Monthly Archives: March 2021

Q&A with Dr Sunny The Medical Cannabis Clinics

Dr Sunny Nayee Answers Patient Questions – Part 2

After a successful live session hosted on the 18th of March, we carry on looking at what Dr Sunny Nayee, Pain Consultant and Medical Director of TMCC had to say in response to some patient questions:

Can you give us an overview on how cannabis works to relieve pain versus opiates such as codeine? 

OK, so one of the big problems in the UK, and certainly in the US, is this opioid epidemic. Part of the reluctance of some doctors to get involved in medical cannabis is the fact that they are a bit concerned that the opioid epidemic may end up being replaced with cannabis. The fact is, medical cannabis opens the door to two main types of cannabis receptors, CB1 and CB2. Essentially, a lot of the CB1 receptors are in the central part of your brain, and there’s also a place in the spine where the nerves from across your body to your arms and legs meet that has a high concentration of CB1 receptors, then there’s then the bigger nerve areas that I’m more distanced from which have the CB2 receptors.

So, medical cannabis can be split into two main components, CBD and THC. THC is mostly involved in modulating and affecting the CB1 receptors, with CBD then being the antagonist or whatnot. So, when compared to opioids, of which there are a lot of receptors out there, I believe that there’s evidence that the rate of things like addiction is higher with stronger opioids – even just after five days of using them. I think that’s awful, and cannabis isn’t necessarily a wonder drug in comparison but it has a much lower addictive effect if used effectively and safely.

When will medical cannabis be available on the NHS?

OK, this is a tough question that I get a lot of people asking me. The NHS, as you’re aware, provides care for points of needs – all treatments on the NHS have to be approved by NICE, which had its big review in 2018, in which it was not recommended to pay for medical cannabis. The two main things that it looks into is cost effectiveness and clinical effectiveness, and one of the main criticisms that NICE came up with against medical cannabis was that the studies and scientific data couldn’t convince them that it has a strong role for pain medicine.

Now, in terms of the evidence, I believe they failed to look at gold standard evidence or a randomised controlled trial. This would essentially involve a patient having an active drug as ‘Pill A’, and then ‘Pill B’ as a placebo. The problem is, it’s inherently impossible to do that in medical cannabis, partly because cannabis itself isn’t a drug talked about for CBD and THC, but also because there are lots of other properties or chemicals in cannabis, such as terpenes, flavonoids and cannabinoids. These all have different functions, and different effects on various different patients. When there are hundreds of drugs for a particular condition, you can see how a scientific like this would be hard to do.

In terms of if it will ever be available on the NHS, we’re looking to gather data from across the world – specifically with studies from Australia or Canada, and as time progresses there’ll hopefully be more data that we can pull to support it. Just this morning, the International Pain Society came up with another statement saying that they’ve looked at all the evidence and that they can’t make their mind up. However, when I’ve gone in and looked at some data, they’re looking at how medical cannabis can affect rats and their nerves and have looked into CBD and THC concentrations for how their behaviour changes and that’s not really applicable. I would say that real life data is key here, and I think that’s where 2021 in the UK will be strong, because we can create evidence based on real life with how our patients’ lives are being changed.

When will other strains be available?

I think this goes back to the fact that medical cannabis is still in its infancy. When I started seeing patients early last year, there were only a few oils, perhaps one or two flowers available for prescription in the UK. There’s been exponential growth between now and then, so I think there will be more and more strains becoming available on the market as more and more patients become involved in medical cannabis. It just takes time, especially with there being various regulatory terms that the pharmacy has to deal with when getting medication out to our patients.

Every few months, I’ve seen novel products and new formulations coming out and, certainly, I think that’s something that will be very important in reducing the stigma around using this medication. For example, there’s been companies who are thinking about bringing in wafers to the UK, which I think would create a smell that’s far more acceptable to an employer or a housemate. I’m quite confident that everyone in the wider medicinal cannabis industry is looking at different formulations and different products to make available, so more strains will become available as that happens. 

Is there more that patients can do to substantiate the benefits of medical cannabis?

I think I’d encourage patients to complete their feedback forms. Patients, such as those on Project 21, have to fill in quite extensive questionnaires for the database. If these are filled out and feedback is given to your doctor, they can then see what’s working and what’s not working and use this for their scientific data. We then would get what you call a positive bias, showing that medical cannabis is really helping someone with their quality of life or reducing their pain, or helping their anxiety and depression. These patients quite often will come back and see their doctor to validate their own experience, but with more private medicine that’s more unusual in the UK, at least for the vast majority, this doesn’t tend to happen so much and could be the death of medical cannabis if it’s not shown to be helpful for the patient.

We look out for the patients who don’t come back for repeat prescriptions because it’s sometimes just as helpful and valuable to see that things aren’t working, so we can make sure we’re informed on both sides of the argument.

What are the best topical cannabis products and how can they compliment cannabis oil medication? 

There are a lot of topical preparations out there for medical cannabis and, on the whole, the concept of there being different preparations is to try and avoid what we call the metabolism effect. If you eat cannabis, and it’s not being prepared in the correct way and then, unfortunately, your gut will absorb the supply and it then goes into your liver and eliminates most of the goodness from its work. This is why we have root suction, and the sublingual oil that goes under the tongue. Other countries have patches, or suppositories, that try to avoid this situation. I don’t know whether suppositories will be available on our market anytime soon, it’s certainly a very ‘watch this space’ topic.

What do you think the pros and cons are of telemedicine? 

So, as some of you may know, we have rooms in Harley Street that we’ve operated out of. When the pandemic struck last year, we sought the CDC approval to do our consultations virtually. There are pros and cons to this, as it’s great to see people face to face but it’s also taking away the length of our patients having to travel into Central London. With a lot of our patients being disabled, I think they found it hard to navigate the building we have. So, in my opinion, there are some advantages to telemedicine – another one being that it’s good to see people in their own environments. This can be good for their anxiety, especially when they have family members with them. I think, as a doctor, it also gives a lot of insight into how patients live their real lives. I remember this one patient had lots of cats everywhere, which was quite amusing to see.

In this pandemic, telemedicine became a bit more prevailing, especially in my NHS practice where we’re still using it for follow up appointments. It’s changed things in terms of how medicinal care will work moving forwards, as I think patients should now be given a choice in terms of whether they want to come and see a doctor or talk remotely post lockdown. There’s definitely going to be more of a demand for people to get to wherever easier for them, and I think there will be people that prefer one side and people that would prefer the other – and we’ll do our best to accommodate both.

Is medical cannabis effective for treating lupus? 

Lupus is an anti-inflammatory disease and we know that cannabis, particularly CBD, has an inflammatory role. When you have inflammatory conditions, I believe that cannabis can be very helpful to treat them. When it comes to evidence, it’s hard to say that there’s clear cut evidence but it’s definitely something that should be considered as a treatment. If you discuss the option with your rheumatologist, and we have rheumatologists working with TMCC if you don’t have one who would be more than happy to talk to you, they can then go through any particular concerns that you may have.

 

We hope that this session was beneficial to all that attended and hope to host more like it soon, but if you do have any other questions you’d like to ask in the meantime then please do get in contact and we’ll do our best to answer them. As Dr Sunny said himself:

“It’s an absolute pleasure dealing with the patients I see through TMCC. I think a lot of doctors that are involved in medical cannabis do it because they like to see the good feedback, so I just want to say thank you. Thank you for choosing us and for giving us this response. It’s important that you keep letting your doctors know how you’re doing, be it good or bad – I do tell my patients that medicinal cannabis isn’t a magic wand, it’s not a cure for all ills so please do let us know if it’s working or not working. We will always do our very best to help you.”

Q&A with Dr Sunny The Medical Cannabis Clinics

Dr Sunny Nayee Answers Patient Questions – Part 1

Last week, The Medical Cannabis Clinics hosted their first live Q&A session with their Medical Director and Pain Consultant, Dr Sunny Nayee. The exclusive event gave many patients the chance to ask anything they wanted to know, and gave us the chance to give some great insights into how medical cannabis works.

For those who weren’t able to attend the event, you can read all of the questions we got to and what Dr Sunny had to say below now:

What advice would you give to someone with regards to the stigma around both the illicit use of medical cannabis in their work and social setting?

“That’s a tricky question that I get a lot from patients during consultations. I think there is still a stigma associated in workplaces and social settings, partly due to the smell when a patient’s vaporising cannabis and, also, perhaps due to a lack of understanding as well. In terms of specific advice that I give people, I think it’s worth noting that this is a legal route to accessing medical cannabis. It’s OK to share your prescription, and I’m happy to do that with employers. I’ve had patients go through to occupational health and inform them, because it’s quite a novel medication.

Quite often, occupational health gets in touch with the clinic and they check in with us, and we’re happy to share medical records, of course with the patient’s consent, and help anyone who’s having particular problems or issues.

We try to educate and share the knowledge, and I think the best advice I can give would be to try and be as open and honest about using this medication as you can. If you’re on morphine or something similar, or you’re having other health-related issues, you’d share that with your employer so I’d encourage you to do the same in this instance.

If that then means that occupational health has to go through certain checks, we’re more than happy to support patients with that.”

What is the cost of treatment, and what is the difference between the CBD and THC cannabis you prescribe?

“I’m pleased to say that the cost’s been coming down.

I remember when medical cannabis first started out in the UK, probably just over a year ago properly, and it was really expensive. There was only one brand that was available for medical use, and that was from a Dutch range – the Dutch being the European pioneers for medical cannabis based patients. We were paying in excess of thousands of pounds a month for that.

In terms of treatment costs, if you’re in the UK and the price is a concern then Project 21 is a great route. This caps prescription costs to one hundred and fifty pounds per product per month. That’s thirty grams of flower or thirty minutes of oil. We do appreciate that there are other ongoing costs, such as consultations, and it can sometimes be expensive for patients.

It can be tricky if patients, for example, are disabled and don’t necessarily have a high income – but I do think that it’s reassuring that the general trend is prices coming down. I’m hoping that will continue going forward.” 

Can evidence be shown for muscle spasticity that takes into consideration patients with special needs accessing medical cannabis?

“There are some areas that allow the use for medical cannabis in this instance, one of these are based on a set of conditions – such as multiple sclerosis, and the specific spasticity that comes with this.

If patients do suffer with spasticity, I would encourage perhaps speaking to their neurologist, if they have one, to see whether they’re eligible for any state funded medical cannabis to treat this.

As far as I’m aware, a patient that has multiple sclerosis has set criteria that takes into account how the NHS can strategically treat this with balanced cannabis bullets in terms of the CBD and THC ratio, and that’s given in terms of spray type formulas, put right to the back of the mouth.

So I would say, with regards to spasticity, do speak to your GP or  neurologist. There is a new drug on the market that particularly targets neck and back spasms called Mayo Pradhan. This is something that’s free and completely non-addictive, so, whilst cannabis has a role in treating this, this is also a good starting treatment. There are also a whole range of other treatment options that you could consider, too.”

Would you recommend medical cannabis as an option for someone with particular pain around a wound and scar tissue other than pregabalin, which is causing many gastrointestinal side effects?

“This isn’t a caveat or specific advice for any particular patient but, in terms of this as a condition, I’m seeing a lot of my NHS pain clinic patients with post-surgical scar pains after operations that are using medical cannabis. If you’ve got an injury like that, I would recommend asking your GP to refer you to a pain clinic as there are lots of techniques out there.

What I always tell my patients, whether they’re seeing me in my medical cannabis cape or through the NHS, is to start to think of pain as a pyramid. You’re going to start off with all the simple treatments first, and then you move up the ladder to some more invasive treatments to try and keep the risks as minimal as possible.

There may be other treatments out there, such as pulsed electrical neuromodulation treatments, but if you’ve tried and failed all of these more conventional treatments then, of course, you can have a chat with one of the doctors at TMCC and we can look at what the best route would be for you.”

Do you think patients will ever be able to grow their own medical supplies? 

“There are various petitions going through parliament at the moment with regards to this, but it’s currently still illegal. Depending on the local police force, I think the ways this is dealt with vary.

Medical cannabis is very, very new in the UK – especially compared to other countries, and I think the only way that laws will change is by patients signing petitions and engaging politicians so that there can be an open, friendly debate about the pros and cons of using cannabis medicinally.

I don’t know of any impending changes with regards to this, but I know that there are various people lobbying for laws to be changed.”

To see what else was asked in this session and what else Dr Sunny had to say, read the second part of our blog on the event next week.

Live Q&A with Dr Sunny The Medical Cannabis Clinics

Exclusive – Live Q&A With Dr Sunny Nayee

As part of a new planned programme of Patient Care webinars, we will be holding a live Q+A with our pain consultant and Medical Director of TMCC, Dr Sunny Nayee.

Register your place now
Live Q+A with Dr Sunny Nayee
Thursday 18 March at 6pm UK time.
Cost: Free

Dr Sunny Nayee has successfully prescribed cannabis for patients suffering from chronic pain, spinal pain, fibromyalgia, arthritis, large joint pain (shoulder, hips, knees), acute pain, post-stroke pain amongst others.

The live session will last 30 minutes and give you a chance to ask questions to Dr Sunny (please note that, due to time constraints, we may not be able to respond to all questions).

If you would like to attend, please register for the event here – places are limited so we recommend you RSVP early to secure your place.

Got a question for Dr Sunny? 

Simply add it to your calendar invite with you RSVP. We will select a few of the bet ones and also leave time in the event for live questions to be picked up from the chat. Alternatively, you can send your questions through to our Facebook Page and we’ll pick the up from there too.

Join our Facebook Group

Our group on Facebook is private and exclusive to our patients. This is a safe space for you to discuss your symptoms, ask each other questions and talk about how your prescriptions are helping improve your lives. We’d love for you to join our group here.

Charles Cumming my legal cannabis journey first steps

My Legal Cannabis Journey | The Third Legal Prescription

In this final instalment, Charles Cumming shares where his medical cannabis journey has led him now and how he’s been able to now stop using medication to manage his Crohn’s Disease symptoms.

“My third prescription arrived within a week and contained two Spectrum No.2 pots and 10 grams of Bol Indica MVA. The Bol flower was recommended for night time use, with THC levels of 20% and CBD levels of 4%.”

I found the new Indica was fast acting, with effects showing within around five minutes and making me feel very sleepy. The taste was fairly neutral, and the vapour was smooth upon inhalation, sending a deeply relaxing sensation throughout my body and displaying its suitability for evening use. At this time, most of the pain I was experiencing from my condition had diminished. I had also been prescribed liquid nutrition for two months, which I would take ten times a day. There were limited side effects, however the high levels of glucose syrup resulted in considerable sleep disturbance. The Bol was ideal for counteracting this side effect and allowing me get to sleep within minutes, however, the morning after I did feel a little fatigued. The Spectrum No.2 was on hand to give me the energy boost I needed when this happened.

My condition improved considerably over the next couple of months, and with my tolerance levels seemingly rising, I was hoping to take this time to give myself a break from cannabis medicines. My doctor recommended that I should be taking a month’s tolerance break every few months of use, and I had now been using the medication daily for at least two years. With this in mind, I stopped using cannabis without tapering off it as I might have done with previous medications. The first few days were a little tricky, I found it hard to get to sleep occasionally and my mood was sometimes a little low. However, after the first few nights, things got better and my sleep improved. I also started to feel more mental clarity. With any withdrawals seeming to be over, my need for the medication’s assistance reduced almost completely.

I’ve now been on a break from medical cannabis for a month, and I’m doing well without the need to medicate most of the time. I can’t imagine how much harder these last five years would have been without the help I had from medical cannabis to assist in my symptoms and the side effects from strong prescription medications. It has helped me get through a very difficult and distressing period in my life without furthering the stress that my condition inflicts, and has given me the option to opt out of pain, get the sleep I need and eat food when I have been in too much pain to even consider it.

I am incredibly grateful now to not be dependent on medication, but also relieved to know I have legal access to cannabis if I still need it’s assistance.”

If Charles’ story resonates with you, or you know somebody who could benefit from similar help, book an appointment with our medical specialists today to start your own journey into improving your quality of life with medical cannabis.

How Medical Cannabis Helps HIV Patients

Ending LGBTQ+ Month – The Evidence Behind Medical Cannabis Treating HIV Patients

As LGBTQ+ history month drew to a close yesterday, we wanted to continue highlighting the effects that medical cannabis can have when treating HIV symptoms after the 80s crisis has been so brilliantly highlighted in ‘It’s A Sin’. With the heart-breaking final episode airing a couple of weeks ago, we couldn’t be prouder to be a part of treating the disease that took so many men from us not so long ago.

While NICE, who oversee matters of clinical regulation for the NHS, haven’t made a determination around the use of medical cannabis in this context, it’s interesting to note that they have allowed for its use in the treatment of chemotherapy-induced nausea and vomiting (CINV), which shares a very similar symptom profile. It’s also significant that, similar to cancer treatments, there are very nascent lines of investigation that could in time support medical cannabis as a direct treatment. 

More advanced studies indicate that cannabinoids have been shown to inhibit productive HIV infection in primary human T cells, and a CB2 antagonist blocked this effect. This is essentially an antiretroviral function, and indicates that cannabis could, at some point, be used in direct treatments.  

The highest standards of evidence are required to support any clinical pathway though, and more evidence is currently required to enable the formal use of medical cannabis to treat HIV or its symptoms. While self-medication data would support its use, careful examination of long term effects in relation to drug interactions with existing antiretroviral medications, and other factors, would be required to satisfy that clinical standard.   

As is often the case for medical cannabis in general, there is substantial and exciting potential around its value for HIV treatments, which demands further study to cross the threshold into widespread pharmacopoeias.   

If you or anybody you know is currently struggling with pain or any other symptoms from this disease or others, our team of professionals are here to help.