Connect with us

Health

12 frequently asked questions about medical cannabis

Published

on

Research has shown the effectiveness of medical cannabis when treating epilepsy, but prescriptions on the NHS are still sparse

Medcan Support, has published new resources for parents and carers who want to know more about medical cannabis and childhood epilepsy. Here, the experts share some of the most common questions they get asked. 

The non-for-profit hub, co-founded by parents of epilepsy patients and high profile campaigners Matt Hughes and Hannah Deacon, provides support and education for others seeking cannabis medicines

The Medcan Support expert committee, which includes cannabis scientist Dr Callie Seaman, paediatric cannabis consultant Dr Bonnie Goldstein and paediatric neurologist Dr Evan Lewis, has responded to a list of frequently asked questions from parents and carers about how to access this treatment.

Medcan Support co-founder Matt, whose son Charlie has a rare epileptic condition known as West syndrome, has seen how medical cannabis has transformed his life and helped bring his seizures under control.

But he didn’t have access to any support or easy-to-find information when he first started researching cannabis.

Matt and Ali Hughes and son Charlie.

“When we first started out, all I had was Google,” he told Cannabis Health.

“Some of the information was incorrect or laws would be different all over the world, it was a very confusing picture and it took a lot of time to really understand everything.

“Through Medcan we have created a central hub for parents to go to. We get so many questions from parents through our Facebook group, this was just a way of bringing them all together.

“For anyone who is looking to try CBD or prescription cannabis for childhood epilepsy, these are the kind of questions you might come across.”

 

How do I get a prescription for medical cannabis?

At the time of writing, the NHS is not prescribing medical cannabis, so patients must be prepared to pay for a private prescription. However, an NHS specialist is legally permitted to prescribe the medicine, so it is always worth asking.

There are only two clinics prescribing for paediatrics, The Medical Cannabis Clinics or Sapphire, details are on our website. Fill in the details required – this usually includes information about your child and medical history. When the clinic responds, they will provide next steps which will vary by provider. They may contact your neurologist on your behalf. Your records will be sent to the clinic’s consultant who will decide whether you are eligible for medical cannabis treatments. Clinics will not see you without the relevant medical records. If you are eligible for medical cannabis treatment, you will be sent an appointment.

Who can prescribe medical cannabis in the UK?

Any doctor on the GMC Specialist Register can prescribe. This is usually a hospital consultant. A GP can prescribe under shared care arrangements under the direction of a specialist. You are more likely to be prescribed medical cannabis from a doctor working for a medical cannabis clinic as those doctors are more likely to have been trained in cannabis medicine.

What is the difference between CBD and THC?

Both THC and CBD have medical properties. THC is the cannabinoid that is the major part of recreational cannabis and in high doses can cause impairment. In lower doses it is a muscle relaxant, can help with sleep and many different causes of pain. It can also help with nausea and other chemotherapy related side effects and shown to be effective in epilepsy. CBD does not cause impairment. CBD is often used in anxiety, epilepsy and pain management also.

There is much overlap between the two when controlling symptoms. When you are assessed by a doctor they will determine the combination that is most likely to help your symptoms.

Most doctors start with a higher CBD product with small amounts of THC and increase the dose slowly, but it will depend on your previous exposure to cannabis and your symptoms. If prescribed carefully, the side effects one commonly recognises with recreational cannabis and unopposed THC use are usually very minimal and well tolerated.

What is the entourage effect?

Cannabis not only contains phytocannabinoids, but also other chemicals called terpenes (which give smell) and flavonoids (which give colour). There are over 100 terpenes and flavonoids. It is thought that the full plant with all those components in various proportions gives a better medical effect than the individual parts. That is the entourage effect. Science doesn’t fully understand the interaction of phytocannabinoids and terpenes within the human body, but observational data and open label studies are leaning towards the use of the whole plant has a better medical effect than isolated parts.

How is medical cannabis taken or administered?

Medical cannabis for childhood epilepsy is usually prescribed as an oil. For the best bioavailability it’s recommended to leave under the tongue, but generally with children suffering develop delay or learning difficulties, this is simply unrealistic. Swallowing is fine and may require a little bit more oil to reach a therapeutic dose.

For children who may have difficulties swallowing, the oil can be administered via feeding tubes although not recommended to mix with water.

What dose should I take?

Your doctor will advise on the dose. Generally, you will be started on a low dose – at around 1mg per kg of body weight and gradually increase in increments. Studies show that around 10- 15mgs/kg is in the therapeutic range, but each child will respond differently. Some may require much less and others much more. If the doctor wants to add in THC then again it starts low (even as low as 1mg THC) and builds up slowly.

We are on the ketogenic diet, can we use cannabis?

Yes you can use CBD/cannabis oil in conjunction with the Ketogenic Diet, but be very careful to the carrier used. Although most CBD oils use MCT oils as the carrier, some have added flavourings which could be from sugars which would impact ketones  produced. If prescribed your clinician should be aware of the carrier oils of products. Speak with your ketogenic dietician if uncertain.

Can CBD / cannabis be administered in hospital?

If you’re using an over the counter CBD oil then no you won’t be allowed to administer it in Hospital, if however you have a prescribed oil, then you should be allowed to administer it. You may need to give the hospital notice and let them know the dosing regime.

Can CBD / cannabis be administered in playgroup/ school?

If it’s a prescribed oil with the correct pharmacy labelling on the bottle, this should be fine, but it has been known that some schools are hesitant in administration and ask parents do so.

What are the side effects of medical cannabis?

CBD is generally very safe, but can give some people stomach upsets, diarrhoea, dizziness and tiredness. THC has more side effects and these can include dizziness, disorientation, drowsiness and dry mouth. Your doctor will start you on a low dose and increase it gradually so that side effects are minimised. Serious side effects, like a psychotic episode, should be avoided by careful screening of whether you are suitable for treatment in the first place.

Does THC affect the developing brain?

Some reports have said that THC can damage the developing brain in children and adolescents. There is no evidence of this in the low doses generally used in cannabis medicine. There are some reports of such problems in high THC recreational cannabis users, but those reports are also controversial. In the low THC doses used in medical practice, that risk is very small indeed.

What will I pay for a medical cannabis prescription?

You will pay for the cost of treatments – an average of £500 per month for your products. Families of children with epilepsy will see costs from £1000+ per month but costs are coming down. You will also pay the cost of import, which can be around £150 per prescription.

However, now bulk importation of medical cannabis products are permitted, we see prices reducing as this cost is split between multiple patients. You will also pay the costs of the pharmacy as well as the cost of any consultation – face to face or telehealth with your consultant. This is usually around £200 for the first consultation and less for follow-up visits, which need to be monthly at first but if you are stable then can then be less frequent.

 

For more FAQs and other resources and support around medical cannabis and epilepsy visit Medcan Support.

Mental health

Mental health, addiction and medical cannabis – an expert’s insight

We sit down with the recently-appointed medical director of The Medical Cannabis Clinics, Dr Luisa Searle.

Published

on

Mental health, addiction and medical cannabis - an expert's insight

The recently-appointed medical director of The Medical Cannabis Clinics, Dr Luisa Searle, shares how her background in psychiatry and addiction is feeding into her new role. 

Dr Luisa Searle has been treating patients with addiction disorders for the last six years, seeing patients struggling with substance misuse and establishing outreach services for young people and the homeless across London. 

Now, she is helping people legally access cannabis, a substance that has historically been demonised as a ‘gateway drug’. 

Feeling burnt out and craving a fresh new challenge, Dr Searle was looking for a change in her career when she crossed paths with The Medical Cannabis Clinics, joining the team as medical director in April this year. 

anxiety: A banner advert for the medical cannabis clinics

“It frustrates me, this division that there seems to be in mental health, whereby if you’ve got a substance misuse issue, you’re not worthy of mental health treatment,” Dr Searle told Cannabis Health. 

“But actually, your mental health is often being self-medicated by substances and whether you agree with that or not, that’s how some people cope.”

Prior to joining TMCC, Dr Searle was unaware that medical cannabis was beginning to be prescribed more widely.

She was coming into the industry with a fresh perspective, and despite her background in addiction medicine, she said she had very little prejudice against cannabis. 

“It didn’t make sense to me to not explore it,” Dr Searle said.

Dr Luisa Searle, medical director at The Medical Cannabis Clinics

A balanced approach

“I’m not here to say it’s a wonder drug. I’m not here to say it doesn’t have its risks or side effects. It’s by no means suitable for everybody, but this idea that it’s a substance of abuse and not even [worth] researching as a potential medicine I think is, unfortunately, based in historical racism and hysteria, which has no place in science as far as I’m concerned.”

But while she was intrigued by this new and emerging field of medicine, due to her past experience, she was determined to take a “balanced approach” to prescribing. 

For Dr Searle, it is imperative that cannabis is seen for what it is. While it has immense potential for managing hard-to-treat conditions and a possible alternative to physically addictive opioids, it is still a substance that can cause dependence. 

“Any substance, legal or illegal, with some psychoactive effect has the potential for abuse, but that’s where I come in as the doctor,” Dr Searle said. 

“If I felt that you needed diazepam, that prescription is entirely under my control. It is down to me to work with patients  to try to prevent [dependency] from happening and to advise and educate them, so that they can make informed decisions about their care.”

Dr Searle is only three months into her role at TMCC but she is already seeing the positive impact that medical cannabis is having on patients. 

People with difficult-to-treat conditions like insomnia and anxiety are seeing improvements in their lives after trying numerous conventional treatments that failed to help. 

Meanwhile, patients who have previously relied on pharmaceuticals like antidepressants and SSRIs  – which can come with severe side effects – were able to “feel themselves” again after reducing their dose of traditional medication in favour of medical cannabis. 

“What’s really been nice is seeing success with people who have tried lots of different conventional treatments and haven’t really gotten anywhere,” Dr Searle said.

“I was talking to a gentleman who had a traumatic brain injury and was getting migraines on a regular basis. He had really struggled with his work and his life. With a small amount of medicinal cannabis flower, he feels much more himself.

“That’s the really nice thing [about] working in this clinic; just seeing that turnaround in people who’ve been quite stuck.”

NHS access

Having worked for the NHS for 15 years, Dr Searle is a firm believer in everyone having access to the healthcare they need. 

Right now, this does not apply to the medical cannabis space. Very few people have been able to access an NHS prescription while private prescriptions can cost hundreds per month. 

“It is a little bit challenging for me that I have to be in a private clinic in order to provide medical cannabis treatment,” Dr Searle said.

“While TMCC has extremely reasonable prices in comparison to other types of private health care, it is still a cost and if you’re on a low income it might as well be a million pounds.”

Dr Searle wants to see medical cannabis being more widely prescribed, but it has to be “sensible” with regulations around who can prescribe and how. 

She continued: “Why shouldn’t it be available on the NHS in the right circumstances? What I don’t want to see is what can potentially happen with opioids – with people becoming dependent on them.

“It’s not a medication for all. There are concerns, particularly among younger people. We’re still not 100 per cent clear as to the risks around potentially life-changing mental health issues and specifically psychosis.”

Importance of eduction

Dr Searle has not encountered huge numbers of cases where recreational users have later developed psychosis, but she has seen enough for it to be a concern. 

“It’s not something that I could just dismiss,” she said.

“When we have young people coming to us, it’s all about education. It’s just like any medication, if you start on antidepressants, you don’t start with a high dose, you start on a low dose and build it up. You check the tolerance and you review the patient regularly to see if there have been any improvements or side effects.”

Dr Searle also points out that studies into psychosis and cannabis use have examined street cannabis rather than medical-grade products prescribed by clinics like TMCC. 

“Street cannabis potentially has incredibly high levels of THC and very low levels of CBD,” she said

The benefits for some patients speak for themselves, but Dr Searle stresses the fact that a medical cannabis prescription is not right for everyone. 

“Whilst I think [medical cannabis] is great and we get lots of positive feedback, we do have some adverse reactions to it where it’s not suitable,” she said.

“People shouldn’t be lulled into a false sense of security that just because your doctor prescribed it and it’s legal for medicinal use it’s not without its risks.”

Dr Searle sees a lot of potential in cannabis as an alternative drug for chronic mental health disorders and pain, even as a possible method for weaning patients off opioids. But she warns that people who are prone to addiction may end up transferring their dependency from one substance to another. 

“If you break your leg, opioids are fantastic for that, but what they’re not so good for is chronic pain,” she said. 

“The withdrawal process from them can be horrendous and there could be a place for cannabis to alleviate some of those withdrawal symptoms.”

But, she added: “I think I would be much more cautious about that, simply because until you’ve dealt with and understood your addiction and those behaviours and those are resolved and you’ve engaged with other ways to cope with your emotional stresses, you may just be switching one addiction for another.”

Home » Health » 12 frequently asked questions about medical cannabis

Continue Reading

Women's health

Medical cannabis and pregnancy – what you need to know

Published

on

Continue Reading

Health

Canadian cannabis patients use less opioids and alcohol – study

Just under half of patients say they have reduced their use of other controlled substances. 

Published

on

Canadian cannabis patients use less opioids and alcohol - study

Just under half of Canadian medical cannabis patients say the treatment has enabled them to reduce their use of other controlled substances. 

According to new data, nearly one in two Canadian patients authorised to use medical cannabis say they have been able to reduce – or cease entirely – their consumption of other controlled substances, particularly opioids and alcohol.

A team of researchers from Canada and the United States surveyed almost 3,000 Canadian patients enrolled in the nation’s federal medical marijuana programme, which began over two decades ago. 

Medical cannabis has been legal in Canada since 2001, the country legalised the possession and retail sale of adult-use cannabis in 2018.

Veterans mental health CBD and cannabis: British army physical health

In the research, which was published in the Journal of Cannabis Research, investigators reported that 47 per cent of respondents acknowledged substituting cannabis for other controlled substances. 

Of those who said that they used cannabis in place of prescription medications, half acknowledged doing so for opioids – a finding that is consistent with other studies. 

Many respondents also reported using cannabis to reduce their alcohol intake.

However, the study highlighted the need for more open communication between patients and their doctors.

Around one-third of respondents did not inform their primary care providers (PCP) that they were engaging in drug substitution.

Authors concluded: “This study examined patient-provider communication patterns concerning cannabis use and substitution in Canada. 

“Results suggest that patients often substitute cannabis for other medications without PCP guidance. The lack of integration between mainstream healthcare and medical cannabis could likely be improved through increased physician education and clinical experience.

“Future studies should investigate strategies for effectively involving PCPs in patient care around medical cannabis with specific focus on substitution and harm reduction practices.”

Commenting on the findings, NORML’s deputy director Paul Armentano, said: “Cannabis has established efficacy in the treatment of multiple conditions, including chronic pain, and it possesses a safety profile that is either comparable or superior to other controlled substances.

“It is no wonder that those with legal access to it are substituting cannabis in lieu of other, potentially less effective and more harmful substances. As legal access continues to expand, one would expect the cannabis substitution effect to grow even more pronounced in the future.”

Home » Health » 12 frequently asked questions about medical cannabis

Continue Reading

Trending