A new in-depth medical cannabis report from Drug Science highlights the anger and desperation of families experiencing the system in the UK.
The detailed report interviews 11 families who were participants recruited through the charity, End our Pain and its spokesperson, campaigner Hannah Deacon. The patients discussed a broad range of issues associated with medical cannabis including access, policies and its benefits.
The four most prevalent issues were concerned with regulation, benefits of medical cannabis and anti-epileptic drugs (AEDs). Patients also highlighted their anger and desperation in the relation to current policies.
Issues related to regulation and policy-making of medical cannabis in the UK are a major concern to families. Parents reported that they felt they were fighting an ongoing battle while dealing with the severe ill health of their children.
“It’s been a battle to get the medicine and it absolutely shouldn’t be”.
The difficulties lie in the current scheduling of medical cannabis as an unlicensed medicine and the challenges for clinicians in prescribing it. Even when clinicians have been supportive and attempted to prescribe, their efforts were blocked by hospital trusts. This makes it almost impossible to receive an NHS prescription for medical cannabis. The report showed only two of the patients are exceptions to this.
Confusion around medical cannabis guidelines
The parents viewed the current guidelines by the British Paediatric Neurology Association as too strict and that they prevent doctors from prescribing. They also added that this caused confusion around the guidelines while adding an unnecessary layer to the challenges of prescribing.
“They’ve said in the guidelines it states that I can’t do it because the guidelines won’t let me but as I said for the shared care agreement with your GP it doesn’t state it has to be an NHS paediatric neurologist, it just states it has to be a paediatric neurologist on the specialist register. At the moment I’m still emailing back and forward saying they are wrong about the guidelines.”
When individual doctors who were supportive attempted to help, they could be ostracised by colleagues.
“He was trying to support us with the cannabis but he was threatened with disciplinary from his supervisors and his trust.”
The problem of cost
As a result of the difficulties in prescribing, patients had to be treated privately at huge financial costs. The average cost is estimated at £1,800 per month which places huge financial strains on families. Two families had to sell their homes in order to continue accessing the treatment.
The Covid-19 crisis also placed an extra burden on families as it prevented offline meetings and as a result meant families turned to online events such as raffles to fund their children’s medicines.
The families were unsurprisingly, extremely disappointed with the current regulations and policies. After the legalisation in 2018, many of the families assumed they would have easier availability to treat their children. This has led to anger and resentment towards regulators, policy-makers and urgent requests for wider access.
Many of the parents said the CBMP option they were offered, which was usually Epidyolex, was not suitable to treat their child’s condition as it did not control their seizures. Many of the parents stressed the need for full-spectrum products and the importance of making a wider variety of medical cannabis products available. All of the parents agree that swapping from one medicine to another may not work was not a risk they were willing to take.
Two families had had to swap their Bedrocan products to another CBMP which had a negative impact on the seizure frequency of their children. This was due to importation issues from Holland. The cost and challenging regulations meant that families often travelled to the Netherlands for help. While some families were able to live short term in the country, others brought the medication back to the UK aware that this may cause a considerable legal risk.
This led to further psychological burdens for families. One family who travelled was refused treatment as “the doctor didn’t want to continue prescribing for all these English children”.
According to the medical cannabis report, many of the families felt resentment towards the current system.
One commented: “It makes me so mad because they need to live a life in our shoes, you know, and then you know, I thought they won’t come back and say you can’t have it. You know when you find the medicine, it could alleviate some of that and it gets refused.”
While another said: “We knew we were coming to the end of the drugs and the neurologist said to us at that point my truck is empty. There’s nothing left to try.”
All families had tried a broad variety and different combinations of various AEDs without sufficient success and indeed, with major side effects, after which some families were asked to start a new cycle going through all the medications again.
Families felt their anger and desperation were heightened by challenging relationships with doctors. They felt frustrated and rejected as they weren’t listened to and their were anxieties dismissed.
This lack of trust in doctors also included the government and the pharmaceutical industry. Some parents raised active distrust that doctors did not have their children’s best interests at heart.
“They are supposed to have the best interests of the patients at heart and they do not, absolutely not- they’ve got the best interest of the pharmaceutical industry at heart- simple.”
Read the full report here
My daughter’s seizures reduced by 95% on medical cannabis – why is it not available on the NHS?
Clover Carkeet’s family have had to fight for her to maintain access to the treatment
Three-year-old Clover Carkeet’s seizures have reduced by 95 per cent with medical cannabis – so why has her family had to fight so hard to maintain access to it?
Clover had her first seizure at just 12 weeks old. Doctors diagnosed her with infantile spasms, a ‘catastrophic’ form of epilepsy that is among the most brain-damaging conditions of its kind.
Early signs of the condition were discovered when her mum, Emily Carkeet, was 30 weeks pregnant.
She was told that Clover was missing the part of her brain that connects the left hemisphere to the right, known in medicine as the corpus callosum.
Seventy five per cent of newborns with the condition will grow up to live completely normal lives, but sadly Clover is among the minority that develops neurological issues from early childhood.
Like many children diagnosed with rare forms of epilepsy, Clover was started on a heavy dose of steroids which she took for six weeks.
“It was a really awful time for us,” Emily recalls. “They made her extremely poorly. She was so upset and angry. She was basically just staring into space.”
After the steroids, Clover was started on a strong antiepileptic drug called vigabatrin, with her enjoying five months without seizures. The freedom gave her the chance to develop, and even learn to crawl.
But it wasn’t just the vigabatrin that was aiding her recovery, Emily believes.
When Clover was four months old, her parents began giving her tiny doses of over-the-counter CBD oil called Hayleigh’s Hope. In the early days of Clover’s diagnosis, Emily had connected with hundreds of families whose children suffered from similar conditions.
“I was always searching for the answers for Clover,” Emily says.
“I found that the children who were taking some form of CBD all seemed to be developing fairly normally. Their seizures were well controlled and they were spending less time in hospital.”
She continues: “Every time we increased her dose she would learn something new, physically her development was ahead of some of her neurotypical peers, she crawled at nine months and walked at 13 months, all these things that they said she wouldn’t do.”
But after five months Clover relapsed and developed something called focal seizures. Despite increasing her pharmaceuticals, her condition worsened until she was having as many as 100 seizures a week.
95% reduction in seizures
At this point, Emily and her partner, Clover’s father, Spencer, were at a “crossroads”. Either introduce more pharmaceutical medication or pursue a CBD prescription.
“It became abundantly clear that what we could buy over the counter just wasn’t strong enough for her,” Emily says.
“We were at a crossroads really; we could either add more meds… but we had made a vow in those early days that that was not what we wanted for her. We wanted to give her a chance to have a quality of life, and we believed the best chance of that was by staying as far away from heavy duty drugs as possible.
“That’s when we decided to go down the prescription route.”
Clover met criteria and was able to access a legal prescription for medical cannabis in August 2020. By November, her seizures had dropped to just three or four per week – a 95 per cent reduction.
The following April, the family added the THC-containing oil Bedica to Clover’s course of medication, which is when the number of seizures fell “dramatically”.
“THC was the game-changer for her. She was sometimes going 10 days without a seizure,” says Emily.
“The biggest doubt for me was that THC might have detrimental behavioural and developmental effects, it worried me, but less than having her on a benzodiazepine, wired up to machines in hospital. As her mum I’ve always followed my gut instinct.”
Battling the BPNA
Despite Clover’s parents seeing a huge improvement in her condition and quality of life, the family faced losing her access to the medicine when her prescribing doctor was reported to the General Medical Council (GMC) last year.
Although she doesn’t know the details of how it came about, the complaint was made shortly after Emily wrote to Clover’s neurologist in the NHS outlining her daughter’s positive response to cannabis-based medicines.
The complaint, believed to have come from the British Paediatric Neurology Association (BPNA), centred around Clover’s age as at the time, at 17 months old, she was the youngest child in the UK to be prescribed the medicine. It stated that the doctor was not a neurologist and therefore should not be prescribing.
BPNA guidance claims that cannabis medicines can only be prescribed in children with epilepsy by a paediatric neurologist. But this is not stated anywhere in current legislation.
The case ended up being dismissed, with the GMC’s independent medical expert quoted during the review as saying the BNPA position is “probably not in the best interests of children”.
“Doctors sign a Hippocratic oath then they don’t do what’s best for their patients. It’s very negligent to deny these kids a medicine that clearly works for them,” says Emily.
“What I don’t understand is this necessity to throw so many drugs at them just because they’re licensed.
“In my opinion – and logic should rule here – if a child finds something that works, why would you then force them to go back and try all these other things that may be detrimental to them? I find this concept of using cannabis as a last resort absolutely crazy.”
Emily believes that the BPNA guidance on medical cannabis is part of the reason why NHS access is so limited for children with epilepsy.
“They complained about Clover and made no effort to speak to me about how she was doing at all. They don’t listen to us as parents, even though, when you’re a parent of a child with epilepsy, you become the expert on their condition,” she says.
“It’s just so wrong on so many levels.”
A “constant juggling act”
Clover is doing well developmentally and starting to communicate more as she reduces her prescription drugs, something Emily puts down to the medical cannabis.
“I had read about neuroprotective benefits from cannabis and genuinely think that because she’s had it in her life since she was so young, it’s probably protected her brain,” she says.
“We’ve never seen any regression from any of her seizures and I honestly think it’s the cannabis we have to thank for that.”
She attends nursery and Emily has been able to return to work. Something which has been a lifeline in funding Clover’s prescription, which currently costs around £1,000 a month.
Emily and Spencer are able to fundraise, but still pay £600 each month out of their own pockets. Emily describes the situation as a “constant juggling act”.
“I feel an extreme pressure to be working more than I am because we have this prescription to pay for,” she says.
“The person who suffers from this is Clover because she doesn’t get as much of her mum as she needs.”
But despite their struggles, Emily feels lucky they have access to the treatment when so many families in the UK are unable to obtain a prescription even privately.
There is currently only one paediatric neurologist prescribing for children with epilepsy in the UK, and he is not currently taking on any new patients.
“There are so many parents who are desperately trying to get this medicine, because they see the results,” she adds.
“It’s an injustice that they can’t access it.”
Cancer survivor reveals how medical cannabis “saved his life”
Barry Freeman swapped his pain medication for medical cannabis.
A US cancer survivor has shared how medical cannabis helped him manage debilitating pain and stop his usage of multiple medications.
Texan cancer survivor Barry Freeman – who also suffers from PTSD – introduced medical cannabis into his treatment plan in 2019 and has since eliminated the consumption of dozens of pain pills while experiencing a drastic reduction in symptoms with no side effects.
In 2015, a time he describes as “the worst year of his life,” Barry lost his son and received a stage-four colorectal cancer diagnosis.
After being initially turned away by multiple doctors due to his terminal diagnosis, Barry underwent 37 rounds of chemotherapy and radiation treatment. He finally achieved remission in 2017 but his cancer treatment’s lasting effects combined with emotional distress led to continued symptoms of chronic pain, anxiety and panic attacks.
“I was in a very dark place that year. Living with cancer and losing my son caused severe depression on top of a barrage of physical symptoms that made my life miserable,” Barry said.
Barry then sustained a debilitating shoulder injury in 2018, exacerbating his condition and leading to a prescription of 12 pain pills per day. It was then his physician recommended medical cannabis as a treatment option.
“Medical cannabis saved my life,” he continued.
“I felt more relief than I’d ever felt through any pain pill. I could feel the calming effect of the medication come over me. I feel better than I did at 45-years-old. Emotionally and physically, it’s extraordinary to be here now and feel this way after being so sick.”
The Compassionate Use Program (CUP) was enacted by the Texas legislature in June 2015, allowing for the first legal use of medical cannabis products by patients with intractable epilepsy.
It was not until the program expanded in 2019 to include terminal cancer, all forms of epilepsy, autism, multiple sclerosis, spasticity, ALS and hundreds of neurodegenerative disorders that patients like Barry became eligible to access medical cannabis.
Following the 2021 session, the programme expanded to include all cancer patients and those suffering from PTSD.
Barry was provided with cannabis by Texas Original Compassionate Cultivation , a licensed medical cannabis producer that works across the state.
Morris Denton, CEO of the company, believes that more still needs to be done to improve access for patients in Texas.
“Barry was ineligible for life-altering medication for almost four years after his initial diagnosis,” Denton said.
“No one should have to endure a delay in treatment for symptoms that medical cannabis is proven to relieve. This is why continuing to expand the Compassionate Use Program matters.
“There are thousands of Texans who can and should be benefitting from the power of medical cannabis now and our team is dedicated to expanding the CUP to include each of them.”
Growing “appetite” for medical cannabis among UK clinicians
Over 300 health professionals have signed up to learn more about medical cannabis.
Over 300 health professionals have signed up to learn more about medical cannabis in the UK since 2019.
Just two and half years after its launch, the Medical Cannabis Clinicians Society (MCCS) now has revealed it now has over 300 members, as it prepares to launch a series of in-person events this year.
Over 300 clinicians, including specialist consultants in a wide range of specialisms, GPs, nurses and allied health professionals, are now active members of the society, sharing best practice, learning from each other, and accessing regular expert support.
Bosses say this growth demonstrates the “appetite” of health professionals to learn more about this “life-changing” medicine.
Throughout 2022, the MCCS executive committee is planning to hold five in-person events across the UK, offering attendees a practical introduction to medical cannabis and CBD.
The first events will take place in Manchester on Thursday 12 May and Belfast on 1 June, followed by sessions in Edinburgh, Cardiff and London before the end of the year.
Further events are expected to take place in Liverpool, Newcastle, Bristol, Birmingham and Dublin in 2023.
Open to clinicians, medical students, scientists, researchers, professionals and patients curious about medical cannabis and the current state of prescribing, evidence and availability in the UK, the events will take place from 6.30pm for two hours, with networking and a panel Q&A for attendees following the speakers.
Prescribing doctors from the executive committee will be joined at each event by society chair, Professor Mike Barnes, as well as medical cannabis patients.
Sativa Learning’s Ryan McCreanor and Volteface’s Katya Kowalski, will also present education opportunities and research insights.
Professor Mike Barnes, chair of the Medical Cannabis Clinicians Society said: “The growth we have seen in our membership over the last two and a half years demonstrates the appetite the UK’s clinicians have to learn about this life-changing medication.
“With significant restrictions meaning that only Specialist Consultants can prescribe, little to no cannabis education for medical students, and the fact that medical cannabis is only available via privately prescribing doctors, the number of clinicians choosing to educate themselves and access support via the Society should be noted by leaders in the health service and in Government.
“Our programme of events, which will see us visit Manchester, Edinburgh, Belfast, Cardiff and London this year, and Liverpool, Newcastle, Bristol, Birmingham and Dublin in 2023, are a fantastic opportunity for clinicians and medical students particularly to learn the facts about this treatment and practical steps to prescribing.”
Hannah Deacon, executive director of the Medical Cannabis Clinicians Society, added: “The Medical Cannabis Clinicians Society believes that everyone who could benefit from medical cannabis should have access to it. Our mission is to give clinicians access to evidence, training, expert guidance, peer support and licensed product information so they can prescribe life-changing medical cannabis treatments to all patients in the UK, on the NHS.
“The Society is an expert-led, independent, not-for-profit community, dedicated to bringing this safe, legal and effective medicine to people living with chronic conditions.”
The first event will take place at The Midland Hotel in Manchester at 6.30pm on Thursday 12 May.
Dr Niraj Singh, consultant psychiatrist from The Medical Cannabis Clinics and executive committee member of the MCCS, will share his experience of becoming a medical cannabis prescriber.
Prof Barnes will explore the history and evidence for medical cannabis.
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