“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”.
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.
“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.
“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.”
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How CBD lube is heating things up in the industry
The CBD wellness industry is booming, so it was only a matter of time before cannabidiol slipped between the sheets.
The American market is overflowing with lubricants and intimacy products to help couples spice things up in the bedroom, but the trend has so far been relatively slow to catch on in the UK.
Although much of the research is anecdotal, many fans have touted its benefits, which are said to include reducing pain and anxiety during sex, increasing arousal and boosting the intensity of orgasm.
This side of the Atlantic, UK CBD producer Medivita is one of the first companies to catch on to its potential.
They teamed up with Sam David at Bnatural to launch their first lubricant earlier this month, after noticing a boom in the adult toy industry during the coronavirus lockdown.
“During lockdown, we were discussing which industries were succeeding, and the two that were performing the best were alcohol and adult toys,” Medivita director, Mike Peates told Cannabis Health.
“We saw CBD lube as a product which had to come to the UK.
“It’s a little bit different to what’s on the market at the moment. There’s a lot of cosmetics and skincare out there but only one other lubricant in the UK, so if people want CBD lube they have to import it from the States.”
Since having the idea Mike has learned how the lubricant can help women experiencing issues such as vaginal pain, dryness and irritation.
It is particularly beneficial for those with gynecological conditions such as endometriosis and vaginismus, where the vaginal muscles automatically tighten up whenever penetration is attempted.
CBD is thought to decrease inflammation, increase blood flow and help with muscle relaxation, which means it could provide welcome relief for those experiencing pain during intercourse.
One woman, who lives with both endometriosis and vaginismus, is Laura, 29, who chronicles her health journey through Instagram account The Endo Monologues.
She first tried US brand Foria – which is renowned for its products aimed at improving women’s health – in 2019.
Now Laura claims CBD lube has allowed her to enjoy having sex again.
“My boyfriend and I use CBD every time,” she said. “It helps the blood flow and reduces pain internally and around my vulva, so I can enjoy sex as opposed to finding it a really painful experience.
“I’m at a point now where I can have penetrative sex and it doesn’t hurt, which is a huge thing that hasn’t happened for a long time.”
Laura vapes CBD and applies the lube 15 minutes before the couple plan to have sex.
She explained: “There’s a warming sensation and you can feel the blood flow increasing, so there’s also that element to it, but for me, it’s more about the fact that it relaxes my muscles and it makes it less painful.
“Sometimes it’s still uncomfortable but it’s definitely helped me to overcome the fear of it hurting.”
She added: “When you live with any chronic illness which affects your ability to have sex, it really takes a toll on your mental health.
“I don’t think I’d be having sex at this point if it wasn’t for CBD. I think it’s something I would still be trying to overcome.”
Mike who has been in contact with Laura since the launch of Medivita’s lube, is now offering discounted rates to followers of The Endo Monologues who live with endometriosis.
But you don’t necessarily need to be experiencing pain and inflammation for CBD lube to boost your sex life, as wellness journalist Ruby Deevoy discovered.
She was initially dubious about trying The Tonic Clit Spritz with her partner recently but found it helped get her in the mood.
“I was pleasantly surprised by how effective it was,” she said. “I’m generally pretty dubious about putting anything on my easily-irritated nethers, so I was a little nervous when I read that this particular lube contained terpenes found in Tea Tree, Eucalyptus and Menthol.
“But I needn’t have been, it was extremely gentle and barely noticeable when first massaged in.
“The inclusion of these extracted terpenes, plus the 100mg CBD made for heightened sensitivity in the best possible way.”
Ruby added: “It’s hard to completely relax and enjoy sex with a three-year-old sleeping next door, but the CBD lube helped amplify sensation and as a result, keep my awareness wholly on the task at hand.
“It’s definitely a product I’ll be using again. In all honesty, it was the best sex I’ve had in quite a while.”
However, Ben Hofmeister, founder of UK CBD brand Kokora warned not to get too carried away.
“As CBD is a potent, natural anti-inflammatory, in the right context it can help reduce inflammation pain, and due to Endocannabinoid receptors being present throughout the female reproductive tract, it can heighten female senses,” he said, while recommending sticking to a natural coconut-oil base.
“CBD is also well known for supporting the processes to reduce stress and anxiety including promoting the production of Anandamide, commonly known as the ‘bliss’ molecule.”
He added: “I think a CBD lube can help, but I don’t think it should be relied upon.”
“If only my uterus could talk”: The story behind The Endo Monologues
The woman behind unflinching Instagram page The Endo Monologues talks to Cannabis Health about battling to get a diagnosis, using her platform to help others – and why she shouts about CBD at any opportunity.
Laura – as she’s known to her followers – asked me not to reveal her surname as she prefers to remain anonymous.
It might seem odd for a social media star with almost 6,000 followers to shy away from the limelight, but it’s not Laura they’re there for – it’s Patricia, her angry uterus.
The 29-year-old, who has endometriosis – a chronic condition where tissue similar to the lining of the womb starts to grow in other places and reacts with the menstrual cycle each month – launched her Instagram account The Endo Monologues at the turn of 2020.
It came about after a few too many drinks on New Year’s Eve (as all good ideas do) and an upsetting incident at work where a colleague assumed her bloated stomach was a baby bump.
“When I have a flare I bloat and it tends to look as if I’m pregnant,” says Laura.
“I thought, that is a really offensive question. I was telling my friends about it at the pub and I said ‘if only my uterus could talk’.
She adds: “After a couple too many, I announced I was going to start a blog from the perspective of my uterus.”
The satirical diary of a woman and her reproductive organs as they battle endometriosis, adenomyosis, vaginismus and vulvodynia was born.
Endometriosis is the second most common gynecological condition in the UK, affecting around one in 10 UK women – although frequent misdiagnosis and a lack of understanding and awareness mean this figure could well be higher.
Symptoms include pain, nausea, intense fatigue and in some cases infertility – with sufferers experiencing heavy, excruciatingly painful periods, and many like Laura being completely debilitated by their menstrual cycle each month.
It takes an average of seven and a half years to get a diagnosis. Laura battled for around a decade before she got hers.
“I started my period when I was 11 and they would last two or three weeks at a time, but my mum and grandmother all had a similar experience so it was just perceived to be normal in my family,” she says. “I just pushed it to the back of my mind.”
Over the years medics dismissed her as just having ‘bad periods’, but by her early 20s they were leaving her bed-bound each month, she was missing university and it was becoming painful to have sex.
Still, Laura says she wasn’t taken seriously, with one doctor suggesting it was a result of her ‘being promiscuous’.
Others ran tests which appeared to come back clear. All returned with the same conclusion – she just had heavy periods.
It wasn’t until a routine check-up for the contraceptive pill where a nurse mentioned a note on her file of suspected endometriosis.
“I had absolutely no idea what she was talking about,” remembers Laura.
“After that, I was rushed through and referred to a gynaecologist.
“In August 2016, I had a laparoscopy and there was endometriosis on both my ovaries, bowel, bladder and my pouch-of-Douglas and it was stage four – so really deep infiltrating endometriosis.”
In January 2019 Laura travelled to London to visit a stockist of the US brand Foria, which is renowned for its products geared towards supporting women’s health.
“I don’t like taking painkillers and I had smoked cannabis before in Amsterdam and it had helped with my symptoms, so I thought I’ve got nothing to lose at this point,” she says.
“I ended up buying the CBD lube and a vape.
“In the last year I’ve started to explore more CBD products and I’m actually at a point now where I barely ever take pharmaceutical painkillers, I can rely completely on CBD.”
Laura now takes around 30-40mg a day – upping her dose if she’s having a particularly bad pain flare – and uses balm and muscle cream on specific areas.
Meanwhile, CBD lube has allowed her to have penetrative sex with her boyfriend again.
“I have vaginismus [when the vaginal muscles automatically tighten up whenever penetration is attempted] that came as a consequence of having really negative experiences with pelvic exams, so not only did it hurt to have sex, but I was also involuntarily tensing,” Laura explains.
“We use CBD lube every time now and for the most part it relaxes me, I can actually enjoy having sex.”
Laura’s boyfriend, who she has been with for most of her post-diagnosis journey, is one of the few people who know about her secret internet identity.
The Endo Monologues, which began as a personal wellbeing project, is now a place thousands of fellow sufferers turn to for advice and a sense of community.
“It just exploded – the fact that I’m now near to 6000 followers just absolutely blows my mind,” she says.
“It’s helped my wellbeing tremendously but it’s also really connected me to other people. I’ve made some really lovely friends and get messages every week from people thanking me.”
Laura continues: “I feel very privileged that people trust me and ask for my advice because there’s a lot of misinformation out there.
“I feel like it’s my responsibility now to spread awareness and make sure people get the right support and education.
“It’s not just a wellbeing project for me anymore, it’s a port of call for people to get information and that’s something I feel really strongly about.”
Laura also uses her platform to share recommendations and reviews of her favourite CBD products, with brands queuing up to feature on her blog.
“I never expected to have so many companies contacting me,” she says.
“I have become really passionate about it because it’s made such a difference to my life. CBD means I can function on a day to day basis. If I forget to take it for a day or two, I literally can’t get out of bed.”
And she’s the first to admit she will mention it at any given opportunity.
She laughs: “Whenever I get asked for recommendations I’m just like ‘have you tried CBD?’”
Find Laura at www.theendomonologues.com and on Instagram @theendomonologues
Slow and steady wins the race – a Q&A with the CBD Sloth
Tom Bourlet – aka the CBD Sloth – tells Cannabis Health how his award-winning blog became the go-to place for those wanting to know more about CBD.
Tom Bourlet has only been using CBD for 18 months, but his blog the CBD Sloth is renowned for helping people find the right product for them.
It won the Media of the Year award at the Cannabiz Summit in Malta just six months after it launched in early 2019 and Tom was invited to be a judge in the CBD category at the Men’s Health awards.
Here he reveals how much the industry has changed in such a short space of time – and what he’s learned so far along the way.
Tell us a bit about you, what’s your background – and do you have a ‘day-job’?
As well as CBD Sloth, I have worked in marketing for a decade now and outside of the CBD world, I’ve been writing my travel blog www.spaghettitraveller.com for seven years.
How did you discover CBD?
I was doing some freelance work with a beauty brand that was considering launching some products that would contain CBD. I didn’t know much about it at the time so I began researching.
I became transfixed with the potential of cannabis and how it was being used to help people with various ailments. But I was also frustrated by the limited levels of regulations in place and felt nervous to try CBD oil, with negative stories coming from brands that didn’t have high standards. I even found a few CBD brands that refused to provide their lab reports – which would hint that they might have lower levels of the cannabinoids they’re stating, they could have pesticides present in the oil or they might not even have a lab report to show.
Why did you set up the blog?
I wanted to provide a place where people could quickly check whether the brand provided lab results and what the certificate of analysis showed, a place where the brands were held accountable and where I could offer real, genuine advice without an ulterior motive.
I still think there needs to be a greater level of transparency from brands. Every time I talk with a brand I’m reviewing, I try to offer advice if I don’t feel their website is offering everything the customer needs to know.
Did you feel people should have somewhere reliable to turn to for advice?
CBD products cost such a large amount of money and people are putting their trust in these brands. When I review products or where I list the best CBD brands, I’m not basing my opinion on anything commercial, I’m basing it on how well it worked for me and whether I feel they’re providing the best quality product at the right price.
I have found that paying a higher price doesn’t necessarily mean a higher quality of product. Some brands overprice their products and call them ‘premium’ without any real differentiation.
How has CBD helped you?
Before CBD, it used to take me around 40 minutes to fall asleep at night. I’m not going to say I fall asleep the moment my head hits the pillow, but it now takes around three to five minutes. CBD isn’t sleep medication, it doesn’t make you tired or drowsy, but it completely alleviates any stress or anxiety in my mind, which allows me to drift off without a million thoughts going through my head.
Are you surprised by how much the blog has taken off?
Surprised would be an understatement! It is becoming increasingly clear that there are a huge amount of people asking questions around CBD and predominantly landing on brand pages, which are trying to sell to you, so I loved offering an unbiased viewpoint and sharing my experiences with others.
It has been an amazing journey and I’m keen to see where it takes me in the years to come – the website traffic has doubled in the last three months alone.
What have you learned since you started out?
There is a real community feeling within the CBD industry. CBD brands are not all started by entrepreneurs trying to make a quick buck, but are often set-up by people trying to find a solution to a health issue they or someone close to them has.
I’ve also learned that brands will mix CBD into anything. I’ve tried CBD coffee, tea, gin, rum, honey, brownies, flapjacks, chai latte and chocolates. I’m not sure what’s next but I’m always guaranteed an occasional surprise.
I’ve recently begun learning more about the other cannabinoids present in cannabis, of which they all have their own set of benefits and potential uses as treatments, but we need a lot more test studies into them in order to fully understand their potential. CBG is probably the fastest-growing behind CBD – I can see CBG oil being a huge seller in a number of years.
Find Tom’s blog at https://www.cbdsloth.com/
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