Dr Rebecca Moore: “The way medicine is gendered drives women to look for another option”

Dr Rebecca Moore is a psychiatrist who has supported hundreds of patients to access cannabis medicines. She reveals what it was like leaving the NHS to “push the boundaries” of medicine and give people living with mental illness another option. 

“It did feel a bit scary,” admits Dr Rebecca Moore, of her decision to begin prescribing medical cannabis two years ago.

“It was brand new, people didn’t understand it and a lot of colleagues were very opposed to it. I had to be brave and trust that I knew why I was doing it.”

Dr Moore, who specialises in trauma, anxiety and mood disorders, first became aware of the role of cannabis treatment in patients with PTSD around five years ago, while working as a psychiatrist in the NHS.

She secured a Winston Churchill Fellowship to travel to the US and see first-hand the work being done with veterans experiencing trauma – and whilst there witnessed the explosion of this new field of medicine.

“I was struck by the veterans who had lived with chronic trauma and were reporting all of these amazing changes in their lives,” she remembers, and so naturally when she could see medical cannabis gathering traction in the UK she was keen to be at the forefront.

“It held such amazing possibilities for people who had lived with trauma symptoms all their lives,” Dr Moore continues. 

“I come from a long career working with women, where a lot of mental illness stems from trauma of one form or another and I was fascinated by the fact that we have something that could profoundly change people’s lives. It felt something that I really wanted to be part of.

She adds: “I’m always keen to kind of push the boundaries of medicine and it really feels like this is doing that.”

In 2019, Dr Moore made the decision to leave her position in the NHS and join a newly-established clinics group, The Medical Cannabis Clinics as a prescribing doctor. 

Since then the clinic has grown from a standing start to having the largest network of cannabis prescribers, and with over 1,500 patients through its (virtual) doors in the 12 months is currently thought to hold more than 60 percent of the UK market.

“It’s been a massive learning curve, and I am grateful to have a really supportive team,” Dr Moore says of the experience.

“People in the cannabis community are very generous in terms of sharing their knowledge and expertise, but the other big difference is the patients in this field are the most unbelievably switched on group.

“It was quite an unusual experience where initially they knew way more than me, so it’s been an amazing to learn from people who have been using this themselves for years.”

While it wasn’t easy to turn her back on the NHS, where she had worked for more than 20 years, Dr Moore felt patients weren’t being offered all the options. 

“The NHS is amazing, without question, but as clinicians you often have to work within quite a narrow framework,” she continues.

“In psychiatry, we have to be honest about the fact that a lot of our treatments medicine-wise don’t work for everybody – they are only effective for about two thirds of people, so there is still a third of patients that are seeking a treatment.”

She adds: “Therapy, antidepressants and traditional medications, all have their place and for some people those things are utterly life-changing, but ultimately it’s about choice.

“I feel strongly that people should have access to all of the potential treatment options.”

However, many colleagues were critical about her decision to prescribe cannabis, particularly for the treatment of mental health conditions, an area still shrouded in a great deal of stigma. 

“I think we need more education full-stop, but mental health is particularly controversial because of the historical literature around cannabis causing psychosis – but it’s much more nuanced than that,” she says.

“Certainly from colleagues I’ve had lots of critical comments… colleagues who might work on an inpatient ward and see lots of people coming in with drug-induced psychosis and not understand anything about the subtleties of prescribing.”

Dr Moore adds: “Cannabis still has a lot of stigma attached to it, but it is more acceptable for pain or end-of-life care than say for somebody with depression.”

But aside from being at the forefront of a whole new field which she believes will “revolutionise medicine”, what drives Dr Moore most is the results she sees from her patients. 

“Truthfully, every month I’m seeing patients who report that cannabis has been life-changing – you just don’t see that very often with other treatments,” she says.

“It’s particularly good for people who have a combination of things going on, so they might have ADHD, anxiety, a bit of low mood and poor sleep as well. Traditionally, they would be on five different drugs, all of which cause side effects, but instead you can get them onto one oil which has none.

“When a patient who has been housebound and crippled with anxiety and depression, tells you they’ve got a job, it’s unbelievable.”

When we speak, it’s the run up to International Women’s Day and as a doctor who has dedicated much of her career to women’s health, I can’t help but ask about her views on how women are represented in the cannabis sector.

She responds: “There’s quite a few women in this field, I actually think it’s more equally matched than traditional medicine, because women are bold and brave, right?

“It’s great to have women peers prescribing, they are brilliant, dynamic and forward-thinking, as are the men in this field.”

But she also believes the pull for women to prescribe cannabis stems from their own experiences and insights into implicit bias in medicine and healthcare. 

“I think a lot of it comes down to how women are often treated themselves,” says Dr Moore.

“A lot of people come to us with stories of not being heard and of being dismissed, particularly from young women presenting with pain and perhaps unusual symptoms, with some form of mood component.”

She continues: “There’s definitely something about the way medicine is gendered, that does bring people to look for another option in medicinal cannabis.

“A lot of women have been told they’re depressed when clearly they are not, or have been told that their pain can’t exist… I think it drives them to see cannabis as a route where they might be validated.”

There’s no doubt that Dr Moore was “bold and brave” to give people another option, how can we encourage other healthcare professionals to do the same?

“There is still a lot of work to be done, but things are inching forward,” she says.

“A lot of colleagues are curious about cannabis so we just need to make sure that we are informing people in a really high- quality way.”

To that aim, Dr Moore is a prescriber for Project Twenty21, out of desire to help patients access more affordable cannabis treatments and be a part of building Europe’s largest body of evidence for their effectiveness and tolerability.

“Clearly, there are issues around cost and access and I really hope that this is something that gets integrated into the NHS in the next decade, because it feels like such a potentially life-changing way to prescribe for people,” she adds.

“It’s hugely exciting… this whole field will revolutionise medicine.”