Monthly Archives: February 2020

Beginner’s guide to CBD & THC

Beginner’s guide to CBD & THC

CBD & THC. You’ve probably heard of them before. But you’ve probably heard about them in very different ways.

In recent years CBD has been heralded as a miracle product that can treat a range of conditions, improve your well-being, give you beautiful skin and even help your pets to stay calm. On the other hand THC is generally regarded as a cannabinoid to be avoided at all costs, as a substance that will give unsuspecting users psychosis and increase their chances of getting schizophrenia. In both cases, we can see media and marketing gone wild, with both spouting unsubstantiated claims to get those on the fence to make up their mind about whether cannabis based products are something they should use or not. 

While there’s a myriad of competing accounts and research studies on the properties and effectiveness of CBD and THC that we could mention and look into, at The Medical Cannabis Clinics we think it’s most necessary to understand some of the basics about CBD and THC so you can determine as much as possible whether the countless articles on this topic are actually legitimate or bending the truth. Read on for a brief beginner’s guide to CBD and THC.

CBD or Cannabidiol 

CBD is the cannabis plant’s second most common cannabinoid, which works primarily by binding to the endocannabinoid system, with its mode of action being through the activation of other neurotransmitter systems within the body. 

In terms of medical effect, CBD is most well known for its anticonvulsant properties. Indeed, CBD is the primary constituent of Epidyolex, a medicine used to treat seizures from certain epileptic conditions that was approved by NICE for use by the NHS last year. 

CBD is also thought to have neuroprotective and analgesic properties. 

One of the main reasons why CBD is being mentioned so frequently in the media is because it’s believed to help people with anxiety and insomnia – two hugely common conditions in our modern world. This is theorised to be because the endocannabinoid system interacts with the neurotransmitter systems affected by anxiety, where it plays a role in minimising the fear response experienced by sufferers.

Research is currently ongoing about CBD’s efficacy in treating various types of chronic pain and inflammation. 

THC or Tetrahydrocannabinol

THC is the most prevalent phytocannabinoid in the cannabis plant as it’s thought to constitute between 12 and 20% of the dried content in some strains and up to 25 to 30 per cent in more potent varieties. 

The high that is associated with the recreational use of cannabis comes from THC as tetrahydrocannabinol is psychoactive. It works primarily through binding to the body’s CB1 and CB2 receptors, where it is considered a partial agonist of them. 

THC also interacts with other neurotransmitter systems within the body including, for example, the opioid systems. Therefore, THC’s effect on the body is not just through its interaction with the endocannabinoid system. 

THC has a number of well-researched medicinal properties. For instance it is believed to be a muscle relaxant and is thought to exhibit anti-nausea, analgesic and anti-inflammatory effects.

The fact that THC is also present in a number of cannabis-based medicines indicates the cannabinoid’s potential usefulness for treating a number of medical conditions.

One medicine that contains THC is Sativex, a product that contains equal amounts of THC and CBD, which was approved for use on the NHS by NICE back in November 2019. This medicine was specifically recommended by the institute for people suffering from spasticity related to multiple sclerosis.

Another medicine that contains THC is Dronabinol, which may also be referred to as Marinol. Dronabinol is recommended for use by those suffering from nausea and vomiting linked to chemotherapy. It’s also used to treat a loss of appetite and encourage weight gain in those who have developed AIDS.

We only recommend taking cannabis-based products following a consultation with a medical professional, and do not advise patients on the recreational use of any cannabis-based products. 

At The Medical Cannabis Clinics, our GMC registered specialists will identify the appropriate cannabis medicine care plan and products for patients following a comprehensive assessment which includes an in-depth evaluation of the main symptoms being targeted, current medications, pattern of symptoms and lifestyle factors such as safety-sensitive occupations. 

They will also monitor and adjust the medication on a regular basis to ensure the best effect with the fewest side effects. There is also a carefully designed process in place to monitor patients’ wellbeing, with follow-up appointments after a week and then every month, for three months after receiving a prescription.

To book an appointment with one of our specialists click here

Cannabis & spasticity

Cannabis & spasticity

A condition that has a relatively large body of evidence when it comes to the efficacy of cannabis-based medicine is spasticity – particularly spasticity related to multiple sclerosis. While the most researched condition in relation to medical cannabis is chronic pain, spasticity is most likely the next most researched condition when it comes to cannabis treatment. 

What is spasticity?

Spasticity is a debilitating and sadly common condition that occurs alongside a number of neurological disorders or after an interruption to the upper motor neural pathway. Spasticity can also be caused by stroke or motor neurone disease. 

Spasticity is characterised by muscle spasms that occur due to issues with signals being sent from the spinal cord and the brain to the muscles. These muscle spasms can go on to weaken the involved muscles and impair coordinated movement, making these spasms often unpredictable and painful. Therefore, effective treatment should aim to combat both pain and the muscle spasms being experienced by the patient. 

Conventional medications already used to treat spasticity include: Dantrium, Tizanidine and Baclofen, which work effectively to reduce spasticity but unfortunately often come with a number of side effects including weakness and fatigue. This is why patients become interested in alternative options that may have less side effects, like medical cannabis.  

How can medical cannabis help? 

There’s evidence that the body’s CB1 and CB2 cannabinoid receptors may be involved in the control of spasticity in multiple sclerosis, and there’s also evidence suggesting that anandamide (the endogenous ligand of CB1) may be an effective antispasticity agent itself. 

Generally, as described by Dr Edmund Bonikowski in The Academy of Medical Cannabismodule on neurological indications, research on cannabis and spasticity in MS patients has found that:

  • Those who are not experiencing full relief from their symptoms with conventional mediation may see significant improvements with cannabis treatment. 
  • Spasm frequency and sleep disturbance measurements often err in favour of cannabis treatment.
  • Cannabis often improves self-reported spasticity and Ashworth scale measurements. 

More specifically, a study carried out by Corey-Bloom et al. concluded that for participants with treatment-resistant spasticity, smoked cannabis showed better symptom and pain reduction than with placebo conditions.

Another obvious sign of the effectiveness of medical cannabis for the treatment of spasticity related to MS is the fact that medical cannabis is already in use for this indication the UK. Late last year, NICE approved the use of Sativex, an oromucosal spray containing equal parts CBD and THC, on the NHS for those suffering from spasticity related to multiple sclerosis. Like the majority of medical cannabis products, Sativex is only recommended for use when all other conventional treatments have proved ineffective. 

For more information on how medical cannabis may be effective in treating spasticity and multiple sclerosis, visit our neurological conditions and symptoms page and sign up for a consultation with one of our neurological specialists. 

We only recommend taking cannabis-based products following a consultation with a medical professional, and do not advise patients on the recreational use of any cannabis-based products. 

At The Medical Cannabis Clinics, our GMC registered specialists will identify the appropriate cannabis medicine care plan and products for patients following a comprehensive assessment which includes an in-depth evaluation of the main symptoms being targeted, current medications, pattern of symptoms and lifestyle factors such as safety-sensitive occupations. 

They will also monitor and adjust the medication on a regular basis to ensure the best effect with the fewest side effects. There is also a carefully designed process in place to monitor patients’ well-being, with follow-up appointments after a week and then every month, for three months after receiving a prescription.

To book an appointment with one of our specialists click here.

Can Cannabis Treat Epilepsy? | The Medical Cannabis Clinics

Can cannabis treat epilepsy?

It’s been known for a number of years now that cannabis is an anticonvulsant and evidence is continually emerging that supports this claim. CBD in particular is a cannabinoid that has shown efficacy in epilepsy treatment, and it is thought that full-spectrum oils containing small amounts of THC may have an even greater effect upon patients. 

But before we look into the evidence, let’s take a closer look at the condition itself in more detail.

What is epilepsy?

Epilepsy is an extremely common neurological condition affecting around 1 in every 103 people in the UK (who have a known diagnosis). A typical characteristic of this condition is repeated seizures caused by an excess amount of electrical activity within the brain. However, while this is a characteristic that typically occurs across all epileptic conditions, the impacts of epilepsy vary widely from person to person as different parts of the brain may be affected in each case. 

Although it is believed that there are upwards of 40 different seizure types, there are three main types of seizure that are most frequently recognised in patients. These are seizures of unknown onset (where the part of the brain affected in unknown), generalised onset seizures (involving both sides of the brain) and focal onset seizures (involving a specific region in the brain).    

What causes epilepsy?

Although around 65% of people with epilepsy don’t know what the cause of their condition is (meaning they have idiopathic epilepsy), there are a number of factors that may increase the likelihood of a person developing the condition, including:

  • Infections like encephalitis or meningitis
  • Trauma or injury to the brain that could have led to scarring
  • Auto-immune disorders
  • Brain tumours
  • Hormonal or chemical imbalances
  • Alzheimer’s or neurodegenerative diseases

It’s also believed that the development of some forms of epilepsy may involve genetics, either due to a genetic mutation or from an issue during the development of the cerebral cortex.  

How can medical cannabis help? 

As stated above, cannabis’ anticonvulsant properties have been known for a long time now, but evidence around the specific cannabinoids involved is continually emerging. From the evidence we do have so far, it’s believed that CBD has better antiepileptic potential than THC, however the exact mechanisms of CBD when treating epilepsy are currently unknown. 

One study that suggests the efficacy of CBD in the treatment of epilepsy is the 2016 Barnes Report, which found that there was an increased drop in seizure frequency in a cannabidiol group when compared to that seen in the placebo group.  

The efficacy of CBD for the treatment of some forms of epilepsy is apparently so clear that last year, NICE approved the use of Epidiolex on the NHS for the treatment of Dravet and Lennox-Gastaut syndrome (very rare forms of childhood-onset epilepsy). Many were disappointed with this move however, as cannabis based products were not recommended for the treatment of epilepsy in general – just these specific and rare conditions.  

However, while CBD’s potential for treating epilepsy has been noted in a number of studies, emerging evidence suggests that full extract oils (particularly those containing THC) might have an even greater effect on seizure reduction due to the theorised entourage effect, in which compounds of the cannabis plant interact with each other to become more effective than when used in isolation.

One study, a 20 week open label trial of 19 patients with Dravet syndrome where a full-spectrum treatment consisting of both CBD and THC was used, saw patients experience a seizure reduction of 47% alongside other noted improvements in their quality of life.

While scientific studies like this are obviously instrumental in highlighting cannabis’ effectiveness, high profile case studies have also crucially demonstrated the efficacy of medical cannabis in treating epilepsy in real-life contexts. For instance, the cases of Alfie Dingley and Billy Caldwell have helped to bring about changes to the law in the UK, as other forms of medication typically taken to control seizures in these cases were ineffective, with medical cannabis giving the young boys relief leagues ahead of that felt with conventional forms of treatment. 

While not as high profile, many patients across the UK have stories like those of Alfie Dingley and Billy Caldwell, and the testimony of fellow epileptic sufferers who have been helped by medical cannabis treatment is often enough to convince many others that medical cannabis treatment might be right for them following a lack of success with other, more conventional forms of treatment. 

As medical cannabis treatment for epilepsy becomes more common at clinics like those run by The Medical Cannabis Clinics, these testimonies will also likely become more common, as patients realise first hand how medical cannabis can have life-changing effects when it comes to the treatment of their condition.

To find out more about how you can get medical cannabis treatment for neurological conditions and symptoms, click here.     

We only recommend taking cannabis-based products following a consultation with a medical professional, and do not advise patients on the recreational use of any cannabis-based products. 

At The Medical Cannabis Clinics, our GMC registered specialists will identify the appropriate cannabis medicine care plan and products for patients following a comprehensive assessment which includes an in-depth evaluation of the main symptoms being targeted, current medications, pattern of symptoms and lifestyle factors such as safety-sensitive occupations. 

They will also monitor and adjust the medication on a regular basis to ensure the best effect with the fewest side effects. There is also a carefully designed process in place to monitor patients’ well-being, with follow-up appointments after a week and then every month, for three months after receiving a prescription.

To book an appointment one of our specialist team click here.

Medical Cannabis Start Low & Go Slow

Why we start low & go slow

Prescribing medical cannabis is not a straightforward matter. Even when the many legislative hurdles are overcome and a medical cannabis prescription is ready to be written, there are a number of factors that have to be considered to ensure that patients get medical cannabis care that is as safe and effective as possible. 

This is why doctors at our clinics create a rational cannabis care plan for patients where many different factors are considered before prescription takes place. In addition to the patient’s conditions and symptoms, factors that our doctors will consider when assessing the patient in question include:

  • Whether the patient is cannabis non-naive (due to self-medication or recreational use) or naive (they’ve never used cannabis) prior to treatment
  • What the most appropriate form of administration/ingestion would be for the symptoms in question
  • What specific product would be best in each instance, with this depending upon the product’s cannabinoid make-up and its batch-to-batch consistency levels amongst other factors
  • Whether daytime or nighttime dosing would be most appropriate for the symptoms being experienced 
  • Whether the patient is taking any other herbal supplements or drugs
  • The patient’s diet

Another crucial thing that our doctors will have to carefully consider when looking to prescribe different medicines is their THC to CBD ratios. 

In a lot of cases, medicines that have higher CBD levels and very little THC are initially prescribed for patients, as these medicines generally considered very safe and easier to start treatment on (particularly if the patient is cannabis naive) as they’re non-intoxicating and have a lower risk of adverse side effects than THC heavy options. 

While these medicines are of course considered to be very effective for a wide range of conditions, some patients may require more THC-heavy medicines over time to continue counteracting their symptoms. 

Starting low and going slow

Due to this relatively common need to make medicines increasingly THC heavy over time, a general prescription rule our doctors follow is to ‘start low and go slow’. 

In essence, this method entails initially prescribing patients medicines with higher CBD formulations before gradually introducing and increasing the levels of THC as required to suit the patient’s evolving needs if they become more tolerant to the original medicines. 

Although starting low and going slow is a method that may be used in some cases, this doesn’t stop different CBD and THC ratios being required in different cases depending upon the conditions being treated. For instance, while high CBD strains are typically used for the treatment of medical conditions like anxiety, treatment-resistant epilepsy, Crohn’s disease and multiple sclerosis, a balanced THC to CBD ratio may be more useful for treating conditions and symptoms like insomnia and muscle spasms. 

More THC dominant strains are often considered more effective than lower THC formulations for post-chemotherapy treatment and the treatment of chronic pain due to THC’s appetite increasing and nausea reducing qualities. However, it’s likely that the ‘start low and go slow’ approach would still be adopted when starting to prescribe these higher THC medicines, with CBD being used to counteract any anxiety that may occur with more THC-heavy medications.

It should also be noted that not everyone needs to escalate their THC consumption over time, as many will find that the initial medication prescribed continues to be effective. This is just an appropriate method to be used with some conditions in some cases.     

Overall, we feel that the ‘start low and go slow’ method allows us to provide a safe, patient-driven approach to prescribing cannabis-based medicinal products, which, when used in combination with our ongoing monitoring and adjusting of medication through follow-up appointments (after a week and then every month, for three months after receiving a prescription) means patients receive the most effective medical cannabis treatment possible with the fewest possible side effects.  

We only recommend taking cannabis-based products following a consultation with a medical professional, and do not advise patients on the recreational use of any cannabis-based products. 

At The Medical Cannabis Clinics, our GMC registered specialists will identify the appropriate cannabis medicine care plan and products for patients following a comprehensive assessment which includes an in-depth evaluation of the main symptoms being targeted, current medications, pattern of symptoms and lifestyle factors such as safety-sensitive occupations. 

They will also monitor and adjust the medication on a regular basis to ensure the best effect with the fewest side effects. There is also a carefully designed process in place to monitor patients’ well-being, with follow-up appointments after a week and then every month, for three months after receiving a prescription.

To register for treatment with our specialists click here

Why Doctors Need Cannabis Education

Why doctors need cannabis education

Speaking at Cannabis Europa’s Madrid event, LYPHE Group’s Head of Patient Access Hannah Deacon brought up an issue that sadly remains a crucial factor in the limited number of medical cannabis prescriptions being issued in the UK, despite it being over a year since medical cannabis was legalised. This issue is a lack of medical cannabis education for doctors. Speaking on this, Hannah Deacon put this point forward:

“For me, I think the problem in the UK is educating doctors, because doctors are very frightened. [For] all the patients I work with, all the doctors are saying to them ‘I can see this is working, this is fantastic, your child hasn’t been in hospital for six months, but I’m not allowed to prescribe’.”

The background context

The UK legalised medicinal cannabis back in 2018 when cannabis was rescheduled to a Schedule Two substance, highlighting its medical efficacy in certain circumstances. However, only doctors on the General Medical Council’s Specialist Register were allowed to prescribe these medicines for a limited group of patients in a severely limited number of circumstances. 

Then, last year, two cannabis-based drugs (Epidyolex and Sativex) were approved by NICE for use on the NHS. While many initially thought this would open the doors for increased medical cannabis prescription throughout the UK, this move didn’t seem to provide enough reassurance for many, as these medicines were only explicitly recommended by NICE for the treatment of those suffering from a limited number of medical conditions. As the guidance of NICE is often taken as gospel in the medical community, these recommendations were enough to dissuade specialists from prescribing for many other conditions that they may have originally been keen to offer medical cannabis treatment for.  

Upon closer inspection of the NICE guidelines though, it becomes clear that NICE aren’t closed off to doctors prescribing for multiple conditions, in fact they are clear about this in their guidelines manual:

Healthcare and other professionals are expected to take NICE clinical guidelines fully into account when exercising their clinical judgement. However, the guidance does not override the responsibility of healthcare professionals and others to make decisions appropriate to the circumstances of each patient, in consultation with the patient and/or their guardian or carer.”

Ms. Deacon, as an advocate in full understanding of the legislation in the UK and aware of the ability of specialists to exercise their clinical judgement to prescribe for patients, addressed this issue at the Madrid event when she stated that:

“We’ve got some of the most progressive legislation in the UK, a registered consultant can prescribe for any indication at all, so it’s very, very liberal if they feel that there’s enough evidence to do that – the problem is that they’re being told that there isn’t [any evidence]. That’s very frustrating … There is a lot of evidence. There is a lot of research happening. And at the moment in the UK, they’re saying ‘well there isn’t, there’s no research’, which we know isn’t true. … I do think the key is [the] education of doctors, because at the moment they’re not happy to prescribe because they don’t understand the product.”

How can doctors get the education they need then?

At The Medical Cannabis Clinics, we agree with Hannah that a lack of education around cannabis is preventing many patients in the UK from getting the medical cannabis treatment they need. This is why education is essential.  

Working in partnership with The Academy of Medical Cannabis, we have amassed a team of skilled specialists who have been specifically trained on the medical efficacy of the cannabis plant, the evidence around its use and how to prescribe products. Once this training is complete, these clinicians can begin prescribing with us at our clinics across the country. It’s clear to see then that through education like this, we can really start getting patients the medical cannabis care they’re looking for.  

To sign up to attend one of The Academy of Medical Cannabis’ face-to-face training sessions led by Professor Mike Barnes click here.

We only recommend taking cannabis-based products following a consultation with a medical professional, and do not advise patients on the recreational use of any cannabis-based products. 

At The Medical Cannabis Clinics, our GMC registered specialists will identify the appropriate cannabis medicine care plan and products for patients following a comprehensive assessment which includes an in-depth evaluation of the main symptoms being targeted, current medications, pattern of symptoms and lifestyle factors such as safety-sensitive occupations. 

They will also monitor and adjust the medication on a regular basis to ensure the best effect with the fewest side effects. There is also a carefully designed process in place to monitor patients’ well-being, with follow-up appointments after a week and then every month, for three months after receiving a prescription.

To book an appointment with on of specialists click here

Illegal THC Levels on UK High Street

Illegal THC levels on UK high street

We’ve known for a while now that there’s a problem with high street CBD. With a number of different regulators depending on the type of product, from the Food Standards Agency (FSA) to the Medicines and Healthcare Products Regulatory Agency, the authorisation process for what CBD can be sold in our shops is far from concrete. 

The latest news that CBD oil being sold in UK high street store Holland and Barrett contains illegal levels of THC is therefore less shocking than it should be. As reported by The Mail on Sunday, the oil in question stocked by Holland and Barrett ‘contains four times [the] legal limit of psychoactive ingredient THC’, with the Jacob Hooy branded oil containing around 4.4 milligrams of tetrahydrocannabinol when, according to the Misuse of Drugs Regulations Act of 2001, products should only contain 1mg of the substance. 

And this is not just a singular, outlying issue with this oil from Holland and Barrett. This news highlights a bigger, widespread issue regarding CBD oils being sold on the high street in general. According to the paper, when a number of CBD brands being sold online and in UK stores were tested, many were found to have THC concentrations above the legal, permitted levels. 

So, why does this matter?

You’d assume that products being sold in trusted high street chains should be safe for use right? Well, with products containing THC you have to be particularly careful, even if you’re putting your trust in a big brand name. 

THC, or tetrahydrocannabinol, is the compound in cannabis that creates the high that we associate with recreational use. In other words, THC is psychoactive. This means that while THC can have a number of medical benefits, for instance it’s analgesic, antioxidant and anti-inflammatory, there are a number of risks associated with its use that should not be overlooked. 

Some psychoactive side effects of taking THC include disorientation, euphoria, paranoia and hallucinations, with it being advised that patients and consumers take small amounts of the substance to avoid such side effects. The use of THC by young people under the age of 18 is also highly discouraged, as it is believed by many that an excessive consumption of THC can have negative effects upon the developing brain. 

One of the major issues around this CBD product being sold then is that the labelling is incorrect, giving consumers misleading information when purchasing and deciding if the product is suitable for them. This factor is particularly vital in a case like this with a product containing more THC than anticipated, as people with potential contraindications like anxiety or mental health disorders may have sought to choose particularly pure CBD with low THC rather than the product in question to ensure no negative side effects occurred. If they bought the product thinking that the THC levels were low, they may have been making what seemed like an educated choice with an unfortunately misleading product.    

Additionally, this sale of products with illegal levels of THC highlights an issue with the regulation of CBD in the UK more generally. This news has thrown into question the ability and power of regulators in the country to control what’s being sold on the ever-expanding CBD market, particularly as a number of bodies are involved in this process depending upon the product being sold. 

As many CBD products are classed as food supplements or herbal remedies much like maca and turmeric, no medical claims can be made about them, so they are not typically subjected to the same rigorous testing methods as medical grade products.

If the product makes any medical claims however, the Medicines and Healthcare Products Regulatory Agency should be involved in the authorisation of the products for sale. The issues with regulation arise when the boundaries between these two categories blur indistinguishably – as may have been the case here.     

How can you be sure your product is safe then?

While there are a number of steps you can take to try to ensure that the CBD product you’re buying on the high street is safe to consume and well regulated, the easiest way to ensure the product you’re consuming is safe is to get a medical product prescribed following an assessment from a medical professional. This is particularly important if you’re looking for medical benefits rather than the general and often negligible placebo-type effects elicited by CBD wellness products. 

For instance, if you seek out medical treatment with The Medical Cannabis Clinics, then you can be assured that the CBD products being offered will have medical benefits due to their rigorous testing as medical, prescribable products. 

Also, there is less risk involved in using these medical grade products as opposed to CBD on the high street, as you will have already discussed your existing health issues with our medical practitioners, who will then have an involved and thorough discussion with you about the best treatment options for your specific circumstances. This means that a safe and effective dosing regime can be adopted with you specifically in mind, with the risk of side effects being minimised as far as possible.

 

We only recommend taking CBD or hemp oil following a consultation with a medical professional, and do not advise patients on the recreational use of any cannabis-based products. 

At The Medical Cannabis Clinics, our GMC registered specialists will identify the appropriate cannabis medicine care plan and products for patients following a comprehensive assessment which includes an in-depth evaluation of the main symptoms being targeted, current medications, pattern of symptoms and lifestyle factors such as safety-sensitive occupations. 

They will also monitor and adjust the medication on a regular basis to ensure the best effect with fewest side effects. There is also a carefully designed process in place to monitor patients’ wellbeing, with follow-up appointments after a week and then every month, for three months after receiving a prescription.

To book an appointment with one of our specialists click here