Is it time for a greater push to help rehab professionals better understand and incorporate cannabis medicine in their interventions?
Patient access to medical cannabis remains a sensitive subject in the UK; official legislation has not yielded a liberation of access and, with a dearth in education and official guidelines for medical professionals, many in healthcare professions believe there is not enough evidence to fully embrace cannabis medicine.
However, some clinicians working with cannabis medicine believe it may be time for rehab professionals to discover the true benefits cannabis can offer as a medicine. Important distinctions must also be made between pharmaceutical grade medical cannabis available on prescription, and wellbeing CBD products available via retailers.
The current NHS advice on medical cannabis is: “Many cannabis-based products are available to buy online, but their quality and content is not known. They may be illegal in the UK and potentially dangerous.
“Some products that might claim to be medical cannabis, such as CBD oil or hemp oil, are available to buy legally as food supplements from health stores. But there’s no guarantee these are of good quality or provide any health benefits.
“Specific cannabis-based products are available on prescription as medicinal cannabis. These are only likely to benefit a very small number of patients.”
Dr Simon Erridge and Professor Mike Barnes are both experts in the field of cannabis medicine. Here they tell NR Times why is it time for rehab professionals to understand and incorporate cannabis medicine.
The benefits of cannabis medicine
“Yes it is time for rehab professionals to grasp the value of cannabis as a medicine” says Professor Barnes
“There is no doubt scientifically that it can help chronic pain of any aetiology. It reduces anxiety and those two together account for about 85 per cent of all prescriptions in the UK.
“What else does it do? Aids sleep, promotes appetite and of course is a very good anti-convulsant. It also reduces spasticity. All of those issues can be real problems for people with a variety of neurological conditions, including stroke.”
Negative connotations and stigma
Currently in the UK cannabis medicine suffers from negative connotations and stigma, that leads to products such as CBD oil being frowned upon by some, despite the health benefits it has to offer.
Dr Erridge believes there is a shift in attitudes towards cannabis-based medicines. He says: “We’ve seen that public attitudes towards cannabis-based medicines are improving all the time, but 84.4 per cent of surveyed medical cannabis patients still perceive themselves to be subject to stigma.
“The biggest problem this poses is that a significant proportion of these patients may be concerned about raising the subject of their prescribed cannabis-based medicines with their GP and other healthcare professionals.
“Another major issue is that simply too few people (approximately 50% of individuals) are even aware that cannabis-based medicines are available for eligible patients on prescription in the UK.
“Without this awareness it will always be challenging to overcome any negative connotations that people still possess.”
Dr Erridge on the argument against cannabis-based medicine
“The core arguments made against cannabis-based medicines are that there is not enough high-quality evidence of its efficacy, and the concerns held around adverse events, particularly medication-induced psychosis.
“With respect to evidence of its efficacy, I believe that there is more than sufficient evidence to support its current place in healthcare and, as mentioned, remain hopeful of more high-quality evidence in the near future to determine if it has a role within routine practice.
“With respect to adverse events, the data we have from UK patients prescribed cannabis-based medicines suggests the majority of adverse events are of mild to moderate severity.
“Whilst I of course understand the additional hesitancy around psychosis, actually these concerns are largely built upon observational studies of recreational and/or illicit cannabis consumption, which is unregulated and contains higher doses of tetrahydrocannabinol (THC) than would be typically prescribed for medicinal reasons.
“This is supported by data from Canada which suggests that the incidence of cannabis-related mental and behavioural disorders in medical cannabis patients is low.”
Dr Erridge’s counter argument: “Many healthcare professionals have gone through their training without receiving any education on cannabis-based medicines, or indeed the endocannabinoid system, the body’s own cannabinoid system which these medicines act upon.
“Providing education to healthcare professionals and even potential patients is therefore very important.
“However, the most important step is taking the available evidence we have to date and using this to perform the types of studies which regulatory bodies are more comfortable using to provide recommendations on how cannabis-based medicines may be best utilised.
“As a clinician is difficult to stay abreast of all the latest research, particularly if it is not within a personal area of interest. Therefore the production of high-quality research that influences guidelines and subsequently clinical practice through will be a big step forwards.”
How safe is it?
Professor Barnes notes that the T21 project has highlighted the safety of cannabis-based medicines: “The Drug Science T21 project has recently reported only three per cent of those receiving cannabis have any side effects at all at three months.
“Sensible prescription is needed as with any medicine it is not right for everyone. Certainly worth considering for many neurological symptoms.”
