Did You Know Cannabis Based Medical Products Are Legal in the UK?
- Brainz Magazine
- Apr 14
- 15 min read
Berta Kaguako is the Co-Founder and Managing Director for EthVida, a patient educational platform, that promotes plant medicine and a holostic healthcare approach. As a patient herself, Berta has made a remarkable transformation, using Cannabis Based Medical Products, to manage 7 diagnosis and 50+ symptoms. And now advocates for plant medicine.
What is Medical Cannabis? Dive into the world of Cannabis Based Medical Products and learn more about how Cannabis medications work and the prescribing frameworks around it. We also get a sneak peek of the patient testimonials to come in The Cannabis Chronicles segments.
On 5th November 2018, the UK implemented a significant paradigm shift to the types of medications healthcare professionals are permitted to prescribe in the UK. However, this went almost completely unnoticed by not just the general public but, shockingly, healthcare professionals alike.
How is this possible, you ask? It may be because the medication that was legalised is Cannabis! Yup, you heard that correctly, Cannabis Based Medical Products (CBMPs), are now legal to obtain on a prescription in the UK.
What are cannabis based medical products & how do they work?
Cannabis Based Medical Products (CBMPs), or Medical Cannabis, are medications derived from the Cannabis Sativa plant, containing cannabidiol (CBD) and/or Tetrahydrocannabinol (THC, which is the psychoactive substance in cannabis).
Due to a lack of clinical trials with respect to Cannabis as a medication, the current studies focus primarily on Cannabis (THC in particular) as a harmful substance. Cannabis medical Products are classified as Schedule 2 Medications, which essentially means they are unlicenced medications and, therefore, controlled substances used for very specific medical conditions that have been shown to be effective anecdotally.
In the UK, medical cannabis has been legalised for the treatment of psychological, neurological, and chronic pain conditions, as well as palliative and/or end-of-life care. For more information on what conditions can be treated, please visit here.
Like all medications, CBMPs have their highs and their lows, with side effects such as drowsiness, dry mouth, heart palpitations, psychological dependence, and Cannabis Hyperemesis Syndrome. The latter 2 mentions have sparked significant controversy in the UK, when awareness for Cannabis as medicine is raised. With years of associating Cannabis as a recreational and/or harmful substance, society struggles to wrap their heads around how this same substance is medicine too.
Why does cannabis work as medicine?
The 2 most common questions asked are:
How does cannabis work as a medication when it is known as a substance to make people high?
How can 1 medication treat a multitude of conditions?
To explain the above, we will explore opioids or synthetic opioid medications, which can be very effective for pain relief. “Strong opioids, such as morphine or oxycodone, are used to relieve moderate to severe pain when weaker pain medicines, such as paracetamol or codeine, are not effective. Opioids can also be used to manage pain or symptoms caused by cancer or long-term conditions such as heart failure, lung or liver disease.”
Side effects of Opioids include constipation, nausea, dry mouth, drowsiness, muscle spasms, confusion, and physical dependence. Opioids, in comparison to Cannabis, are known to hold more risks as a medication, but these are prescribed, as when used safely, they can be an effective medication. With regard to Cannabis medications, the same principle applies: when used responsibly, it can be just as effective, and in a lot of cases, patients report having more symptom relief and a significant reduction in pharmacological interventions.
Kyle Brown, a patient with Cranio Metaphyseal Dysplasia (CMD), ADHD, Autism, and Deaf says without Cannabis Based Medical Products “I would have ended my life if it weren’t for the relief Cannabis gave me for my conditions and the side effects of long-term overuse of opioids to manage my conditions (mainly CMD)”
Lydia Donaldson, a patient with Cystinuria, PMDD, Chronic Pain, and suspected ADHD & Crohn’s disease, says, “Before cannabis, I wasn’t living, just existing. At 23, I was left with no support and bed-bound in agony 24/7 after a routine operation went wrong. I had enough of being maxed out on opioids and found Medical Cannabis. Life with medical cannabis is the sun coming out after a long winter; I’m able to live a healthy life. I’m not cured, but I’m back being active, happy and less reliant on addictive pharmaceuticals”.
With regard to how Cannabis is so effective at treating a multitude of conditions. Well, that is compliments to the Endocannabinoid System.
What is the endocannabinoid system
An interview with General Practitioner and Cannabis Prescriber, Dr Richard Hazlett. Dr Hazlett is a GP with over 15 years of experience in modern and alternative healthcare, holding degrees in Medicine and herbal Medicine and a Postgraduate Diploma in Mental Health Practice. His diverse career spans hospital and general practice, with expertise in evidence-based holistic health, chronic disease, and lifestyle management. Dr. Hazlett also has a special interest in cannabinoid-based medicines and holistic healthcare, using a combination of the two to treat patients with CBMPs.
Dr. Hazlett explores the Endocannabinoid System (ECS) and explains.
“The ECS was discovered in 1992 and although widespread through the body and the brain, it was only discovered very late in physiology research due to the prohibition of cannabis and limited awareness of the importance of cannabis as a viable treatment option. The ECS helps to manage homeostasis, or in other words, helps the body to adapt to changes in the environment and internal changes to keep the body in balance.
The reason cannabis can have any effect on the human body is due to the endocannabinoid system. There have been more than 140 cannabinoids found in nature of which most people know of THC and CBD. These mimic our own “endocannabinoids” to stimulate or suppress certain effects.
The two primary cannabinoids in the human body are Anandamide (AEA) and 2-arachidonoylglycerol (2-AG). Ananda is the Sanskrit word for bliss or joy, and AEA is involved in modulating the reward circuitry in the brain, appetite, memory, thermoregulation, and sleep and helps to module pain responses and how signals are passed along nerves. This molecule is also found in high concentrations in Cacao, which is used to make chocolate, and is responsible for the “runner's high” associated with exercise. 2-AG is involved in regulating energy production, immune function and pain modulation.
These molecules interact with the CB1 and CB2 receptors. THC and CBD mimic the body’s own endocannabinoids to have a similar effect on inflammation, immune function, and energy balance. CB1 receptors are primarily found in the brain and regulate mood, memory and pain. CB2 receptors are mostly found in the immune system and help to regulate inflammation and immune responses.
Our own gut microbiome also contributes to the production of chemicals that interact with the ECS. Dietary fibres are broken down by bacteria in our own microbiome and produce further short-chain fatty acids that interact with our own ECS. Many fats and oils act as precursors for molecules that interact with the ECS. Omega 3 fatty acids and omega 6 fatty acids are all required as basic building blocks for mediators involved in the ECS. However, omega 6 fatty acids also contribute to proinflammatory chemicals when eaten in excess. Fruit oils such as olive oil and avocado oil or nut oils contain a much healthier balance of these essential fatty acids than other proinflammatory refined seed oils.
The modern Western diet contains very high levels of omega 6 fatty acids, which, although essential for proper bodily function, are usually consumed in excess of the body’s requirements. This, combined with low levels of omega 3 fatty acids in the modern diet, contributes to increased inflammatory chemicals, which affect how excess energy is used, shifting the balance from excess energy being converted to heat to being stored as fat and contributing to obesity. The Mediterranean diet is characterised by lower levels of omega 6 fatty acids and higher levels of omega 3 fatty acids due to high levels of olive oil, fish, and high-fibre vegetables.
When the endocannabinoid system is functioning correctly, it helps the body adapt to internal and external changes. However, when the system is out of balance, say due to stress, poor diet, or illness, it can lead to physical and mental health problems. This is where Medicinal Cannabis treatment can play a role. THC, CBD, or others from the 140 cannabinoids discovered thus far, when used correctly, can help to restore this balance and alleviate symptoms like chronic pain, anxiety, and inflammation. However, like any good thing, too much can be harmful. If we overstimulate these receptors, say by using very high doses of cannabis regularly and over a long period, then this can affect the homeostasis or balance of bodily functions.
Our bodies reduce the number of cannabinoid receptors available, requiring larger doses of medication to maintain the effectiveness. The enzymes that break down the cannabinoids after they have carried out their function can also become overwhelmed.
It is important to ensure that you speak to a professional if you are considering cannabinoid based medical products and to ensure you follow the low and slow approach to their use which ensures we use the lowest effective dose and continue monitoring for any worsening of symptoms or the development of adverse effects, some of which can develop slowly overtime”.
Challenging stigma
With awareness starting to spread about Cannabis Medications, there is an increase in concerns around unregulated prescribing. Due to the general public having a limited understanding of the prescribing process and risk mitigations in place, it is important to explore the legal frameworks in place to ensure safe prescribing.
The Misuse of Drugs Act 1971 and Misuse Drug Regulations 2001 govern the prevention of non-medical use or diverging of certain drugs, in particular, controlled drugs/medicines (Schedule 2). The Act sets out standards for both healthcare and non-healthcare settings, handling of controlled drugs/medications: outlining the steps to prescribing, supplying, storing, and destroying controlled medicines.
Under the controlled drugs ‘safe use and monitoring guidance’, there are 5 general indicators to observe when identifying suitability of a controlled drug for a patient:
Potential for or evidence of abuse?
Potential for physical or psychological dependence
Potential to play a role in putting health or public at risk
Potential for harmful pharmacological effects
Potential role as a precursor of other controlled drugs
As part of overseeing and monitoring the prescribing of controlled medications, National Institute for Health and Care Excellence UK (NICE) have written guidance in line with the subsequent acts, to enforce standardisation of controlled medications, and monitoring of potential abuse. NICE explains “It aims to improve working practices to comply with legislation and have robust governance arrangements. It also aims to reduce the safety risks associated with controlled drugs.”
To briefly summarise the guidance, NICE outlines the following when prescribers are contemplating a controlled drug/medicine prescription:
A need to appropriately weigh out the risk of the controlled medication prescribed versus health risks
Is the dosage safe
Ensure stringent review of existing medications (no medications left, to avoid counteractions)
Have other formulations been trialled
Once a prescriber has reviewed the above and felt it justifiable to prescribe a controlled drug. It is important then that the following service provisions are adhered to: continuity of care, no double prescribing, and avoidance of treatment delays. It is also important to note, that every organisation handling controlled medicines requires a Controlled Drugs Accountable Officer (CDAO), who is responsible for ensuring all processes are adhered to, all incidences around controlled medications are rectified and external notifications and alerts are made, where applicable: CQC (Care quality Commissions - adult health services governing body), NHS Protect (National Health Services – publicly funded healthcare system in UK), Police etc.
Furthermore, the International Classification of Disease 10 (ICD – 10) lays out the international standard for diagnosing and healthcare procedure codes. The ICD-10 outlines steps in identifying or assessing acute intoxication and/or drug dependence, adding an additional safety measure when prescribing controlled medications. Section 5, F10-F19, explores the impact of psychoactive medication, either prescribed or non-prescribed, formulating a guidance or questionnaire on identifying dependence or harmful prescribing. The ICD-10 explains, “Identification of the psychoactive substance should be based on as many sources of information as possible. These include self-report data, analysis of blood and other body fluids, characteristic physical and psychological symptoms, clinical signs and behaviour, and other evidence such as a drug being in the patient's possession or reports from informed third parties”.
Considering the standardised procedure with regard to controlled medications (schedule 2). It is important to reflect on the professional parameters in place for the prescribing of CBMPs, as these heavily mirror the advice set out by the ICD-10, NICE guidelines, governing legislation and regulatory compliance. Moreover, there are additional precautions in place in line with substance misuse guidance that aid towards risk management when prescribing CBMPs. Prescribers use the CUDIT-R, which is the Cannabis Use Disorder screening tool, designed to measure level of use or ascertain Cannabis Dependence Disorder. Based on a patient’s CUDIT-R score, prescribers can assess whether the frequency of use is concerning or if you are presenting with symptoms of cannabis hyperemesis syndrome, enabling them to put preventative measures in place, including discontinuation of the prescription, where applicable.
Interview with Dr. Hazlett on prescribing CBMPs and risk management
What is your understanding of risk management and healthcare and why is it so important?
Risk management would be the balancing of the risks versus the benefits of any treatments or intervention. Obviously, it's important that we don't cause any harm to the patient and as an extension of that, I also try and avoid harm to society as a whole. Therefore, with medicinal cannabis treatment, one of the things that we would always be looking out for would be for any evidence of medication diversion, where patients may be obtaining excess than the amount needed to treat their condition and diverting that excess either to the black market or to friends or family.
We also ensure there are no significant interactions with other medications or risk of worsening other existing health problems. For example, within GP practice, when we would start a patient on blood-thinning medicines, say following a stroke, we would always weigh up and assess their risk of having a further stroke versus the risk of them having a severe bleed due to the medication. Either one of these outcomes could result in harm to the patient, and we need to try and make sure that the balance is always towards the better option. The same applies to medicinal cannabis and we rely on teams of specialist doctors from many areas of medicine and value each other's opinions on this.
What are the kinds of risk associated with cannabis based medical products in the UK?
Many risks with cannabis are somewhat well-known, however some of these risks have been skewed or maybe exaggerated through years of prohibition. There is a large focus on the common perception that cannabis causes psychosis, which we know now that there's very little evidence showing any causation. However, certainly if someone is already predisposed or has pre-existing psychosis, it can lower the threshold at which that comes back again.
More of the risks that I would be concerned about would be of developing a dependence or using this as a crutch, rather than looking at other options, which may help patients to recover further and make improvements in their lives. So, through my practice, a lot of what I discuss is focused on a holistic approach to their life, mental health and daily activities. I practice very patient-centred medicine, and I'll try to meet the patient halfway, but a lot of it will be on agreement that they will then seek further treatments, for example, discussing how to use cannabis to reduce pain enough to start exercising. Or reducing anxiety and panic so they can engage with talking therapies or trauma-specific therapies. I always want to try and ensure they're treating this from multiple different angles and not relying on cannabis as a magical panacea.
How are you putting measures in place to mitigate these risks?
When a patient comes to a clinic seeking a prescription or an opinion on medical cannabis, we would always want to review their previous medical history with a particular focus on anything that may be made worse by cannabis. Be that mental health or physical health. As a GP, I am unable to initiate prescriptions in the UK; that can only be done by a doctor on the specialist register. This is at odds with other countries that have had legalised medicinal cannabis treatment for much longer. In Australia or Canada, this treatment can be initiated by a GP or Family Physician.
Once a patient has been seen by a specialist at the UK-based clinic, the case would be discussed at a multidisciplinary team meeting involving doctors from various specialities. This allows discussion regarding whether this is a suitable treatment method for this patient. If all agree, a formulation is decided, and the most common form is inhalation, as most people come to us already smoking cannabis in the community, and although it's not ideal, it is very fast-acting and much faster than say a sublingual oil or a pastille.
In the UK, current regulations are that they would only be allowed to inhale treatments via dry herb vaporizer, which instead of burning at around 600°C, the vaporiser heats it to between 170°C and 210°C. At this level, the amount of harmful components in the vapour is greatly reduced compared to smoking. There's currently little evidence about lasting impact of the respiratory system, we still need to see the longer-term evidence of that, and oral treatments are still the preferred route of administration.
Following prescribing, we then would see the patient regularly for follow-ups. During these appointments, we would be reviewing mental health, screening for signs of dependence and assessing for any adverse effects either in their health or in their social life and their activities of daily living. Cannabis can impact on many aspects of a patient’s life, and in cases where we have concerns, we would return to discuss the case with the multi-disciplinary team and the patient’s overseeing consultant.
Thank you and just because you just briefly touched on stigma, I just thought I'd mention it very quickly in terms of the stigma, that's out there and a lot of patients are as a result, being, I suppose, judged for using their medications. What is your feedback on that? Sorry, I know that's a big question.
There are multiple forms, you’ve got the perceived stigma from general public, healthcare professionals, or members of law enforcement. You also have internal stigma. We hear patients talking about this very frequently, reporting huge reductions in their internal stigma where they no longer feel guilty for using an illegal product and supporting organised crime and everything that comes along with that. As a result, a lot of them report huge improvements to their mental health because they're no longer having to make themselves a criminal to find a treatment option that works well for their symptoms.
At the MCCS (Medical Cannabis Clinicians Society), we offer advice for law enforcement to help them identify prescriptions vs illicit use, and how to support these patients. We are also running education sessions for clinicians, either clinicians who want to prescribe or clinicians who just want to know more about this treatment. For decades, the public and medical professionals have been told this is a harmful drug that makes people develop psychosis and worsens anxiety and depression. Which we now know when misused, yes, I can do that, but when used appropriately and under supervision, we see huge improvements in mental health, and I see many people returning to work after years out of the workforce.
Thank you so much, especially for the clarification around when misuse and when used appropriately. Because I feel like, especially when it comes to the general public who are Cannabis naive, that's the key area that they don't understand, and they immediately assume that a prescription equals misuse or somebody solidifying their misuse.
On that topic, any final thoughts for patients or healthcare professionals who may be concerned about risks and the industry mitigating these risks?
Medical cannabis, or cannabis based medical products, has probably been used for longer than any other medicine in the world, most likely before the opium poppy has been used. However, we know that, unlike opium, there is a low risk of harm from using cannabis within recommended guidelines and under supervision. Certainly, the physical risks are extremely low. When we're treating patients and guiding them through the process of titration, we follow a very slow process where we advise a low and slow approach. We gradually increase the dose if required and continually assess for any worsening symptoms be that mental or physical health.
If we aim to identify any societal or physical health side effects that can develop and reduce the dose or stop treatment if required.
We see a lot of patients self-regulate where they may initially titrate to the upper level of treatment as they have severe pain or their anxiety symptoms are very poorly controlled. Once better control is achieved, we often see the cannabis dose will reduce over time without any intervention from medical professionals. Unlike opiate medication, where we rarely see patients reducing their medication without advice or intervention from their clinicians. As patients' symptoms become better controlled, they often report that they are happier and sleeping better. These patients then reduce their use to a couple of times a week or as and when required, and often we will see patients discontinuing treatments and representing in a year or 2 years’ time if they had a flare of the symptoms again. I very rarely see anything like this within my normal GP practice. When using other stronger painkillers like opiates, gabapentin, pregabalin, or antidepressants, etc.
Conclusion
Overall, it can be very scary to make the mental transition into recognising that cannabis based medical products can be a very effective treatment option for patients, with patients reporting significant lifestyle changes as a result of this medication. When you are accustomed to hearing the word ‘Cannabis’ spoken in whispers due to its association with delinquency. However, one of the major challenges patients face when embarking on their plant medicine journey is the scrutiny from peers, healthcare professionals, and law enforcement.
Therefore, it is so important to understand the impact this has on a person. In a lot of cases, it’s their first time in a long while where they are able to regain their quality of life and are being judged or treated like a criminal. Solely because of their use of Cannabis based medical products! Ask yourself, would you rather they continue to suffer? Because that is the life you are asking them to live when you criticise their use of Cannabis as medicine.
The Cannabis Chronicles is a monthly segment that aims to bring awareness to Cannabis Based Medical Products and change the narrative on Cannabis as Medicine. The Cannabis Chronicles aims to showcase the benefits of Cannabis Based Medical Products by speaking to various healthcare professionals in the sector, as well as sharing patient testimonials as they explore the highs and lows of being a Cannabis patient in the UK.
Read more from Berta Kaguako
Berta Kaguako, Health and Social Care Consultant
Berta Kaguako is a Health and Social Care Consultant, with an Undergraduate in Psychotherapy and Masters in Psychoanalysis. Berta’s background is in Mental Health, Substance Misuse and Children & Families: in both a therapeutic and senior management capacity, having won 3x Blooming Strong Awards (Recognition from UN for contribution to violence against Women).
Berta is also the Co-Founder and Managing Director for EthVida, and independently runs the wellbeing service / educational platform.
References:
The classification of cannabis under the Misuse of Drugs Act 1971
Strong Opioids, Chelsea and Westminster Hospital: Strong opioids — Chelsea and Westminster Hospital NHS Foundation Trust
NICE Guidelines (Controlled Medications Overview): Overview | Controlled drugs: safe use and management | Guidance | NICE.
ICD-10 - ICD-10 Version:2016 (who.int)
