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“Acceptance is only a matter of time”

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When cannabis for medicinal purposes was legalised in November 2018, the hope, or rather the expectation, was that anyone in need of the drug as a means of improving their quality of life could now receive it. 

However, since that momentous change in the law, for many people, little has changed. The struggle to access the cannabis they believe could well transform their life – based on the evidence-based testimonials of many other patients – remains very real. 

Some of the frequently-cited issues in accessing cannabis are the cost – prescriptions for some can cost more than £1,000 per month – and continual resistance from many within the medical profession.

Stories from patients of their doctor reacting in shock at their desire to try medical cannabis are common; and their mission to obtain the prescription they so badly want ends at that point. 

These are issues Dr Samuel Murray comes across frequently, and which he is helping patients to overcome. As director of Cannabis Access Clinics, an Australian prescribing clinic which now has a base in London’s Harley Street, he has seen it all before in his native country. 

Since cannabis was legalised there on a federal level back in 2016, a huge amount has changed in terms of attitudes towards the medicinal drug, particularly among the medical community. 

“Australia is roughly two years ahead of where the UK is now and I do think the situation here will change over time, as it has done in Australia,” says Dr Murray. 

“Most patients in the UK contact us directly, but in Australia 90 per cent are referred from their GPs, so that’s quite telling in itself.

“As more evidence becomes apparent and more people show the benefits, that will play a big role.

“Even the most hard-nosed, evidence-driven GP will surely take notice of these benefits once they see the effect on one of their patients who has struggled with chronic illness. The difference this can make to their quality of life is huge.

“It’s not a magic cure and might not work for everyone, but it should be an option for people.

“I believe is a person is being treated for their GP and they can’t offer any other alternatives, then absolutely medical cannabis should be considered if there is a possibility it can change this person’s life.” 

As someone who regularly prescribed cannabis in Australia, and has seen many instances of how the results have been life-changing for patients, Dr Murray frequently offers to impart the benefit of his experience to fellow, less accepting, medics. 

“I always offer to speak to someone’s GP directly if they have doubts, as it is still a very new concept for many of them, whereas it is an area I have prescribed in widely. Some respond really well, some still don’t, but I do think it’s a situation that will change. It’s a matter of time,” he says. 

“I appreciate there is a big barrier as far as GP education goes. I studied at graduate medical school quite a few years ago now, but the cannabinoid system is still not something that is taught, it’s just not acknowledged at all in education. That is something that will hopefully change too.”

Having become a pioneer of widening access in Australia, Cannabis Access Clinics is helping to do the same in England, with Dr Murray and the team of prescribing doctors being a lifeline for patients who have felt they have nowhere else to turn. 

The COVID-19 pandemic has seen even greater numbers of patients contacting the clinic, in desperation after their NHS appointment was cancelled. In response, Dr Murray and the team have introducing consultation by video, allowing them to easily interact with patients across the country.  

“Until recently, we have held all of our consultations in person in the UK. Video consultations are used widely in Australia and they work really well. It’s something we have pushed for in the past here, but now we’re being enabled to do so through the circumstances and they’re working really well here too.  

“A lot of our new patients have had appointments cancelled with their pain specialists, or can’t see their GP for their repeat prescription, and they are looking for alternatives. We have had women coming to us with endometriosis, in tremendous pain, and they can’t get an appointment anywhere else.

“I’d say patients by and large prefer video consultation, it’s very simple. You follow a link sent to you by email and there is a doctor there waiting to speak to you.”

While video consultation is a ‘needs must’ measure at present amidst COVID-19 social distancing measures, it is something Dr Murray believes should become much more commonplace. 

“COVID or no COVID, it’s not always the best or safest option for people to travel to see us if someone is suffering from chronic pain or mobility issues.

“In the past, our patients have been from London, with very few exceptions to that. But in the past few weeks, we have had patients from across England and Scotland,” he says. 

“While the situation can be different with patients with acute conditions, they are patients we would probably prefer to examine in person, but with chronic conditions consultations via video are normally more straightforward. 

“We are hopeful that this period will lead to new opportunities in how people are able to access their medical cannabis, and that it is realised how effective and positive video consultations can be. We hope the use of video will be embraced more widely than it has been previously.”  

As well as enabling access to a prescribing doctor, Cannabis Access Clinics also wants to make cannabis more accessible price-wise, so those who do qualify for a prescription can actually afford to obtain it.  

“We regularly hear stories about prescriptions costing £1,000 a month, but as an average, our patients can expect to pay between £150 to £200 a month. Some even less although some will be more, it depends on the individual circumstances of the person and their treatment. We continue to be surprised to hear what some patients are charged elsewhere.  

“I think as more companies enter the UK with bulk imports, this helps to make cannabis more affordable. I think this will help to change the price for the longer term, prices will inevitably come down, but we are pleased to be one of the leaders in offering accessible pricing. We aren’t tied to any one producer or company, so this helps to make things more affordable.

“We have also recently introduced a free initial consultation, which helps people to understand their eligibility for treatment without having to commit. We know that in some clinics this alone can cost a lot, without even getting to the costs of the prescription. 

“We want the process to be about accessing cannabis in a timely and affordable manner, so all of the appropriate checks and assessments are made and costs are kept down.” 

Alongside evidence from patients, and greater awareness and education of cannabis and its effects, Dr Murray believes more accessible pricing will be another key factor in its wider acceptance within the medical profession. 

“I do believe cost has also been an issue for GPs as a cannabis prescription can seem completely unaffordable. 

“If some patients are accessing their NHS prescriptions for free or a few pounds, then others could be paying £1,000 a month for cannabis, then that is a huge difference. Understandably, GPs are trying to look after their patients’ best interests from both a health and financial point of view, and when those kinds of sums are involved, it is very difficult for some to find any acceptance of that. 

“I think as the costs come down, which they inevitably will and are starting to do now, they will become more open to the idea.” 

While Cannabis Access Clinics has attracted widespread attention for its efforts to widen access to cannabis during the COVID-19 pandemic, it hopes to continue to do that and enable those for whom cannabis could be an option to at least explore that further. 

“Our aim is to improve access to specialist doctors who prescribe medical cannabis to patients in need, and that’s what we will continue to do. 

“It’s great we are able to help people at the minute during the COVID pandemic, but this is what we do. Video is working so well and whereas before we had one patient from Scotland, which was a real exception, now we have a number and can hold consultations with people wherever they are. That is something we very much want to continue.” 

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You are what you eat

When it comes to CBD, most people think of balms and oils, but snacks containing the active ingredients are growing in popularity.

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When it comes to CBD, most people think of balms and oils, but snacks containing the active ingredients are growing in popularity. Cannabis Health finds out more.

Britain is a nation of snackers. With 66 per cent of the population snacking at least once a day, the appetite for new products is growing all the time.

And one of the largest growth markets is in so-called ‘healthy’ snacks, although some may feel this is somewhat of an oxymoron.

Nevertheless, with the way we eat changing – increasingly busy lifestyles mean more and more people are eating on the go – consumers are looking to get more out of their snacks than just something to eat.

Kale chips, rice cakes, protein bars – these have all risen in popularity over the past few years, as snackers look for something that offers them something in the way of nutritional value.

Research has found that 44 per cent of adults see snacks as a good way to boost their nutritional intake – and with only half of Britons getting their recommended five a day, healthy snacks play a growing role in helping the nation make healthier choices.

With a health-conscious audience keen to try new things and a variety of innovative – and tasty – foodstuffs available, it’s fair to say that CBD snacks have definitely found their time to shine.

Epicurium is a health food distributor based in Consett, County Durham, which has been selling innovative, on-trend snacking products since 2011.

Always keen to offer retailers and consumers something new, the site has been stocking a range of CBD products for nearly a year now.

Customer engagement manager Michael Ratheram explains: “Research has found that about ten per cent of UK adults have tried a CBD snack, and four in ten Millennials would be willing to try CBD in a soft drink, so the demand is obviously there.

“We sell two CBD-infused drinks brands – Leaf Life and Drink420, along with a baked oat bar called Nooro – all are very new to market as you’d expect.

“The market is still very much at the early adopter stage; a year ago, CBD may not have even been on shoppers’ or retailers’ radars – some will have likely have never even heard of it!

“Having said that, the products we stock have been remarkably popular from the get-go – with about 10 per cent of our customers stocking the range.”

As those familiar with CBD will know, one of its principal uses as a health food supplement is for stress and pain relief, and this is as true for snacks as it is for the more traditional oils and balms.

As Epicurium trading manager James Christie explains: “One of the reasons for the popularity of CBD drinks and snacks is the health benefit. People are using these products to relieve physical and mental pain, such as stress, anxiety and insomnia, and so they’re more than happy to swap a sugary, less functional drink for one that satisfies their thirst and gives them something back.”

Consumers’ growing sense of adventure and desire to be different also plays a part, with buyers always looking for the next big thing.

“Today’s shoppers want more than a standard can of pop and chocolate bar,” says Michael. “Instead, they are open to more adventurous ingredients and healthier versions of sugar laden or more mundane options.

“They’re paying closer attention than ever to ingredients and health benefits, demanding more exciting flavours whilst not compromising on taste, and this is all opening up fresh opportunities for growth in the independent sector.”

Of course, CBD is not without its issues – the comparison with cannabis still endures and many consumers are wary of infused products, with ongoing legislative issues adding to the confusion.

Michael says: “I think above all else, there’s still confusion whether or not it’s classed as an age-restricted purchase for retailers to offer, as well as some concerns around legalities due to a lack of understanding.”

James adds: “We find a lot of customers are concerned over certification and still associate the negativity of cannabis with CBD. However, with the novel food classification coming in in March 2021, we will finally see the grey areas removed, with 74 per cent of people supporting the guidance on the subject.”

Despite the concerns, demand for CBD products continues to grow, particularly among younger consumers and those more attuned with what’s on trend – a fact borne out by the types of retailers buying Epicurium’s stock.

Michael said: Our typical customers are likely to be the early adopters and forward thinking retailers –university campus stores, convenience stores in city centre/transient locations, online snack subscription retailers – it’s those agile businesses who want to keep ahead of the curve.

“Universities are always very eager early adopters of new and innovative products, as it’s the perfect fit for their consumer base; it’s new, it’s in the limelight and with Gen-z and Millennials leading the charge in healthy snacking, it’s the perfect item to stock.”

While CBD oils and balms are still popular, particularly for those looking for relief from physical pain, an increased focus on nutrition, combined with a stressed and anxious population in need of new ways to relax, mean CBD snacks may have found themselves in the right place at the right time.

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Enterprise and education – a CBD story

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Mike Peates, founder of Medivita

From selling personalised chocolates to CBD balms and edibles, Medivita founder Mike Peates tells Cannabis Health how his latest venture was inspired by his chronic pain.

As a salesman, Mike Peates was used to spending hour after hour in his car, travelling around 25,000 miles a year.

And when he stopped to set up his own business, making and selling personalised chocolates with company logos printed on them, he found the problem only increased, as he spent up to five hours a day standing.

“The final quarter of the year, from October through to January, would be my busiest time, and I’d be spending most of my working day on my feet,” he says.

“I already had chronic back pain from my years spent in cars, and, over the five years, I had the chocolate business, it just got worse and worse.

“It got to the point where I’d come home from work and I’d be lying on the floor for about an hour to try to straighten my back out. And then the next morning, it’d be very much a question of, ‘okay, how do I move to even just get out of bed?’.

“The pain was so bad; it was a question of doing every action in stages, like pushing a chair back, then standing up, then managing to walk and get out of the house and do a full day’s work. And I managed all this for a couple of years.”

It was a chance remark on a Facebook post that prompted Mike to look into alternative remedies for his pain – despite being a self-confessed sceptic.

He said: “I saw a post from an old school friend about a health food shop in Lincolnshire that was moving to larger premises in order to stock CBD products.

“I happened to be off work for a few days at the time and so I ended up in a bit of a Google wormhole, researching what CBD is and what it could be used for.

“And to be honest, I was the biggest cynic ever in regards to what I’d call ‘herbal medicine’ in inverted commas, I always thought it was just one of these fads people are joining up to more and more.”

However, Mike’s curiosity was piqued, and, having thoroughly researched what would be the best product to start with, he decided to give it a try.

“I must admit, the price was a little off-putting, and I was concerned it was quite an expensive way to try it and for it not to work, but then I thought, why not?

“So, I ordered some; it arrived the next day, and I told myself to be open-minded and give it a go.

“Well, I took a couple of drops and within 20 minutes, I could feel a huge difference. I mean, it wasn’t just like taking the edge off the pain; the pain almost disappeared. And that was just my first dose!”

Mike continued using the CBD – “it was just the case that it really, really worked for me” – while working on a project at a tech incubator hub in Basingstoke, where he lives. In need of a little extra cash, he began reselling the CBD he was buying online to family and friends, which was the catalyst for his latest venture.

He explains: “I got talking to my mentor at the tech incubator about it and said, ‘look, I’ve been doing this, I’ve sold about £700 in the first few weeks without even doing any marketing’.

“Now, he knows what he’s doing – he founded two businesses which he exited very successfully – and he suggested we sit down over coffee and have a chat about it all.

“So, one Saturday morning, we have that meeting, we came out and we decided we were going to set up a CBD business together.

“It wasn’t a quick process – it took most of the summer to actually choose a name and choose the branding – but by September we were ready and Medivita was born.”

Mike admits it took a while to get established, and both he and his business partner were keen to ensure they got the right product, which is where his own experiences proved invaluable.

“Because I’d taken CBD before, I knew what worked, but we went through about six or seven different samples of CBD oil before we before we decided on the one we now sell,” he says.

“We knew we wanted full spectrum (a variety typically high in CBD, with only trace amounts of minor cannabinoids, and very low in THC, the main psychoactive compound in marijuana). We knew we wanted it to be full plant and we knew that it actually had to work when I tested it – it actually had to deliver some benefit from taking it.

“To be honest, there were a few that I had which left me just feeling, ‘well, it’s okay, but it’s not great, it’s not just quite hitting the spot’. And supply wise, even a year ago it was actually quite difficult to find people wholesaling and white labelling (the practice of putting a different brand on a product than that of the original producer). I think in 12 months that has really, really changed, and it’s now a lot easier to find wholesalers and white labels.”

Since then, the business has gone from strength to strength, but Mike is keen to stress that Medivita is not simply about selling a product – he works with a number of groups to help them understand the potential benefits of CBD.

He explains: “We sell online and we sell quite a lot locally, but we also do a lot of work in the local area with the Basingstoke Disability Forum, doing talks at their events, to educate people.

“That’s why we closely follow the likes of Professor Mike Barnes and Dr Dani Gordon with what they do. It helps to keep ourselves up to date with what’s happening, but it’s also useful to have that knowledge when people ask us, not simply about our product, but about CBD levels and THC levels and the endocannabinoid system, and so forth.

“We want to become people who consumers can trust, through knowing what we’re doing so that we can give best information and let people make a really informed choice, rather than just buying the cheapest bottle on the shelf.”

Mike is aware of the cynicism surrounding the use of CBD as a food supplement, but, as a former sceptic himself, he is able to relate to a level of mistrust.

“When we’re talking to disability forums and the like, we are met with quite a bit of resistance – which I understand,” he says.

“We do find that because a lot of the people we speak to are on a full regime of medication, they can be quite reluctant to try something new. I remember one lady in particular from when we attended the Chronic Pain Forum, who we’ve just had a testimonial from.

“In January, I went to a meeting and met her, and in May, she bought her first bottle – so that was four months from me seeing her to her deciding to buy some. 

“And you know, she had exactly the same experience as me; as soon as she tried it, she was sleeping better, her pain was better, she’s a lot less stressed. And she wrote and told me, ‘You know, I was a cynic, when I saw you that night and I didn’t believe it’.

“So, we can definitely turn people’s opinions around, but we still meet with resistance.”

As for the future, Mike hopes to see more clarity in the industry, giving consumers the ability to make informed choices.

He said: “My vision, as a consumer as well as a seller, is getting to the point where consumer confidence is there, and I don’t think it is at the moment. I think that’s why some CBD businesses struggle, because we need clarity of labelling, we need clarity of what’s in the bottle, backed up with the lab reports on websites – very much like with alcohol, where, if you go and buy a bottle of wine or a bottle of beer, you can tell how much alcohol is in it.

“I think we need to get to that sort of standard whereby a bottle of CBD tells you exactly how much CBD is in there and how much THC is in there, so that people can make that informed purchase.

“If things continue as they are, then we may get to a position where a lot of CBD is synthetic, made by the pharmaceutical companies and that, from a consumer point of view, isn’t possibly the best way forward.

“In the industry, we know that the natural product is the one that works, and that should be what’s being promoted to the consumer.”

Whatever happens within the industry, Mike says Medivita is here to stay: “We’re quite small at the moment, I make no bones about that, but we’ve got plans to grow.

“We’re not in it for the short term, we’re in it for the long run; we’re not just interested in making a quick buck overnight.”

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Could CBD really boost fertility?

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Cannabis Health reports on cannabis oil’s rising prominence in the lives of people hoping to start a family.

With data showing that around 1 in 7 couples in the UK struggle to conceive, and alternatives such as IVF proving costly, many couples are keen to try alternative methods to help them on their journey to parenthood – including CBD oil.

While there may not be much official guidance and advice surrounding the correlation between CBD oil use and enhanced fertility, some studies suggest the oil could play a role in increasing fertility in couples who previously struggled to conceive.

This shouldn’t be confused, however, with the intake of Tetrahydrocannabinol (THC) through smoking weed, which is shown to have damaging effects on fertility. Previous studies have shown that smoking cannabis can result in reduced testosterone levels and poor sperm count and mobility, making it much more difficult for men to conceive naturally.

Research into CBD and fertility is emerging, with early studies, plus anecdotal evidence from patients showing a potentially positive link.

Firstly, let’s talk science and hormones. Studies have suggested that CBD oil can play a vital role in hormone balancing for both men and women, aiding in the success of conception.

Researchers at the Paediatrics Department at Vanderbilt University said: “The life of the egg and the beginning of a pregnancy, depends on a healthy endocannabinoid system.”

Elsewhere, in the paper ‘The role of the endocannabinoid system in female reproductive tissues’, researchers state: “While the ECS is known to modulate pain and neurodevelopment, it is also known to impact the female reproductive system.”

Various other papers have also indicated a positive correlation between a balanced ECS and improved fertility, in particular the benefit of a specific amount of the endocannabinoid anandamide.

In women, high levels of anandamide – a type of endocannabinoid found in the body – occur at ovulation and are associated with a successful pregnancy, where low levels or a deficiency can be detrimental.That’s where CBD can begin to have an impact, boosting anandamide levels by preventing its breakdown and supporting successful ovulation.

However, timing is everything for in this relationship. Low levels of anandamide are required during embryo implantation, meaning use of CBD after conception may have a negative interference with the pregnancy.

Cannabinoid receptors have also been found in female ovaries, including granulosa cells or follicles cells of secondary and tertiary follicles.

According to researchers from the University of Naples, Italy: “Cannabinoid and adrenergic systems coordinate together oviductal motility for normal journey of embryos into the uterus.”

Researchers in Canada also found that CBD can have a positive impact at the very start of conception, linking female sexual arousal to activity in the endocannabinoid system.

Meanwhile, research conducted by Dr. Hans Hatt at Ruhr University in Germany has found a link between CBD and the impact on male fertility.

The study found that a receptor (GPR18) previously thought to be part of the ECS is also present in sperm cells, providing a link between cannabinoids, the ECS and fertility.

Evidence suggests CBD may play a key role in an essential biological process for procreation called the acrosome reaction.

When the GPR18 receptor in sperm cells is activated, this acrosome reaction is triggered, altering the sperm slightly to remove the protective ‘cap’ on its head and allowing it to effectively penetrate the egg.

While more research is needed, early indication is that CBD can positively impact the chance of conception in both parties.

Anyone who has had difficulty to conceiving will know that mental health can often have as much of an impact as physical causes.

Stress, anxiety, depression and other mental health conditions can have a hugely negative impact on fertility in both men and women by lowering hormones necessary for egg and sperm production.

Again, this is where CBD can help. It is widely reported this can directly activate serotonin (the ‘happiness chemical’) receptors, helping to boost mood and relax both partners.

CBD has also been found to regulate cortisol secretion, the stress activating hormone. Among other things, stress can also delay ovulation, making it difficult for women to attempt conception at their most fertile.

So, while research and guidance from industry bodies is still emerging, preliminary studies are showing a positive relationship between the use of CBD oil and fertility.

With ever-increasing sales, it seems more and more are opting to try something new on their journey to parenthood.

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