Monthly Archives: November 2019

Can Medical Cannabis Help Geriatric Patients?

Can medical cannabis help geriatric patients?

People aged 65 and over in the UK make up only 17% of the population, but use over 50% of the NHS budget, representing, as a group, more than one-third of all prescriptions for drugs

Recently at The Medical Cannabis Clinics, we’ve found that a substantial amount of people enquiring about medical cannabis fall into this geriatric age bracket. A large number of people in this group are cannabis naïve, having  never used it recreationally before, so there is much for them to learn about medical cannabis generally. However, increasing media interest and coverage on cannabis and its benefits means geriatric patients are gradually being exposed to information about this form of treatment, leading them to enquire about medical cannabis use for many valid reasons. 

One of the most serious medical issues affecting geriatric patients is Alzheimer’s disorder. With this in mind, let’s take a look at what the research says about how cannabis could help with the treatment of this disease and its debilitating comorbid psychiatric issues. 

Alzheimer’s Disease

According to the NHS, Alzheimer’s disease is the most common type of dementia, a syndrome related to an ongoing decline of brain functioning, in the UK. As Alzheimer’s disease is a progressive medical condition, the symptoms worsen with age, making it a more severe and debilitating condition for the geriatric age group, with the disease ‘affecting an estimated 1 in 14 people over the age of 65 and 1 in every 6 people over the age of 80’

Some of the main symptoms of the disorder include: 

  • Memory issues – including general confusion and forgetting conversations, names, places and objects. 
  • Issues with language and speech. 
  • Experiencing hallucinations. 
  • Changes in personality (with people often becoming suspicious of others or becoming more aggressive).

In the search for treatments for this condition, terpenoids and cannabinoids found in cannabis seem promising due to their in vivo and in vitro biological activity and their anti-Alzheimer’s disorder therapeutic agents. 

Whilst, undeniably, there’s still a lack of human trials in this area due to issues preventing the research of cannabinoids because of their legal classification, preliminary studies seem to suggest that cannabinoids can reduce the formation of neurofibrillary tangles and plaques and can help to minimise oxidative stress. As these are some of the notable features of late onset Alzheimer’s disorder, this research is highly promising. 

Additionally, a preclinical in vitro study carried out in 2014 that analysed the “potential therapeutic effects of THC” on Alzheimer’s disease found that THC may play a role in delaying the progression of the disease. 

Aside from the well-known effects Alzheimer’s disease has on cognition and memory, it should also be noted that the disease also frequently elicits comorbid depression and anxiety issues too. At The Medical Cannabis Clinics, we support patients living with a range of psychiatric conditions and symptoms, including depression and anxiety

Mental Health Disorders and Chronic Pain 

Chronic pain and various other diseases experienced disproportionately by older patients may make them more likely to experience mental health disorders and anxiety issues as they struggle to cope with their progressing illnesses. Also, if the geriatric patient already has existing psychiatric issues prior to experiencing physical pain conditions, the worsening of such pain and disease may exacerbate their mental symptoms as they try to contend with their physical and mental health simultaneously. 

In respect to mental issues and the effectiveness of cannabis-based treatments, studies carried out in the area have shown that neurotransmitter systems, including dopamine and serotonin systems, can be modulated in part by cannabidiol (CBD). 

In addition, further studies have suggested that Tetrahydrocannabinol (THC) may be useful for the treatment of a number of psychiatric conditions including depression, PTSD, anxiety and panic disorders, as this cannabinoid has an effect upon neurotransmitters involved in the regulation of mood and fear arousal. However, it should be noted that in this case, the published evidence is not particularly strong, with this research being reliant upon case reports and traditional use cases. 

It should also be noted that while CBD, THC and cannabis-based products may help with anxiety and other mental health disorders, some patients may experience anxiety as a side effect of cannabis use. However, this experience of anxiety may be due to some patients overmedicating using unregulated street cannabis rather than seeking proper medical advice and getting safe medical cannabis treatment for their psychiatric issues.  

As always, patients should only seek to use medical cannabis products after a close consultation with and careful assessment from an experienced medical practitioner. This is where we can help. At The Medical Cannabis Clinics, we offer our patients the UK’s leading cannabis-based therapy and care for a number of conditions and symptoms, including those discussed above.

To book an appointment with one of our specialists click here

Doctors Prescribing Medical Cannabis

Why doctors should prescribe medical cannabis

There’s a huge number of reasons why doctors should consider prescribing medical cannabis, whether these are more emotive or if they come from a distinctly logical, efficacy-based perspective. 

Here are some of the main reasons we believe doctors should consider prescribing this game-changing form of treatment.     

1. It can treat a number of conditions:

Although medical cannabis is a novel and under-used method of treatment that many are wary of using due to the substance’s historical stigma, new research shows that medical cannabis can be useful in the treatment of multiple health conditions. 

Conditions that have a lot of scientific backing for medical cannabis treatment include chronic pain, treatment-resistant epilepsy and some side effects of chemotherapy. 

The main three categories of physical conditions and symptoms that our specialists can treat as part of The Medical Cannabis Clinics are:

  • Pain conditions & symptoms: like arthritis, bladder pain, fibromyalgia, back and neck pain, muscle cramps (spasticity), nerve conditions and more. 
  • Neurological conditions & symptoms: like epilepsy, migraines, multiple sclerosis, motor neurone disease and Parkinson’s disease symptoms amongst others. 
  • Psychiatric conditions: like anxiety, depression, eating disorders, obsessive compulsive disorder (OCD), post-traumatic stress disorder (PTSD), stress and sleep disorders. 

 These cannabis-based prescriptions provide hope for those who are affected by these disorders and have had little success with conventional forms of treatment and therapy. 

2. People desperately need prescriptions:

Through prescribing this novel form of treatment, you can give hope to those who have been treated for a long period of time with no success, giving them a life-changing alternative. These people are often desperate for a form of treatment that works for them as they believe no other option is left.

A famous case study of a patient who has been hugely helped by medical cannabis treatment is Alfie Dingley, a young sufferer of PCDH19 Epilepsy, a treatment-resistant epilepsy syndrome.

Before he began using medical cannabis treatments, Alfie had to be treated with intravenous steroids that presented the risks of psychosis and premature death. Even with the use of these steroids, Alfie still experienced seizures that meant he could rarely attend school, practise hobbies or generally live the normal life of a young boy.

With medical cannabis treatment however, with oil prepared from Bedrolite eventually coupled with THC oil given under medical guidance, Alfie’s condition improved dramatically, with no seizures experienced for an astonishing period of 40 days. Even when Alfie did experience a cluster after this time, these seizures were far easier to control and were far less intense.

Alfie’s life-changing medicines were prescribed by The Clinics’ Clinical Director, Professor Mike Barnes, who works closely with us to get doctors training to prescribe. Through working with The Medical Cannabis Clinics and Professor Barnes to prescribe medical cannabis products, you can help more patients like Alfie to see a complete change in their quality of life.  

3.You can help rid the medicine of its stigma:

Only through prescribing medical cannabis treatments can the outdated stigma related to medical cannabis be eradicated. 

Once patients are aware of how these treatments can help them and improve their symptoms, they will be able to see for themselves how outdated our societal beliefs are as their results speak volumes. 

With patients successfully treated with and educated about the use of medical cannabis, the word will undoubtedly spread across their social circles and even further, slowly undoing the years of stigma associated with this form of treatment that is now more advanced than it ever has been before. 

If you are a doctor reading this article and are interested in finding out more about how you can train to prescribe medical cannabis treatment and improve the quality of life of patients in need, sign up for face-to-face training with Professor Mike Barnes here. Early bird tickets are available until Monday 25th November.

If you’re a patient reading this article, make sure to share it with your doctor so they can educate themselves and train to help you and many others in need using medical cannabis products.  

Standardised Cannabis Medications

Standardised cannabis medications

Last week, NICE updated their draft guidelines on medical cannabis. Of note, they approved the use of two standardised cannabis medications, Sativex and Epidiolex. Here’s a quick run down on both.

Sativex

Sativex (nabiximols) is an oromucosal spray containing cannabinoids and is the first cannabis-based medicinal product to be licensed in the UK. Sativex is currently the only licensed drug in the UK for the treatment of spasticity caused by Multiple Sclerosis.

Much like many other cannabis-based medicinal products, Sativex is only recommended for use when other conventional treatments have proved ineffective, or if an individual’s side effects are proving intolerable.

Sativex can also be used in some rare instances in combination with an individual’s usual anti-spasticity medications.

How do you use Sativex?

Sativex comes in an oromucosal spray form which you administer into orally.

In this spray is an equal combination of CBD and THC and you can take up to 12 doses a day, although the starting dose is only once per day before increasing to responsiveness.

This dose can be increased over a number of days until the optimal dosage is achieved for the patient in question. Required dosages can differ from person to person, so finding the correct number of sprays for each person should be figured out by evaluating how many doses give good relief of symptoms whilst giving the fewest side effects.

If the drug hasn’t had any noticeable effect on spasticity symptoms after 4 weeks, the patient is encouraged to stop taking it and to look for alternative therapies.

Epidiolex

Epidiolex is used to treat seizures from certain epileptic conditions like Dravet or Lennox-Gastaut syndrome. These forms of epilepsy are particularly rare early childhood forms, with Lennox-Gastaut syndrome affecting between 1 and 5 out of every 100 children with epilepsy whilst Dravet syndrome affects 2 or 3 children per 500 children with epilepsy. Both forms are also often resistant to typical forms of treatment.

Due to this resistance to typical forms of treatment, Epidiolex has been considered by many as a possible medical alternative for these conditions.

The cannabidiol in Epidiolex is thought to work by acting on the body’s TRPV1 and GPR55 protein channels,where it has an effect on the epileptic activity in the brain.

How do you use Epidiolex?

As always, cannabis-based drugs should only be taken after close consultation with a doctor, who will determine if the medication is suitable for the patient and what dose would best suit their symptoms and specific epileptic condition. The doctor will also take into account the other medications the patient is taking, the patient’s response to this treatment and their weight.

Epidiolex should be taken orally as instructed by the doctor, usually around twice daily,with care being taken to administer the drug the same way with each dose (for instance if you take the dose with food, you should always maintain this method when taking the next dose to achieve consistent results).

As is often the case with drugs containing cannabidiol, the doctor will most likely suggest that the patient takes a ‘start low and go slow’ approach to dosing, so that detrimental side effects can be avoided.

You can find out more about these drugs and if they’re the right treatment option for you by speaking with one of our specialists. Book a consultation here.

Acute & General Medicine Conference

Acute and General Medicine Conference

This week The Medical Cannabis Clinics had the pleasure of taking part in and exhibiting our company at the Acute and General Medicine Conference. As the MD, this was a great opportunity to understand where the industry is at the moment.

How did we we find it:

Medical cannabis is everywhere across media outlets following the release of the NICE guidelines, so this event was attended by a significant number of GPs and specialist consultants – many of whom have little to no knowledge of the cannabis plant and its uses in medicine.

The acceptance and knowledge of medical cannabis amongst them varied wildly, with the overwhelming consensus being: they didn’t know enough about the substance but thought it sounded like it might be useful. A big step forward for the industry here was the inclusion of twotalks around medical cannabis, the first being a thirty minute presentation by neurologist and complex care specialist Dr Liz Iveson that was attended by over a hundred delegates.

The second session, led by Dr Michael Platt, focused on the impact of medical cannabis on pain. The inclusion of these sessions highlights the fact that the medical community, driven by daily inquiries from patients, is asking more and more questions themselves. 

 A major issue that doctors working in A&E told me is that they just see people ‘out of it’ from smoking – they had no idea that there are more than 130 different cannabinoids that could be behind this. What these doctors are describing is driven, most likely, by high levels of THC bred into illegal and unregulated recreational products. This is no doubt something that is not delivered through medical school modules, and naivety is a broad problem. 

Many doctors were unaware of how to administer medical cannabis and were under the false impression that you can medicate only by smoking. This is not the case. It is occasionally vaped but is mainly taken as an oil in drops or in capsule form. A few GPs even asked if it’s injected or given in the form of a pill. These questions are forgivable though, as there has been very little in the way of education, especially in the primary care scene, given it is a drug of last resort. The challenge for GPs is substantial as patients can be well-informed, but just as easily can be armed with alarming amounts of incorrect information that GPs cannot correct.  

Pain specialists were by far the most receptive of the attendees and all had some basic knowledge of medical cannabis. Upon further discussion it was clear that they wanted a platform or event to learn more, and an opportunity to support gathering larger evidence-based research for the UK market.

This is of course a separate issue from the currently fashionable CBD retail scene. While there are some good over-the-counter CBD products that can provide good benefits, we’re talking specifically about medical grade EU GMP standard prescribed medical cannabis. It has been legal to prescribe since November 2018, but owing to the startling lack of movement in prescriptions, the question arises – what are the medical community and policymakers doing to support doctors? 

The government changed the law with no clear plan to educate and support practicing healthcare professionals, let alone academic or institutional resources. The NICE guidelines appear to be heavily steered towards pharma led products and totally omit pain or psychiatric conditions – despite the growing evidence base from other countries around the impact of medical cannabis on chronic pain and the side effects versus opioids.

Over a year on, there’s still a great deal to sort through, and a tremendous amount of frustration among patients whose hopes were raised last year. It would appear there is some light at the end of the tunnel though. 

Events like the AGM give me the opportunity to speak to a number of open minded medical professionals who want to educate themselves further, to satisfy an academic curiosity and understand how to put this wonderful plant into practice to support their patients where other medicines have failed. 

The Medical Cannabis Clinics, with the support of The Academy of Medical Cannabis, are here to help support the education of doctors and open up patient access to trained and experienced specialists. 

To read more about our training services and book a training date, please visit The Academy page

 

Cannabis Treatment for Anxiety

Dr Rebecca Moore on cannabis treatment for anxiety

This week is National Stress Awareness Week. In recognition of this we asked our doctor Rebecca Moore to explain her experience treating anxiety, a condition that affects more and more people each year.

She mentioned:

“Anxiety is one of the most common presentations that I see and work with; in 2017 there were 284 million people living with anxiety worldwide.

Anxiety can present itself in many forms, with a constant fear of agitation and inner restlessness, feeling on edge and unable to relax, panic attacks, feeling unable to cope socially, a racing heart or feeling short of breath. It can even impact our appetite and sleep patterns.

It’s very tiring and exhausting to feel anxious and panicked all the time and it can have a huge impact on those who experience it, affecting their ability to work, parent, and their relationships with family and friends.

Many people will have tried medication for anxiety and found that it didn’t help them or gave them side effects. One study from 2019 found that medical cannabis users perceived a 58% reduction in anxiety and stress following cannabis use.

Medical Cannabis can give patients another option in treating and managing their anxiety long term, it’s usually taken as an oil droplet or smoked and for most people there are little or no side effects.

An assessment for anxiety would typically involve a thorough chat with me around all your issues and symptoms and then we’d work collaboratively together to make a plan for treatment that might include medical cannabis alongside dietary changes, supplements and exercise. “

If you are suffering with a mental health condition, it’s important to reach out and seek support. At The Medical Cannabis Clinics we have a great network of doctors who are ready to meet you and create personalised treatment.

At The Medical Cannabis Clinics, we have a ‘start low, go slow approach’ to achieve symptom relief for patients with the lowest dose required. Find out more about how we can help with mental health here.