With around 35,000 GPs practicing across the UK, many believe they could be the key to unlocking wider access to medical cannabis.
When Heather told her GP cannabis helped with her chronic pain, he laughed in her face.
“I’ve told doctors so many times that cannabis helps but they don’t listen,” said the 40-year-old, whose pain has gotten so bad over the last 10 years, she now relies on fentanyl and still some days cannot get out of bed.
“I once told my doctor that I had tried it abroad and he laughed and said I should move to the US.
“They say there’s nothing they can do, some of them aren’t even aware that it’s legal here.”
It’s not uncommon for GPs to be ill-educated on the legality of cannabis medicines in the UK, despite the law change in 2018.
Other patients, including those who have managed to obtain private prescriptions, have spoken about GPs not knowing cannabis flower is legal, for instance, or being completely unaware that around 6,000 prescriptions have now been issued in the UK.
As more often than not a first port of call for patients, how a GP responds to an enquiry about medical cannabis can drastically shape someone’s experience of accessing treatment and determine their next steps.
Lucy Stafford’s GP was incredibly supportive when she raised the prospect of getting cannabis on prescription to help manage her Ehlers-Danlos syndromes (EDS).
He even wrote to the local Care Commissioning Group to request funding and tried everything in his power to get her prescription through the NHS.
“My GP had treated me since I was 13, he saw me get better and be able to walk again, he could literally see the transformation in me,” explains Lucy, who is now advocacy director at patient group, PLEA (Patient-Led Engagement for Access).
“He wanted to help, he did everything he could and I was so grateful for his support, but his hands were very much tied as a GP, he can’t make a prescription even though he would love to.”
Being able to speak openly about medicinal cannabis with her GP was vital when it came to managing her care effectively, as well as making her feel at ease.
“There were times in the past when I was medicating illegally, when I didn’t mention it and it feels like you’re keeping a secret about something that’s actually a very important part of your treatment regime,” she continues.
“It really impacts your relationship with them and how you communicate.”
Lucy adds: “I know how daunting it is when you are having those conversations and you don’t know how it’s going to be received.
“You don’t know whether you’re going to have cannabis use disorder written on your medical records, unknowingly – it’s a risk and it’s not fair that patients are still facing that stigma when it’s a legal medicine.”
In more than 50 countries worldwide where cannabis has been made legal for medical purposes, GPs make up the majority of prescribers. And with over 35,000 registered GPs, caring for over 60 million patients in the UK, they appear to be the obvious missing link in widening access to medical cannabis here too.
“73% open-minded about a more active role in the field”
However, currently they are only permitted to prescribe under the direction of a doctor on the specialist register. It’s rare this happens, with few GPs willing, or feeling equipped to do so due to the complexities involved in the process, a general lack of education and training and costly insurance fees.
But according to Dr Leon Barron, founder of the Primary Care Cannabis Network (PCCN),the UK’s largest network of GPs with a professional interest in learning about medical cannabis, there is a “growing groundswell” of GPs who want to learn more.
He explained: “GPs make up the majority of medical cannabis main prescribers in many of the more established legalised medical markets.
“In the UK however, GPs have largely been left out of the conversion and we feel it’s time to change that.”
Dr Barron, surveyed more than 1,000 GPs on their attitudes towards medical cannabis.
The findings, published earlier this year, offer the first insight into where many stand on the issue – and the outlook is promising.
“24% willing to prescribe medical cannabis”
Just under three quarters (73 percent) were open-minded about having a more active role within the field, while almost a quarter (24 percent) said they would be willing to take on the role of prescribing and overseeing medical cannabis treatments.
According to the report, over half of GPs believe cannabis-based medicines could benefit patients who have exhausted conventional treatments, while 27 percent feel it can offer improved quality of life.
Just under a quarter believe it can offer multi-symptom management and reduced dependency on other prescribed medications, while 13 percent believe it can offer more patient-led personalised medicine.
Medical cannabis was favoured for use in chronic cancer pain, palliative care, intractable epilepsy, and spasticity in Multiple Sclerosis (MS). All of these conditions – apart from epilepsy – can be managed within a primary care setting.
Dr Julia Piper, is founder of PrivateGP.com, which recently became the first GP practice to join Project Twenty21, a scheme which aims to collect the UK’s largest body of evidence of the safety and efficacy of medical cannabis.
Dr Piper believes that GPs have a vital role to play in prescribing and are uniquely placed to offer the holistic approach that is necessary when it comes to treating patients with cannabis medicines.
“GPs have an incredibly important role to play,” she says.
“When you see a specialist you are only seeing one aspect of the condition, whereas a GPs scope is much broader.
“If the system is working well, they should have a good, holistic and balanced view of their patient, meaning they are better placed to determine, more quickly, what a patient needs in terms of medical cannabis.”
Dr Piper, who has more than three decades experience as a practicing GP, has spent the last 12 years working in functional medicine. She believes in taking a holistic approach to get to the root of medical problems, rather than only treating the isolated symptoms.
Medical cannabis prescribing was a natural progression for her, after learning about the workings of the body’s endocannabinoid system.
“There are a multitude of chronic illnesses that are mismanaged with our current knowledge,” she continues.
“We have moved on from treating one problem with one drug, because the human body is just too complex. We don’t have to dumb people down with strong psychiatric drugs when we could be resolving things at the root cause.”
Private GP’s medical cannabis arm has a multidisciplinary team consisting of consultants and GPs to facilitate the prescribing of medical cannabis.
Consultants will issue the initial prescription and if the patient responds well and things remain stable, the GP can take over and oversee the writing of repeat prescriptions.
Since it opened in May 2021, it has successfully treated a handful of patients this way, but the process is time-consuming and not without its challenges, says Dr Piper.
“Everything has to be very well documented and peer-reviewed, it’s very labour intensive work, but we’ve got to understand what we’re doing. You can’t just sign a prescription, you’ve got to understand the full story when it comes to every patient,” she explains.
“It’s been a long and tricky process, setting up all of the procedures to get to this point, but for everybody involved, we all want to learn because we see such benefits for patients who really wouldn’t have other treatment options.
“There really are some miraculous cases and it’s very rewarding.”
That said, Dr Piper can understand why other GPs may be wary.
“[Prescribing cannabis medicines] is much more of an inexact science – there’s no one-size fits all – and doctors are not really familiar with that route,” she adds.
“I can understand the reticence for a lot of people who think black and white because they’re trained that way, an incredible sea change needs to take place for doctors to think in a different way.”
Seventy two percent of respondents in the PCCN’s survey said their main concern was that the majority of cannabis-based products are unlicensed medicines, while 68 percent had concerns around lack of evidence of efficacy.
“68% concerned over lack of evidence”
This is partly why Dr Piper was keen to join Project Twenty21, to contribute to creating the evidence which will change views, but also to have the support of other prescribers.
“It’s so important that what we’re doing for patients we can share with the Government and with researchers so that we can influence thinking.
“Project Twenty21 has a great framework in place so that as the whole sector moves forward we can share that information,” she says.
“But as a prescriber, you also want to be in a safe environment while you’re doing this, with the support of your peers, it’s challenging work, you don’t want to be isolated.”
With a third of GPs (33 percent) saying they are asked about medical cannabis treatment by their patients approximately every six months, the PCCN’s survey highlights the need for standardisation in how they approach the subject with their patients.
“33% asked about cannabis every six months”
While its use for conditions such as chronic pain, epilepsy and MS were welcome, mood disorders such as anxiety, depression, and PTSD were not generally seen as suitable indications for medical cannabis treatments.
This is despite growing numbers of patients being prescribed privately for these conditions. After chronic pain, anxiety is the second most common indication prescribed for, according to data from Project Twenty21.
Participant’s concerns ranged from the understandable,‘I am not a familiar prescriber and do not have the training or skills to justify it’ – to the more misguided, ‘Abuse and demand by patients faking symptoms’; ‘Gateway to the real thing’ and ‘Medicalisation of people wanting to get high’.
The comments highlight that patients are still taking a gamble when broaching the subject of medical cannabis with their GP and the need for more widespread education.
This is something Dr Barron and the PCCN is committed to providing as its next steps after the survey.
“Cannabis based medicines is a rapidly emerging field of medicine which is only just gaining popularity,” he said.
“It is our duty to be informed and approachable on the subject but further to that doctors now have the opportunity to develop professional skills in an area of personalised medicine which is growing rapidly.
“We encourage UK GPs to join us at PCCN and to expand our knowledge as we are just at the cusp of a huge growth area in healthcare.”
Lucy would welcome more training for GPs and would love to see them permitted to prescribe as part of the move towards NHS access.
“GPs are perfectly positioned to be prescribers of medical cannabis, they definitely have a role to play and I think they want to” she says.
“They know their patients so well and the complexities of their conditions so they can have a much better understanding than your hospital consultant who you see once every six months.
“It would make life so much easier for patients.”
And that above all, should be a GPs’ main priority, agrees Dr Piper.
“In the end we have to do what is right for our patients,” she adds.
“That’s why we go into medicine to try and heal people, therefore we need to be offering them all the available options.”
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