Medical Cannabis is now available from a selection of private clinics and dispensaries in the UK. It is still an unlicensed product with mostly experimental guidelines. However its roll-out hopes to contribute towards more holistic and personalised approaches to care; and in addressing the stigma, it sheds light on the need for greater transparency across industry relationships.
Despite cannabis having been legally classified as a medicine since November 2018, only a handful of patients have received a prescription on the NHS. Lobby and patient groups suggest the number of patients currently using illicit cannabis for therapeutic purposes in the UK is in the region of 1.4 million. Legal and political complications mean that there is still a lack of data and prescribing guidelines, shifting access to mostly private clinics and dispensaries with vertically integrated supply chains.
Criteria and Clinics
A list of criteria and clinics in the UK are available via the T21 website, who also offer concessions on prescriptions in return for data collection and research contribution. I initially enrolled with the Lyphe Group, although they are now no longer part of the T21 project. Lyphe are integrated with their own Dispensary Green, and mainly supply NOIDECS. I was slightly put off this brand after investigating previous batch recalls, owing to their large-scale production practices.
I subsequently tried the Medical Cannabis Clinic Cardiff. As an independent clinic they are not partnered with a dispensary and are able to offer a wider array of products. This includes non-irradiated flower such as the Grow Flower range, Khiron, and Therimos. They also have outdoor grown flower (under glass) from the Together range cultivated in Uganda. All their medications are currently imported. Most oils use ethanol extraction, but some CO2 extraction is also available. The majority of brands seem to be growing indoor monocultures. It is still largely difficult to attain detailed product information via brand websites, so further insights are usually found in forums, or from direct brand and clinic requests. Not all brands respond to these.
While not routine, it is recommended that you ask for a discreet letter explaining your licence to use cannabis products. You can also sign up for a Cancard and will just need to submit copies of your prescriptions. This is supposed to be an ID recognised by UK police, and acts as a validated indication to any third-party that you are consuming cannabis for medical reasons. Cannabis-based Medicinal Products (CBMPs) remain controlled drugs but are legal to possess and use on a named-patient basis so long as there is adherence to guidelines on safe and legal use. Bizarrely, this does not include traditionally smoked product – but novel vaporisation is fine. As is sublingual use of oils.
Markets and Medication
The main distinction between legal / regulated cannabinoids (CBD, CBG, CBN etc) and illegal / prescription tetrahydrocannabinol (THC) is the psychoactive component and its derivatives. You cannot find buds or whole leaf extracts and distillates on the over the counter (OTC) market if these contain THC. Medical grade and prescription products are also usually more refined and processed, with much higher concentrations. This is not necessarily a good thing, especially in an emerging industry, and many advocates of cannabis safety have cited its extensive historical applications and traditional use-base.
The main advantage of legalisation is that supply chains are supposed to be more transparent and appropriately regulated; meaning contents, quantity and dosing is better accounted for and more ethical. However as there is currently only partial-legalisation, many supporters of the ‘black market‘ / illicit market argue that some of the smaller-scale, community growth practices are more sustainable and holistic, if you can find a trusted supplier.
The issue is a complex and nuanced one, but in some instances there may be a small element of truth to this. And while I am a supporter of the intentions behind ‘better business’ regulators such as the B Corp movement, even their approach to growth can be hypocritical – as they are predominantly designed with ‘greater growth for greater impact’ in mind, when growth itself is not always the most sustainable or qualitative means of impact; especially in the current environment of exponential excess. Prices, accessibility, strength and levels of transparency (trust) vary between all markets; the private prescription market incurs the added clinic and pharmacy fees.
Solutions and Side-Effects
Having shifted off the hybrid NOIDECS flowers, I requested one CBD-dominant oil and one THC-dominant oil:
The CBD product I was prescribed was Cannim’s Lumir full spectrum: CBD 100mg/ml and THC <10mg/ml in a 30ml oral solution from Specials Pharma. The recommended dose for this is 0.1ml as required with a maximum of 2ml daily. The THC product was a Stenocare THC extract of THC 30mg/ml with CBD 1mg/ml in a 30ml solution from Curaleaf Pharma; recommended dose is 0.05ml as required. They also suggest increasing by 0.05ml per dose every 2 days if needed, to a max of 1ml daily. You should not take medication like this if driving and operating machinery.
Aside from the official list of recommended uses, I was curious to see if these products would have any effects on my menstrual cycle which is regularly irregular. Cannabis and ‘plant medicines’ such as adaptogens are often touted as being beneficial for restoring the body’s ‘natural homeostasis’. But 9 months on, maybe regularly irregular is just the norm for me as an individual.
While these products come with dosing guidelines, this is arbitrary and is not backed by an extensive amount of literature, especially in these novel formats. This has obvious drawbacks, but is also meant to flexibly accommodate more personalised approaches. However, I was taken aback by just how potent these prescriptions are, even at tiny doses, and it’s not hugely feasible to trial different strains and strengths. Despite being ‘full spectrum’ they also do not have very balanced cannabinoid and terpene profiles. I experimented with mixing some into creams for topical application; but they generally feel aggressive and come with heavier side-effects.
These medicines, and the wide variety of strains and applications available, act differently and affect different individuals in various ways. However one common use of prescription cannabinoids is for insomnia and sleep, and a THC-dominant strain is usually prescribed for this purpose. But I’ve found that while it can assist with falling asleep faster in the short-term, in the long-term, this may negatively impact quality REM.
When I weaned myself off medication, I experienced withdrawals from the THC products, lasting between 3 days and 2 weeks depending on strength and frequency. The most prominent effects of this were an exacerbation of symptoms: feeling too stimulated to fall asleep, and disrupted sleep patterns with intermittent waking during the night. However after the 1-2 week timeframe, I often slept longer and deeper as if my body was catching up.
One of the more interesting things about this was that, when I initially asked about the possibility of withdrawal effects in the clinical context, this was not highlighted as a valid concern. Across the array of practitioners I consulted they all explained that these are the symptoms of ‘an abnormally under-active endocannabinoid system’ warranting further substance-use. This was particularly prominent in the Lyphe Group who have a vertically integrated dispensary, and may also receive internal training.
An element of this presents a narrative problem, because while there might be some conditions that result from distinctly abnormal endocannabinoid profiles (such as genetic conditions and certain migraines) – everything from caffeine to entertainment affects endocannabinoid activity, as an extensive part of the nervous system and its neuromodulatory feedback loops. In many cases, the main difference between ‘withdrawal’ and ‘abnormal’ is the shifting ‘norm’ of the non-clinical vs clinical container.
In a similar way to the idea that taking cannabis every day to alleviate symptoms outside of the clinical context would class me as an ‘addict’ instead of a ‘patient’, if I were using illicit market cannabis, these same symptoms would probably be labelled as withdrawal effects. And this might actually be more helpful in enabling me to see them as temporary and to persevere in seeing them through to attenuation, instead of immediately reaching for further medication. This instigates the kind of cycle that many people with sleeping pill and narcotic addictions find difficult to break.
Due to the demands on healthcare resources and increasingly fragmented and outdated systems, there is often a lack of continuity to mainstream care. And this can further exacerbate such cycles. While many people who are used to using cannabis outside of the clinical setting are aware of the nature of ‘tolerance breaks’, in the current clinical context it is more often the case that should effects start to plateau, you are encouraged to keep increasing the dose and strength instead. If I were a palliative care patient this might be less of an issue.
I intuitively prefer to use cannabis in phases or blocks when I feel that I need or want to, as opposed to having a continuous prescriptive daily dose. The endocannabinoid effects can often extend beyond a day, and symptoms are not limited to the medication or condition itself. Some of the symptomatic criteria for such medicines are also related to the body’s ability to deal with stressors: intangible and tangible lifestyle or environmental factors affecting mood, cognition, appetite, sleep and their regulatory feedback loops.
The Lyphe group had a flexible and autonomous booking system for follow-ups that suited this phasic method. They also had a wider variety of practitioners available inclusive of therapists, nurses or doctors. The Cannabis Clinic Cardiff require a commitment to regular monthly appointments with a doctor. While I think this can be a good way of seeing how things are progressing, when I requested greater flexibility, they were honest in explaining that the subscription-based commitment is mainly necessary to sustain their business model.
In general, more personalised and less patriarchal approaches to care respect patient capacity and encourage agency and autonomy as part of a collaborative and dynamic process that holistically considers factors beyond base medication-use, or economic incentives (in an ideal world). One clinic that seem to be designed with some wider lifestyle factors in mind are the higher-end boutique service of the London Resilience Clinic.
I am fortunate to have had the opportunity to trial such medications, and there is by now little doubt that for some people, these substances are lifesaving or vital for effective symptomatic relief. There are still many people who turn to illicit activity because they do not have access to these prescriptions or cannot afford them. Equally, human health and wellbeing is not just the absence of disease, and there are some that choose to use cannabinoid products for religious, exploratory, and relaxation or leisure purposes, yet are penalised for doing so.
Some users describe their cannabis-use as akin to vitamin supplementation, and sometimes a good OTC brand will do. These should have their certificates of analysis available online. There are a wide array of varieties, applications and uses for these products ranging from short-term band-aids to longer-term adjuncts. The emerging cannabis industry is an interesting space with a multitude of facets that epitomise some of the issues present in the intersection of health, politics, power dynamics, economics, regulation, research and integrative care.