Dr Evan Lewis, a paediatric neurologist and founder of the Neurology Centre of Toronto (NCT), has treated hundreds of epilepsy patients, for whom there is no doubt that cannabis is medicine.
I’m a paediatric neurologist and epilepsy specialist, with over 500 adult and paediatric patients in my practice currently being treated with medical cannabis for epilepsy and a broad range of other neurological conditions.
For these patients, there is no doubt that cannabis is medicine.
As a start, five major randomised controlled trials have been completed, with recently published follow-up data, in complex, drug-resistant paediatric epilepsy. These studies show that medical cannabis exerts the same degree of anti-seizure control as our traditional anti-seizure drugs, with comparable side-effect profiles.
It might also be helpful to point out that cannabis, in the form of a purified CBD oil called Epidiolex®, has been approved as a medical treatment for certain types of epilepsy in children by the FDA in the US, the EMA in Europe, and NICE/MHRA in the UK.
I can personally share numerous stories of the children I have treated with unrelenting seizures who, after failing multiple medications for several years, finally responded to cannabis.
However, none of that is needed.
While there may be some subjectivity inherent in the management of pain and anxiety, the clear effects that cannabis can produce in drug-resistant epilepsy are difficult to argue.
A child is either seizing or they are not. The child is treated with a cannabis oil. The seizures stop.
If that is not a medicine, then what does one tell the parents of these children they are giving to their child.
Here in Canada, there is a well-defined medical pathway within the Cannabis Act that provides a mechanism by which patients can undergo a consultation with a physician or nurse practitioner and be provided medical direction, oversight, follow-up and medical authorisation to receive the treatment.
In the UK too, cannabis for medicinal purposes was legalised in 2018. There are now over 10,000 patients prescribed cannabis-based medicines, including about 150 children with drug-resistant epilepsy, according to the Medical Cannabis Clinicians Society.
The majority of these children are thriving, several have now been seizure-free for a prolonged period of time, and all have seen dramatic improvements in their quality of life.
Despite the above and years of medical legalisation, families who seek cannabis treatment after trying numerous options are still met with reluctance on the part of the health care system. Some of that reluctance lies in the challenges that practitioners perceive with cannabis products and safety.
Producing a consistent cannabis product from batch-to-batch is one of the many challenges faced by licensed producers of cannabis, but that should not serve as rationale to delegitimise cannabis as a medicine or pressure families to feel compelled to work with medications they feel will not work for their child. This only works to reinforce inaccessibility, and children should not be the ones to suffer because of these challenges.
Reflexively turning away from the medical potential of cannabis for epilepsy does a great disservice to the many children and families struggling with the condition.
The opinion that cannabis is not a medicine is not only outdated but is also dangerous.
Dr. Evan Cole Lewis is a Neurologist and Clinical Neurophysiologist with expertise in paediatric neurology and epilepsy. He is the founder and medical director of the Neurology Centre of Toronto (NCT) and VP Psychedelic Neurology at Numinus. He is assistant professor with the Department of Paediatrics at the Hospital for Sick Children and the University of Toronto.
Estimated reading time: 4 minutes
Fibromyalgia diaries: Travelling as a medical cannabis patient
Medical cannabis patient, Julia Davenport, on the challenges of travelling with a prescription.
While cannabis oil has dramatically improved fibromyalgia patient Julia Davenport’s quality of life, it has brought with it new challenges when it comes to travel, as she explains here.
Chronic pain has a nasty habit of getting in the way of doing the things you love.
My big passion which I share with my husband, and I guess our one extravagance, is jetting off to far flung places.
Over the years, however, fibromyalgia, arthritis and aching joints have conspired to make travelling evermore arduous.
Now in my 70s with various replacement parts, difficult terrain is one of the biggest barriers to exploring new places.
Certainly, my husband’s bucket list destination, the Galapagos Islands, is on my no-fly list. I would have adored to go there at some point, but navigating those volcanic rocks, even with my walking stick, would be a nightmare.
Familiar holiday spots closer to home are also becoming increasingly inaccessible. Every year our extended family visits the same Northumberland cottage, which is at the bottom of a steep bank.
In years gone by, I’d be fine to walk down to it through the working farm in which it stands. Now, because my back and shoulders have deteriorated, I have to drive right to the door.
Finding ways to compensate for the things you can no longer do is a constant theme with chronic pain conditions.
Aside from mobility challenges, another restriction on travel with rheumatological conditions can be the weather, and humidity can play havoc with chronic pain. I’d love to go to Central America, for example, but I just couldn’t tolerate the heat and humidity.
Having said that, although hot dry weather is far better than the cold British winter, the difference is not enough to drag me away from my family at Christmas time.
For all my gripes about life on the road, though, traveling remains my great joy, and discovering medical cannabis and CBD has definitely helped; although it’s not all plain sailing.
Travelling with medical cannabis
In November I’m returning to South Africa, a place I’ve visited a few times and which has a special place in my heart.
On previous visits, because we’ve flown via Dubai, I’ve not taken medical cannabis or CBD with me.
There is no way I’d risk taking cannabis with me to the UAE, where people have apparently been arrested and put in jail for having codeine, never mind anything else, despite having a prescription for it.
They have a ridiculously long list of substances that they deem addictive which you can’t have. There are things you can apply for permission to take, but I just wouldn’t trust that I wasn’t going to get arrested.
When we’ve flown long-haul through Dubai in the past, I would tend to take enough medication just for the journey. I have even flushed pain medication down the toilet on a connecting flight to Dubai just to make sure I’m not in possession on arrival.
I’ve then managed to pick up cannabis products quite easily in certain final destinations.
In South Africa there was a shop similar to a Holland and Barrett which sold CBD products legally. They were able to match the equivalent of what I was already taking to their products.
In Japan, it was also relatively easy to buy CBD over the counter, even with the language barrier.
In the past, the ease at which you can buy CBD has definitely influenced my travel choices. There are lots of countries that I’d give a wide berth to because of their approach to medication, which is often underpinned by false views on addiction.
At the same time, with so many countries opening up to CBD, travelling is getting easier and the main challenge is the routing of flights through the Gulf.
Thankfully on my next trip to South Africa we are travelling direct to Cape Town directly so I can rest easy that I won’t end up behind bars.
Guidance for travelling with medical cannabis
Some countries allow medicinal cannabis and some even recreational cannabis. Some allow CBD but others do not.
Guidance from the Medical Cannabis Clinicians Society recommends that patients always contact the embassy to check the legal situation in the country they are visiting before travelling with medical cannabis.
Some countries require a letter of proof from a clinician, some require a request to be submitted to the embassy requesting to travel, some restrict the amount of medication you are able to travel with, i.e. up to 30 days supply. It is suggested that any guidance is sought and confirmed in writing.
It is advised that travellers keep medication on their person, stored in its original packaging along with a copy of their issued prescription and relevant corresponding paperwork.
You can get an idea of the country’s stance on cannabis initially by searching for “legality of cannabis” on Wikipedia – but always check with the embassy as well.
Fibromyalgia diaries: To vape or not to vape?
Medical cannabis oil has been life-changing for Julia, but she’s still struggling to come to terms with vaping.
Fibromyalgia patient Julia Davenport says cannabis oil has been life-changing for her, but she’s still struggling to get on board with flower.
My perception of cannabis has changed dramatically in the few years since I started taking it as pain relief.
As I mentioned in my last entry, I’m from a generation which, despite living through the enlightened age of the 1960s, grew up believing the plant to be bad.
This created a strong resistance to even trying CBD or medical cannabis when they emerged as possible treatments for pain associated with my fibromyalgia and arthritis.
I’m over that now, and take CBD daily, with a private medical cannabis prescription to use orally whenever I have a flare-up.
One taboo I’m still struggling to get past, however, is the use of vape.
Buried in my kitchen drawer is a dry herb vapouriser, alongside the medical cannabis flower prescribed to me by a pain consultant.
With this, I’m armed and ready with what I understand to be the fastest route for medical cannabis to get into the bloodstream.
But, sadly, although it could have rescued me on several occasions in the year since I bought the device, its box remains sealed.
I’m sure many Cannabis Health readers will be shaking their heads right now. What a travesty that something millions of people with a range of conditions could potentially benefit from is going to waste.
I do truly feel lucky to have a private prescription at a time when countless others are unable to access medical cannabis through cost, red tape or misinformation.
The problem I have is my huge aversion to smoking. Yes vaping isn’t smoking, but the action of ingesting something that looks like smoke into your lungs just doesn’t feel right.
While I’ve never smoked in my life, my father was a heavy smoker who suffered from the lung disease, chronic emphysema. My mother also had coronary artery disease, possibly related to smoking.
For these reasons, I just have a mental block about vaping, despite reading about how effective it can be as a breakthrough remedy.
No doubt many people my age, who grew up with parents who smoked, also feel the same; and perhaps there is some way to go before vape vendors can escape perceived links to smoking.
Maybe more evidence on the impact of vaping on the lungs will help to change this over time – and I’ll eventually make use of my vapouriser.
Meanwhile, in putting my fibromyalgia diary together, I began to think about all the ways cannabis has changed my life. I thought I’d share perhaps the most unusual one – going cold turkey on my teddy bear collection.
With chronic pain conditions, including fibromyalgia, night time can be particularly difficult and insomnia is common. It is a horrible experience to feel utterly drained but be unable to fall asleep, sometimes for days.
Before discovering CBD and medical cannabis I would often find myself wide awake in the middle of the night. It was at these times that my attention drifted on my iPad to eBay.
For some reason, possibly nostalgia, my search for distraction amid the pain and boredom took me to the furry world of vintage teddy bears.
Many nights spent bidding for bears in the blue light led to a considerable collection building up.
Now, my days as an arctophile (yes there is a word for someone who collects or is very fond of teddy bears) are over.
My CBD and medical cannabis regime has significantly cut the number of sleepless nights I experience and, in turn, the volume of new bears taking up space on my shelves.
Next time: Travelling as a medical cannabis patient.
“As a psychiatrist I have been amazed by the power of medical cannabis”
Dr Tahzid Ahsan, a consultant psychiatrist on discovering the benefits of cannabis for mental illness.
Estimated reading time: 6 minutes
For almost 20 years I was shamefully oblivious to the truth, but now I have seen the benefits of medical cannabis in all walks of society, writes Dr Tahzid Ahsan, consultant psychiatrist and prescriber at The Medical Cannabis Clinics.
Professor David Nutt wrote a recent article for the British Medical Journal, entitled; Why doctors have a moral imperative to prescribe medical cannabis
So when did the moral compass change around cannabis and why?
For thousands of years cannabis has helped humankind with discomfort and diseases of the mind, body and spirit, discussed in great detail as a form of medicine in ancient Hindi, Chinese and Arabic manuscripts.
The current stigma arises from a period of civil rights movement in the 1960s US, leading to a direct ban on all psychoactive substances during the ‘flower power ‘era.
The US’s number one ally followed suit, with the UK enforcing the 1971 Drugs misuse act as swathes of ethnic minorities were migrating to the UK, leading many to being incarcerated for cannabis use.
In the 1980s I grew up in an inner city area of a major city, where social and economic deprivation were rife. I recall young black and ethnic minority men being incarcerated by the police due to cannabis use, some were even placed into mental health units under the premise of the 1983 Mental Health law, stating that they were psychotic due to cannabis use.
Despite substantial evidence to suggest that migration and trauma is a factor for someone to develop schizophrenia and psychosis, the abhorrent stigma still remains that cannabis directly causes this.
As a result , rightly or wrongly, the three associations that are currently most attached to cannabis are criminality, race and socioeconomic status, preventing a nascent industry and treatment from getting the exposure that it deserves.
For almost 20 years I was shamefully oblivious to the truth, the veil of ignorance preventing me from seeking further knowledge around a substance that had helped with mind, body and spirit for thousands of years.
As a training day coordinator for my consultant training scheme in 2017, I managed to have an invitation accepted by my ‘hero’ Professor Nutt himself. Witnessed by over 150 psychiatrists, Professor Nutt reflected on the past, present and future of psychiatry, with us. I recall the grumbling tones of protestation from the crowd when cannabis was mentioned as a potential treatment for many mental health conditions in the future.
In 2018, the story of young Alfie whose life was transformed by medical cannabis, led to a dramatic change to the 1971 Drugs Misuse Act, whereby cannabis for medical use was reduced in scheduling meaning it could ‘be prescribed in humans’. This small change in the law has led to a fledgling industry.
I joined The Medical Cannabis Clinics in November 2020, the first medical cannabis clinic to form in the UK. I then became a registered doctor for Project Twenty21, set up by Professor Nutt’s organisation Drug Science. The project made medical cannabis prescriptions more affordable, as well as gathering important real world evidence for research.
Over the past two years I can honestly say I have been truly amazed by the power of medical cannabis.
My shock comes from how medical cannabis can traverse such a huge range of mental illnesses in such a short space of time, with very little side effects noted.
Patients love the fluidity and malleability of medical cannabis, they don’t feel it’s dictating their lives like traditional medications have done. Some have even described cannabis as an accompaniment to their lives like a “long lost friend”, helping them cope from moment to moment, providing them with the necessary headspace to recover, grow and learn.
With one cannabis flower I have treated people with depression, anxiety, autism, ADHD, PTSD, insomnia and more.
I have seen the benefits in people from all walks of British society, from the 70-year-old lady in a local village to an 18-year-old male from south London.
I have heard many stories where people were literally at the end of the tether, having gone through a multitude of medications and therapy, to finally find something that can help them feel ‘normal’ again. They can now live life to the fullest, with a new found confidence in themselves to interact with the world around them in a fruitful manner. When I hear patient’s stories of how they have reconnected with people who they had avoided for many years, it almost brings a tear to my eye.
In my entire 20 years of being in the medical field, I have never once heard an equally glowing review about a particular psychotropic medication, in comparison to medical cannabis.
My whole perception of medical recovery has changed. As clinicians we dictate what the patient should have, and at what time. If they don’t conform, we label them as ‘non-compliant’ (bad patients), despite the side-effects causing more issues for some than the condition itself.
With medical cannabis, patients can choose what strain and how much percentage of THC or CBD they would like, the terpene profiles that suit their goals and needs, adjusted according to how it benefits them. For the first time in their lives patients are enjoying recovering from their mental ailments through the power of medical cannabis.
Unfortunately most in the UK are completely oblivious to the immense benefits of cannabis as described above, still associating cannabis with criminality, race and socio-economic status.
Due to certain elements of the Proceeds of Crime Act 2012, we have been left in a position where the UK is one of the biggest exporters, as well as the biggest importers of medical cannabis. Yet UK patients cannot benefit from locally grown medical cannabis, they can only be prescribed cannabis that has been transported across the world. This has created a bottleneck where patients have been left waiting for weeks due to stock issues.
It’s promising to hear that MPs such as Jeff Smith, who recently motioned the Medical Cannabis Access Bill, are working to try and make quality medical products more easily accessible to patients.
In the west, research and subsequent treatment depends on the gold standard of randomised controlled trials (RCTs). If evidence of treatment has not followed these standard research protocols, the evidence is almost dismissed by clinicians.
As you can imagine it’s easy to do research on a drug where dosages can be changed very easily in a neat incremental manner. But cannabis does not fit into the neat categories within RCTs. The effect of the flower can change according to the strain, terpene profile and cannabinoid content. It requires a different approach and respect when it comes to evidencing benefits of medical cannabis, with more emphasis on qualitative clinical case studies.
At a time of great division nationally after Brexit and ongoing worldwide geopolitical turmoil, medical cannabis could be a unifying force that allows for more compassion and understanding between all of us.
Cannabis, like the notion of ‘faith’, knows no boundaries, colour creed, or religion. I feel truly blessed that I have come across a treatment that I believe will shape the western philosophy of medicine for the foreseeable future.
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