OPINION: Cannabis medicines generate suspicion in doctors – until they see the results for themselves

Dr Mark Wilbourn is a GP prescriber of medical cannabis in Jersey and a member of the Medical Cannabis Clinicians Society (MCCS). Taking a holistic approach to prescribing has seen “life-changing” results, which are helping to transform perceptions on the island, he writes.

Dr Mark Wilbourn. Credit: The Medical Cannabis Clinics

I first met a patient self-medicating with cannabis as a medical student in the mid 90s. 

His rheumatoid arthritis was in remission, thanks to the cannabis he was growing in his garden greenhouse, but he was concerned that his GP or rheumatologist would find out and take it away from him. 

This left me with the perception that the medical profession and the law needed to facilitate good medical care with cannabis, and – finally – this has happened. 

At that time, I didn’t know cannabis had been used as a medical treatment for millennia, nor that some famous historical figures like Queen Victoria had benefited from its medicinal effect. 

I completed the rest of my undergraduate medical training and cannabis was only briefly mentioned as an illegal drug.

I am now a doctor practicing as a GP in Jersey with training in cannabis medicine. Here, when the legislation around medical cannabis was created, any doctor was permitted to prescribe, without the UK requirement to be on a specialist register. 

The holistic approach

All the guidelines advise prescribing within a doctor’s scope of practice. This means that GPs, who look after patients with multiple medical problems, are able to prescribe cannabis holistically in Jersey. 

We can take all the elements of a patient’s needs into account. 

Let’s take the example of an anxious patient with chronic pain and trouble sleeping (insomnia). Anxiety falls within the remit of a psychiatrist. Chronic pain is treated by a pain specialist anaesthetist, while insomnia doesn’t have a mainstream specialist yet. 

Anxiety is managed with a Cannabidiol (CBD) dominant Cannabis Based Medical Product (CBMP) or a balanced product. Pain can be treated with a Cannabis Sativa. Insomnia is treated with a Cannabis Indica at night.

Laying down the law

Jersey’s Police Officers lack the legal power that their UK counterparts have to exercise discretion in dealing with people found to possess tiny amounts of illegal cannabis, even if it’s obvious that medicinal use is intended. 

In the UK, there is a legal maximum Tetrahydrocannabinol (THC) blood concentration limit of two micrograms per litre and, if convicted, you face a year long driving ban. 

THC is the main psychoactive component of cannabis so there is some logic to this, but it is a bit more complicated than that. 

A Cannabis Sativa may increase alertness, while Cannabis Indica may reduce it. Balancing THC with CBD will alter the THC effect. Different people react to cannabis in different ways, so a blood concentration of THC alone is an inaccurate way to assess an individual’s ability to safely continue to control a motor vehicle.  

DVS, the Jersey equivalent of the DVLA, sensibly says: “It is a driver’s responsibility to decide whether they consider their driving is, or they believe might be, impaired on any given occasion.”

There is currently no arbitrary blood THC concentration limit in Jersey law.

A surge in demand

The geographically-isolated nature of Jersey meant that when Covid-19 necessitated travel restrictions, the supply of illegal cannabis for self-medication became restricted. 

This has encouraged patients to come forward to legitimate clinics to such an extent that the three clinics in Jersey have sometimes struggled to meet demand from a population of just 108,000.  

Switching from black market cannabis to properly produced medicine means quality assurance of the product, consistency of cannabinoid levels and no risk of the cannabis being cut with toxic chemicals or contaminated with harmful pesticides and fertiliser. 

Treating people with cannabis is emotionally rewarding for the doctors involved. “Life-changing” is a description that I hear frequently from patients.

Treating a person’s high blood pressure or high cholesterol will increase life expectancy on a population level, but does nothing immediate to improve quality of life for that individual. 

However, treating a person’s chronic insomnia or anxiety with medical cannabis frequently, immediately improves quality of life in many ways. 

Poor sleep is associated with shorter life expectancy, so a prescription of medical cannabis may eventually be proven to extend lives too. It is not unusual to see a pale shadow of a patient at initial appointments and bright, engaged, well people at follow up, once they have benefitted from medicinal cannabis. 

Word of mouth is strong and it’s not unusual to see whole, adult families coming through the clinic over a number of months. 

Much stigma remains around cannabis medication, but this is reducing.

Seeing is believing 

When we opened the Jersey branch of The Medical Cannabis Clinic (TMCC) in November last year many local doctors were reluctant to see CBMP as a medicine. 

But a procession of patients, who have obtained fantastic results, has transformed perceptions and some of our, once sceptical, GP colleagues now direct and refer patients to us. 

Much of medicine is about treating one problem with multiple drugs, whereas cannabis-based products can treat many problems with one family of medical botanics. 

Their ability to do this confounds conventional medical thinking and generates suspicion in doctors until they see the results for themselves. 

However much it is drummed into doctors that they should follow peer reviewed medical research, seeing is believing.

Jersey has positioned itself to be a net producer of cannabis, with commercial growing licenses currently being issued. 

The island already produces good quality, full-spectrum CBD and Cannabigerol (CBG) oils at the Jersey Hemp farm. 

An Island that is traditionally known for its Jersey Royal potatoes and sunny beaches could become known for production of an ancient, once forgotten medicine. 

Find out more about joining the MCCS here

If you’d like to share your experience as a medical cannabis prescriber or patient, we’d love to hear from you. Please email sarah@handwmedia.co.uk