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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  Royal Society of Medicine and Integro Clinics announce pain and cannabis medicines event

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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Pain

Exercise may reduce inflammation by boosting endocannabinoids – study

Exercise is known to decrease chronic inflammation, but so far little is known as to how it does this. 

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The study found that exercise intervention in people with arthritis reduced inflammation

New findings show that exercise could help treat conditions such as arthritis, cancer and heart disease by boosting the number of endocannabinoids in the body.

A study from the University of Nottingham has found that exercise increases the body’s endocannabinoids or ‘cannabis like substances’, in turn helping to reduce inflammation.

The research, published in the journal, Gut Microbes, found that exercise intervention in people with arthritis, did not just reduce their pain, but it also lowered the levels of inflammatory substances (called cytokines). 

It also increased levels of cannabis-like substances –  known as endocannabinoids – produced by their own bodies, by altering the gut microbes.

Pain: A banner advert for the medical cannabis clinic

Exercise is known to decrease chronic inflammation, which in turn causes many diseases including cancer, arthritis and heart disease, but little is known as to how it does this. 

A group of scientists, led by Professor Ana Valdes from the School of Medicine at the university, tested 78 people with arthritis. Thirty-eight of them carried out 15 minutes of muscle strengthening exercises every day for six weeks, and 40 did nothing.

At the end of the study, participants who did the exercise intervention had not only reduced their pain, but they also had more microbes in their guts of the kind that produce anti-inflammatory substances, lower levels of cytokines and higher levels of endocannabinoids.

The increase in endocannabinoids was strongly linked to changes in the gut microbes and anti-inflammatory substances produced by gut microbes called SCFAS.  

At least one third of the anti-inflammatory effects of the gut microbiome was due to the increase in endocannabinoids.

Doctor Amrita Vijay, a research fellow in the School of Medicine and first author of the paper, said: “Our study clearly shows that exercise increases the body’s own cannabis-type substances. Which can have a positive impact on many conditions.

“As interest in cannabidiol oil and other supplements increases, it is important to know that simple lifestyle interventions like exercise can modulate endocannabinoids.”

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Chronic pain patients reduce opioid use with medical cannabis – study

73 per cent of patients were able to decrease or stop their opioid consumption all together.

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Pain: A bottle of opioids on their side spilling white tablets onto a counter

A study found that chronic pain patients, who use medical cannabis products, managed to decrease their use of opioids and benzodiazepines

A study on chronic pain patients, published in the journal Cannabis and Cannabinoid Research, found that those taking medical cannabis products under their doctor’s authorisation were able to decrease their use of prescription painkillers.

Researchers from the Rothman Orthopedic Institute at Thomas Jefferson University determined prescription drug consumption among a group of chronic pain patients. They noted the amount before and after they started the state-licensed medical cannabis products.Pain: A banner advert for the medical cannabis clinic

The patients included were experiencing chronic lower back pain, multifaceted pain from fibromyalgia or neuropathies, neck pain, and joint pain.

The data was collected through Pennsylvania’s Prescription Drug Monitoring Program for six months before and after the patients started medical cannabis.

Chronic pain study results

The researchers found that the majority of the patients at 73 per cent were able to decrease or stop their opioid consumption. A further 69 per cent of patients on benzodiazepines were able to reduce their use or stop taking them completely.

The participants also included reduced pain, improvements to their physical and mental health. This was combined with better overall of quality life following medical cannabis.

The authors wrote: “In patients with chronic musculoskeletal non-cancer orthopaedic pain, cannabis reduces pain, improves mental and physical health, and improves the quality of life. Our results show an objective association between the initiation of cannabis therapy and the reduction of both opioid and benzodiazepine prescriptions. Our results support the use of cannabis as an effective analgesic and prescription drug-sparing therapy.”

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The study noted that 52 per cent of pain patients did not experience intoxication as a side effect of medical cannabis. The results were also recorded within three months of starting cannabis therapy before stabilising at follow-ups.

Previous studies

The findings from this study are consistent with previous studies on prescription pain killers for chronic pain patients.

An earlier study from Florida revealed that 65 per cent of medical cannabis patients had been able to reduce their medication use over time. A further 18 per cent reported they were able to stop taking opioids for chronic pain while another 18 per cent stopped using anxiolytics. Patients also reported being able to swap their NSAIDS.

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The men in mental health: “I felt a sensation and realised this is what happiness feels like”

In a new series marking Men’s Mental Health Month, we speak to men about cannabis, caring and what needs to change.

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For men’s mental health awareness month, Cannabis Health speaks to fathers, patients and carers about their experiences, with a focus on what needs to change.

In the second of our series, we meet medical cannabis patient, Lewis Morgan. Lewis has PTSD as well as chronic pain caused by injuries he sustained twelve years ago.

Read the first part of our men and mental health series here

Talking about mental health

Mental health can be a difficult topic for anyone to talk about. However, when it comes to reaching out for help, men seem to struggle more than most. The statistics for men’s health show that it does appear to be more difficult for men to open up about how they are feeling.

In a YouGov poll which surveyed 2111 adults in 2009 before comparing to figures from a survey taken again in 2019. The results revealed that two in five men report feeling low in an increase of 37 per cent since 2009. It also showed that men aged 45 to 49 have the highest age-specific suicide rate.

Men also struggle when accessing help. The same survey from YouGov revealed that 10 per cent of male participants said that they didn’t seek help as they feared being told they had a mental illness. The reasons for not seeking help may be complex such as believing in traditional masculine values such as remaining stoic or being dependable. They may also see discussing mental health issues as a ‘weakness.’

Mental health: A banner advert for the medical cannabis clincs featuring a doctor in a white lab coat

Lewis’s story

Speaking with Cannabis Health News, Lewis Morgan explains how he came to be diagnosed with Post-Traumatic-Stress Disorder (PTSD). He originally experienced a bleed on the brain but an attack four years later, post-recovery, left him with brain injuries.

“When I was at university, I had a small bleed on my brain which took me a while to get over. It took a while for my concentration and reading to come back. I also had flickers in my vision intermittently. I managed to get through my degree but I did need a year out,” he said.

“I felt like I was starting to recover but then shortly after that, I went to work in a radio station one night then I woke up the next day in the hospital. I had been attacked on a night out where someone knocked me out then stood on my head several times. I had severe facial injuries too.”

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Lewis feels that there were not many checks into how he was coping with the mental side of his injuries such as the potential for developing PTSD or depression. Six months later, he had begun to develop a lot of pain and was also diagnosed with PTSD.

“I got sent back to the hospital six months later and they determined then that I had a brain injury. I developed PTSD along with a lot of pain which was not in the injury sites but in locations where it shouldn’t have been. I was eventually diagnosed with complex regional pain syndrome (CRPS).”

He explained: “Later on I started to experience chronic fatigue, fibromyalgia and all sorts of seizures. I have a functional neurological disorder that basically causes seizures, pain, psychological problems. My brain translates emotion as physical symptoms which is a nightmare because there is nothing you can do about it.”

Lewis highlighted that his many different diagnoses mean that he doesn’t know what symptoms correlate with different conditions but that PTSD has been constant throughout.

Mental health: Two heads in different colours to highlight hidden mental health. One head is dark while the other is light against an orange background

Mental Health and PTSD

PTSD is a mental health condition caused by a traumatic experience. Those with PTSD can often relive the trauma through nightmares and flashbacks and may experience feelings of isolation, irritability or guilt. They may also struggle with insomnia.

He said: “I get these sensations in my chest like spikes of adrenaline. I put the telly on to watch the news then I’m ranting at the telly like a madman. Then I realise I haven’t had any medicine today so I get on the medical cannabis and thankfully that brings me back to being a civilised human being.”

“It’s gone so long untreated and unmedicated that I’ve been keeping myself isolated to avoid making it someone else’s problem. It feels bad enough as it is without extra guilt or anything from erupting when I’m out. I tend to get spikes of rage which is fight or flight from adrenaline surging through my body.”

Lewis explained that the fight or flight mode is a permanent state for him. It helps him to avoid what he described as ‘pure misery’ afterwards.

Often people with PTSD, in particular veterans, find that their stress and anxiety levels are heightened. Over time, this can lead to problems with heart disease or blood pressure.

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In a study on veterans, researchers took 14 patients with PTSD and 14 without to determine the effect that it had on the body. They discovered that the patients with PTSD had higher levels of adrenaline and less control over their heart rate due to blood pressure changes.

Lewis outlined how medical cannabis helps him to not just control his PTSD symptoms but to feel happiness.

He said: “Thankfully medical cannabis is helping. If I have it in time then it seems to prevent me from getting into a rut where everything is triggering me. As winters coming, I’m finding a lot of symptoms are getting worse and it’s more of a battle to get control with that.”

He added: “It seems to make me feel happy. Sometimes I get a little chuckle and it’s really sad. I realised the first time that this happened, I felt a sensation and realised this is what happiness feels like. It’s so alien to me even though I’ve been to places since my injuries where I’ve had fun. It dawned on me that I never actually had that feeling of happiness.”

Lewis stressed that there is not much support from a mental health perspective. He has been trying to get help for his PTSD but struggling to access services. He is grateful for the help he has had from cannabis.

“I don’t get much support and I don’t see many people. I’ve been trying to get help with PTSD and not really having any help whatsoever. The only thing I’ve had to turn to has been cannabis. I didn’t realise it would help so much. It’s helped my physical symptoms and the PTSD too,” he said.

“I was struggling not to have a seizure last night because it’s getting damp. I was rigid and spasm a lot but [cannabis] makes it bearable even in those times. It is a shame it has taken so long to access it.”

Cannabis and mental health

Lewis is thankful that Project Twenty21 has made it easier for patients to access cannabis due to subsidising the costs. Now that he has cannabis, he has begun to reduce the number of prescription drugs that he was given as he feels there are negative side effects to some of them.

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When it comes to speaking to other male patients or groups, he has found it difficult to stay in touch over the 12 years since he has been injured.

“I’ve been cut off for a really long time because I’ve been ill so long. Even the people that you know quite well, not many of them last twelve years. When you are too ill to be proactive in staying in touch with people then you do lose touch eventually. Then when it comes to meeting new people, it’s hard because you are unable to work and you stay at home,” he said.

Lewis keeps himself entertained by learning the guitar. He is also learning to speak Spanish with the language app, Duolingo.

Mental Health: A photo of Lewis Morgan and his dog, Biggie

“If I have enough comfort from my medication then I can do Duolingo. I’ve managed to learn a lot of Spanish there which is surprising because of my injuries. My memory doesn’t really work but I can somehow learn music and play on instinct. I don’t know if it’s because I’m so sensitive and my nerves had been so horrifically activated.”

This time of year is difficult for Lewis as it’s near the anniversary of his injury. He finds that the autumn season can almost trigger an internal remainder of the event. He struggles with physical flashbacks, nightmares and finds that he becomes hyper-vigilant. He doesn’t have any mental health medication from his GP and relies solely on cannabis.

Lewis has recently adopted a dog which helps to keep him company. Biggie, a chihuahua is a rescue pet that Lewis took in to help a local shelter. Originally named Bruiser, he felt that Biggie was a better fit given the small dog’s attempts to fight larger dogs. He highlighted that they are both helping each other to get over their trauma.

“I got him a month ago as a rescue. I think he has got as much trauma as me and my symptoms but I’m trying to keep him calm and I take him out. I took him in to help the charity but I couldn’t let him go after that.”

Read the first part of our series on men’s mental health here

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