Curious about accessing a medical cannabis prescription? It can be difficult to know where to start or what to expect.
Cannabis Health News editor, Caroline Barry, who has a medical cannabis prescription for ADHD, and Dr Jean Gerard Sinovich, medical director of the Cannabis Access Clinics discuss how the process works.
When I decided to get a medical cannabis prescription, I had exhausted all the other options. I had tried prescription drugs for ADHD like Ritalin with little success over my teenage years before moving to various therapies as an adult.
I tried holistic approaches such as acupuncture or CBD which improved my sleep and anxiety but did little to my hyperactivity. Eventually, I reached out to the NHS for medication before having no luck.
Prepare your paperwork
I found a clinic in the UK that offered cannabis prescriptions for ADHD and reached out to them for assessment. The first thing I needed to do was collect my paperwork. As I already had my diagnosis from a psychiatrist, I needed to get proof of this along with which medications I had had over the years.
Dr Sinovich said: “To be assessed for medical cannabis, you need to apply to a clinic either directly or through your GP. We normally advise people to get a full medical history from the GP as to what medications they tried in the past. The person is assessed on an individual basis to find out what the patient is presented with and who specialises in that.”
He continued: “The aim of medical cannabis is to improve your pain, sleep and mood. Patients would have had to have tried other conventional medications for their conditions. If they have exhausted most possibilities and avenues then they could be assessed for medical cannabis. It doesn’t mean that every patient who comes to the clinic is prescribed cannabis.”
Prepare for your assessment
When it was time for my assessment, I was actually really nervous. When you are speaking to doctors, it can be extremely nerve-wracking to accurately get across the level of pain or discomfort you are in. I find that because my ADHD is not visible, I worry about being believed or qualifying for medication. Having had no luck with conventional medications, I was worried that this was my last resort and I wouldn’t get a prescription.
My assessment was with a psychiatrist online. A lot of medical cannabis clinics are based in London which I am not. It’s one of the few positive things to come out of Covid-19, that we have held on to telemedicine.
My appointment was very thorough, but none of the questions were difficult. The feeling of relief when the doctor said he thought I qualified was immense.
Dr Sinovich added: “The consultation process normally lasts anything from half an hour to 45 minutes where we go through the medical history, what their aims are, their views and why they decided to access cannabis at this stage in their life. We also have to make sure there are no possible interactions with any of the other medications.”
Costing out medical cannabis prescriptions
Dr Sinovich highlighted one of the key issues with accessing medical cannabis which patients need to be aware of – the cost.
“The most important thing is that it’s not [widely available on the NHS] so it’s all privately funded. People must be aware of the costs that it entails,” he said.
“It takes time for cannabis to work, it’s not overnight. It can take a good six to eight weeks and you need to follow up continuously to make sure there are no side effects.”
Affording medical cannabis can be difficult as there are few options available for support. Despite cannabis being legalised on NHS three years ago, there remains only a handful of prescriptions that have been written.
Project Twenty21 can help with capped prescription costs as long as patients can qualify for the conditions listed and have a history of two or more prescriptions that have proved ineffective. They have recently launched a student scheme aimed at helping patients affording medical cannabis while on a college-friendly budget.
The cost of medical cannabis tends to be dose-dependent. Cannabis Access Clinic estimate that the average cost of cannabis prescriptions in the UK is around “£150 to £250 per month for a THC and CBD inclusive prescription.”
A CBD only prescription is listed as being on average £100 to £150 a month although they note that some epileptic disorders will require much higher doses.
Patients also have to take into account the consultation fees which can vary from £100 to £200 depending on the clinic. Patients are also monitored through online questionnaires about their moods.
Speaking to your GP
When it comes to speaking to your doctor about a decision to try medical cannabis, they may not be supportive. If a patient prefers not to speak to their GP about it, they can ask for a copy of their medical records and self-refer.
I spoke to my GPs in both Ireland and the UK. While I had a positive reaction from my English GP who was interested in what effect this would have, my Irish GP was not as supportive. He was dismissive of my seeking medication as an adult in general so the medical cannabis element was a step too far for him. I got my paperwork and have not been in touch with either about my ADHD since then.
Dr Sinovich said: “Most of the time, you can request paperwork from the GP because it’s your details at the end of the day. Most GPs are quite open to medical cannabis in terms of an augmentative treatment to help with different conditions. You get very few GPs that say no. If patients are having trouble with GPs then they can always arrange a call to explain the benefits. We do a lot of educational work with GPs as it’s new and with anything new to a market, people want to see results and can be sceptical about it.”
Don’t be nervous
Before I went for my assessment, I was very nervous. I have had bad experiences with doctors not listening or taking my ADHD symptoms seriously because they may not always believe in the condition. My Irish GP once said to me when I phoned to say I was seeking medication, that ADHD adults ‘grow out of it’, which is a common misconception about ADHD and some forms of neurodiversity. No wonder I was nervous but I need not have been, as the doctors were incredibly supportive. Knowing your symptoms is key though.
Where does my medical cannabis come from?
Once my assessments were over and the team had discussed my case and decided I qualified, I had to decide what the best course of medication was for me. I opted for a vape because it’s easy for me to fit that into my lifestyle in comparison to oils. ADHD people are often forgetful, and I know this applies to me, so I worried I would forget to take an oil dose. My prescription was sent to Rockshaw pharmacy and arrived at my door discreetly. No one would have had a clue as to what the parcel actually was.
“Once you’ve had your consult – and every clinic is different – the script is approved by a multi-disciplinary team then goes to an independent pharmacy,” explained Dr Sinovich.
“The pharmacy will then get the product to them in the next day or within 24 hours. If you are outside of the UK then you may have to wait a little bit longer. For example, we have Guernsey patients who have to apply for a licence so it does take a little bit longer for that process. The patient deals directly with the pharmacy in terms of costs.”
Medical cannabis prescription abroad
It’s worth noting that if you travel, you may not be able to take your prescription with you. As an Irish woman living in the UK with a prescription, I can’t travel with my medication back to Ireland. If you do travel then be prepared for the potentially negative outcome.
Dr Sinovich agreed: “It’s a very difficult one, unfortunately. If you look at the United States and Canada then you can’t travel between borders as there are strict rules in place. We normally advise patients to consult with the consultant and the terms of the country that they want to visit. There are no blanket rules for everyone but most countries in Europe are happy for individuals to transport their medical cannabis across borders. It varies from country to country. Normally we issue a script that they have to carry in hand luggage.”
“We normally advise individuals that it’s not for public use. It’s why a lot of people converted to oil or a capsule. People must realise that if they do get stopped then they need to show proof that they are taking medical cannabis legally and according to doctor’s guidelines,” said Dr Sinovich.
“In the UK, it’s still relatively new so people are starting to get more access to products. It’s going to take some time but the law will change.”
Still thinking about accessing a medical cannabis prescription?
My prescription has been the best thing I’ve ever done. It’s helped me to enjoy my evenings instead of being hyper-focused and tense and I also sleep better now.
Dr Sinovich said: “The nice thing about medical cannabis is it is tailored to an individual. I don’t think I have a single patient with exactly the same dose. It’s a tailor-made plan for an individual and you assess them to see if it’s working. You can adjust the CBD to THC ratios and there are lots of different products to choose from.”
He added: “It’s another armour you can use in treatment. There are multiple CBD receptors in the central nervous system. It’s about adjusting the mindset, obviously, it takes time and individuals need to invest in it. It’s investing in your future itself and what you could achieve or how you could improve your life.
“I have a lot of patients that I’ve seen for whom it is life-changing.”
Medical Cannabis Awareness Week returns with call for real world evidence
Three years since the law changed supporters call for regulators to consider real world evidence
Medical Cannabis Awareness Week will return to mark three years since the law changed, with a fresh call for regulators to consider real world evidence and ensure fair access for patients.
Led by patient advocacy group, PLEA (Patient-Led Engagement for Access), Medical Cannabis Awareness Week takes place in the first week of November and brings together patients, doctors, supporters and stakeholders across the sector to raise awareness of the plea for fair access to medical cannabis.
On 1 November 2018, medical cannabis was made available on prescription in the UK. Three years on, only three prescriptions have been issued by the NHS.
Out of desperation, patients are now funding private prescriptions and up to 1.4 million patients are forced to turn to illegal methods.
Patients unable to afford and access treatment are suffering due to the fear, stigma and financial barriers preventing them accessing this safe, and potentially life-changing, treatment.
The first Medical Cannabis Awareness Week to take place last year saw over 50 speakers and 1500 live attendees, with 60,000 people reached.
This year, taking place from 1-7 November, Medical Cannabis Awareness Week 2021 aims to highlight the real need for real-world evidence in evolving access to this new treatment, calling for fair access to medical cannabis treatment on the NHS.
Patients from across the UK will be sharing their stories about the life-changing impact of medical cannabis and their difficulties in accessing a prescription.
Gillian Flood, member of PLEA’s Management Committee who is prescribed medical cannabis for fibromyalgia and PTSD, commented:“Life before and after cannabis medicine really is like night and day, before constant pain left me feeling hopeless and depressed, unable to function, trying all different medications, dealing with awful side effects. After, well, I feel like me again, I can enjoy a meal, go for a walk, sleep and manage my pain better while having a clear head.
“While all this is amazing the financial cost bring a whole new anxiety around how I afford my medicine, every month I struggle to pay for it, I don’t want to go back to my life before, not now I know I don’t have to suffer so much, there is a relief available, my plea is that this medication becomes available through the NHS so no patient has to endure the pressure of trying to fund a private prescription.”
How you can get involved
There are several ways supporters can get involved, with virtual events taking place each day, aimed at patients, doctors, supporters and anyone else with an interest in medical cannabis.
Join patients, advocates and organisations to help raise awareness, address the stigma and call for change by sharing a video or audio clip or written post of your PLEA on social media using the hashtag #MCAW2021.
Have a conversation about medical cannabis. Ask questions, and connect with medical cannabis supporters, patients, and allies via the #MCAW2021 hashtag on social media.
Help spread the word about fair access to medical cannabis treatment by writing to your MP.
Abby Hughes, chair of PLEA commented: “Having witnessed the transformation of quality of life for many patients like myself, it is hard to accept that the only access many have to medical cannabis treatment is through the private sector. Why is there enough evidence for a private pain consultant or psychiatrist to prescribe unlicensed cannabis medicines, yet the same treatment is not afforded to patients via the NHS, which was created to provide universal, comprehensive and free health care?
“With only three NHS prescriptions having been issued three years on from Sajid Javid’s promise to make medical cannabis treatment accessible, my plea for Medical Cannabis Awareness Week 2021 is that the real need for real world evidence is explored and accepted in evolving access to this new treatment.”
We’ll be sharing more details of all the events and how you can get involved in the coming days.
For full event listings and to access resources for patients, doctors and supporters visit www.pleacommunity.org.uk/mcaw
Cannabis and driving – Calls for urgent law reforms to protect patients
A new report highlights the myriad of issues facing medical cannabis users on the road.
Campaigners are calling for urgent reforms to legislation around cannabis and driving as patients risk criminalisation.
A new report, published by the Seed Our Future campaign, highlights the myriad of issues facing medical cannabis users on the road.
The group, which lobbies for the decriminalisation of cannabis, is calling for the removal of THC from Section 5 and reverted to Section 4 of the Road Traffic Act 1988 (RTA), where evidence of impairment would be required to convict.
Following an amendment to the RTA in March 2015, any driver who is stopped by the police can expect to be swabbed and if THC is identified, a blood test is enough to secure a conviction.
This means that anyone who has consumed cannabis within the last few days – or has been subject to passive smoking – may be over the zero-THC limit and at risk of prosecution, regardless of whether there is evidence of impairment.
According to the report, the effects of THC have generally gone after two to four hours when inhaled, longer when orally ingested. And the research conducted by Seed Our Future has found no cases of any serious vehicle accidents which conclusively shows cannabis as the primary cause.
Patients facing criminalisation
Although patients who hold a legal prescription have a right to a medical defence, this is not always taken into account and those who are unable to afford one are being criminalised and having their licences removed without any evidence of driving impairment, argues the report.
In 2021 alone, Seed our Future has supported four people with legal cases in relation to cannabis driving offences. All four suffer from long-term conditions and fit the criteria for obtaining medical cannabis prescriptions, with one holding a legal prescription at the time and two accessing one shortly after arrest.
In all cases, the subjects had taken cannabis several hours before driving and there was no evidence of any sign of driving impairment.
According to the report, in 75 per cent of the cases, the police had “no idea” that the law had changed regarding medical cannabis in 2018.
Seed our Future claims that the inclusion of cannabis in Section 5 of the RTA was based on “political and financial motivations” and not “conclusive road safety data”.
The report concluded: “The concept that a laws exists which leads to a criminal record, fines and a driving disqualification without any evidence of the defendant being a risk to road safety, whom with all likelihood is practicing their inalienable human right to health by utilising globally recognised essential medicine risks jeopardising the fabric and integrity of the judicial system and exposes the incompetence of the police force in being able to gather evidence sufficient to constitute criminal intent.”
Calls for standardisation
Guy Coxall, the groups founder is also asking for standardisation of labelling for medical cannabis prescriptions and health practitioner advice in regard to guidance for driving.
He has called on the Cannabis Industry Council to ensure all importers of cannabis-based products have the correct labelling, in line with UK regulations, and all practitioners provide advice to patients in line with guidance from the Medical Cannabis Clinicians Society (MCCS).
It states: “Patients, on higher THC products especially, should be warned not to drive or operate heavy machinery whilst under the influence of side effects of a cannabis product… Like any other medications that may cause impairment, do not drive or operate a vehicle if feel impaired or are unsure if you feel impaired and follow your physician’s advice.”
Coxall said: “This lack of standardisation places a number of UK patients in danger of criminalisation and penalties.
“We would also like to see discussions surrounding basic educational programmes for Police Officers, CPS solicitors and Judges to update on legislative changes and provide information to reduce stigma and medical and financial discrimination against medical cannabis users/patients, as identifying ways of protecting medical cannabis users who are at present unable to afford private medical prescriptions until availability is made accessible on the NHS.”
GMC must address “serious concerns” over BPNA guidelines on prescribing medical cannabis
An open letter has been signed by more than 30 parents and carers of children with intractable epilepsy
Dozens of parents whose children rely on medical cannabis have written to the General Medical Council (GMC) outlining their concerns about the blocks to access.
More than 40 parents and carers of children who are prescribed medical cannabis to treat conditions such as intractable epilepsy have signed an open letter to the GMC outlining a number of issues.
Earlier this week, 50 medical professionals issued a letter from the Medical Cannabis Clinician’s Society, expressing their concerns over the British Paediatric Neurology Association (BNPA) guidelines on prescribing unlicensed cannabis medicines.
The letter, which was published in the Times, claims that the guidelines play a part in denying medical cannabis treatment for children with epilepsy, many of whom have had their lives significantly improved it.
It includes a comment from an expert witness in a case brought to the GMC by the BPNA, reported as stating that: ‘The BPNA position that only paediatric neurologists should initiate treatment is not supported by other national guidance, and probably not in the best interests of children, as it may impede debate and research into the appropriate use of Cannabidiol (sic) in refractory epilepsy’.
In response the parents of these children say they felt moved to write directly to the GMC to express “serious concerns”.
In the letter they stress that they feel the guidance issued by the BPNA plays a significant role in preventing doctors from prescribing.
It states: “The quote from the GMC expert witness highlights that the BPNA guidance is ‘not supported by other national guidance’.
“From our knowledge of these matters, we believe that this other national guidance may well be that from NHS England, NICE and indeed, to some extent, your own.
“If a professional medical body is producing guidance that is ‘probably not in the best interests’ of the patient cohort at issue, surely that matter should be investigated and then appropriate steps taken to ensure that the guidance in question is corrected?
Speaking with Cannabis Health, Joanne Griffiths, mother of Ben, 11, who suffers from treatment-resistant epilepsy, said: “We felt moved, as a group of parents and carers with loved ones affected by intractable epilepsy, to write to the GMC to ask that they address what we believe to be serious concerns relating to the BPNA position on the prescription of medical cannabis following the recent article in The Times.”
Joanne added: “This is clearly extremely concerning and needs to be addressed. The almost total block on NHS prescriptions is causing untold huge emotional and financial distress to our families.”
The letter states: “Without exception our loved ones have shown very significant improvements in their symptoms following the administration of medical cannabis.
“In many cases, the improvements could more accurately be described as ‘dramatic’ with children who were suffering up to hundreds of seizures a day and being rendered semi-comatose due to the effects of conventional pharmaceutical drugs being able to lead almost normal drugs.
“However, since the law change, to the best of our knowledge, there have only been three NHS prescriptions for whole-plant extract medical cannabis for cases of paediatric epilepsy. The rest of us have had to face the daunting and emotionally and financially draining burden of having to find up to £2,000 a month to fund the medicine privately
“Raising this money is a massive challenge in normal times. During Covid, it has been impossible.”
The parents have now called on the GMC to address their concerns, stating that failure to do so may mean doctors may be “unwittingly failing” in their ethical duty to patients.
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