Tag Archives: Specialists

TMCC CQC Good Badge

TMCC is the first medical cannabis clinic to be awarded ‘Good’ by CQC

We are pleased to announce that The Medical Cannabis Clinics has been awarded the first rated ‘Good’ cannabis clinic in the UK by health and social care regulator Care Quality Commission (CQC).

The Medical Cannabis Clinics (TMCC), which cares for more than 60% of all medical cannabis patients in the UK has passed with a ‘Good’ rating after a thorough inspection by CQC which regulates to ensure patients are provided with safe, effective, compassionate, and high-quality care. This was the first inspection of a cannabis clinic by the CQC.

TMCC was awarded one of four licences to trade as a cannabis clinic by CQC in 2019, and has since dedicated its focus to opening access for patients to receive care and treatment from the finest consultants across a number of medical areas including Pain and Psychiatry. 

Over half of all doctors that are currently prescribing medical cannabis, are working at TMCC which operates completely via telemedicine services, and due to patient number growth five new doctors are being onboarded monthly. 

Chief Medical Officer, Dr Sunny Nayee said of the CQC rating: “We are delighted to receive this rating from CQC, as it shows that the hard work from the doctors and support staff has all been worth it. The industry is not by any means mature yet and we are always looking for ways to improve how we do things for the greater good of the patient. For us, patient safety and efficacious treatment is the central pillar of the clinic, and I am proud this has been noticed by CQC.”

Group Managing Director of LYPHE Group, Jonathan Nadler said: “I would like to congratulate everyone at TMCC for playing their part in making the clinic a critical care operator for patients seeking medical cannabis. We have set the standard for all other cannabis clinics to now follow.”

TMCC - treating ADHD with Medical Cannabis

Dr Niraj Singh talks with Mary Biles about ‘Cannabis for ADHD: An emerging therapeutic option.’

TMCC’s psychiatric specialist Dr Niraj Singh appears in a recent article published by Project CBD, interviewed by author and CBD thought leader Mary Biles.

In the article, ‘Cannabis for ADHD: An emerging therapeutic option’, Biles questions whether doctors are mistaking self-medication for cannabis use disorder. She asks Dr Singh about his professional experience in prescribing medical cannabis to people with ADHD. 

Dr Singh says “We find that patients…may go out to get some drugs to self-medicate. It may lead to a downward trajectory, and these are very able people who may have lived a relatively stable life.”

Many studies suggest that dopamine is connected with the development of ADHD. Dr Singh explains how medical cannabis’ effect on the dopamine system can help with day-to-day behaviour.

“The dopamine system is all about focus, concentration, reward. That impacts what’s called ‘executive functioning’, which is the ability to plan, task sequence, and make judgments. It also has an impact on memory and our emotional regulation as well.”

“These stimulants essentially trigger dopamine production in the cells of the frontal lobe of the brain, and people report some really good symptom reduction. So, they focus better, concentrate better, and they feel less restless.”

Aside from the scientific findings, Dr Singh also provides first-hard examples of how medical cannabis has helped his patients better manage their ADHD symptoms.

“[One patient] was smiling and talking about how everything has shifted in a real positive way,” Dr Singh recalls. “Work had improved, the boss had commented and commended him on how things were progressing at work. His wife was really pleased with the change and described that the person she knew had come back.”

“I think one of the great things with medical cannabis is that it can be used to treat a whole host of problems and a whole spectrum of issues really, because it gets to the core,” says Dr Singh.

To read the full interview with Dr Singh see here.

If you or somebody you know is affected by ADHD and you’d like to know  more about how medical cannabis can help, please find further information on our condition page here.

Treating mental health conditions - how can Medical Cannabis help?

Supporting mental health during these times – can medical cannabis help?

In recent years and especially during the pandemic, more and more people are speaking openly about their mental health and seeking support. The NHS reports that 2,878,636 people got in contact with mental health services between 1 April 2019 and 31 March 2020. That shows just how many people are in need of care and treatment when it comes to mental health.

The silver lining of COVID-19 is the way that it has helped to improve mental health awareness by shedding light on all of the existing mental health problems that so many of us face: anxiety, depression, PTSD, and insomnia being some of the most common complaints. Social distancing and prolonged loneliness have brought all of these conditions to the fore for many people. The lack of family and friends has removed the support systems for thousands of people, leaving them vulnerable. So what can be used to help people manage the symptoms of these mental health conditions?

How can medical cannabis improve mental health?

When used in line with advice from a qualified doctor, medical cannabis has been proven to help those suffering from a variety of mental health conditions. According to Dr Anup Mathew, Psychiatric Consultant at The Medical Cannabis Clinics, use of medical cannabis can be a lifesaver for vulnerable patients.

“Medical cannabis in the UK is life-changing treatment for patients with a wide range of conditions that not only eliminates the suffering and despair they experience from their illness, but also reduces the UK’s significant health burden,” explains Dr Mathew. 

“The scientific evidence has always been supportive, however nothing is as powerful as hearing and seeing the direct positive impact medical cannabis treatment has had for patients. 

“This is further magnified when the vast majority of patients reveal no side-effect profile or dependency concerns for medical cannabis compared to standard pharmacological treatments. It is a privilege to be part of the UK’s medical cannabis revolution in view of establishing it as a primary treatment option for so many chronic and enduring mental health conditions.” 

Many patients at The Medical Cannabis Clinics can also personally testify to the positive effects of their prescription, carefully created specifically for them with their own needs in mind.

Can medical cannabis help reduce anxiety?

Illustration of a woman in a highly anxious state of mind

A Canadian study from 2019 showed that lower doses of cannabinoids, present in medical cannabis, helps to reduce the symptoms of anxiety, by helping to promote feelings of relaxation and lowering the heart rate. 

The results also speak for themselves. Lottie Robert, a 25-year-old legal assistant had anxiety that was affecting her life in many areas. After using medical cannabis for a year and a half, she had this to say: “I have anxiety which used to limit the things I do, places I went and stopped me sleeping every evening.  Since starting medicinal cannabis treatment, I have managed my condition naturally, without supplementing any prescription drugs at all. I am more confident and capable – I am in control of my anxiety, it no longer controls my every-day. I am a better person, employee and friend with my new treatment. I truly have my life back.”

Can medical cannabis help with stress or depression?

In the same way that medical cannabis has been shown to help with anxiety, it also helps to combat the negative feelings associated with stress and depression. Where traditional treatments have let down some of our patients, medical cannabis alone has shown to have a positive effect.

In the case of this patient, medical cannabis has proven to be an incredibly useful tool for treatment, after just two months of using it. 

“I have been clinically depressed for the last 25 years,” they said. “Medical cannabis has calmed me down, I don’t cry as often as I used to. I’m still down sometimes but I’m in a calmer place to think things through. It also helps me sleep longer instead of a few hours where I wake up exhausted. I truly believe it is helping me.”

Can medical cannabis help improve PTSD?

Many of the symptoms of PTSD can become overwhelming. Medical cannabis can be a useful aid to help manage those symptoms so people suffering from the condition can continue to lead fulfilling and happy lives.

Hear from one of our patients, 30-year-old Christopher James McBard, a horticulturist and garden designer, who has taken medical cannabis for a full year. for his PTSD: “It brings me down from my usual state of hyper-awareness where I’d usually live in constant alert of anxiety and paranoia. With cannabis, I am able to recognise my triggers and relax in a way I cannot without. It has allowed me to get back to work and better my life significantly.”

Can medical cannabis help those suffering from insomnia?

Man struggling to get to sleep looking at the time on his bedside clock

An American study from 2019 showed that the use of CBD improved the sleep in the majority of patients who were experiencing insomnia. This stems from CBD’s calming effects on the nervous system, helping patients drift off into a restful sleep.

Warehouse manager, Mark, 57, has been taking medical cannabis for 7-12 months.

“Before taking my first prescription, I was lucky to get two to three hours of sleep a night,” Mark explains. “This has increased to five to six hours of sleep, sometimes unbroken. This hasn’t happened for well over 10 years. It has also alleviated bad moods and tiredness in the mornings.  Medical cannabis has had a really positive impact on my life.”

Ultimately, medical cannabis can act as a useful tool alongside other forms of treatment for a variety of mental health conditions. It’s vital that we continue to promote mental health awareness and explore all avenues of treatment available to us.

Supporting Fibromyalgia Awareness Month

Fibromyalgia – why it’s more common than you might think

It might not have an instantly recognisable name, but fibromyalgia is a much more common condition than you might think. Not only does it affect a lot of people, many celebrities have shared their own experiences with the condition.

Also known as fibromyalgia syndrome (FMS), fibromyalgia is a chronic condition causing widespread pain all over the body. As there is no known cure for fibromyalgia, traditional treatment options focus on managing the symptoms of chronic pain and make it easier to live with. The stories of successful celebrities show that it is possible to live a fulfilling life with fibromyalgia – but what does that life actually look like?

How common is fibromyalgia?

The NHS estimate that between 1.2 and 2.8 million people have fibromyalgia in the UK. They can only estimate within that broad range because it’s notoriously tricky to diagnose. Many of the symptoms are similar to those of other conditions, so definitively establishing whether someone has fibromyalgia can take time. 

It’s more common amongst women, with 75-90% of people with fibromyalgia identifying as women. The exact cause for fibromyalgia is not known, but many experts believe that it’s related to abnormal levels of certain chemicals in the brain. 

Which celebrities have fibromyalgia?

Many famous household names have also been diagnosed with fibromyalgia. Some of them have spoken out about the condition to raise awareness about the difficulties of dealing with chronic pain. 

Lady Gaga

Lady Gaga on the red carpet at the Golden Globe Awards

Lady Gaga confirmed in September 2017 that her struggles with chronic pain were because of fibromyalgia. Her condition came about after breaking her hip. Her fans were able to see an up-close account of what it’s like to live with fibromyalgia in her Netflix documentary, ‘Gaga: Five Foot Two’, where she also shared the coping strategies she’s developed. 

“My pain does me no good unless I transform it into something that is. So I hope people watching it who do struggle with chronic pain know that they’re not alone. It’s freeing for me… and I want people that struggle with it to hear me,” Gaga said.

Morgan Freeman

Morgan Freeman in a professional headshotEveryone’s favourite gravelly-voiced actor shared his experiences with fibromyalgia in an interview with Esquire magazine, saying that it did prevent him from doing certain activities, such as sailing. Nonetheless, Freeman has kept a positive outlook and maintains that there are ways to live a fulfilling life with fibromyalgia.

“There is a point to changes like these,” said Freeman. “I have to move on to other things, to other conceptions of myself. I play golf. I still work. And I can be pretty happy just walking the land.”

Lena Dunham

Lena Dunham on the red carpet

Alongside sharing her experiences with endometriosis, Dunham has also shared about the chronic pain she struggles with from fibromyalgia. She wrote about her story on Instagram: “I appear to be totally able-bodied but it’s complex, and I am just trying to do everything required to maintain a life of joy and service. My work costs everything I have. This is fibromyalgia. It’s little understood and so, even though I have a lot of knowledge and support, it’s hard to shake the feeling I am crazy. But I’m not (at least not this way!) and you’re not.”

Dunham went on to assert that everyone’s pain is valid and get easier to manage over time.

How can medical cannabis help with fibromyalgia?

As all of these stories from celebrities show, it’s definitely possible to have a fulfilling and satisfying life with fibromyalgia. There are ways to manage the symptoms of chronic pain and find some relief. One of those ways is medical cannabis. 

Two studies, one from 2010 and one from 2018, both provide evidence of cannabinoids helping people suffering from fibromyalgia manage their symptoms, specifically in pain management. Medical cannabis has been shown to have analgesic effects, or the ability to minimise the feelings of pain without causing loss or disruption to consciousness. On top of that, some forms of medical cannabis can also improve sleep in patients with fibromyalgia and even be a substitute for other medications. Many people with fibromyalgia end up taking various prescription medicines, so replacing those more natural substances is often preferable.

For those looking to try new ways to manage symptoms of fibromyalgia, medical cannabis can be a productive way forward. 

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.