As the healthcare professionals who often have the closest contact with patients, nurses need a voice in the medical cannabis conversation, those in the field tell Cannabis Health.
Despite being the care providers who often develop the most in-depth relationships with patients, up until recently the role that nurses play in the medical cannabis sector had been somewhat overlooked.
Launched at the end of last year, a first of its kind series of webinars has been designed to bring a deeper understanding of medicinal cannabis to the nurse and patient care pathway.
Aimed at nurses and other healthcare professionals, the series brings the multidisciplinary team (MDT) approach – which is so ingrained in other areas of care – to cannabis treatment for the first time.
The initiative was designed and spearheaded by the Nurses Arm of Cannabis Patient Advocacy & Support Services (CPASS), which is made up of practicing nurses who are keen to improve understanding of medical cannabis among others in their profession.
Over the course of 2021, medical leaders from a multitude of disciplines will come together to provide world-class education on medicinal cannabis for UK registered nurses and healthcare professionals.
Each event, led by nurses, will be structured into two parts – the theory behind the benefits of cannabis medicines within key areas of medicine, and an MDT demonstrating how the theory is put into practice.
The second in the series, taking place on Monday 29 March, will explore the role of cannabis medicines in oncology, with registered nurses, Eleanor Owen-Jones RN DPSN MSc Clinical Research and Megan O’Rahilly RN CNS Upper GI Oncology in conversation with specialist consultants Dr Matt Brown MD (Res) FRCA FFPMRCA MRCS & Dr Charlotte Fribbens.
Sarah Higgins, an NHS nurse and sexual health lead for CPASS hopes the webinars will reduce some of the anxiety around cannabis medicines and bring nurses into the conversation.
“Our motivation is to educate nurses. We’re trying to demystify cannabis based medicines, to reduce the stigma and normalise them as just another tool in the box, the same as any other medicine,” she says.
“More often than not when anything is new, it creates some anxiety in healthcare professionals, particularly if they are not sure of the evidence around it.”
Sarah became involved with CPASS as she found many of her patients would consume cannabis illicitly to help with medical issues.
“In my area of health we talk a lot about recreational use of cannabis and when you delve a bit deeper into why people are using it, there seems to be quite a lot of therapeutic reasons given, such as around the time of their menstrual cycle,” she says.
As the healthcare professionals who have the most direct and regular contact with the patient, nurses can play an important role in opening up dialogue about cannabis, but also need to be educated in it themselves and able to practice safely.
“Nurses advocate for patients and are quite often the first port of call for them,” says Sarah.
“Typically a nurse’s bedside manner can elicit quite a lot of information from a patient that they maybe wouldn’t share with a doctor or consultant, so we develop trusting relationships with them.
“We’re able to feed back information to the rest of the team but we’re also able to support patients in a non-judgmental way in making choices around their therapies.”
She continues: “Nurses play the same role they would in any other kind of health care package, but the work CPASS is doing is to reduce some of the anxiety around this particular group of medicines and to look at ways that nurses can work safely in this area.
“We don’t want anybody working outside of the boundaries that they feel comfortable with.”
Each CPASS event is structured into two parts, the theory behind the benefits of cannabis medicines within key areas of medicine and the MDT demonstrating how the theory is put into practice.
Each MDT features a specialist consultant, nurse, GP and pharmacist, all working within the medicinal cannabis field in the UK. Their discussion will illustrate real world case studies within areas including; pain, mental health, neurology, oncology, women’s health and palliative care.
Former ICU nurse, clinical lead and co-founder of the Nurses Arm of CPASS, Sophie Hayes, left her job in the NHS to join the medical cannabis space last year.
Now lead nurse specialist at Integro Medical Clinics, she is one of the first practicing in the field.
Sophie is keen to encourage others into the field, believing the sector is currently missing a key component of person-centred care.
“The nurse is a key component of any care team. We often have the most regular contact with patients and as a result, have in depth knowledge of their health picture. This includes information regarding the patient as a whole person, not simply as a collection of diagnoses,” she says.
“This insight is invaluable when an MDT is coming together to make a decision regarding how best to move forward with the care of complex patients. A doctor might create a care plan that in theory would successfully manage the patient’s condition and the associated symptoms.
“However, it is the nurse who will be able to assess whether this fits with the patient lifestyle, and if it doesn’t work for the patient, it doesn’t work for anyone.”
Commenting on the first CPASS MDT event which took place in November, Sophie adds: “In these clinics we are often a last resort, these patients are complex and have already been reviewed by some of the countries most experienced clinicians.
“The problem solving potential of a fresh perspective of an MDT like this can be monumental for patients and the nurses role is an invaluable part of this.”
But while the cannabis sector may be lacking practicing nurses, Sarah doesn’t feel their role is undervalued.
“It’s a very new, emerging area of medicine and I would expect it to be doctor-led – lots of areas of medicine are doctor-led and and nurse-delivered, it’s just about making sure that information trickles down to everybody,” she says, encouraging nurses to ask questions and be open about their understanding of cannabis medicines.
“I would like nurses to look at cannabis based medicines as they would opioids, to try to reset any kind of previous views or opinions that they’ve held about it.
“It’s important to remember that we’re not discussing it in terms of something that has been bought on the street, we’re talking about something that is regulated and prescribed through a pharmacy.”
“But I’d also urge them not to feel embarrassed about the questions they have,” she adds.
“It’s important that we discuss our concerns or fears and address the barriers – I don’t think there is a silly question when it comes to cannabis.”
Ireland to fund patient’s medical cannabis up front
Campaigner Vera Twomey described “relief” that her determination has finally paid off.
Campaigner Vera Twomey has described her “relief” as the Irish Government agrees to fund medical cannabis patient’s prescriptions up front.
Eligible medical cannabis patients in Ireland will now have their medication paid for up front, after months of pressure on the Government from campaigners.
Health Minister Stephen Donnelly announced on Monday 19 July that the refund system for patients who obtain their prescribed cannabis-based products from the Netherlands, will now be replaced by a direct payment system.
The HSE will pay the dispensing pharmacy in the Netherlands directly, rather than the burden falling to the patients and their families, who were then required to apply for a refund.
Vera Twomey, whose daughter Ava Barry, 11, has a severe form of epilepsy known as Dravet syndrome, is among 40 patients who have now been granted an individual ministerial licence to import Bedrocan oil to Ireland.
But the family were paying 10,000 Euros up front every three months for Ava’s prescription and waiting up to five weeks for it to be refunded.
Twomey, who has four other children, has previously spoken of the huge financial strain this system placed on her family.
Over the last 16 months she has relentlessly called for action, making dozens of phone calls daily to politicians and lobbying ministers on social media with the backing of thousands of supporters in Ireland and across the world.
Twomey, who received a phone call from Ireland’s Prime Minister, Micheál Martin on Monday confirming the news, says she is “delighted” that her determination has finally paid off.
“There’s a sense of relief that we have accomplished this, but also a little bit of shock because we have been trying to resolve it for so long,” she told Cannabis Health.
Twomey’s activism gained national attention in 2017 when she walked from her home in Cork to Leinster House in Dublin to ask former Health Minister Simon Harris to grant access to medical cannabis for her daughter.
Initially having to travel to the Netherlands to collect the prescription herself, during the pandemic Twomey successfully campaigned to secure the permanent delivery of Bedrocan oils for Ava and other patients.
Now she says she is looking forward to focusing on her family and putting the phone down for a while.
“I don’t think anybody who has gone through this fight, seeing the injustice that we have had to deal with could ever walk away,” she said.
“But at the same time, I’ve made a lot of sacrifices and for the moment at least, I need to give 100 percent to my other children, to do normal things and be a family.”
But the fight in Ireland isn’t over.
The Irish Government announced the provision of funding for the Medical Cannabis Access Programme (MCAP) in January – almost two years after it was introduced – but only four low dose cannabis-based medicines are covered by the programme, for people living with one of three qualifying conditions.
“There are other issues – we still need expansion and improvement in medical cannabis access, the journey is over by any means, but we’re at the beginning and getting Bedrocan recognised as a medicine that is funded up front is very important.
“I think the Irish are actually miles ahead of the British on this one and I hope [politicians] will take notice and catch up.”
She added: “The greatest gift you’ll ever receive is to lose your fear, then you can accomplish anything with focus and determination.
“If you have the determination to keep going you will get there. It’s not going to be easy, they are not going to make it easy but it can be done.”
Patients eligible for the direct payment system are those suffering from one of three stated conditions; spasticity associated with multiple sclerosis, intractable nausea and vomiting associated with chemotherapy and severe, refractory (treatment-resistant) epilepsy.
The HSE says it will be contacting patients directly.
Health Minister, Mr Donnelly, commented: “I am delighted that the HSE and Transvaal Apotheek in the Netherlands are implementing a new process which will give peace of mind to the seventeen patients and their families who until now have been using the refund process.”
Kanabo’s cannabis vaporiser for metered dosing launches in UK
The VapePod will give thousands of UK patients access to pain relief in a metered dose.
Cannabis company Kanabo’s new extract formula and vaporiser will give thousands of UK patients access to pain relief in a metered dose.
UK patients will be the first in Europe to have access to Kanabo’s vaporiser, the VapePod, and its new extract formula when is it delivered later this month.
The deal, in conjunction with LYPHE Group, will see patient’s of LYPHE Group’s ecosystem, including The Medical Cannabis Clinic and Dispensary Green, able to access the VapePod under the brand name NOIDECS.
Under the agreement, PharmaCann and Kanabo established a customised production line for Kanabo’s VapePods cartridges.
An alternative to cannabis flower
The VapePod is a medical-grade, handheld vaporiser which enables accurate and precise micro doses of cannabis extract, dispensing 1mg of formula for each inhalation.
This will benefit to patients as inhaling extracts rather than tinctures and oils allows for faster onset and higher bioavailability.
It will also allow clinicians to more confidently prescribe and monitor a patient’s dosage, as well as providing more accurate patient data.
Previously, cannabis patients in the UK have only been able to access medical cannabis dry flower and oil tinctures for which the majority of patients consume via inhalation due to fast onset time.
Kanabo’s medical line aims to enable patients to move away from the harmful act of smoking medical cannabis flowers as they can now take their medicine without inhaling soot, tar and carcinogens into the lungs.
Avihu Tamir, Kanabo’s CEO, said: “The VapePod is a world first allowing specialist consultants to prescribe a metered dose of medicinal cannabis that is healthier for patients than the alternative, which is typically smoking.
“Medical cannabis is a safer alternative to the conventional opiate solutions and other pain management treatments. This announcement ensures that thousands of UK patients have access to the most effective medicinal cannabis delivery system.
“The fact that the VapePod gives exactly 1mg on every inhalation is crucial for GPs because they can prescribe an exact dose which they haven’t been able to do before. For patients who want the similarity to smoking but know they are not inhaling soot and tar. There’s also the bioavailability factor too.
“The reason GPs haven’t been prescribing is the issue of dosing and flowers – they don’t feel comfortable asking patients to smoke. With Kanabo, they can prescribe exact dosing in a safe and consistent way.”
The medical extract formula, which is based on the Israeli medical cannabis pharmacopoeia as a recommendation for the treatment of pain management, has a purity of 70 percent THC with 15 percent minor cannabinoids and terpenes.
Earlier this year Kanabo became the second cannabis company to list on the London Stock Exchange.
Dean Friday, LYPHE’s CEO commented: “Kanabo are experts in novel delivery with their VapePod greatly improving onset times, and for our chronic pain patients we now have an alternative to flower vaporisation. This is the start of a revolution in medical cannabis application and we are delighted to be supplying it under the NOIDECS brand.”
Cancer survivors turn to cannabis for physical and mental health – study
Cancer survivors are more likely to use cannabis to help pain, anxiety, sleep and nausea.
Cancer survivors are frequently using cannabis to manage physical and mental health symptoms, says a new study.
Research from the US indicates that cancer survivors are more likely to use cannabis for symptoms such as pain, anxiety, trouble sleeping and nausea.
A team of investigators analysed results from a Covid-19 cannabis health study to examine changes to cannabis use, methods of cannabis delivery, and coping strategies among cancer survivors since the pandemic.
They found that individuals with a history of cancer are more likely to report cannabis use to manage mental health and pain symptoms.
This group of people were also more likely to report fear of a Covid-19 diagnosis, compared to adults without a history of cancer.
Data was collected from 158 responses between 21 March 2020 and 23 March 2021, from cancer survivors who identified as medicinal cannabis users.
These were then compared to medicinal cannabis users without a history of cancer of the same age.
According to the study, cancer survivors were more likely to report using cannabis as a way of managing nausea/vomiting, headaches or migraines, seizures, sleep problems or as an appetite stimulant.
Sixty one percent of respondents with a history of cancer used cannabis to manage anxiety symptoms and 54 percent for chronic pain.
Forty eight percent said they used it to manage depressive symptoms and 25 percent for PTSD, while smaller numbers used it for symptoms of another autoimmune disease, and irritable bowel syndrome.
While there were no differences in how often they used cannabis or their method of administration, cancer survivors were “more likely to have an advanced supply of cannabis”.
The findings support the need for more conversations between doctors and their patients about the use of cannabis, say those behind the study.
The authors concluded: “Overall, we observed that cancer survivors are frequently reporting the use of cannabis to manage both physical and mental health symptoms associated with their cancer diagnosis and that cancer survivors are more likely to report fear of a Covid-19 diagnosis compared to those without a history of cancer.
“Given the frequency of mental and physical health symptoms reported among cancer survivors during the Covid-19 pandemic period, clinician–patient interactions should include questions around cannabis use, particularly those with a history of cancer.”
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