like a lot of Irish teenagers unable to find work and looking to leave home, Joe decided to leave Ireland for the UK. While working on a building site, he encountered other workers using cannabis.

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“Although I had my condition to contend with it, my symptoms were at their worst in autumn and winter and I went to the UK in the summer to work on building sites (I had no idea my short visit would last 33 years and counting.”

“I was brought up in Ireland with typical conservative social values. Many fellow workers on site were smoking cannabis but I had no interest and indeed felt it was both inherently morally wrong as well as being illegal.”

“For months my fellow workers would say to try some. I relented when we were out together one night as I had a few drinks so my guard was down. I smoked some cannabis. I was violently ill. I did not know that smoking cannabis with drink would have such an immediate and obvious effect.”

Emigration: A red Irish passport sitting on a black bag

Emigration, cannabis and pain

Joe began to feel more pain as winter began and his joints reacted to the cold. Despite his illness the first time, he tried cannabis again and noticed an effect on his pain levels. His quality of life began to improve and he started to make positive changes.

“I tried cannabis again a few weeks later and by this time the winter was in full flow and my bones were aching. I noticed that I was in less pain when I took it. I prayed for guidance on the issue and felt it was not a sin for me to use cannabis because it was helping to alleviate my symptoms.”

“I then started to use cannabis more frequently. When I reached 19, I no longer needed to take my prescription and I was able to cancel an appointment for injections. As my condition had relented I was able to reengage with my passion for sport and would swim a mile per day, cycle to and from work and work as a scaffolder during the day.”

“I studied A levels at night school. I returned to studies as I felt if my condition worsened I would not be able to engage in physical labour and I also had a calling to be a lawyer. Anyone who has handled scaffolding tube on a cold winters day will also understand why I felt a move indoors could be a welcome change.”

Joe did well enough in his A levels to gain a place to study law at university. He qualified as a solicitor and worked at one of the top regional practices in the country. He had the honour of meeting Irish President Mary McAleese on one of her trips to Manchester. He credits being able to live such a full life to the benefits of cannabis.

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Breaking the law

However, he was starting to worry about what could happen if his use was to become public knowledge. Especially as someone working in law.

“Cannabis had managed my condition so effectively that I was able to play football for the corporate team and had no outwards signs which could not be dismissed as being down to simple stiffness. I was concerned however that should my use of cannabis become public knowledge my career would be brought to an abrupt end.

“I was leading a double life – cannabis at the time was dismissed as having no medical use and I was afraid no-one would believe me if I said I was taking it for my arthritis.”

Joe stopped using cannabis for three years as he became fed up with breaking the law. He had also noticed attempts to change the law in regards to medical cannabis and wanted to see if he could access it legally. But his symptoms flared up as a result of him stopping his treatment.

“During my cannabis break however my arthritis flared up with a vengeance. Although now prescribed methotrexate, sulfasalazine and naproxen. During my near 30 year use of cannabis prior to this point, I needed no other drugs. Significant bone erosion occurred in this 3 year period.”

“My hands and feet were badly affected and I was unable to form a fist with either hand for about 2 years. I had to stop playing classic guitar. In addition to studying law, I also studied music and played guitar in ensembles and gave performances with others in my spare time so losing the ability to play was quite hard to take”

Joe was delighted when his prescription for cannabis was approved. After taking it for about a year, he found his condition far more under control and began to come off some of the drugs he had been prescribed. He was also able to play the guitar again.

One of the biggest things, he notes, is the feeling of being able to access his medication responsibly and not break the law.

“Cannabis, for me, does have limitations. Once I take it, I won’t drive for the rest of the day. It can give me mood swings although nothing too extreme. I can be grumpier in the mornings. I am mindful that all drugs have their side effect. I am losing my hair due to methotrexate which gives me a number of bladder issues as well as nausea.”

Emigration: two hands packing a suitcase with clothes ready to travel

Emigration and settling

Although Joe is happily settled in the UK with no plans to move home, he still has family in Ireland who he would like to visit. This presents him with an issue, how to pack his prescription?

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Going without cannabis while abroad can result in a lot of pain as Joe discovered when he stopped taking it. However, bringing it with him can result in having to again break the law. The other alternative is accessing the black market which is not safe for patients.

“My elderly parents live in Ireland and I would love to visit them. Ireland’s policy on drugs is different to that of the UK. There is nothing unusual about this as individuals states have their own laws. The UN passed the psychoactive Substances Convention in 1971. The Convention enables international travellers to bring their medication with them to other jurisdictions, even though they have different drug policies. Ireland is a signatory to this convention. The Irish State also supplies details of who to write to seek prior approval for the carriage of controlled drugs.”

Seeking approval

Joe has started an email and letter campaign of writing for help. He is not the only Irish person in the UK who has experienced emigration and wants to travel home. He encourages others to get involved.

“I have on many occasions asked both the relevant Secretary for Health and the Minister for Health for permission to travel to Ireland with my cannabis prescription and for clarification of Ireland’s drug policy for tourists and have pointed out the large numbers of people who could be affected. It’s not just persons prescribed cannabis if Customs is going to seize all controlled drugs.”

“Although nearly 6 months have passed, I am yet to receive either a formal approval or rejection of my request to travel home. In the meantime, my parents are of course getting older as indeed am I.”

There are also other concerns about using cannabis medicine while in another country besides emigrating.

Joe cautions: “To anyone who is thinking of just leaving their cannabis medication at home in the UK and then driving in Ireland, please bear in mind that in addition to dealing with withdrawal symptoms you may also fail a roadside drugs test.”

“It’s not at all clear that you will have a medical defence to a drug driving charge in Ireland. Thus if you want to travel lawfully with a car, consider not taking your cannabis prescription for sufficient time to pass a drug driving test, but obviously, this is impractical for sick people who are only granted a prescription for cannabis where other medicines haven’t worked.”

Joe advises that those thinking of travelling to Ireland with their prescriptions for CBMP should seek approval for their medication. This can be done by writing to the Controlled Drugs Unit in Dublin.

Catch up on part two: Adrienne’s story in our series on medical cannabis and emigration.

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CBD and gaming: Could CBD help you level up?

When it comes to gaming, could CBD give you a competitive edge? Always Pure Organics’ Sally Dempster explores the benefits.

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Always pure organics

Always Pure Organics’ Sally Dempster explores the CBD trend within gaming.

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Gaming Community

The gaming community is growing exponentially, from people playing casually with friends to professional esports competitors, all of whom are contributing to the phenomenal 1.8 billion (US) dollar industry. Especially with the lockdown conditions of Covid-19, the gaming industry has seen a huge surge in revenue and time spent video gaming- increasing by double digits in all regions. The increased amount of time spent gaming can sometimes lead to health problems; frequent players often report physical aches and pains, altered sleep cycles, stress and anxiety. Many of these health problems can be caused by the prolonged periods of time spent at a console or in front of a screen.

Physical aches and pains from gaming can manifest themselves in a variety of forms including carpal tunnel syndrome, gamer’s thumb, and tennis elbow. Avid gamers can sometimes fall prone to these problems which cause inflamed muscles, nerves, or tendons due to overuse.

Whilst cannabidiol (CBD) cannot cure the underlying damage caused by carpal tunnel syndrome, gamer’s thumb or tennis elbow, it may help to reduce overall swelling and it has been shown in studies to relieve inflammation. Research on CBD has also shown that the Cannabis sativa extract may, in some cases, be beneficial as a method of pain relief. Using CBD as a form of pain management could help to relieve pain from gaming conditions, enabling players to be more stress-free and relaxed throughout the natural healing process. It is important to note that using CBD as a method of pain management for acute pain will not result in instant healing; users should be aware that any decrease in pain does not equate to a fully healed injury.

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Gaming: Two men holding gaming devices playing a football game on the Tv

Read more: How medical cannabis could help with rare skin conditions

Gaming and scientific debates

There are ongoing scientific debates as to whether video games induce stress or whether they help to manage and reduce it. The answer to this debate perhaps depends on the level of investment that the player has in the game. Players who spend less time gaming or who only play for recreational and social purposes, for example, are less likely to get stressed during play compared to high stakes players or career gamers.

Evidence points towards CBD having a calming effect on the central nervous system. Taking CBD before gaming may help pre-emptively mitigate stressful feelings, this is due to the fact that CBD is a neurotransmitter that will bind to receptors in the brain. These bindings displace any anxiety-inducing neurotransmitters and stop them from binding to the receptor, which helps to restore equilibrium in the brain.

A recent study determined that video games do affect the stress system, in addition to the cognitive system of humans depending on the game style. Fear inciting games, which feature genres such as, survival, action, and psychological horror is more prone to elicit feelings of stress and tension. The research also demonstrated that the type and level of stress triggered in the players depend on the game style (Aliyari et al., 2021).

Esport competitions have closely monitored regulations regarding doping. Competitions adhere to the World Anti-Doping Agency (WADA) list of prohibited substances; players found breaking these regulations could find themselves (and their teammates) banned from competing. Cannabidiol is the only cannabinoid compound found in cannabis permitted in esport competitions.

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Although WADA has removed CBD from its list of prohibited substances it is still advised that competitors using the extract choose CBD products carefully as some broad-spectrum products contain low levels of THC which is still a banned substance in esports competitions.

As the number of gamers increases and the industry grows, player gaming injuries will become more prevalent; extracts such as CBD may prove useful in mitigating these issues. Cannabidiol could, in some cases, also aid with the reduction of stress created when playing video games. Especially at high levels of competitive esports, there is an intense amount of pressure on the players to perform; now that WADA has approved CBD for use in competitions it may be able to minimise players’ feelings of stress and anxiety while gaming.

Read more: When should you consider medical cannabis?

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CBD may reduce side effects associated with anti-seizure medications.

Could CBD help with the side effects of anti-seizure medications for people with epilepsy?

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Anti seizure medication: A brown pill bottle on its side with white pills spilling out against a blue background

A study published in the journal, Epilepsy and Behaviour examined CBD’s potential impact on anti-seizure medications for people with epilepsy.

There are 600,0000 people living with Epilepsy in the UK. It’s one of the most common nervous system disorders affecting people of all ages. It’s a neurological condition that can result in seizures. Treatment for epilepsy can include anti-seizure medication, diet therapy such as the ketogenic diet and surgery.

The side effects of medication can include dizziness, nausea, headaches, fatigue, vertigo and blurred vision.

There are medications such as Epidolex prescribed for rare seizure disorders such as Dravet syndrome or Lennox-Gastaut syndrome. However, it is not approved for other forms of epilepsy. There are around 60 different types of seizures and it is possible to have more than one type. Seizures can vary depending on where in the brain they are happening.

The study

Researchers at John Hopkins Medicine in collaboration with the Realm of Caring Foundation and other institutions conducted the observational study.

They analysed data collected between April 2016 and July 2020 from 418 patients. The participants included 71 adults with epilepsy who used artisanal CBD products for medicinal purposes and 209 who were caregivers of children or adults who also used artisanal CBD. The control group of 29 adults with epilepsy who were considering CBD and 109 caregivers who were interested in it for dependent children or adults.

Participants were asked to fill in a survey and answer questions about their quality of life, anxiety, depression and sleep. They were also given follow up surveys every three months for over a year.

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Read more: Can CBD help me sleep?

Anti seizure medication: A golden bottle of oil against a green background with a dropper dripping oil into the bottle.

The results

In comparison with the control group, artisanal CBD users reported 13 percent lower epilepsy medication-related adverse effects. They also had 21 percent greater psychological health satisfaction at the beginning of the study.

Their anxiety was recorded as being 19 percent lower and depression was 17 percent. Both the adult and youth groups reported better quality sleep than the control group.

The caregivers of patients currently using CBD reported 13 percent less stress and burden in comparison with the control group. Patients in the control group who started using artisanal CBD reported improvements in their physical and psychological health. They also self-recorded reductions in anxiety and depression.

Reactions

Participants were asked to record possible adverse effects related to their CBD use. Among all of the participants, 79 percent did not report any effects.

Of the remaining participants, 11 percent reported potential drowsiness, 4 percent said their symptoms may have gotten worse, 3 percent had concerns about the legality and 4 percent worried about the cost of the profits.

The researchers reported that further research is needed to understand how the findings could be applied to patients. They also stated that patients should consult with their doctor before trying CBD products.

Read more: When should you consider medical cannabis?

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