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

A holistic approach to prescribing has seen “life-changing” results in Jersey, writes Dr Mark Wilbourn.

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MEDICAL CANNABIS
In Jersey GPs are permitted to prescribe cannabis medicines

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 [email protected]

 

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Fibromyalgia diaries: Travelling as a medical cannabis patient

Medical cannabis patient, Julia Davenport, on the challenges of travelling with a prescription.

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South Africa remains one of fibromyalgia patient Julia Davenport's favourite places - but getting there isn't always easy.

While cannabis oil has dramatically improved fibromyalgia patient Julia Davenport’s quality of life, it has brought with it new challenges when it comes to travel, as she explains here.

Chronic pain has a nasty habit of getting in the way of doing the things you love.

My big passion which I share with my husband, and I guess our one extravagance, is jetting off to far flung places.

Over the years, however, fibromyalgia, arthritis and aching joints have conspired to make travelling evermore arduous.

Now in my 70s with various replacement parts, difficult terrain is one of the biggest barriers to exploring new places.

Certainly, my husband’s bucket list destination, the Galapagos Islands, is on my no-fly list. I would have adored to go there at some point, but navigating those volcanic rocks, even with my walking stick, would be a nightmare.

Fibromyalgia: A banner advert for the medical cannabis clinic

Familiar holiday spots closer to home are also becoming increasingly inaccessible. Every year our extended family visits the same Northumberland cottage, which is at the bottom of a steep bank.

In years gone by, I’d be fine to walk down to it through the working farm in which it stands. Now, because my back and shoulders have deteriorated, I have to drive right to the door.

Finding ways to compensate for the things you can no longer do is a constant theme with chronic pain conditions.

Aside from mobility challenges, another restriction on travel with rheumatological conditions can be the weather, and humidity can play havoc with chronic pain. I’d love to go to Central America, for example, but I just couldn’t tolerate the heat and humidity.

Having said that, although hot dry weather is far better than the cold British winter, the difference is not enough to drag me away from my family at Christmas time.

For all my gripes about life on the road, though, traveling remains my great joy, and discovering medical cannabis and CBD has definitely helped; although it’s not all plain sailing.

Travelling with medical cannabis

In November I’m returning to South Africa, a place I’ve visited a few times and which has a special place in my heart.

On previous visits, because we’ve flown via Dubai, I’ve not taken medical cannabis or CBD with me.

There is no way I’d risk taking cannabis with me to the UAE, where people have apparently been arrested and put in jail for having codeine, never mind anything else, despite having a prescription for it.

They have a ridiculously long list of substances that they deem addictive which you can’t have. There are things you can apply for permission to take, but I just wouldn’t trust that I wasn’t going to get arrested.

When we’ve flown long-haul through Dubai in the past, I would tend to take enough medication just for the journey. I have even flushed pain medication down the toilet on a connecting flight to Dubai just to make sure I’m not in possession on arrival.

I’ve then managed to pick up cannabis products quite easily in certain final destinations.

In South Africa there was a shop similar to a Holland and Barrett which sold CBD products legally. They were able to match the equivalent of what I was already taking to their products.

In Japan, it was also relatively easy to buy CBD over the counter, even with the language barrier.

In the past, the ease at which you can buy CBD has definitely influenced my travel choices. There are lots of countries that I’d give a wide berth to because of their approach to medication, which is often underpinned by false views on addiction.

At the same time, with so many countries opening up to CBD, travelling is getting easier and the main challenge is the routing of flights through the Gulf.

Thankfully on my next trip to South Africa we are travelling direct to Cape Town directly so I can rest easy that I won’t end up behind bars.

Guidance for travelling with medical cannabis

Some countries allow medicinal cannabis and some even recreational cannabis. Some allow CBD but others do not.

Guidance from the Medical Cannabis Clinicians Society recommends that patients always contact the embassy to check the legal situation in the country they are visiting before travelling with medical cannabis.

 Some countries require a letter of proof from a clinician, some require a request to be submitted to the embassy requesting to travel, some restrict the amount of medication you are able to travel with, i.e. up to 30 days supply. It is suggested that any guidance is sought and confirmed in writing.

It is advised that travellers keep medication on their person, stored in its original packaging along with a copy of their issued prescription and relevant corresponding paperwork. 

You can get an idea of the country’s stance on cannabis initially by searching for “legality of cannabis” on Wikipedia – but always check with the embassy as well.

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Fibromyalgia diaries: To vape or not to vape?

Medical cannabis oil has been life-changing for Julia, but she’s still struggling to come to terms with vaping.

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Fibromyalgia diaries: To vape or not to vape?

Fibromyalgia patient Julia Davenport says cannabis oil has been life-changing for her, but she’s still struggling to get on board with flower.

My perception of cannabis has changed dramatically in the few years since I started taking it as pain relief. 

As I mentioned in my last entry, I’m from a generation which, despite living through the enlightened age of the 1960s, grew up believing the plant to be bad. 

This created a strong resistance to even trying CBD or medical cannabis when they emerged as possible treatments for pain associated with my fibromyalgia and arthritis. 

I’m over that now, and take CBD daily, with a private medical cannabis prescription to use orally whenever I have a flare-up. 

Fibromyalgia: A banner advert for the medical cannabis clinic

Read more about how Julia discovered medical cannabis

One taboo I’m still struggling to get past, however, is the use of vape. 

Buried in my kitchen drawer is a dry herb vapouriser, alongside the medical cannabis flower prescribed to me by a pain consultant.

With this, I’m armed and ready with what I understand to be the fastest route for medical cannabis to get into the bloodstream.  

But, sadly, although it could have rescued me on several occasions in the year since I bought the device, its box remains sealed.

I’m sure many Cannabis Health readers will be shaking their heads right now. What a travesty that something millions of people with a range of conditions could potentially benefit from is going to waste. 

I do truly feel lucky to have a private prescription at a time when countless others are unable to access medical cannabis through cost, red tape or misinformation.

The problem I have is my huge aversion to smoking. Yes vaping isn’t smoking, but the action of ingesting something that looks like smoke into your lungs just doesn’t feel right. 

While I’ve never smoked in my life, my father was a heavy smoker who suffered from the lung disease, chronic emphysema. My mother also had coronary artery disease, possibly related to smoking. 

For these reasons, I just have a mental block about vaping, despite reading about how effective it can be as a breakthrough remedy.

No doubt many people my age, who grew up with parents who smoked, also feel the same; and perhaps there is some way to go before vape vendors can escape perceived links to smoking.  

Maybe more evidence on the impact of vaping on the lungs will help to change this over time – and I’ll eventually make use of my vapouriser. 

Meanwhile, in putting my fibromyalgia diary together, I began to think about all the ways cannabis has changed my life. I thought I’d share perhaps the most unusual one – going cold turkey on my teddy bear collection. 

With chronic pain conditions, including fibromyalgia, night time can be particularly difficult and insomnia is common. It is a horrible experience to feel utterly drained but be unable to fall asleep, sometimes for days. 

Before discovering CBD and medical cannabis I would often find myself wide awake in the middle of the night. It was at these times that my attention drifted on my iPad to eBay. 

For some reason, possibly nostalgia, my search for distraction amid the pain and boredom took me to the furry world of vintage teddy bears.

Many nights spent bidding for bears in the blue light led to a considerable collection building up. 

Now, my days as an arctophile (yes there is a word for someone who collects or is very fond of teddy bears) are over.

My CBD and medical cannabis regime has significantly cut the number of sleepless nights I experience and, in turn, the volume of new bears taking up space on my shelves.

Next time: Travelling as a medical cannabis patient.

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“As a psychiatrist I have been amazed by the power of medical cannabis”

Dr Tahzid Ahsan, a consultant psychiatrist on discovering the benefits of cannabis for mental illness.

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“As a psychiatrist I have been amazed by the power of medical cannabis”
"With one cannabis flower I have treated people with depression, anxiety, autism, ADHD, PTSD, insomnia and more."

Estimated reading time: 6 minutes

For almost 20 years I was shamefully oblivious to the truth, but now I have seen the benefits of medical cannabis in all walks of society, writes Dr Tahzid Ahsan, consultant psychiatrist and prescriber at The Medical Cannabis Clinics. 

Professor David Nutt wrote a recent article for the British Medical Journal, entitled; Why doctors have a moral imperative to prescribe medical cannabis

So when did the moral compass change around cannabis and why?

“As a psychiatrist I have been amazed by the power of medical cannabis”

Dr Tahzid Ahsan

For thousands of years cannabis has helped humankind with discomfort and diseases of the mind, body and spirit, discussed in great detail as a form of medicine in ancient Hindi, Chinese and Arabic manuscripts.  

The current stigma arises from a period of civil rights movement in the 1960s US, leading to a direct ban on all psychoactive substances during the ‘flower power ‘era. 

The US’s number one ally followed suit, with the UK enforcing the 1971 Drugs misuse act as swathes of ethnic minorities were migrating to the UK, leading many to being incarcerated for cannabis use.

In the 1980s I grew up in an inner city area of a major city, where social and economic deprivation were rife. I recall young black and ethnic minority men being incarcerated by the police due to cannabis use, some were even placed into mental health units under the premise of the 1983 Mental Health law, stating that they were psychotic due to cannabis use. 

Despite substantial evidence to suggest that migration and trauma is a factor for someone to develop schizophrenia and psychosis, the abhorrent stigma still remains that cannabis directly causes this.

As a result , rightly or wrongly, the three associations that are currently most attached to cannabis are criminality, race and socioeconomic status, preventing a nascent industry and treatment from getting the exposure that it deserves. 

For almost 20 years I was shamefully oblivious to the truth, the veil of ignorance preventing me from seeking further knowledge around a substance that had helped with mind, body and spirit for thousands of years. 

anxiety: A banner advert for the medical cannabis clinics

As a training day coordinator for my consultant training scheme in 2017, I managed to have an invitation accepted by my ‘hero’ Professor Nutt himself. Witnessed by over 150 psychiatrists, Professor Nutt reflected on the past, present and future of psychiatry, with us.  I recall the grumbling tones of protestation from the crowd when cannabis was mentioned as a potential treatment for many mental health conditions in the future. 

In 2018, the story of young Alfie whose life was transformed by medical cannabis, led to a dramatic change  to the 1971 Drugs Misuse Act, whereby cannabis for medical use was reduced in scheduling meaning it could ‘be prescribed in humans’. This small change in the law has led to a fledgling industry. 

I joined The Medical Cannabis Clinics in November 2020, the first medical cannabis clinic to form in the UK. I then became a registered doctor for Project Twenty21, set up by Professor Nutt’s organisation Drug Science. The project made medical cannabis prescriptions more affordable, as well as gathering important real world evidence for research. 

Over the past two years I can honestly say I have been truly amazed by the power of medical cannabis. 

My shock comes from how medical cannabis can traverse such a huge range of mental illnesses in such a short space of time,  with very little side effects noted. 

Patients love the fluidity and malleability of medical cannabis, they don’t feel it’s dictating their lives like traditional medications have done. Some have even described cannabis as an accompaniment to their lives like a “long lost friend”, helping them cope from moment to moment, providing them with the necessary headspace to recover, grow and learn. 

With one cannabis flower I have treated people with depression, anxiety, autism, ADHD, PTSD, insomnia and more.

I have seen the benefits in people from all walks of British society, from the 70-year-old lady in a local village to an 18-year-old male from south London. 

I have heard many stories where people were literally at the end of the tether, having gone through a multitude of medications and therapy, to finally find something that can help them feel ‘normal’ again. They can now live life to the fullest, with a new found confidence in themselves to interact with the world around them in a fruitful manner. When I hear patient’s stories of how they have reconnected with people who they had avoided for many years, it almost brings a tear to my eye. 

In my entire 20 years of being in the medical field, I have never once heard an equally glowing review about a particular psychotropic medication, in comparison to medical cannabis. 

My whole perception of medical recovery has changed. As clinicians we dictate what the patient should have, and at what time. If they don’t conform, we label them as ‘non-compliant’ (bad patients), despite the side-effects causing more issues for some than the condition itself. 

With medical cannabis, patients can choose what strain and how much percentage of THC or CBD they would like, the terpene profiles that suit their goals and needs, adjusted according to how it benefits them. For the first time in their lives patients are enjoying recovering from their mental ailments through the power of medical cannabis. 

Unfortunately most in the UK are completely oblivious to the immense benefits of cannabis as described above, still associating cannabis with criminality, race and socio-economic status. 

Due to certain elements of the Proceeds of Crime Act 2012, we have been left in a position where the UK is one of the biggest exporters, as well as the biggest importers of medical cannabis. Yet UK patients cannot benefit from locally grown medical cannabis, they can only be prescribed cannabis that has been transported across the world. This has created a bottleneck where patients have been left waiting for weeks due to stock issues. 

It’s promising to hear that MPs such as Jeff Smith, who recently motioned the Medical Cannabis Access Bill, are working to try and make quality medical products more easily accessible to patients.

In the west, research and subsequent treatment depends on the gold standard of randomised controlled trials (RCTs). If evidence of treatment has not followed these standard research protocols, the evidence is almost dismissed by clinicians. 

As you can imagine it’s easy to do research on a drug where dosages can be changed very easily in a neat incremental manner. But cannabis does not fit into the neat categories within RCTs. The effect of the flower can change according to the strain, terpene profile and cannabinoid content. It requires a different approach and respect when it comes to evidencing benefits of medical cannabis, with more emphasis on qualitative clinical case studies.

At a time of great division nationally after Brexit and ongoing worldwide geopolitical turmoil, medical cannabis could be a unifying force that allows for more compassion and understanding between all of us. 

Cannabis, like the notion of ‘faith’, knows no boundaries, colour creed, or religion. I feel truly blessed that I have come across a treatment that I believe will shape the western philosophy of medicine for the foreseeable future. 

Dr Tahzid Ahsan, is a consultant psychiatrist and prescriber at The Medical Cannabis Clinics. If you could like to share your story contact [email protected]

 

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