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BMJ publishes first case study of medical cannabis for chronic pain

A medical cannabis patient with Ehlers-Danlos syndrome (EDS) has appeared in the BMJ

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Lucy, chronic pain patient
Lucy Stafford has seen her health transformed through medical cannabis

The first case study of medical cannabis as a novel treatment for chronic pain has been published in the British Medical Journal.

A medical cannabis patient living with Ehlers-Danlos syndrome (EDS) has broken new ground in the move towards widespread acceptance of cannabis as a medicine.

Lucy Stafford has recently seen her journey treating the condition with medical cannabis, published in the British Medical Journal (BMJ).

It marks the first time a case study of medical cannabis as a treatment for chronic pain has appeared in the highly-respected publication. 

Stafford, who was diagnosed with hypermobile EDS aged 17, after years of living with symptoms, has seen her health transformed through medical cannabis.

EDS is a multisystemic condition, meaning it affects many of the body’s organ systems. Since the age of 10, Stafford had lived with debilitating symptoms, which resulted in her leaving school at the age of 15.

She was prescribed numerous treatments, including strong opioid medication and underwent surgery for a dislocated jaw.

By the time she accessed medical cannabis at the age of 18, she had to be fed through a feeding tube and was reliant on a wheelchair.

Lucy was reliant on a wheelchair before accessing medical cannabis

According to the report, within days of self-medicating with cannabis, Stafford’s pain levels “considerably subsided” and within three months she was able to come off all her opioid medications.

A survey of 500 patients with EDS in the United States found that 37 percent used cannabis therapeutically and according to the paper’s author Sabeera Dar, of University College London Medical School, there is growing evidence for this in the UK too.

But research of the use of cannabis in this condition is severely lacking.

Dar writes that she hopes to “shed more light on this subject” to support a better understanding of the “improved clinical outcome” in patients.

“This is the first BMJ case report that attempts to quantify the multifaceted benefits given by cannabinoid medication to a multisystem condition,” Dar tells Cannabis Health. 

“It explores how chronic pain impacts many aspects of life and for this reason urges the profession to embark on further research on medical cannabis as a potential solution.”

The pair spent hours working through Stafford’s medical records to create a full picture of her journey through the healthcare system, something Stafford describes as “traumatic” at times, but ultimately a “healing” process.

“Getting to grips with the complexities in Lucy’s journey with the healthcare system and her medication regime was challenging,” admits Dar.

“I wanted to make sure we mapped everything in enough detail to show just how significantly the medical cannabis has helped her.

“The key findings in this case report stem from the patient’s story. The use of medical cannabis rapidly alleviated long standing chronic pain and dramatically reduced side effects related to opioid medication as these became less necessary to take.”

Stafford, now advocacy director for patient organisation, PLEA (Patient-Led Engagement for Access) hopes this marks the beginning of patients being seen as the real evidence for the efficacy of medical cannabis.

“I see myself as the guinea pig for how patients will become the evidence and how we can communicate it in a powerful way that clinicians and academics will take seriously and understand,” she says.

“Working with PLEA we are hoping to see many more case studies published, particularly of those rare conditions for which cannabis is transformational where nothing else is.”

In her paper, Dar highlights the lack of clinical evidence preventing doctors from prescribing and suggests that adopting a “patient-centred approach” to research, will allow for “vast swathes of reports illustrating the therapeutic benefits of medical cannabis”.

She says: “Despite there being a plethora of real-world patient stories online documenting a marked therapeutic benefit from medical cannabis there remain few randomised controlled trials, this is one of the reasons why physicians are hesitant to prescribe medical cannabis.

“Therefore, practically speaking in order to see the ease of access we want, we need to widen patient participation in such trials and begin to clarify which patients could benefit the most.”

Addressing barriers to access of prescribed medical cannabis, supporting clinical expertise and expanding clinical data collection regarding the therapeutic and wider economic benefits of medical cannabis, are noted as three key learning points from the report.

Initiatives such as Project Twenty21, which aims to collect the UK’s largest body of evidence for the efficacy of medical cannabis are already working towards these goals, collecting real-world data from patients enrolled on the scheme.

But Stafford highlights the importance of having individual case studies alongside this data, which show the breadth of the impact medical cannabis can have on a patient’s life. 

“Real world evidence and registries like Project Twenty21 are so important, but so is understanding the day to day impact of these medicines,” she says.

“They are not like other medications where it just affects one aspect of your condition, cannabis  is so holistic and only case studies will truly show the wide ranging impact they have on the patient’s quality of life, but also on their family and all aspects of their care.”

She adds: “I hope that my experiences will contribute towards clinician’s education and understanding of medical cannabis and hopefully invigorate some research into EDS and cannabis.”

PLEA would like to hear from any medical students interested in publishing case reports and from any patients interested in joining its patient working group, please contact: hello@pleacommunity.org.uk

READ MORE  UK experts explore back pain and medical cannabis

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71% of CBD users self-determine dosage without professional help

A large percentage of of those who use CBD for pain determined the dosage through trial and error

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A new survey has revealed that 31 per cent of respondents use CBD to treat pain – but found that 71 per cent of those do not check the dosage with professionals first.

The dosage survey conducted by industry watchdog, Leaf Report, reported that 22 per cent of 1360 respondents did not check their dose before taking CBD.

Almost three-quarters of those surveyed said they do not seek professional advice while 29 per cent did. A further 44 per cent decided the dosage themselves based on trial and error.

Dosage: A banner advert for Medical Cannabis Clinic

CBD-infused gummies, edibles, and beverages were the most popular method of taking CBD with a further 26 per cent preferring oils or tinctures. Vapes were the least favourite method of consumption at 10 per cent.

The survey asked a series of eleven questions about dosage and use. Among the findings, it revealed that 48 per cent of participants took the same dosage every time while 26 per cent do not check the concentration of their CBD products.

Just over half the respondents used CBD for pain with 31 per cent using it every day.

Lital Shafir, head of product at Leafreport said: “After our team reviewed the findings from the dosage survey, we realized that most users are not seeking out the opinions of professionals when trying CBD, which can lead them to negative experiences.”

“Our mission at Leafreport has always been to educate consumers on the many aspects of the CBD industry, and we want to offer educational tools like extensive reports for those who want to get away from ‘trial and error’ tactics when taking CBD.”

READ MORE  Coppafeel founder uses CBD to lead a 'happier life' with cancer

Correct dosage and misinformation

This survey findings are similar to another conducted on cancer patients earlier this year.

The earlier survey of 100 cancer patients at an oncology care clinic revealed they are interested in trying CBD to allievate symptoms but lack information about how to take it. Both set of findings highlight the need for more education around CBD. The main symptoms listed were uncontrollable pain, depression and anxiety.

The survey of 100 patients at an oncology care clinic showed participants were interested in CBD as a way to alleviate symptoms. They listed their main symptoms as uncontrolled pain, depression and anxiety.

When asked about their understanding of CBD, 45 percent said they were unsure if there were any risks. A further 17 percent believe there was no or low risks but 25 percent “reported uncertainty of the alleged benefits of using CBD.”

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New UK trials to study medical cannabis and chronic pain

A trial at the University of Manchester will study cannabinoids in patients with fibromyalgia and chronic pain

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A human pilot study will be launched in the UK, in coordination with the University of Manchester

A new UK trial will explore the effects of medical cannabis in patients with fibromyalgia and chronic pain.

US cannabis producer Flora Growth is set to begin clinical trials to explore the use of cannabinoids in patients suffering from fibromyalgia or chronic pain.

Primary research sites will be located in the US and the UK, with the hopes of fast-tracking traditional FDA and NHS timelines by running phase trials in parallel.

A human pilot study will be launched in coordination with an internationally recognised clinical research group based at the University of Manchester.

In addition, parallel molecular and pharmacokinetic studies will be conducted in the US with key scientists and colleagues of Dr Annabelle Manalo-Morgan, Flora’s lead scientific advisor. 

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“A paradigm shift is upon us where healthcare practitioners, researchers, patients, and adult-use consumers are starting to understand, accept, and embrace the therapeutic potential offered by phytocannabinoid-based medicine,” said Dr Manalo-Morgan.

“As such, there is an urgent need for more research to better understand the molecular and biochemical effects of cannabis at the cellular level, to begin to apply its implications as a pharmaceutical drug.”

According to an announcement earlier this month, Flora intends to work with government regulators, as well as academic institutions to initiate academic studies in order to reduce costs and develop new cannabis-based drugs.

​​It plans to “honour the traditional FDA and NHS route in scientific processes” to deliver cannabinoids for specific disease conditions, backed by data, with an initial focus on fibromyalgia, brain health, pain, and related research.

The firm’s immediate next steps are to submit data for ethics committee review, with further details expected upon approval.

Dr Manalo-Morgan added: “I’m extremely pleased that our team recognises the importance and necessity of this research, not only to create and bring to market novel pharmaceutical cannabis products for patients around the world that are more efficacious and have a superior safety profile compared to traditional and incumbent pharmaceutical treatment options, but to also enhance long-term shareholder value.”

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Pain and cannabis medicines – experts present at the Royal Society of Medicine

Experts in the field of medical cannabis present at the Royal Society of Medicine

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pain and cananbis medicines

Earlier this month, experts in the field of pain and cannabis medicines presented at the Royal Society of Medicine. Alex Fraser, patient access lead for Grow Pharma, reviews the event.

Real-life in-person events are few and far between in these days of Covid. This is just one of many reasons why we at Grow Pharma were so excited to be a part of last week’s educational event at the Royal Society of Medicine hosted by Integro Medical Clinics.

Aptly titled; Pain and cannabis medicines: Everything you want to know (but were afraid to ask), the event, held on Monday 11 October, was a day-long agenda of presentations from some of the leading experts in their respected fields, primarily medical cannabis prescribing, regulation, pharmacology and research. 

Grow was honoured be asked to sponsor the event alongside Aurora Cannabis, LVL Clinics and The Centre for Medicinal Cannabis.

As well as sponsoring, I had the personal pleasure of kicking the day off with a presentation on the history of cannabis and route to legalisation on prescription in the UK (not a brief subject to fit into 20 minutes). I was also asked to host one of the sessions later in the day introducing Integro’s stellar team of cannabis-prescribing specialist doctors. I’m still in awe to have shared a stage with so many individuals that I respect so much.

pain and cannabis medicines event

Alex Fraser presents at the RSM

It was fantastic to hear from Professor Raphael Mechoulam calling in via Zoom. The world-renowned Israeli biochemist, now in his 90s, discovered THC and the endocannabinoid system (ECS) and as such is a true legend in the field. Also speaking were the ever-passionate Dr Arno Hazekamp, an independent consultant with extensive experience in the field including seven years as Dutch medical cannabis pioneer Bedrocan’s head of research and the insightful Paul Chrisp of NICE, an organisation it would be negligible not to include in a high-profile medical cannabis event.

Paul Chrisp of NICE

 

READ MORE  Canadian study finds 'significant reduction' in opioid use in medical cannabis patients

However, it was the clinical team at Integro that were most fascinating. Integro clinical lead and pain specialist Dr Anthony Ordman played the charming host throughout and gave a hugely informative presentation on the uses of different formulations of cannabis medicines. Integro Clinic’s specialist nurse, Sophie Hayes, gets a special mention for organising the impressive line-up of speakers on top of delivering a comprehensive talk on the practicalities of caring for patients prescribed cannabis medicines.

pain and cannabis medicines

Sophie Hayes, Integro Clinics

Dr Basil Almahdi spoke passionately about the potential of cannabis medicines in the treatment of migraines. Pain specialist Dr Sally Ghazaleh and gynaecologist Srinivas Vindla gave insights on the use of cannabis medicines in the context of women’s health. Neuropsychiatrist Dr Mayur Bodani presented on mental health and cannabis medicines.

Oncologist Dr Andrew Gaya gave a powerful talk on the use of cannabis medicines for patients undergoing cancer treatment. He also gave an important review of the evidence to date for cannabinoids treating cancer and reducing tumour size (an area where prescriptions are not currently allowed, and research is still in its infancy).

Dr Gaya spoke about the positive impact seen in one of his patients who had undergone six years of progressive cancer and various treatments finishing by pointing out that the patient was doing well enough that they were present in the room for the talk on their own case study (for those interested the patient has an anonymised Instagram account covering their journey since being prescribed cannabis medicines).

Dr Andrew Gaya

Dr Ayesha Mian of the CMC gave a talk on education for clinicians. Pharmacologist John Brew from cannabis-prescribing clinic LVL Health spoke about their focus on research. Dr Matt Brown was unfortunately taken ill not long before the event but was replaced last-minute by former colleague Eleanor Owen-Jones to give a perspective on clinical research in cannabis medicines.

Each talk was important, illuminating and insightful and, in the coffee breaks, lunch and drinks that followed, attendees, including doctors interested in prescribing, industry professionals from some of the world biggest producers of cannabis medicines as well as regulators, nurses and other HCP’s weren’t shy about expressing how impressed they had been with the whole day.

Among the many cannabis-prescribing clinics we work with at Grow, it does feel Integro have taken it upon themselves to lead the pack. Not only with events like this, but in their day-to-day practice and patient care. They are the only clinic that provides a Monday-Friday 9-5 nurse phone line to support their patients and, from speaking with patients on a daily basis –  often in relation to the good and bad experiences with the various clinics – I can’t remember a patient having a bad word to say of Integro or their team.

Since the event I’ve updated a list of cannabis clinics I use to help inform patients and noted the number of these now in the UK and Channel Islands has trebled since the start of 2021.

Nearly three years since the law change, it’s certainly been a long time coming, but with events like this and clinics like Integro, patients can be assured that they are in safe hands as medical cannabis in the UK starts to grow more rapidly. 

For more information visit www.integroclinics.com or email: Contact@integroclinics.com

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