A study published in the journal, Epilepsy and Behaviour examined CBD’s potential impact on anti-seizure medications for people with epilepsy.
There are 600,0000 people living with Epilepsy in the UK. It’s one of the most common nervous system disorders affecting people of all ages. It’s a neurological condition that can result in seizures. Treatment for epilepsy can include anti-seizure medication, diet therapy such as the ketogenic diet and surgery.
The side effects of medication can include dizziness, nausea, headaches, fatigue, vertigo and blurred vision.
There are medications such as Epidolex prescribed for rare seizure disorders such as Dravet syndrome or Lennox-Gastaut syndrome. However, it is not approved for other forms of epilepsy. There are around 60 different types of seizures and it is possible to have more than one type. Seizures can vary depending on where in the brain they are happening.
They analysed data collected between April 2016 and July 2020 from 418 patients. The participants included 71 adults with epilepsy who used artisanal CBD products for medicinal purposes and 209 who were caregivers of children or adults who also used artisanal CBD. The control group of 29 adults with epilepsy who were considering CBD and 109 caregivers who were interested in it for dependent children or adults.
Participants were asked to fill in a survey and answer questions about their quality of life, anxiety, depression and sleep. They were also given follow up surveys every three months for over a year.
In comparison with the control group, artisanal CBD users reported 13 percent lower epilepsy medication-related adverse effects. They also had 21 percent greater psychological health satisfaction at the beginning of the study.
Their anxiety was recorded as being 19 percent lower and depression was 17 percent. Both the adult and youth groups reported better quality sleep than the control group.
The caregivers of patients currently using CBD reported 13 percent less stress and burden in comparison with the control group. Patients in the control group who started using artisanal CBD reported improvements in their physical and psychological health. They also self-recorded reductions in anxiety and depression.
Participants were asked to record possible adverse effects related to their CBD use. Among all of the participants, 79 percent did not report any effects.
Of the remaining participants, 11 percent reported potential drowsiness, 4 percent said their symptoms may have gotten worse, 3 percent had concerns about the legality and 4 percent worried about the cost of the profits.
The researchers reported that further research is needed to understand how the findings could be applied to patients. They also stated that patients should consult with their doctor before trying CBD products.
Emigration: “I tried cannabis again and I noticed that I was in less pain when I took it.”
In a new series, we speak to Irish cannabis patients about their decision to emigrate in search of easier, safer cannabis access.
In a new series, Cannabis Health News talks to people who have experienced emigration in search of safe, legal cannabis access.
Our previous stories have focused on the difficulty of packing your entire life into boxes and emigrating with your family to a new country for access. However, there is another side to emigration: the potential for return.
What happens once you are a medical cannabis patient in another country and need to travel home?
The returning Irish from emigration in the past few years has hit record numbers. As people settle into life away from home, it gets harder to return. Travel options have never been easier with several flights to and from Ireland daily from all over the country, ferry options and failing that, zoom calls are a vast improvement on Skype.
COVID lockdowns meant that it’s been a difficult year for travel. Families who have experienced emigration may not have seen in their families since the beginning of the crisis. Now thanks to vaccines, travel is starting to become a possibility again.
This leaves medical cannabis patients in a confusing situation. What do you do if you have a prescription in one country yet need to go to another?
This is the situation *Joe is in. This is not his real name but he has asked to remain anonymous due to the persisting negative attitudes towards cannabis which he is prescribed for debilitating arthritis.
“I have since the age of 14 suffered from debilitating rheumatoid arthritis. I also suffer from sciatica. I played rugby six days a week for my school, worked on the family farm and lived a full and normal life. My body then changed and while initially my shoulders were affected but then my knees. It felt like someone was trying to tear my arms from their sockets and that I had broken glass in my knees. That was 36 years ago.”
Arthritis is a common condition that causes pain and inflammation in a person’s joints. Osteoarthritis and rheumatoid arthritis are the two most common forms of the condition. It can start when a person is between 40 and 50 years old although it also affects children and teenagers.
In rheumatoid arthritis, the body’s immune system targets affected joints causing pain and swelling. The outer covering of the joint is the first place to be affected before it spreads across the joint leading to further swelling and a change in shape. This may cause the bone and cartilage to break down. People with rheumatoid arthritis may also develop problems with other tissues and organs.
The Irish Children’s Arthritis Network (iCAN) estimates there are over one thousand children and teenagers currently diagnosed with juvenile arthritis.
Emigration in Ireland soared in the 1980s as a result of a harsh recession and lack of jobs. It is estimated that during the ten years of the 1980s, 206,000 more people left Ireland. Like a lot of Irish teenagers unable to find work and looking to leave home, Joe decided to leave Ireland for the UK. While working on a building site, he encountered other workers using cannabis.
“Although I had my condition to contend with it, my symptoms were at their worst in autumn and winter and I went to the UK in the summer to work on building sites (I had no idea my short visit would last 33 years and counting.”
“I was brought up in Ireland with typical conservative social values. Many fellow workers on site were smoking cannabis but I had no interest and indeed felt it was both inherently morally wrong as well as being illegal.”
“For months my fellow workers would say to try some. I relented when we were out together one night as I had a few drinks so my guard was down. I smoked some cannabis. I was violently ill. I did not know that smoking cannabis with drink would have such an immediate and obvious effect.”
Emigration, cannabis and pain
Joe began to feel more pain as winter began and his joints reacted to the cold. Despite his illness the first time, he tried cannabis again and noticed an effect on his pain levels. His quality of life began to improve and he started to make positive changes.
“I tried cannabis again a few weeks later and by this time the winter was in full flow and my bones were aching. I noticed that I was in less pain when I took it. I prayed for guidance on the issue and felt it was not a sin for me to use cannabis because it was helping to alleviate my symptoms.”
“I then started to use cannabis more frequently. When I reached 19, I no longer needed to take my prescription and I was able to cancel an appointment for injections. As my condition had relented I was able to reengage with my passion for sport and would swim a mile per day, cycle to and from work and work as a scaffolder during the day.”
“I studied A levels at night school. I returned to studies as I felt if my condition worsened I would not be able to engage in physical labour and I also had a calling to be a lawyer. Anyone who has handled scaffolding tube on a cold winters day will also understand why I felt a move indoors could be a welcome change.”
Joe did well enough in his A levels to gain a place to study law at university. He qualified as a solicitor and worked at one of the top regional practices in the country. He had the honour of meeting Irish President Mary McAleese on one of her trips to Manchester. He credits being able to live such a full life to the benefits of cannabis.
Breaking the law
However, he was starting to worry about what could happen if his use was to become public knowledge. Especially as someone working in law.
“Cannabis had managed my condition so effectively that I was able to play football for the corporate team and had no outwards signs which could not be dismissed as being down to simple stiffness. I was concerned however that should my use of cannabis become public knowledge my career would be brought to an abrupt end.
“I was leading a double life – cannabis at the time was dismissed as having no medical use and I was afraid no-one would believe me if I said I was taking it for my arthritis.”
Joe stopped using cannabis for three years as he became fed up with breaking the law. He had also noticed attempts to change the law in regards to medical cannabis and wanted to see if he could access it legally. But his symptoms flared up as a result of him stopping his treatment.
“During my cannabis break however my arthritis flared up with a vengeance. Although now prescribed methotrexate, sulfasalazine and naproxen. During my near 30 year use of cannabis prior to this point, I needed no other drugs. Significant bone erosion occurred in this 3 year period.”
“My hands and feet were badly affected and I was unable to form a fist with either hand for about 2 years. I had to stop playing classic guitar. In addition to studying law, I also studied music and played guitar in ensembles and gave performances with others in my spare time so losing the ability to play was quite hard to take”
Joe was delighted when his prescription for cannabis was approved. After taking it for about a year, he found his condition far more under control and began to come off some of the drugs he had been prescribed. He was also able to play the guitar again.
One of the biggest things, he notes, is the feeling of being able to access his medication responsibly and not break the law.
“Cannabis, for me, does have limitations. Once I take it, I won’t drive for the rest of the day. It can give me mood swings although nothing too extreme. I can be grumpier in the mornings. I am mindful that all drugs have their side effect. I am losing my hair due to methotrexate which gives me a number of bladder issues as well as nausea.”
Emigration and settling
Although Joe is happily settled in the UK with no plans to move home, he still has family in Ireland who he would like to visit. This presents him with an issue, how to pack his prescription?
Going without cannabis while abroad can result in a lot of pain as Joe discovered when he stopped taking it. However, bringing it with him can result in having to again break the law. The other alternative is accessing the black market which is not safe for patients.
“My elderly parents live in Ireland and I would love to visit them. Ireland’s policy on drugs is different to that of the UK. There is nothing unusual about this as individuals states have their own laws. The UN passed the psychoactive Substances Convention in 1971. The Convention enables international travellers to bring their medication with them to other jurisdictions, even though they have different drug policies. Ireland is a signatory to this convention. The Irish State also supplies details of who to write to seek prior approval for the carriage of controlled drugs.”
Joe has started an email and letter campaign of writing for help. He is not the only Irish person in the UK who has experienced emigration and wants to travel home. He encourages others to get involved.
“I have on many occasions asked both the relevant Secretary for Health and the Minister for Health for permission to travel to Ireland with my cannabis prescription and for clarification of Ireland’s drug policy for tourists and have pointed out the large numbers of people who could be affected. It’s not just persons prescribed cannabis if Customs is going to seize all controlled drugs.”
“Although nearly 6 months have passed, I am yet to receive either a formal approval or rejection of my request to travel home. In the meantime, my parents are of course getting older as indeed am I.”
There are also other concerns about using cannabis medicine while in another country besides emigrating.
Joe cautions: “To anyone who is thinking of just leaving their cannabis medication at home in the UK and then driving in Ireland, please bear in mind that in addition to dealing with withdrawal symptoms you may also fail a roadside drugs test.”
“It’s not at all clear that you will have a medical defence to a drug driving charge in Ireland. Thus if you want to travel lawfully with a car, consider not taking your cannabis prescription for sufficient time to pass a drug driving test, but obviously, this is impractical for sick people who are only granted a prescription for cannabis where other medicines haven’t worked.”
Joe advises that those thinking of travelling to Ireland with their prescriptions for CBMP should seek approval for their medication. This can be done by writing to the Controlled Drugs Unit in Dublin.
CBD and gaming: Could CBD help you level up?
When it comes to gaming, could CBD give you a competitive edge? Always Pure Organics’ Sally Dempster explores the benefits.
Always Pure Organics’ Sally Dempster explores the CBD trend within gaming.
The gaming community is growing exponentially, from people playing casually with friends to professional esports competitors, all of whom are contributing to the phenomenal 1.8 billion (US) dollar industry. Especially with the lockdown conditions of Covid-19, the gaming industry has seen a huge surge in revenue and time spent video gaming- increasing by double digits in all regions. The increased amount of time spent gaming can sometimes lead to health problems; frequent players often report physical aches and pains, altered sleep cycles, stress and anxiety. Many of these health problems can be caused by the prolonged periods of time spent at a console or in front of a screen.
Physical aches and pains from gaming can manifest themselves in a variety of forms including carpal tunnel syndrome, gamer’s thumb, and tennis elbow. Avid gamers can sometimes fall prone to these problems which cause inflamed muscles, nerves, or tendons due to overuse.
Whilst cannabidiol (CBD) cannot cure the underlying damage caused by carpal tunnel syndrome, gamer’s thumb or tennis elbow, it may help to reduce overall swelling and it has been shown in studies to relieve inflammation. Research on CBD has also shown that the Cannabis sativa extract may, in some cases, be beneficial as a method of pain relief. Using CBD as a form of pain management could help to relieve pain from gaming conditions, enabling players to be more stress-free and relaxed throughout the natural healing process. It is important to note that using CBD as a method of pain management for acute pain will not result in instant healing; users should be aware that any decrease in pain does not equate to a fully healed injury.
Gaming and scientific debates
There are ongoing scientific debates as to whether video games induce stress or whether they help to manage and reduce it. The answer to this debate perhaps depends on the level of investment that the player has in the game. Players who spend less time gaming or who only play for recreational and social purposes, for example, are less likely to get stressed during play compared to high stakes players or career gamers.
Evidence points towards CBD having a calming effect on the central nervous system. Taking CBD before gaming may help pre-emptively mitigate stressful feelings, this is due to the fact that CBD is a neurotransmitter that will bind to receptors in the brain. These bindings displace any anxiety-inducing neurotransmitters and stop them from binding to the receptor, which helps to restore equilibrium in the brain.
A recent study determined that video games do affect the stress system, in addition to the cognitive system of humans depending on the game style. Fear inciting games, which feature genres such as, survival, action, and psychological horror is more prone to elicit feelings of stress and tension. The research also demonstrated that the type and level of stress triggered in the players depend on the game style (Aliyari et al., 2021).
Esport competitions have closely monitored regulations regarding doping. Competitions adhere to the World Anti-Doping Agency (WADA) list of prohibited substances; players found breaking these regulations could find themselves (and their teammates) banned from competing. Cannabidiol is the only cannabinoid compound found in cannabis permitted in esport competitions.
Although WADA has removed CBD from its list of prohibited substances it is still advised that competitors using the extract choose CBD products carefully as some broad-spectrum products contain low levels of THC which is still a banned substance in esports competitions.
As the number of gamers increases and the industry grows, player gaming injuries will become more prevalent; extracts such as CBD may prove useful in mitigating these issues. Cannabidiol could, in some cases, also aid with the reduction of stress created when playing video games. Especially at high levels of competitive esports, there is an intense amount of pressure on the players to perform; now that WADA has approved CBD for use in competitions it may be able to minimise players’ feelings of stress and anxiety while gaming.
How GPs could open up access to medical cannabis
With around 35,000 GP’s across the UK, are they the key to unlocking wider access to medical cannabis?
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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