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My experience as a medical cannabis prescriber on Project Twenty21

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In the second of a two-part series, Cannabis Health speaks to Dr Rebecca Moore about her experience as a prescriber on Drug Science’s Project Twenty21.

Project Twenty21 is a landmark scheme that seeks to widen access to medicinal cannabis and build Europe’s largest body of evidence for its efficacy.

Launched in November 2019 by the UK drug advisory committee, Drug Science. In August 2020, the patient registry handed out its first medical cannabis prescription. 

A medical cannabis prescription is notoriously difficult to access on the NHS. In fact, an Advisory Council for the Misuse of Drugs (ACMD) report from 2020 revealed that less than five have been handed out by the health service. Meanwhile, those who can afford private healthcare can sometimes be left forking out thousands of pounds per month for a prescription. 

The prescriber’s perspective

Dr Rebecca Moore, a consultant psychiatrist specialising in trauma and PTSD, is one of the doctors prescribing through the scheme. With a particular interest in women’s mental health, Dr Moore co-founded Make Birth Better, a campaigning group on a mission to make women’s experience of pregnancy better. 

CH: What got you interested in medical cannabis? 

RM: I’ve been aware of medical cannabis for quite a few years now. At university, I had a friend who had a cancer diagnosis. I watched her use cannabis and saw how helpful that she found it for her symptoms. 

My expertise is in general psychiatry, but particularly around trauma and PTSD. I think that’s why I was drawn to medicinal cannabis prescribing; I’ve seen a lot of research around its use with trauma.

During my training, and more recently, I’ve been lucky enough to be able to go and shadow some colleagues in America and see them prescribing medicinal cannabis. 

And I was really astounded at the efficacy of that for people. People coming back and reporting that it had helped them with so many different aspects of their life: pain, sleep mood. I was really interested and intrigued by that, and wanted to be part of this when it was possible in the UK. 

 

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CH: What kind of patients do you work with as part of Project Twenty21? 

RM: I see a wide range of patients coming to see me in the clinic. They often have a very long history of contact with mental health services or with their GP and might be presenting with anxiety, low mood, trauma and lots of other presentations. 

What is often a common theme is people that have tried lots and lots of things in the past and never really felt that they have been particularly helpful for them. They might have tried numerous prescribed medications, different types of therapy, exercise, but never really found the right thing that they felt controlled all their symptoms or improved their quality of life.

I really feel that medicinal cannabis is something that we should be talking about with people because for many people, it can be a really good choice in their treatment.

 

CH: Why were you excited to get involved with Project Twenty21?

RM: I felt really passionate [about the project] because I had seen how helpful medicinal cannabis could be for many, many people. And as it’s very new in the UK, it was really exciting to be part of something that is at the forefront of what I believe is going to be one of the most important fields of medicine over the next decade. 

 

CH: What is the importance of data in prescribing medical cannabis? 

RM: It was really important for me to be part of this project because of all the amazing data that this is going to give us as it progresses.

I think one of the key things as a medicinal cannabis prescriber is being asked about data and where the evidence is. The fact that we have this wonderful project that’s capturing data from people presenting lots of different conditions is so important to me because I want to be able to give people this evidence about how cannabis might help them and how it might help with particular symptoms. 

CH: What are your hopes for Project Twenty21? 

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RM: The people that I’m working with really like feeling that they’re part of this project and they’re contributing to something that’s going to be really helpful for others. There’s a real sense of people wanting to help. 

I hope that it means that we have this amazing array of data, which we can use to transform the way that medicinal cannabis is prescribed. And clearly, the end goal for me is that I would really like this to be available for people on the NHS so that there is equity of access for anybody who wants to consider it as a choice. 

And alongside that, there’ll be data that can be published so that everybody across the world can learn from this. 

 

If you’re a clinician who would like to know more about becoming a medical cannabis prescriber with Project Twenty21, please email prescribers@drugscience.org.uk

Matthew Taylor shares his experience as a patient on Project Twenty21 here

Find out more about joining here

Epilepsy

CBGA may be ‘more potent’ than CBD against seizures in Dravet syndrome

Dr Lyndsey Anderson said there is more to explore when it comes to creating more treatment options for Dravet syndrome.

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Dravet Syndrome: A row of test tubes containing CBGA oil with a doctors white gloved hand holding one up to the light

Scientists say they have found the ‘Mother of all cannabinoids’ which may help to reduce seizures in Dravet syndrome.

A new study on mice from the University of Sydney found that three acidic cannabinoids found in cannabis reduced seizures in Dravet syndrome, an intractable form of childhood epilepsy.

The three cannabinoids are cannabigerolic acid (CBGA), cannabidivarinic acid (CBDVA), cannabigerovarinic acid (CBGVA). All three but CBGA in particular “may contribute to the effects of cannabis-based products in childhood epilepsy” noted the researchers and were found to potentially have ‘anticonvulsant properties.”

The study marks the first time that three acidic cannabinoids were found to potentially help reduce seizures for Dravet syndrome.

Speaking with Cannabis Health News, the lead author of the study, Dr Lyndsey Anderson, said: “We found that CBGA exhibited both anticonvulsant and pro-convulsant effects. CBGA was more potent than CBD against febrile seizures in a mouse model of Dravet syndrome. We also found that a combination of CBGA and clobazam was more effective than either treatment alone. Additionally, we found that CBGA was anticonvulsant in the maximal electroshock acute seizure model, a model for generalized tonic-clonic seizures.”

She added: “CBGA did, however, present some proconvulsant effects. The frequency of spontaneous seizures in the mouse model of Dravet syndrome was increased with a high dose of CBGA. Also, CBGA was proconvulsant in the 6-Hz acute seizure model, a model of focal, psychomotor seizures.”

Although CBGA shows promise, Dr Anderson also stressed that it needs more research before it can replace CBD. She cautioned that Dravet syndrome patients may still need to proceed with caution.

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“Artisanal cannabis-based products are believed to reduce seizures in Dravet syndrome patients,” she said. “As these oils contain rare cannabinoids like CBGA, it is possible CBGA then contributes to the anticonvulsant effects of these artisanal cannabis oils. However, there were proconvulsant effects observed with CBGA, suggesting that Dravet syndrome patients may need to proceed with caution. The proconvulsant liability of CBGA would need to be addressed before it replaced CBD as an anticonvulsant.”

What is CBGA?

Sometimes referred to as ‘the mother of all cannabinoids,’ CBGA is the precursor molecule to many different cannabinioids including CBD and THC. It is thought to help some diseases such as colon cancer, metabolic disease and cardiovascular disease. It is a non-intoxicating cannabinoid much like CBD.

Dr Anderson explains that more research is needed to explain how the three cannabinoids work together.

“We don’t know how they work together yet,” she said. “We found that CBGA, CBDVA and CBGVA were all individually anticonvulsant against thermally induced seizures in the mouse model of Dravet syndrome. We did not investigate whether a combination of these three cannabinoids would result in a greater anticonvulsant effect than either cannabinoid alone. Future work will definitely explore this possibility.”  

CBGA future research

This isn’t the end of the research into CBGA for Dravet Syndrome. Dr Anderson said there is more to explore when it comes to creating more treatment options for Dravet syndrome.

 

She said: “Next on the horizon for this research is to explore whether the anticonvulsant properties of CBDVA and CBGVA translate to other seizure types including spontaneous seizures in the mouse model of Dravet syndrome. Additionally, we have extensively interrogated the anticonvulsant potential of individual cannabinoids and identified ten with anticonvulsant properties.”

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“We are now interested in investigating what happens when we combine these anticonvulsant properties. It remains an open possibility that greater anticonvulsant effects are achieved when the cannabinoids are administered in combination.”

The study was recently published in the British Journal of Pharmacology (DOI: 10.1111/bph.15661)

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Industry

New York regulators vote to allow home grow for medical cannabis patients

The new regulations would allow medical cannabis patients and carers in the state a safe, cost-effective way to access their medication

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New York: The statue of Liberty against a blue sky and the skyline of New York city

The proposed regulations would allow medical cannabis patients and carers in New York to grow up to six plants, indoors or outdoors, for therapeutic use.

New York cannabis regulators voted unanimously for the proposed regulations which would not only allow qualified patients to grow their own plants.

According to a slide from the Cannabis Control Board presentation, patients would be allowed six plants each but carers with more than one patient,  can “cultivate 1 additional cannabis plant for each subsequent patient.”

The new regulations would impose a duty on patients to ensure no one under the age of 21 can access the plants or any products cultivated from them.

Landlords would also have the option to prohibit their tenants from growing cannabis on their property if they chose. The products must not be processed using anything other than alcohol.

The regulations will now have a 60-day public commentary period before review.

Tremaine Wright, chair of the Cannabis Control Board (CCB) said: “We are proud to present those proposed regulations. The home cultivation of medical cannabis will provide certified patients with a cost-effective means of obtaining cannabis through personal cultivation while creating a set of standards governing the conduct and activities relating to the personal cultivation of cannabis.”

In a press release, the CCB also gave an update on the expungement of cannabis convictions. “Approximately 203,000 cannabis-related charges are presently being suppressed from criminal background searches and are in process of being expunged, adding to the approximately 198,000 records that were expunged as part of the first round of cannabis expungement following legislation enacted in 2019.”

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New York recreational market

Earlier this year, New York. It would become the 16th US state to legalise recreational cannabis creating thousands of jobs and tax revenue. The bill was signed into law by Governor Andrew Cuomo in March.

The law would allow for possession of up to three ounces of marijuana for personal use. It would allow licensed dispensaries to sell cannabis products to those over 21.

Neighbouring states who have already legalised marijuana, including New Jersey and Massachusetts, meant that New York citizens were leaving to access cannabis losing tax revenue in the process.

It is expected that home grow for recreational users will follow the proposed regulations for medical cannabis patients but only after the new market is established.

Read more: California governor signs Ryan’s Law to allow medical cannabis use in hospitals

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CiiTECH announces new CPD-accredited training course

It aims to support and encourage UK pharmacists, physicians and nurses.

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Ciitech academy
The course aims to support and encourage UK pharmacists, physicians and nurses.

Cannabis healthcare company CiiTECH has been awarded CPD accreditation for its academy course, which aims to support and encourage UK pharmacists, physicians and nurses.

CiiTECH’s Cannabis Science and Therapeutics course has had tremendous success after launching the course earlier this year.

The new and innovative course offers an interactive digital platform with a 12 chapter syllabus comprising of medical cannabis, CBD knowledge and information, specifically catered for healthcare professionals in the UK.

Industry experts in the UK could potentially face serious challenges if the trainers in question who are both recommending, and dispensing information are not up to the required standards in the field.

People currently working in the industry, such as pharmacy professionals will feel more secure and confident after taking the course. With such an array of knowledge from the experts, they are better able to recommend, treat and understand benefits and causes of their patients.

Besides all the learning and comprehensive information, simple FAQ questions by patients can be simply downloaded to have at hand as an ongoing reference.

The CBD industry is an extremely fast growing market, people are becoming more and more aware of benefits and common usage. It’s said that by 2025 the market in the UK only will be worth over £3 billion.

This means that clinics and pharmacies must be sourcing trustworthy information to their customers.

This course is aimed at filling an education gap in the market, by covering several points in intricate detail, from plant history to dosing, and patient care. A lot of occupations in the UK require an on going learning process each year, with positive results overtime, leading to a greater service in the industry.

“Through years of experience serving UK customers with our portfolio of CBD brands it was abundantly clear that the level of misinformation was enormous and confusing for everyone involved,” says Clifton Flack, CEO and founder of CiiTECH.

“Formal education is always important but with little to no existence in the UK we could not see a better way to help lead the industry than to establish our own online academy and give healthcare professionals the opportunity to not only learn about cannabis therapeutics but to earn further education points at the same time.”

Flack adds: “With the rise in UK cannabis prescriptions and CiiTECH’s long awaited move into the THC medical cannabis arena, now is the time to increase professional education and it is exactly why we have embarked on this education journey. CiiTECH is fast becoming the UK’s one stop shop for all your cannabis needs; research, education, consumer brands.”

CiiTECH collaborated with Medical Cannabis Mentor to produce the course and prepare it for CPD certification.

Joe Dolce, founder and CEO of Medical Cannabis Mentor, comments: “The course synthesises the most up-to-date scientific research and clinical guidelines in an engaging format to help professionals make informed treatment decisions.”

The course can be found on https://cpduk.co.uk/ or for pricing and registration visit:  https://ciitech.academy

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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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