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

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Dr Moore left the NHS in 2019 to join the The Medical Cannabis Clinics as a prescribing doctor

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.”

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Advocacy

How do I access a medical cannabis prescription?

Two experts discuss the process of accessing a medical cannabis prescription

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Medical cannabis prescriptions: A pair of hands being held out. One hand has pink and blue pills in the palm and the other has cannabis flower. The person wears a white lab coat

Curious about accessing a medical cannabis prescription? It can be difficult to know where to start or what to expect.

Cannabis Health News editor, Caroline Barry, who has a medical cannabis prescription for ADHD, and Dr Jean Gerard Sinovich, medical director of the Cannabis Access Clinics discuss how the process works.

When I decided to get a medical cannabis prescription, I had exhausted all the other options. I had tried prescription drugs for ADHD like Ritalin with little success over my teenage years before moving to various therapies as an adult.

I tried holistic approaches such as acupuncture or CBD which improved my sleep and anxiety but did little to my hyperactivity. Eventually, I reached out to the NHS for medication before having no luck.

Prepare your paperwork

I found a clinic in the UK that offered cannabis prescriptions for ADHD and reached out to them for assessment. The first thing I needed to do was collect my paperwork. As I already had my diagnosis from a psychiatrist, I needed to get proof of this along with which medications I had had over the years.

Dr Sinovich said: “To be assessed for medical cannabis, you need to apply to a clinic either directly or through your GP. We normally advise people to get a full medical history from the GP as to what medications they tried in the past. The person is assessed on an individual basis to find out what the patient is presented with and who specialises in that.”

He continued: “The aim of medical cannabis is to improve your pain, sleep and mood. Patients would have had to have tried other conventional medications for their conditions. If they have exhausted most possibilities and avenues then they could be assessed for medical cannabis. It doesn’t mean that every patient who comes to the clinic is prescribed cannabis.”

Prepare for your assessment

When it was time for my assessment, I was actually really nervous. When you are speaking to doctors, it can be extremely nerve-wracking to accurately get across the level of pain or discomfort you are in. I find that because my ADHD is not visible, I worry about being believed or qualifying for medication. Having had no luck with conventional medications, I was worried that this was my last resort and I wouldn’t get a prescription.

My assessment was with a psychiatrist online. A lot of medical cannabis clinics are based in London which I am not. It’s one of the few positive things to come out of Covid-19, that we have held on to telemedicine.

My appointment was very thorough, but none of the questions were difficult. The feeling of relief when the doctor said he thought I qualified was immense.

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Dr Sinovich added: “The consultation process normally lasts anything from half an hour to 45 minutes where we go through the medical history, what their aims are, their views and why they decided to access cannabis at this stage in their life. We also have to make sure there are no possible interactions with any of the other medications.”

Medical Cannabis Prescriptions: A doctor in a white lab coat signed a prescription. In front of him, there is a yellow bottle with oil in it next to CBD capsules and a cannabis bud

Costing out medical cannabis prescriptions

Dr Sinovich highlighted one of the key issues with accessing medical cannabis which patients need to be aware of – the cost.

“The most important thing is that it’s not [widely available on the NHS] so it’s all privately funded. People must be aware of the costs that it entails,” he said.

“It takes time for cannabis to work, it’s not overnight. It can take a good six to eight weeks and you need to follow up continuously to make sure there are no side effects.”

Affording medical cannabis can be difficult as there are few options available for support. Despite cannabis being legalised on NHS three years ago, there remains only a handful of prescriptions which have been written.

Project Twenty21 can help with capped prescription costs as long as patients can qualify for the conditions listed and have a history of two or more prescriptions that have proved ineffective. They have recently launched a student scheme aimed at helping patients affording medical cannabis while on a college-friendly budget.

The cost of medical cannabis tends to be dose-dependent. Cannabis Access Clinic estimate that the average cost of cannabis prescriptions in the UK is around “£150 to £250 per month for a THC and CBD inclusive prescription.”

A CBD only prescription is listed as being on average £100 to £150 a month although they note that some epileptic disorders will require much higher doses.

Patients also have to take into account the consultation fees which can vary from £100 to £200 depending on the clinic. Integro Medical Clinic lists their initial consultation at £95 to £195 with repeat consultations at the same price. Patients are also monitored through online questionnaires about their moods.

Medical cannabis prescriptions: A hand in a black rubber glove holds a small glass jar of cannabis flower

Speaking to your GP

When it comes to speaking to your doctor about a decision to try medical cannabis, they may not be supportive. If a patient prefers not to speak to their GP about it, they can ask for a copy of their medical records and self-refer.

I spoke to my GPs in both Ireland and the UK. While I had a positive reaction from my English GP who was interested in what effect this would have, my Irish GP was not as supportive. He was dismissive of my seeking medication as an adult in general so the medical cannabis element was a step too far for him. I got my paperwork and have not been in touch with either about my ADHD since then.

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Dr Sinovich said: “Most of the time, you can request paperwork from the GP because it’s your details at the end of the day. Most GPs are quite open to medical cannabis in terms of an augmentative treatment to help with different conditions. You get very few GPs that say no. If patients are having trouble with GPs then they can always arrange a call to explain the benefits. We do a lot of educational work with GPs as it’s new and with anything new to a market, people want to see results and can be sceptical about it.”

Don’t be nervous

Before I went for my assessment, I was very nervous. I have had bad experiences with doctors not listening or taking my ADHD symptoms seriously because they may not always believe in the condition. My Irish GP once said to me when I phoned to say I was seeking medication, that ADHD adults ‘grow out of it’, which is a common misconception about ADHD and some forms of neurodiversity. No wonder I was nervous but I need not have been, as the doctors were incredibly supportive. Knowing your symptoms is key though.

Where does my medical cannabis come from?

Once my assessments were over and the team had discussed my case and decided I qualified, I had to decide what the best course of medication was for me. I opted for a vape because it’s easy for me to fit that into my lifestyle in comparison to oils. ADHD people are often forgetful, and I know this applies to me, so I worried I would forget to take an oil dose. My prescription was sent to Rockshaw pharmacy and arrived at my door discreetly. No one would have had a clue as to what the parcel actually was.

“Once you’ve had your consult – and every clinic is different – the script is approved by a multi-disciplinary team then goes to an independent pharmacy,” explained Dr Sinovich.

“The pharmacy will then get the product to them in the next day or within 24 hours. If you are outside of the UK then you may have to wait a little bit longer. For example, we have Guernsey patients who have to apply for a licence so it does take a little bit longer for that process. The patient deals directly with the pharmacy in terms of costs.”

Medical cannabis prescription abroad

It’s worth noting that if you travel, you may not be able to take your prescription with you. As an Irish woman living in the UK with a prescription, I can’t travel with my medication back to Ireland. If you do travel then be prepared for the potentially negative outcome.

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Dr Sinovich agreed: “It’s a very difficult one, unfortunately. If you look at the United States and Canada then you can’t travel between borders as there are strict rules in place. We normally advise patients to consult with the consultant and the terms of the country that they want to visit. There are no blanket rules for everyone but most countries in Europe are happy for individuals to transport their medical cannabis across borders. It varies from country to country.  Normally we issue a script that they have to carry in hand luggage.”

Read more about travelling with medical cannabis here

Police involvement

“We normally advise individuals that it’s not for public use. It’s why a lot of people converted to oil or a capsule. People must realise that if they do get stopped then they need to show proof that they are taking medical cannabis legally and according to doctor’s guidelines,” said Dr Sinovich.

“In the UK, it’s still relatively new so people are starting to get more access to products. It’s going to take some time but the law will change.”

Patients can also apply for ID cards such as MedcannID and Cancard which has been designed with the help of the police to identify medical cannabis patients.

Medical Cannabis Prescriptions: A doctor in a white lab coat signed a prescription. In front of him while examining a cannabis leaf

Still thinking about accessing a medical cannabis prescription?

My prescription has been the best thing I’ve ever done. It’s helped me to enjoy my evenings instead of being hyper-focused and tense and I also sleep better now.

Dr Sinovich said: “The nice thing about medical cannabis is it is tailored to an individual. I don’t think I have a single patient with exactly the same dose. It’s a tailor-made plan for an individual and you assess them to see if it’s working. You can adjust the CBD to THC ratios and there are lots of different products to choose from.”

He added: “It’s another armour you can use in treatment. There are multiple CBD receptors in the central nervous system. It’s about adjusting the mindset, obviously, it takes time and individuals need to invest in it. It’s investing in your future itself and what you could achieve or how you could improve your life.

“I have a lot of patients that I’ve seen for whom it is life-changing.”

Read more: New study: can cannabis alter speech production?

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Cannabis legalisation not linked to rise in car accidents, says study

Cannabis legalisation sparked fears that it would increase driving-related emergency rooms admission

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cannabis legalisation car accidents

A team of researchers have studied emergency room records and determined that cannabis legalisation in Canada has not resulted in an increase in admissions.

The data published in the journal of Drug and Alcohol Dependence revealed that there has been no increase in two provinces, Alberta and Ontario.

Canada legalised cannabis in 2018, which led to concerns that it would increase the number of traffic injuries, especially among young drivers.

The researchers, from the Centre for Addiction and Mental Health and the University of British Columbia, assessed emergency department records to find any patterns in traffic-injury visits in the months leading to the legalisation and immediately afterwards.

They separated the drivers into two groups focusing on adult drivers and teenagers aged 14 to 18-years-old.

Cannabis legalisation and drivers

They reported: “The current study found no evidence that the implementation of the Cannabis Act was associated with significant changes in post-legalisation patterns of all drivers’ traffic-injury ED visits or, more specifically, youth-driver traffic-injury ED presentations.”

“Given that Canada’s Cannabis Act mandated that the Canadian Parliament review the public health consequences of the Act no later than 2023, the findings of the current study can provide empirical data not only for the Canadian evaluation of the calculus of harms and benefits but also for other international jurisdictions weighing the merits and drawbacks of cannabis legalisation policies.”

The Canadian data is consistent with studies from the United States that show no changes in traffic safety in the months following legalisation.

The study does not take into account the longer-term implications of legalisation despite other studies producing mixed results.

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A study from earlier this year reported that drivers who use cannabis may not feel as impaired as someone else who used the same amount but a different strain.

Read more: Cannabis shortage may have caused a rise in synthetic cannabinoids being consumed

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Advocacy

UK Fibromyalgia to host two-part webinar on medical cannabis and CBD

A two-part series will educate on the experiences of those living with fibromyalgia and arthritis

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UK Fibromyalgia, a magazine dedicated to the chronic condition, will host a two-part webinar discussing the role that medical cannabis and CBD can play in treatment.

UK Fibromyalgia has joined forces with Integro Clinics, Primary Care Cannabis Network, Cannabis Patient Advocacy and Support Services (CPASS) and PLEA (Patient-led Engagement for Access) to present a two-part webinar discussing fibromyalgia, arthritis and cannabis medicines.

An approximate 1.5-2 million people suffer from fibromyalgia and 10 million have arthritis in the UK. The management of the symptoms of these conditions can take a long time to diagnose correctly and can take even longer before they are effectively brought under control.

This two-part series aims to educate attendees on the experiences and lives of those living with fibromyalgia and arthritis, as well as show the benefits that cannabis medicines and CBD can have in alleviating symptoms of these conditions.

Ann-Marie Bard is one of three patients, who will be speaking at the second episode of the webinar. She suffers from fibromyalgia and takes medical cannabis to manage her symptoms. She shares her story from diagnosis to gaining her CBMP prescription and describes how it has improved her quality of life.

Ann-Marie’s story

Ann-Marie was a respected and accomplished full-time dental surgeon, having practised for over 25 years before she developed fibromyalgia.

In October 2018, she started to experience unexplained pain all over her body, but as is very common, she did not get a final diagnosis until March 2021. She eventually saw a rheumatologist, who was able to classify what she was experiencing as fibromyalgia. This only happened as a result of an emergency dash to the hospital as she was in such crippling pain.

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Anne-Marie said: “I had a major flare-up at work and had to go to the hospital, it was just terrible. I was in severe pain and couldn’t walk, this was by far the worst attack I had ever had. That’s when things became clear and having seen a rheumatologist, I found out it was fibromyalgia, causing my pain.”

“I was put on various medications such as steroids and pain killers; tramadol, amitriptyline and duloxetine. At first, these helped the pain slightly, but the side effects made me feel like a zombie, I had ‘brain fog’, exhaustion and I wasn’t able to drive while I was on them.”

Her fibromyalgia led to her losing the full use of her hands and she was left unable to grip, which meant that she could no longer perform surgery. This had a devastating effect on her mental and psychical health.

It reached the point, that the side effects of these conventional medicines were becoming unbearable. She had first read about Dr Anthony Ordman, a well-known pain consultant and medical lead at Integro Clinics in a UK Fibromyalgia Magazine.

Ann-Marie decided that medicinal cannabis might be worth trying as a solution to her pain. After first seeing Dr Ordman, she immediately felt that she had come to the right place to help her deal with her condition.

Anne-Marie said: “Dr Ordman made me so calm and at ease. I found the whole process so easy because I was speaking to someone who truly listened, understood everything there is to know about fibromyalgia and cared. He really went the extra mile, keeping my GP in the loop and letting them know exactly what he was going to prescribe. Speaking to him made me feel secure and that I was going to get the help that I needed.”

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Ann-Marie was prescribed a mix of THC and CBD cannabis oil, which she found had a hugely positive and beneficial effect.

UK Fibromyalgia: A blue and white logo for the charity UK Fibromyalgia

Fibromyalgia and cannabis

She added: “The cannabis oil has helped me so much, taking it means I can actually get on with things like yoga, gardening and driving as there is no ‘brain fog’ effect. I can be present mentally, rather than being spaced out and spend more quality time with my family. For me, there are no side effects from the oil, it doesn’t feel like it did when I was on all of the traditional medications. The oil has given me my life back. Cannabis medicines really should be more accessible for everyone, they have changed my life and I believe they can help people in a similar situation to me.”

Ann-Marie believes that more needs to be done to raise awareness when it comes to medical cannabis. She thinks that the NHS should understand that it really is a substantial alternative to conventional medicines.

She explained: “I’m taking part in the webinar because I believe, ultimately, that this medicine should be more accessible. Fibromyalgia sufferers should have access to information about medical cannabis and I hope to raise more awareness of it, letting people know that there are other options than just traditional opioids.”

To register for this free event please follow the links to get your tickets:
Part 1: https://www.eventbrite.co.uk/e/168090997699
Part 2: https://www.eventbrite.co.uk/e/168112536121

If you would like further information or to speak to Dr Anthony Ordman please contact Integro Clinics:

Website: www.integroclinics.com
Email: Contact@integroclinics.com
Twitter: @clinicsintegro

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Dr Anthony Ordman senior clinical adviser and hon. clinical director Integro concluded: Integro Medical Clinics Ltd always recommends remaining under the care and treatment of your GP and specialist for your condition, while using cannabis-based medicines, and the Integro clinical team would always prefer to work in collaboration with them.

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Cannabis Health is a journalist-led news site. Any views expressed by interviewees or commentators do not reflect our own. All content on this site is intended for educational purposes, please seek professional medical advice if you are concerned about any of the issues raised.

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