Medical Cannabis in the UK

Before becoming a brain injury solicitor I was a pharmacist for almost a decade. I remain fascinated by medicines. With great interest I attended a medical conference in which one of the presentations was on medical cannabis.  It was fascinating to hear highly respected doctors talk about cannabis and how it can be used medicinally. This inspired me to write this blog to inform about cannabis as a medicine and to, hopefully, provide an enjoyable 5 minute read.

In this blog I will talk about what is cannabis; medicinal uses; harmful effects; and how it is being used medicinally right now.

What is cannabis?

What is cannabis in terms of a medicine? This is not a straight forward question. Due to the modern pharmaceutical industry we think of a medicine being a single compound which works on the body in a very specific way. Cannabis is a plant which is made up of hundreds of compounds all working together in synergy to produce its effects. The technical name for this is an ‘entourage effect’ – apologies as a former scientist I love a technical term. The two main compounds which most people have heard of are THC and CBD.

THC was first isolated in 1964. This chemical is responsible for the psychoactive effect of cannabis (i.e. gets you stoned). It’s also a painkiller; and fights inflammation, in this respect it is 20 times stronger than aspirin.

CBD can be bought legally in shops and you’ve probably seen it on your local high street. CBD is not psychoactive and protects against the harmful effects caused by THC. CBD can help with anxiety, seizures and nausea.

Clinical evidence for medical cannabis

Cannabis has been studied clinically as a medicine and there is good evidence it is beneficial for a number of conditions.

Chronic pain

There is good evidence that cannabis, whether smoked or isolated chemical compounds, work well for a variety of pain, such as neuropathic pain, post surgical pain, cancer and headache. There has been a recent BMJ recommendation in 2021 for a trial of non-inhaled medical cannabis if standard pain treatment is not sufficient.

Spasticity

Spasticity is where there is increased contraction/tension in muscles, causing pain and interference with movement. A pharmaceutically produced drug called Sativex has been shown to be effective in relieving spasticity. This is particularly interesting to me as I have had severely brain injured clients with spasticity, although none of them have been treated with a cannabis based medicine.

Anxiety

There is good evidence CBD helps with anxiety. Interestingly, THC in low doses relieves anxiety, but in high doses causes anxiety.

Epilepsy

There is good evidence that CBD improves seizure frequency in children.

Harmful effects of cannabis

The harmful effects of cannabis are well proven. Heavy use of high potency cannabis increases the risk of:

• Psychosis
• Suicide
• Cognitive impairment

More recent data suggests cannabis use is an important contributor to violence. For example according to the National Homicide Enquiry 2018, almost half of all patients with schizophrenia who committed homicide misused cannabis or alcohol.

Misuse of cannabis causes harm, however if it used correctly it is beneficial and can be used as a medicine. You may be surprised to know cannabis is available on prescription from a doctor in the UK.

UK cannabis prescriptions today

Since 2018 doctors have been able to prescribe cannabis for any condition. The only requirements are the prescribing doctor is on the Specialist Register (hospital consultants); GPs or junior doctors may prescribe under the direction of the aforementioned.

As of September 2021 there have been three NHS medical cannabis prescriptions compared to around 10,000 private prescriptions. There is a great reluctance on the part of NHS doctors to prescribe cannabis medicinally.

There is no evidence to show medical cannabis issued to patients enter the illicit supply chain. A reason for this is if it is prescribed properly with CBD, it doesn’t get you high.

There is a growing body of respected medical opinion supporting the use of medical cannabis. If we abandon our preconceptions about cannabis and consider the evidence for therapeutic benefit, there is no reason to not use cannabis medicinally for conditions which standard medicine cannot help.