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“We’ve lost doctors because of it” – Concerns over “abusive” behaviour in medical cannabis sector

Healthcare professionals say they are experiencing ‘threatening’ and ‘abusive’ behaviour from a minority of patients

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Cannabis clinics say aggressive behaviour towards staff will not be tolerated

Medical cannabis clinics are reporting a rise in ‘threatening’ abuse being directed at staff from a ‘small number’ of patients.

Healthcare professionals working in the medical cannabis field have revealed the extent of abusive behaviour they are experiencing at the hands of a small minority of patients.

Staff have reported experiencing a “pressure to prescribe” with some patients becoming more “aggressive” – and even threatening to report doctors to the General Medical Council (GMC) – when they have refused to provide a specific treatment. 

In the most extreme cases clinicians are said to have left the sector due to the stress that was being placed on them.

A source from one UK clinic, which is said to have been reported to the Care Quality Commission (CQC) “several times”, although none of these were upheld, told Cannabis Health: “Overall I have seen hundreds of patients, and the majority would say the experience has been positive, and even life-changing for them, but there is a cohort that can be very abusive and rude towards staff.

“Some patients have been using cannabis for a long time and are very knowledgeable, they know exactly what they want, and we get a lot of the blame when products aren’t available or there are issues with the supply chain.”

They continued: “We have lost doctors and other members of staff because of it, it’s very demoralising.

“All of our doctors are specialists in their field, they have spent many years as consultants in the NHS, but some are being told repeatedly by patients that they don’t know what they are doing.”

Feeling pressured to prescribe

Another prescriber, who asked to remain anonymous, said they have experienced more abusive behaviour from such patients when prescribing medicinal cannabis than they previously saw working in the NHS.

“What I’ve experienced and heard from colleagues is a real pressure to prescribe, in a way that the patient wants to dictate and not listen to medical advice from the doctor. When declined they have become quite abusive and threatening,” they said.

“We’re never doing it to deny people medication, but we have to prescribe within the framework.”

The doctor added: “I understand it’s frustrating and it’s fine for people to feel anxious, but on a couple of occasions I have had patients be verbally aggressive and vile towards me.

“We are just human beings at the end of the day, and it’s never nice to be treated in that way.”

Staff also referred to a “vocal online community” where “upsetting” comments are made about clinicians, with individuals often being named in threads. 

In one recent incident a member of staff had their personal details shared on social media and received an onslaught of phone calls from patients out of hours.

Rising frustrations

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Medical cannabis patients have become increasingly frustrated with industry standards in recent months, with supply issues leaving some experiencing delays to their prescriptions and in some instances going for periods without access to medication.

Earlier this month, two batches of cannabis flower products were recalled after they were suspected to be contaminated with a potential mould, which has heightened tensions further. The Medicines and Health Regulatory Authority (MHRA) and manufacturer BOL Pharma are currently undergoing investigations. 

But there are fears that the actions of a minority of patients could have a detrimental effect on continued access to this new treatment option.

As one source puts it: “If prescribers who have the knowledge and experience in cannabis leave the sector, what do we have left?

“We want to spend our time treating patients, not writing responses to complaints, it takes us away from what we want to be doing, which is helping patients. If this continues, it’s hard to see how cannabis medicines will ever be accepted by the NHS.”

Another industry expert agreed that there are areas which need improvement, but urged patients to have “reasonable expectations”.

Since medical cannabis was legalised in November  2018, the industry has grown from a handful of patients to several thousand over the last 18 months, with access now more widely available since the introduction of schemes such as Project Twenty21. 

But restrictive regulations around the importation of cannabis medicines and the growing and manufacturing of them here in the UK, have resulted in a system struggling to keep up with demand.

“Nobody is hiding from the fact that patients need access to quality medicines on time, but there needs to be reasonable expectations,” they told Cannabis Health.

“The industry has grown from zero to thousands of patients in a very short space of time, there are going to be unexpected issues on occasions. 

“It’s not acceptable in healthcare and we’re doing everything we can to improve it, but we are limited by the regulations we have to follow and the infancy of the supply chains.”

They added: “Like most other people in this industry I’m here because I wanted to make a difference to people’s lives. 

“It is a minority of people, but unfortunately it’s often the minority who shout the loudest and we’re at a crucial point for the industry if we want to move forward.”

Patient-led advocacy group, PLEA (Patient-Led Engagement for Access) told Cannabis Health it was aware of “several ongoing issues” affecting patients in the prescription medical cannabis space which “need to be addressed” – but that abusive behaviour was “never acceptable”.

“Frustrations are quite understandable – patients are paying a huge amount of money for treatment; access to good quality products is needed, on time and with a good standard of care,” said Abby Hughes, chair and outreach director of PLEA.

“Sadly, PLEA is also aware of some aggressive behaviour from a small minority of those caught in these situations. Things do not always go to plan, yet, however frustrating, abusive behaviour towards others is never acceptable.”

She continued: “It is important for patients to recognise that industry stakeholders must work within their means, including where things may have gone wrong and need rectifying. PLEA is working with clinics and pharmacies to ensure patients are aware of reporting processes, and with patients to offer support through these processes where requested.”

Calls for industry ‘code of conduct’

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Early discussions are said to be taking place among members of the newly-formed Cannabis Industry Council around the introduction of a code of conduct to improve things for both patients and prescribers. 

Meanwhile PLEA says clear systems should be in place for patients to provide feedback on their clinical experience.

“Patients should be actively encouraged to share their experiences, particularly with reporting any issues that need rectifying, so that care can continue to be improved,” said Hughes.

“Systems should be in place for patients to provide feedback, however it is understood that processes are not always clearly defined, often leading to further frustrations.”

PLEA is currently exploring the development of a “more robust support system” to allow patients to share their experiences anonymously and where necessary request assistance from a patient liaison. 

“The newly formed Cannabis Industry Council is a welcome development also, with a Standards Subgroup operating to hold the industry to account,” added Hughes.

“It is hoped that a ‘code of conduct’ will be developed for both industry stakeholders and patients to work together cohesively to improve this rapidly developing space.”

Zero tolerance

Those on the frontline say they understand the frustrations and acknowledge patients’ right to complain, but abusive behaviour towards staff is “never acceptable” and “will not be tolerated”.

“Cannabis is a very new field, things are changing all the time and we want patients to work with us to help us provide a good standard of service and care,” said the clinic.

“We always welcome valuable feedback where it is within our power to improve things.

“But abuse towards healthcare professionals would not be accepted in the NHS, why should the cannabis sector be any different?”

Any patient who requires assistance can contact PLEA on hello@pleacommunity.org.uk for support.

 

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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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Industry

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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