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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

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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 

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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

 

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Simply CBD: The beginner’s guide to CBD

New to CBD? Simply CBD has put together a beginner’s guide to help you find the right product.

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Simply CBD
Simply CBD: The beginner’s guide to CBD

New to CBD? Simply CBD has put together a beginner’s guide to help you find the right product for you.

Chances are you may have seen or heard about CBD in recent years. And as we’re starting to learn more about it, a variety of new ranges are hitting the shelves, including lotions, oils, vapes, balms, edibles and water-soluble solutions. Here, Simply CBD gives you all of the information you need to get started.

What is CBD?

CBD products come from the cannabis plant. They contain minimal THC – less than 0.2%, in fact. As THC is the psychoactive component of marijuana, this means that they won’t get you high.

Popular with adults and pensioners, it is legally sold to people aged 18 and over. If you’re looking to buy products, you can find them in the form of oils, edibles, lotions, balms, gummies, capsules and more. They’re easily accessible too, which means you can pick them up on high streets and from a range of recommended online stores.

Will it get me high?

This is probably one of the most common questions asked, and the simple answer is no. This is because products must contain less than 0.2% THC, which is the psychoactive part of the plant. You can even find products on the market that contain no THC at all.

Getting started

Want to find a product that’s right for you? The good news is that there’s an extensive range of products that are helping many people try it for the first time. Several factors determine which one to buy, and sometimes this comes down to preference of how you want to take it.

Simply CBD always advises that you should ‘start low and slowly grow’ when you set out on your CBD journey. Here are some of the options from the range that are ideal for beginners, and are great value too!

Premium oils

The Green CBD oil is a great starter product because it is low strength, and you can simply place it under your tongue. This is a full spectrum oil mixed in a base of hemp seed oil, which is high in both CBD and CBDa. Because it’s a full spectrum oil, it has multiple cannabis plant extracts, including essential oils, terpenes and cannabinoids.

Simply CBD

Liquid Gold CBD oil

The signature Liquid Gold CBD Oil with turmeric and black pepper combines full spectrum CBD with double-strength curcumin turmeric and black pepper. It has a pleasantly earthy, spicy and nutty flavour, and is placed under the tongue. This oil is low strength, and perfect for those looking to combine it with curcumin turmeric.

Alternatively, Entourage Aqua Water Soluble CBD is a full spectrum, water-soluble CBD that can be added to drinks. This revolutionary product is an alternative to taking traditional oils, plus you can add it to both hot and cold beverages.

Water Soluble CBD drops

CBD gummies

Simply CBD also offers CBD gummies that you can easily take on-the-go. They come in packs of 20 delicious, mixed fruit-flavours. Each one contains 10mg CBD extract, plus they are suitable for vegans and vegetarians.

Simply CBD

CBD Gummies

CBD balm

You don’t have to take products orally. In fact, other options such as balms are a great option. The CBD Muscle Balm is particularly great for beginners as it’s gentle on the skin and absorbs easily.

CBD Balm

CBD Patches

A new product is the CBD Patches which are a convenient alternative to starting with CBD. They are simply placed onto the body and last for up to 36 hours, even better they are discreet! 

Simply CBD

CBD Patches

How do I build up my use?

No matter what type of product you choose, it’s important to follow the ‘How to use’ instructions.

Simply CBD offers a complete range in varying strengths, types and flavours to make it accessible to everyone. What’s more, its products are all independently tested and are extracted from Dutch high-grade cannabis. You can also benefit from customer support and join the unique, thriving Facebook community forum with over 45,000 other members. Here, users share their experiences and views on products, which can help you decide what you want to try. Ratings are an average of 4.93 stars!

The company also offers express delivery on all orders shipped in the UK and promises to supply products at competitive prices. The team is happy to answer any questions or concerns you might have.

To find out more, visit simply-cbd.co.uk

Read more: What’s the best way to take CBD?

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“Millions of cannabis patients face criminalisation behind the wheel – even if completely unimpaired”

Campaign group, Seed Our Future, is calling for urgent reforms to protect patients from criminalisation on the road

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cannabis driving laws
Many police officers are unaware that cannabis was legalised for medical use in 2018.

Urgent reforms are needed to driving laws to protect patients from criminalisation on the road, writes Seed Our Future founder, Guy Coxall. 

In October 2020, Seed our Future released our first report, Cannabis and the Law – No Evidence, No Crime, a report which assessed the unjust and unfounded cannabis laws in the UK via the Misuse of Drugs Act 1971 (MoDA).

The report concluded that cannabis laws are based on ideology, racism and political motivations and that the alleged harms associated with cannabis use are not based on scientific evidence but causal assumptions. It also demonstrated the urgent need for reform so as to protect our health, the environment and our economy.

The second report, developed to support the complete removal of cannabis from the MoDA 1971 via a judicial review, covers approximately 130 years of investigation into the alleged harms of cannabis and the story of prohibition to the present day. 

It is clear that the evidence of relative safety was ignored, whilst propaganda campaigns of fear and lies protected political and corporate interests, whilst millions suffered and died.

Rising numbers of driving convictions

Although the chance of being incarcerated for personal possession or cultivation of cannabis is unlikely these days – a caution, suspended sentence or community order is more likely – but these still carry a criminal record. The seemingly forgotten recent developments in driving laws are the greater threat to cannabis users in the UK, where over 10,200 people were convicted in 2019 and these numbers are increasing year on year.

Up until March 2015, cannabis users who drove a motor vehicle were provided with a fair and impartial trial as the police had to provide evidence of driving impairment in order to secure a conviction. 

I’m sure we can all agree that anyone getting behind the wheel of a vehicle whilst impaired should have the book thrown at them as they are endangering other road users. But for the majority of cannabis consumers, like those who use prescribed medicines such as opiates and benzodiazepines, are responsible enough not to drive when unfit to do so. 

Due to a low conviction rate, the police struggling to carry out field impairment tests properly and to follow other European and international countries, a review was carried out, led by Sir Peter North in 2010 to assess the implications of drug driving. A later report was published in 2013 by a so-called expert panel on drug driving. The findings of both led to an amendment to the Road Traffic Act, Section 5 (A) which essentially removed the need to prove impairment and relied entirely on blood tests showing above a per se zero tolerance level of specified schedule 1 drugs. 

The evidence used was seriously lacking and completely inconsistent as much of the data of road collisions showing THC in the system also showed presence of alcohol or other drugs and so there was little to no evidence of cannabis being a primary cause of driving impairment, in fact many trials showed that cannabis users were more careful drivers.

No evidence of impairment

Due to global changes in legislation for cannabis, a great deal of research has been carried out over the past several years to assess the implications for road safety. The new evidence shows that collisions have stayed constant, that the blood tests have no correlation with impairment and are thus inadmissible in a court as evidence of impairment, validated by the UN and that the blood tests do not provide evidence of recent use.

What does this mean? Millions of cannabis users in the UK are at risk of being criminalised and punished every time they get behind the wheel, even if they are completely unimpaired and may not have consumed cannabis for several days.

In court you will not be provided with a fair and impartial trial, as there is no evidence that you were a risk to road safety, no evidence of impairment or even that you consumed cannabis on the day of arrest. The lack of evidence and the infringement on our civil and human rights doesn’t seem to matter and at present, tens of thousands of drivers are being unfairly prosecuted every year.

The ‘medical defence’

Only those with a medical prescription are provided with a ‘medical defence’, but this does not stop the many police – who are still ignorant of the change to legislation in 2018 – dragging you through the courts and unfortunately, thousands of those with prescriptions are currently unable to meet the full criteria for the defence (something Seed Our Future are looking to rectify in the coming weeks).

What about the millions of cannabis users who use cannabis medicinally but simply can’t get access on the NHS or can’t afford a private prescription? Seed our Future have been supporting several members with this issue over the past year and have built a defence which we hope will soon set a precedent in law. It’s high time that the courts accept that to criminalise people for using essential medicine, is a clear breach of human rights and that persecuting people for not being able to access or afford a prescription is medical and financial discrimination. 

What happens now?

As more people become aware of the unique and expansive therapeutic properties of cannabis and as the roadside use of swabs (which detect only cannabis and cocaine) are increasingly used, Section 5 (A) of the Road Traffic Act has become the leading cause of criminalisation and punishment for cannabis users in the UK.

Seed our Future feels it imperative that the Department for Transport revisit the legislation, using the most recent evidence and take the recent change in legislation for medical cannabis use and the current inability of access into account in order to protect our human rights and civil freedoms. We recommend and will call for cannabis being removed from section 5 (A) of the Act and reverted to Section 4 where evidence of impairment was required.

Guy Coxall is a prominent cannabis campaigner, and the founder of Seed Our Future. To access the report and for more information visit www.seedourfuture.co.uk 

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“As a black medical cannabis patient, the sense of unfairness hurts deeply”

Maz Mills discusses the challenges facing black patients in an ‘all-white’ industry. 

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black medical cannabis patient
Black people are still overly stopped and searched by police

As a black medical cannabis patient, you can’t help feel a sense of hypocrisy that an all-white industry is doing what black people are persecuted for, writes Marie ‘Maz’ Mills, member of PLEA’s patient working group.

Marie Mills, black medical cannabis patient

Marie Mills is a member of PLEA

I have been a sufferer of fibromyalgia syndrome for 18 years. Recently, I was able to replace my medical cocktail of pregabalin, sertraline, amitriptyline, and propranolol with medical cannabis, having met some of the members of PLEA (Patient-Led Engagement for Access) in a Facebook group and then signing up to a private clinic in the UK.

The most notable part of my medical cannabis journey is the emotional rollercoaster of mentally getting my head around legal cannabis in the UK as a black patient.  

I am fully aware of the severe racial disparities that have clouded families of colour for as long as I can remember.  There is an even deeper association due to my Jamaican heritage, and it is undisputed that the most recognised association of cannabis lies with Rastafarianism on a global scale.  So, you can imagine my shock to find there are no black people as patients, or involved in this process or the emerging industry, and many still seem oblivious to access to legal cannabis in the UK.  

Racial divide

Why is this?  I feel as if I am sitting on a fence of racial divide. On the one side of the fence is an emerging cannabis industry that certainly could not have been started by black people, but their absence makes the industry seem as if it lacks validation.  

On the other side of the fence, black people are fully prosecuted, to the full extent of the law, more than any other race for possession of cannabis. Cannabis has been used as a weapon of destruction in the war against drugs and black people have been over persecuted for using it as medicine for as long as I have been alive.  

As a black patient you cannot help but feel a sense of hypocrisy now that an all-white industry is doing exactly what black people are persecuted for in exactly the same way. These feelings cannot be helped, they are just there, like a ball in your stomach. It haunts me every time I medicate, the sense of unfairness hurts very deeply indeed.

As a black patient this is an absolute brain fry. 

I think the deep-rooted negative association with cannabis makes it an extremely culturally sensitive issue which must be taken into consideration when dealing with black patients and their needs. 

I had no idea I would experience such a surge of emotion, involving tears, frustration, feelings of isolation, betrayal, guilt, relief, and deep confusion. I have worked in so many exciting industries and it has never occurred to me to look at things as ‘black’ and ‘white’ until legal cannabis, and it has caused a sense of trauma.  

The issues facing of people of colour

The medical cannabis industry must consider the culturally sensitive issues that will be faced by patients of colour and acknowledge the sense of trauma that legal cannabis may initiate unexpectedly.  

The racial disparities are still very present, black people are still overly stopped and searched, always asked if they have bud for sale by white people and may suffer from negative stigmas from their own culture. There are also trust issues that black people may be sold out to the police by this system. And in addition, the marketing and presentation of the industry seems like it is exclusively aimed at white people.

Culturally we are taught not to open up to white doctors on medical issues such as anxiety, depression, or mental health.  This is formed from a conditioned fear of being sectioned that is ingrained and this creates a barrier to access for people of colour.  

I am appealing for more people of colour to reach out to their doctors and to be open with them in order to reduce this cultural barrier to medical cannabis.  

People of colour may not have the noted history to qualify for the prescriptions. If the Project Twenty21 database is to reflect society’s cannabis patients to present the data for NHS access, people of colour must come forward and support this cause.

Lack of support

The industry needs to be equitable in light of the racial disparities suffered by people of colour.  There must be rehabilitation for people with cautions, warnings and convictions for possession of cannabis or who may have lost jobs for failing drugs tests for cannabis use.  They may have a range of transferable skills which could be invaluable to the industry.  A programme for patients to return to work and enter the industry is also a great initiative.

While medical cannabis has worked wonders for my day-to-day life, the toll on my mental health as a black patient and the unanticipated traumas that would arise from it is shocking.  

There is also zero support for anything I have been going through and it made me afraid to refer to more black people unless something is in development to cater to their needs.  But at the same time the relief is essential for medical users.  

Being able to identify and address the issues I’ve been facing will enable me to help both sides of the fence to work towards an equitable industry of the future.  I also look forward to a diverse database of users with all sorts of conditions in the united fight for our medication on the NHS.

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