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Medical Cannabis in the UK

Understanding and Treating Conditions with Cannabis and Cannabis Extracts in the UK

The use of cannabis for medical purposes has evolved to encompass a variety of cannabis-based treatments aimed at alleviating numerous health conditions. These treatments, derived from different strains and components of the cannabis plant, have shown promise in managing certain medical issues.

However, the procurement of these cannabis products online presents a significant challenge. Given the wide range of suppliers and limited regulatory oversight, ensuring the quality, purity, and composition of these products is a complex task. More importantly, without proper regulations, these products can be illegal and potentially dangerous within the UK, emphasising the need for effective laws and guidelines to protect patient safety.

Products sold as ‘medicinal cannabis’ are available as dietary supplements from health shops. However, there’s a caveat to this accessibility: there is no guarantee that their quality or medicinal properties can be trusted. Due to the lack of rigorous testing and regulatory oversight, the efficacy, safety, and actual content of these products can significantly vary, leaving consumers in a challenging position.

Prescription-based cannabis medicines, known as medical cannabis, hold potential benefits. These medications, created under strict manufacturing conditions and backed by medical research, can benefit a small, specific subset of patients who might not respond to conventional therapies.

The Prerequisites for Medicinal Cannabis Use in the United Kingdom

Access to medical cannabis in the UK is still relatively limited. Despite its therapeutic potential, the chances of receiving a prescription for medical cannabis are currently minimal. It’s usually prescribed for a narrow range of conditions, typically when other treatments have failed. At present, medical cannabis is usually prescribed for:

Individuals of all ages suffer from rare, chronic forms of epilepsy. These patients often struggle with standard antiepileptic drugs, finding limited relief or battling adverse side effects. Medical cannabis specifically forms high in cannabidiol (CBD), has shown promise in managing treatment-resistant epilepsy.

Adults undergoing chemotherapy who suffer from severe nausea or vomiting are often unresponsive to standard antiemetic drugs. Some components of cannabis can help in reducing these debilitating side effects, improving the patients’ quality of life and tolerability of cancer treatments.

People living with Multiple Sclerosis (MS) who experience muscular stiffness and convulsions. For these patients, muscle spasms and pain can be an everyday occurrence, seriously affecting their quality of life. Certain cannabis-based medicines have been found to help in alleviating these symptoms.

Epidyolex: A Beacon of Hope for Individuals with Epilepsy

Epidyolex is a shining example of the potential of cannabis in medicine. This purified liquid contains cannabidiol (CBD), a medicinal compound present in cannabis. Unlike THC (tetrahydrocannabinol), the compound known for its psychoactive effects, CBD does not induce the sensation of being ‘high’ typically associated with recreational cannabis use. This characteristic makes Epidyolex a suitable choice for medical use, providing potential benefits without the psychoactive effects.

Epidyolex has been authorised in the UK by medical specialists for individuals diagnosed with Lennox-Gastaut syndrome and Dravet syndrome. These rare forms of epilepsy are often resistant to standard treatments, and patients suffer from multiple severe seizures. Epidyolex has shown a significant reduction in seizure frequency in these patients, improving their quality of life and providing new hope for their treatment.

Utilising Nabilone: An Ally for Patients Undergoing Chemotherapy

Chemotherapy, a cornerstone in the fight against cancer, is often accompanied by severe side effects, including intense nausea and vomiting. When other medications fail to provide relief, doctors may suggest Nabilone. This synthetic form of cannabis is taken as a capsule and is designed to mimic the effects of THC, the active substance in cannabis.

Nabilone provides an alternative antiemetic (anti-nausea and vomiting) option for patients undergoing chemotherapy. By interacting with the body’s endocannabinoid system, Nabilone can help manage these side effects, improving the patient’s comfort and ability to complete their chemotherapy regimen.

Nabiximols (Sativex): An Effective Treatment for Multiple Sclerosis (MS)

Nabiximols, also known as Sativex, is another example of the therapeutic application of cannabis. This oral spray, containing a balanced mix of THC and CBD, is approved in the UK for adults experiencing intractable muscle stiffness and spasms due to multiple sclerosis.

Traditional treatments for MS-related spasticity often have limited effectiveness and significant side effects. For these individuals, Sativex offers a promising alternative, showing to improve symptoms and patient-reported outcomes.

Chronic Pain and Medical Cannabis Use

Chronic pain management remains one of the most challenging fields in medicine, with many patients finding insufficient relief from standard pain medications. While there’s some evidence pointing towards the potential benefit of medicinal cannabis in certain types of pain, the current evidence is insufficient to recommend it as a frontline treatment. However, in cases of intractable chronic pain not responding to conventional therapies, medicinal cannabis may be considered under careful medical supervision.

Obtaining Cannabis-based Products

While it’s technically possible to purchase cannabis-based products, including those labelled as CBD oils, from the internet without a doctor’s prescription, the legality of this action is dubious. More importantly, these products may contain tetrahydrocannabinol (THC), which could pose potential health risks.

Health shops may offer some CBD products, but the reliability of these items cannot be guaranteed. The CBD content in these products is typically relatively low, and without rigorous testing, their potency and actual benefits remain uncertain.

Safety of Medical Cannabis: A Priority

As with any medicinal product, safety is a top concern. Cannabis products containing THC are yet to be fully understood regarding their long-term effects, making clinical studies critical before recommending their widespread use. However, products that exclusively contain CBD, such as Epidyolex, don’t carry the same uncertainty related to THC.

Nevertheless, most cannabis-based items are likely to have some level of THC, increasing the importance of regulation and testing to ensure patient safety. Frequent cannabis use has been associated with an increased risk of mental health disorders, such as schizophrenia, in susceptible individuals. This risk is particularly elevated with products with high THC concentrations and highlights the importance of professional medical oversight.

Potential Side Effects

Depending on the type of medicinal cannabis used, certain side effects may be experienced. These can include decreased appetite, diarrhoea, nausea, weakness, mood changes, dizziness, tiredness, feeling ‘high’, visual and auditory hallucinations, and even suicidal thoughts. If any issues arise from the use of medicinal cannabis, inform your healthcare providers and report them using the Yellow Card Scheme.

It’s essential to consult with a medical professional about any potential interactions between CBD, THC and other medications you are taking. CBD use can affect liver function, necessitating regular check-ups by medical professionals.

Obtaining a Prescription for Cannabis-based Medicine

Only specialist doctors can provide a prescription for medical cannabis if other treatments for conditions like epilepsy, multiple sclerosis or chemotherapy-induced nausea have proven unsuccessful.

The specialist will explore all other treatment options before considering a cannabis-based product. A prescription for medicinal cannabis would only be issued if it was deemed to be in the patient’s best interest, and when alternate treatments had been unsuccessful or were not suitable. This is expected to affect only a minuscule number of people in England.

Providing Proof of a Medical Prescription

It’s vital to keep the original packaging of medications as the information labelled on the container provides crucial details about the drug and the individual it has been prescribed for. You should have an ID that matches the details on the label, prescription, or doctor’s letter. Acceptable identification includes a current passport, a driver’s license with a photo, or a PASS card from the national Proof of Age Standards Scheme. If in doubt, consult a legal professional regarding possessing and using cannabis-based medicine.

Future Cannabis Legislation

The government in the United Kingdom currently has no plans to legalise cannabis for recreational use. Regardless of the intended use, possessing cannabis is still illegal under existing laws. This excludes the use of cannabis for medicinal purposes, but only when you have a prescription for it. The legality of cannabis use is an evolving issue and is likely to continue to be a significant focus of public health and policy debate in the future.

Medical Cannabis in the Context of Mental Health

Medical cannabis is also a field of research in mental health care. Anxiety, depression, post-traumatic stress disorder (PTSD), and certain sleep disorders are areas of interest. However, this is a complex and contentious topic, with research results often showing contradictory findings. Some studies suggest that certain components of cannabis, such as CBD, might have anxiolytic properties, potentially offering relief to those suffering from anxiety disorders. Other studies highlight the risk of dependence and the potential for worsening mental health conditions, particularly with THC-rich cannabis. In this context, further research is needed to fully understand the role of medical cannabis in mental health.

Medical Cannabis in Neurodegenerative Diseases

The potential application of medical cannabis extends to neurodegenerative diseases like Alzheimer’s, Parkinson’s, and Huntington’s diseases. In these conditions, pre-clinical studies suggest that cannabinoids might have neuroprotective effects, potentially slowing disease progression. However, these are early-stage findings, and robust clinical trials in humans are still required to verify these results.

Cannabinoid Hyperemesis Syndrome: A Cautionary Tale

As we consider the potential benefits of medical cannabis, it’s also essential to acknowledge its possible downsides. Long-term cannabis use can lead to a condition known as cannabinoid hyperemesis syndrome (CHS). Characterised by cyclical episodes of nausea, vomiting, and abdominal pain, CHS can be severe and debilitating. While this condition is more commonly associated with recreational use, it underscores the importance of appropriate dosing and monitoring in medical cannabis use.

The Role of the Endocannabinoid System

The effects of medical cannabis occur through its interaction with the body’s endocannabinoid system. This complex cell-signalling system plays crucial roles in maintaining physiological balance, influencing functions like mood, appetite, sleep, and pain. Cannabinoids in cannabis – namely THC and CBD – interact with this system, potentially influencing these functions. An understanding of the endocannabinoid system is fundamental in appreciating how medical cannabis works, and why it might help in certain conditions.

Medical Cannabis and Paediatric Patients

The use of medical cannabis in paediatric patients is a sensitive issue. In conditions like severe epilepsy syndromes, where other treatment options have been exhausted, medical cannabis can offer hope. However, this must be balanced against the potential risks, given the developing brains in children and adolescents. Ongoing monitoring and research are needed to ascertain the long-term effects of medical cannabis use in this population.

Stigma Surrounding Medical Cannabis

Despite growing evidence supporting the use of medical cannabis in specific conditions, stigma and misconceptions remain. These can act as barriers, hindering patients from exploring this therapeutic option. Education, both for the public and healthcare professionals, is vital in addressing these misconceptions.

Role of Medical Cannabis in Palliative Care

Palliative care is another area where medical cannabis could find a role. Managing symptoms like pain, nausea, and loss of appetite can be a significant challenge in end-of-life care. Medical cannabis, as part of a comprehensive care plan, might offer some relief. However, more research is needed to fully understand its place in palliative care.

Moving Forward with Medical Cannabis

As our understanding of medical cannabis continues to evolve, so will the laws and guidelines surrounding its use. The potential benefits must be carefully weighed against the risks, ensuring that patient safety remains paramount. This requires robust, well-designed research studies to provide clear, evidence-based recommendations for the use of medical cannabis.

The landscape of medical cannabis in the UK is likely to continue changing. It’s a subject of ongoing debate, discussion, and research. As we navigate this dynamic field, patients, healthcare providers, and policy-makers must stay informed of the latest data on medical cannabis.


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