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Medical Cannabis

Dr Roger Henderson
Reviewed by Dr Roger HendersonReviewed on 13.10.2023 | 7 minutes read
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There has been much discussion in the UK popular press recently about the use of cannabis-related medication to treat certain conditions, and the very few numbers of NHS prescriptions being written for these. 

Here at Healthwords we know you may have questions about this, so in this article we look at why this is the case, and when and how you may be a suitable candidate for medical cannabis.

What is medical cannabis?

The term ‘medical cannabis’ is a broad one and people can interpret it in a number of ways, but it basically means any cannabis-based medicine that is used to relieve symptoms.

For a cannabis-based product to be used as a medicine, it must satisfy three key criteria:

  • It is produced for medicinal use only in humans
  • It must be, or must contain, cannabis, cannabis resin, cannabinol, or a cannabinol derivative
  • It is a medicinal product (or a substance or preparation for use as an ingredient of – or in the production of – a medicinal product).

If the product satisfies these three criteria in the UK, then it may then be considered as a ‘cannabis-based product for medicinal use in humans’. This also makes it a Schedule 2 drug under the 2001 Misuse of Drugs Regulations.

When is medical cannabis legal?

Non-medical cannabis is currently a Class B drug in the UK which means that its possession is illegal and can result in a prison sentence. However, unlike other Class B drugs it comes under the UK discretionary warning scheme that means a police officer can choose to issue a warning only (which does not trigger a criminal record) provided that:

  • A small amount is involved and for your personal use only

  • It’s the first time you have been found with an illicit drug

  • You have no previous criminal drug record

  • You comply with the police, are non-aggressive and admit the drug is for your personal use only

Although recreational use remains illegal in the UK, if you are prescribed medical cannabis by a specialist for health reasons, you may possess it without fear of prosecution.

What medical properties does medical cannabis have?

The chemical constituents in cannabis that have been studied most for their medical benefits are tetrahydrocannabinol (THC) and cannabidiol (CBD). THC is the main psychoactive constituent of cannabis, responsible for giving the drug ‘high’ to users whereas CBD is not psychoactive and so does not.

Medical cannabis has the medical properties of helping reduce severe muscle spasm, reducing the number of seizures in certain types of epilepsy, and reducing severe nausea symptoms caused by some cancer treatment. It is also reported to reduce severe pain in some people although the evidence is limited for this.

Cannabis is currently a Class B drug in the UK, which means that its possession is illegal and can result in a prison sentence. However, unlike other Class B drugs, it comes under the UK discretionary warning scheme which means a police officer can choose to issue a warning only (which does not trigger a criminal record) provided that:

  • A small amount is involved and for your personal use only
  • It’s the first time you have been found with an illicit drug
  • You have no previous criminal drug record
  • You comply with the police, are non-aggressive and admit the drug is for your personal use only

Although recreational use remains illegal in the UK, if you are prescribed medical cannabis by a specialist for health reasons, you may possess it without fear of prosecution.

The chemical constituents in cannabis that have been studied most for their medical benefits are tetrahydrocannabinol (THC) and cannabidiol (CBD). THC is the main psychoactive constituent of cannabis, responsible for giving the drug ‘high’ to users, whereas CBD is not psychoactive and so does not.

What conditions are medical cannabis used for?

Medical cannabis is only considered as a prescribed medication when other treatments are not suitable or have not helped when tried in:

  • Children and adults with severe, rare forms of epilepsy
  • People with multiple sclerosis who have severe muscle spasms and stiffness caused by the illness
  • Adults with severe nausea and vomiting caused by chemotherapy treatment where other treatments have not worked

Despite some people who use cannabis as a treatment for pain reporting significant pain relief as a result - and the fact there is some evidence that medical cannabis can help with certain types of pain - current NHS guidelines are that this evidence is not strong enough to recommend it for pain relief as an indication for prescribing it. However, some clinical trials do use medical cannabis for pain.

Can I get a prescription for medical cannabis?

Most prescriptions for medical cannabis currently come from the private sector rather than on the NHS as private doctors on the General Medical Council’s specialist register are legally able to prescribe cannabis-based products for medicinal use.

A GP may make a referral to a specialist on the GMC specialist register once the patient reaches the appropriate point in their treatment pathway. The patient must also have tried all licensed medicines for treating epilepsy without a successful response.

What types of medical cannabis are available on prescription?

Three forms of medical cannabis can be prescribed in the UK depending on the condition they are being recommended for.

Nabilone

This type of medical cannabis is used to treat the nausea and vomiting that can occur during chemotherapy (cancer treatment) when other treatments have not worked. Taken as a capsule, it is a ‘man-made cannabis’ which acts in a similar way to THC (tetrahydrocannabinol) – the ingredient that produces the cannabis ‘high’.

Epidyolex

Used for children and adults with severe epilepsy (specifically the rare forms called Dravet syndrome and Lennox-Gastaut syndrome) this is taken as a liquid and contains highly purified cannabidiol (CBD) – the substance in cannabis that appears to provide the most medical benefit. Because it does not contain any THC, there is no ‘high’ from using it.

Nabiximols

Also known as Sativex, this form is given as a mouth spray and is used to treat the muscle stiffness and spasms linked to multiple sclerosis where other treatments have failed. This is currently the only cannabis medicinal product in the UK that has marketing authorisation from the MHRA - the Medicines and Healthcare Products Regulatory Agency.

(Cannabis-based medicinal products do not include any raw or unrefined cannabis or the cannabis or hemp oil products that can be purchased online or in health food shops. These products are <u>not</u> produced for medicinal use and so cannot be recommended or prescribed.)

What are the side effects of medical cannabis?

Although medical cannabis has been designed not to have the psychoactive properties of street cannabis, as with all prescribed medication it does have the potential to cause side effects. These include:

Common or very common

  • Gut symptoms such as nausea, abnormal appetite, constipation, altered taste, diarrhoea, vomiting and a dry mouth

  • Impaired balance, concentration or memory

  • Dizziness or disorientation

  • Low mood

  • Blurred vision

Uncommon

  • Hallucinations, paranoia, suicidal thoughts or delusions

  • High blood pressure

  • Palpitations

  • Throat irritation or soreness

Cannabis extract medication should not be prescribed if there is a family or personal history of psychosis, or if there is a history of another severe psychiatric disorder.

How can I access cannabis-based medicinal products?

There are three ways this can occur in the UK at present:

  • A doctor on the General Medical Council specialist can prescribe it as an unlicensed ‘special’ medicinal product, including on a private prescription
  • People in a medical clinical trial can be given a cannabis-based product without a marketing authorisation
  • A specialist doctor can prescribe a product that has been granted marketing authorisation by the MHRA (currently only Sativex in the UK)

Is medical cannabis safe?

If a product (such as Epidyolex) contains only CBD and no THC, have none of the risks that may occur with those that do contain THC (and the long-term risks of using products that contain THC are unclear). In general, the greater the concentration of THC in the product, the greater the potential risks.

One significant risk is of becoming dependent on the medication (although in a controlled setting and when under the supervision of a specialist doctor this risk is small), and another is of psychosis. There is evidence that the regular use of street cannabis (especially the high-strength form) can trigger psychotic illnesses such as schizophrenia in some people. The most dangerous form of cannabis is that bought from drug dealers where the strength and ingredients are unknown.

The Grow Group provides high-quality medical cannabis products, from flowers and extracts to capsules and vape cartridges. Working with leading global producers to ensure an excellent supply chain and sustainable stock,

Healthwords is delighted to now be working in partnership with them to help our users access medical cannabis if needed.

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Dr Roger Henderson
Reviewed by Dr Roger Henderson
Reviewed on 13.10.2023
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