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12 frequently asked questions about medical cannabis

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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?

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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?

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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?

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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.

Women's health

Menopause and medical cannabis – how we’re tackling the stigma

A new event will explore how medical cannabis can help women manage symptoms of menopause

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menopause

Ahead of World Menopause Day on Monday 18 October, Cannabis Health, Integro Medical Clinics and Cannabis Patients Advocacy and Support Services (CPASS) announce a new event exploring how cannabis can help manage symptoms.

The third episode in groundbreaking webinar series exploring the role of medical cannabis in women’s health, will focus on the multi-faceted and often challenging experiences of menopause and perimenopause.

Taking place online on Tuesday 30 November, a panel of expert clinicians and patients will discuss the experiences of  women who have found these medicines helpful in managing their symptoms.

Menopause: An event image advertising a panel discussion around women's cannabis and menopause

Menopause and perimenopause symptoms are chronically poorly treated in the modern healthcare system.

Many women are frequently, simply told to ‘manage their stress better’, ‘lose some weight’ or ‘do more exercise’ when seeking medical treatment for debilitating menopause symptoms which include anxiety, depression, insomnia, low libido, headaches and hot flushes, amongst others.

This lack of recognition can be  both cultural and medical. Women often feel ashamed to speak openly about their experiences due to stigma and many doctors lack the training and time to treat symptoms effectively.

Menopause management

Increasingly women are finding cannabinoids helpful in managing some of their menopause symptoms.

Since the legalisation of cannabis-based medicines two years ago, female patients have been able to discover that the rebalancing of their endocannabinoid system can be incredibly helpful in the management of conditions ranging from Endometriosis, bladder and nerve pain, gynaecological pain and PMS to mental health conditions such as anxiety, insomnia and depression.

Aimed at both the general public and caregivers, the event will explore the experiences of women who have lived with perimenopause and menopause symptoms and how they have found cannabis-based medicines helpful.

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Expert speakers:

Dr Sally Ghazaleh

Dr Sally Ghazaleh, MENOPAUSE EVENT

Dr Sally Ghazaleh is a pain management specialist

Women’s health consultant at Integro Clinics. She specialises in managing patients with lower back pain, neck pain, neuropathic pain, abdominal pain, cancer pain and complex regional pain syndrome.

 

Dr Mayur Bodani

Dr Mayur Bodani

A neuropsychiatrist with over 25 years of experience, he has successfully treated many patients with psychiatric disorders such as depression, bipolar disorder, anxiety, psychosis, dementia and many other conditions.

 

Sarah Higgins CNS

Sarah Higgins CNS

Sarah is a clinical nurse specialist, with over 10 years of experience working in the NHS. She is also the women’s health lead at non-profit organisation CPASS Nurses Arm.

 

Patient speakers:

Lauren

Lauren

Having been a successful mental health nurse for 30 years, Lauren had to give up her career after being diagnosed with primary progressive MS. She has found cannabis medicines helpful in dealing with her MS symptoms and menopausal symptoms.

 

Rachel Mason

menopause

Rachel Mason

Rachel is founder of ‘Our Remedy’, a wellness brand for women. She has found CBD to be very helpful in dealing with her menopausal symptoms.

 

Patient story

Lauren worked successfully as a mental health nurse for 30 years before menopause symptoms, alongside the symptoms of her primary progressive multiple sclerosis became so debilitating that she could no longer work and found daily life too difficult to handle.

“When I discovered cannabis medicines (CBMP’s), they completely changed my life. CBMP’s eased my anxiety and meant that I could get a decent night’s sleep. The fact that I was well-rested, meant that I could start to lightly exercise again, which was unthinkable a year ago,” Lauren said.

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Medical cannabis has helped Lauren to deal with anxiety, brain fog, and gave her an overall sense of wellbeing. Lauren has found cannabis medicines have given her life back, she can once again exercise and return to her daily routine.

The webinar takes place on Tuesday 30 November at 7pm and is completely free of charge, go to the Eventbrite link here to register.

 

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. The Integro clinical team would always prefer to work in collaboration with them.

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

 

Read more: Canadian study shows more women using cannabis for menopause

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Breast milk of THC-positive mothers not harmful to short-term health of infants – study

Researchers reported no differences in short-term health impacts such as breathing difficulties or feeding issues.

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Breast milk: A bottle of milk for an infant

According to a new study, the breast milk of THC-positive mothers was not found to be harmful to the short-term health of premature infants.

Researchers compared early pre-term infants who were breast-fed from mothers who consumed THC to those who were fed formula or breast milk from non-THC consuming mothers.

They reported that breast milk caused no differences in short-term health impacts such as breathing difficulties, lung development or feeding issues.

The study analysed the medical records of 763 early pre-term babies from 2014 to 2020. Researchers discovered that 17 per cent of the mothers tested positive for THC at the time of giving birth. They also examined post-natal exposure through breast milk.

Researchers found that overall the babies born to mothers who tested positive for cannabis were similarly healthy at the time of their discharge when fed their mothers breast milk in comparison to those who did not receive their mother’s breast milk.

The authors wrote in the abstract: “In our study, we found no evidence that providing [mother’s milk] MM from THC-positive mothers was detrimental to the health of this early preterm population through hospital discharge. A better understanding of longer-term perinatal outcomes associated with THC exposure both in-utero and postnatally via MM would inform appropriate interventions to improve clinical outcomes and safely encourage MM provision for early preterm infants.”

Breast milk from mothers who consume THC is often restricted by neonatal intensive care units because the effects on early preterm infants are unknown. It is thought that the active ingredient can pass through breast milk. Studies have shown that breast milk is a good way to improve pre-term baby outcomes and reduce infection risk along with intestinal issues.

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Researchers cautioned women to abstain as the long term effects are still unknown.

THC-positive breast milk

Natalie L. Davis, associate professor of paediatrics at the University of Maryland School of Medicine said: “Providing breast milk from THC-positive women to preterm infants remains controversial since long-term effects of this exposure are unknown.”

She added: “For this reason, we continue to strongly recommend that women avoid cannabis use while pregnant and while nursing their babies. Our study, however, did provide some reassuring news in terms of short-term health effects. It definitely indicates that more research is needed in this area to help provide women and doctors with further guidance.”

“Teasing out the effects of THC can be very difficult to study,” Dr Davis concluded. “We found that women who screened positive for THC were frequently late to obtain prenatal care, which can have a detrimental effect on their baby separate from cannabis use. This is important to note for future public health interventions.”

The study abstract will be presented at the virtual American Academy of Paediatrics National Conference and Exhibition.

Read more: Four ways women could benefit from CBD

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Women's health

Half of US breast cancer patients use cannabis alongside treatment

A study also revealed that many patients do not share this information with their doctors

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breast cancer patients use cannabis

New research indicates that almost half of US adults with breast cancer use cannabis alongside their cancer treatment to manage symptoms.

The breast cancer study, published in the American Cancer Society journal, Cancer, also found that many do not discuss their cannabis consumption with their doctors.

Cancer patients often turn to cannabis for symptom relief alongside their treatment, with symptoms including pain, fatigue, nausea and other difficulties depending on the type of cancer and treatment.

Cancer is also one of the qualifying conditions for a prescription in several different US states. However many doctors feel they do not have the knowledge to discuss it patients, making more education essential for those working in healthcare.

Cancer study

Researchers conducted an anonymous online survey designed to examine cannabis use among adults who had been diagnosed with breast cancer. The participants were all members of the online communities, breastcancer.org and heathline.com.

The results revealed that of the 612 participants, 42 per cent reported using cannabis for symptom relief which included pain, insomnia, anxiety, stress and nausea. Among those, 75 per cent said it was extremely helpful at relieving their symptoms while 79 per cent said they used it during treatment such as systemic therapies, radiation and surgery.

Almost half of the participants who consumed cannabis believed that it can be used to treat cancer itself despite its effectiveness being unclear. Most participants believed that cannabis products are safe.

Patients in the survey used a wide variety of products with various qualities and purities. Half of the participants sought information online. They felt that other patients were the most helpful source of information while doctors ranked low on the list.

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Most of the participants who sought information on cannabis use for medical purposes were unsatisfied with the information they were given.

Lead author Marisa Weiss, of Lankenau Medical Center, said: “Our study highlights an important opportunity for providers to initiate informed conversations about medical cannabis with their patients, as the evidence shows that many are using medical cannabis without our knowledge or guidance.”

She added: “Not knowing whether or not our cancer patients are using cannabis is a major blind spot in our ability to provide optimal care. As healthcare providers, we need to do a better job of initiating informed conversations about medical cannabis with our patients to make sure their symptoms and side effects are being adequately managed while minimising the risk of potential adverse effects, treatment interactions, or non-adherence to standard treatments due to misinformation about the use of medical cannabis to treat cancer.”

Read more: Survey shows just under half of all Americans have tried cannabis

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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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