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Peter Reynolds

The life and times of Peter Reynolds

Posts Tagged ‘doctor

What Is The Matter With Doctors About The Use Of Cannabis As Medicine?

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In the UK, most doctors, and the medical profession as a whole, are ignorant and bigoted about cannabis.

Their ignorance is not entirely their own fault.  For 50-odd years, since cannabis tincture was last available from UK pharmacies, they have been subject to the same relentless tide of propaganda from the Home Office, successive governments, the tabloid press and rabble-rousing politicians as the rest of society.  Many still regard cannabis as a dangerous drug consumed by degenerates that almost inevitably leads to mental illness.  The idea that it could be a safe and effective medicine which offers real benefits in a wide range of conditions is regarded as laughable.

However, there is no excuse for such laziness amongst a profession that regards itself as scientific.  And this is the charge – indolence, carelessness and laziness – that needs to be laid at those doctors at NHS England, the Royal College of Physicians and the British Paediatric Neurologists Association, that are responsible for the disgraceful ‘guidelines’ published two weeks ago.

Throughout Europe, Israel, Canada and the USA there are thousands of doctors who have made the effort to learn about cannabinoid medicine.  They have had to make extraordinary effort to do because even the most basic science is still rarely taught.  The endocannabinoid system is on the syllabus of very few medical schools, anywhere in the world, despite the fact we now know that it is the largest neurotransmitter network in the body and affects almost every aspect of our health and all medical conditions.  This is a dreadful indictment of the medical establishment but particularly of doctors in the UK, very few of whom have made any effort at all.

So while, to a degree, the ignorance can be forgiven, the bigotry cannot. It is cowardice. These doctors prefer to cover their own backs, protect themselves and prefer an absurd level of caution to doing what is in their patients’ best interests.  The incredibly low risk attached to cannabis in any form, at any age and particularly when under medical supervision, is simply overlooked.

Yes, the medical profession is known to be ‘conservative’ but in the case of cannabis this is an excuse.  Yes, we live in an increasingly litigious society but any truly professional doctor would not be cowed by such fear when the evidence is widely available, if they could be bothered to look. And what is this ‘conservatism’ of?  Modern medicine is barely a century old.  It is new in the history of our species and while the reductionist approach has brought great benefit and made huge advances, it is at the expense of thousands of years of human experience which has been dismissed as valueless.

These doctors may feel that the reforms have been foisted on them with no consultation and little notice but this is not a political game, it affects the lives of millions, from the youngest baby to the oldest, most senior citizens.  These doctors are failing in their professional duty.  For too long they have enjoyed being regarded with ultimate respect, rarely being questioned or challenged by their patients but those days are gone.  Most of the population is now far better informed than ever before, largely because of the internet and although this may cause doctors some problems, they have to learn to live with it.  They have to respect their patients, parents and carers and recognise more than ever before that healthcare is about co-operation, about working together. They have to come down from their ivory towers and start delivering truly patient-centred medicine.

 

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Written by Peter Reynolds

November 13, 2018 at 4:57 pm

Cannabis Advocates Really Need To Stop Accusing Doctors of Being Bribed By Pharmaceutical Companies.

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There may well be some doctors who are corrupt and there are still, despite much improvement, serious questions over the relationship between pharma companies and doctors but the idea that every member of the Faculty of Pain Medicine who signed that letter to the Times is taking bribes is ridiculous.

The real reason is ignorance and that’s not an attack on doctors, it’s a reason.  They have been subject to the same relentless torrent of reefer madness propaganda from government and media as the rest of society.  They have been prevented even from learning about the endocannabinoid system by the authoritarian policy of prohibition and any doctor in the UK who has any experience of cannabis as medicine will have been in breach of professional ethics as well as the law.

CLEAR has been working with some of the very few enlightened doctors since way before the cause of cannabis as medicine became fashionable.  Working with members, their MPs and doctors, we have organised lobbying of ministers and MPs over more than the past 10 years. In several instances we had doctors, both GPs and consultants, contact the Home Office to enquire about obtaining a licence for a specific patient.  In at least three instances these doctors were then contacted by Home Office officials who warned them off using threats and intimidation.  Shocking but completely true.

It is and it always has been government – stupid, prejudiced, bigoted and self-opinionated politicians – who have prevented access to cannabis, even in the face of overwhelming evidence.  This means that there has been no education at all and doctors are as poorly informed as everyone else. They’re also, and understandably, worried, even scared.  They don’t understand cannabis, many will not even have heard of the endocannabinoid system and they are concerned about being sued, professionally disgraced, losing their job and now of being swamped by patients demanding cannabis about which they know nothing.

Of course, it was thoroughly stupid to assert in the letter that “the evidence suggests that the prescribing of cannabis (containing the psychoactive and addictive tetrahydrocannabinol component) will provide little or no long-term benefit in improving pain and may be associated with significant long-term adverse cognitive and mental-health detriment.”

There is no reasonable interpretation of the evidence that supports this. THC can be addictive in a very modest sense but the withdrawal symptoms and negative effects are trivial compared to those from opioids which doctors prescribe readily and frequently.  There is excellent evidence from many sources that cannabis containing THC and CBD benefits pain and while there may be some cognitive and mental health effects, to suggest they are significant or even come remotely close to those from opioids is false and in opposition to the evidence.

I repeat, doctors aren’t saying this because they are bribed by pharmaceutical companies, it’s because they have no idea what they are talking about.

The urgent requirement now is medical education.  It is amazing how radical the new regulations are and many people still don’t seem to realise how far the government has gone.  They go much further than we at CLEAR had even dared to dream and the definition of cannabis-derived medicinal product (CDMP) is very broad.  When we were consulted on it by the Department of Health and MHRA we never thought they would accept all our recommendations.  They enable the prescription of every form of cannabis, including flower, oil and concentrate, provided they meet quality standards.

So the problem with the law is gone. Literally, it is all over. It is absolute and total victory. Now two big problems remain. Education is the first but this is being addressed.  NICE has acted commendably fast to start recruiting a panel to advise on prescribing guidelines and Professor Mike Barnes, CLEAR’s scientific and medical advisor has already developed a series of introductory online training modules. Early in November his Medical Cannabis Clinicians Society launches and this will be an important forum for the future.

The second big problem is supply.  Where are the CDMPs to come from?  Sativex falls into the definition and this was GW Pharma’s big opportunity to act responsibly and imaginatively.  The possibility still exists that it will substantially reduce the absurd, rip-off price that it has been charging for Sativex since 2010.  If it had the imagination it could very easily turn over some of its production to unlicensed CDMPs for which there is now a ready market. I fear that it is wedded to licensed products only, hugely expensive and, in my judgement, unnecessary clinical trials and very high prices for its end products.  If so, then I will be selling my shares.  I admire the company for its courage, innovation and high standards but if it does not seize this opportunity then I believe it is failing in its duty to shareholders and also to Britain, which let’s remember has gifted it a privileged and unique opportunity in the world.  Fail now to provide for the needs of UK patients and that amounts to betrayal.

So for now the only possible sources of supply that meet the definition will be Bedrocan in the Netherlands and some of the Canadian licensed producers. US companies cannot export.  Neither can the Israeli companies and they would also face a thoroughly deserved boycott of their products even if Netanyahu was to issue export licences.  Bedrocan can barely meet demand from its existing customers and there is talk of it having difficulties with a ceiling on its export licenses. Only some Canadian producers meet the required GMP quality standards and they too are facing shortages as they also supply the recently legalised recreational market which is seriously short of product.

So the Home Office has to act and start issuing domestic production licences and it has to do so immediately.  Whether it will, remains to be seen.  Its drugs licensing department is a shambles, staffed by officials who do not even understand the law they are supposed to administrate, who regularly give different, contradictory answers on different days and exceed their lawful authority as a matter of course.  If there is a ‘hostile environment’ for immigration in the Home Office, for drugs licensing and cannabis production it has been hostile but also aggressive, paranoid and stupid ever since the Misuse of Drugs Act 1971.

The urgent need is for prospective British cannabis producers to mobilise their MPs and for immediate pressure to be brought on the Home Office at the highest level.  Sajid Javid has shown he can act decisively.  Expanding domestic cannabis production is the inevitable next step in what he has already achieved.  He must act now.

So the future in the UK for those who need cannabis as medicine is brighter than could ever have been imagined.  The next steps are challenging but nowhere near as difficult as the campaign to reform the law that CLEAR has fought for nearly 20 years.  Don’t blame doctors, continue to blame the government and hold their feet to the fire until they act on medical education and cannabis production as they must.

British Doctors Don’t Understand Cannabinoid Medicine. They’ve Been Denied Education In The Basic Science.

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Today’s letter to the Times from a group of pain medicine consultants (reproduced below) is is an astonishing display of evidence-free ignorance from a profession that needs to challenge its own prejudice.

To compare the addiction potential of cannabis with opioids is ridiculous and demonstrates just how detached from the science and evidence are those making this claim.

Doctors will understandably feel challenged by a medicine that upturns many of their conventional habits. They have been prevented from understanding the science of cannabis as medicine by prohibition policy. Most doctors have received no education at all about the endocannabinoid system which we now know is the largest neurotransmitter network in the body and is the mechanism by which cannabis exerts its therapeutic effects.

Understanding cannabis as a medicine requires a new attitude and mindset which looks at the patient’s overall health and physiological stability or homeostasis. Modulating the endocannabinoid system with cannabis can effect many factors which contribute to illness including pain, mood, memory and perception. It’s actually a much more complex model rather than the simplistic, reductionist theories that modern medicine is based on.

‘Holistic’ is a fashionable but much misused word that is truly expressed in cannabinoid medicine. There are a few progressive doctors in the UK, including some pain consultants, who through experience and self-education have learned how this new approach to medicine works.

Outside the UK, in jurisdictions which have taken a more enlightened approach, cannabinoid medicine is much better understood by many more doctors. The profession in UK needs to open its mind and its doors to education and training from overseas. Then they will start to understand this much more rounded and broadly-based approach which can lead to a long-term, preventative approach with fewer side effects and better outcomes for nearly all patients.

 

Letter to The Times, 26th October 2018

CANNABIS PAIN RELIEF

Sir, We, as a group of pain medicine consultants, are concerned that the Home Office and NHS England propose to allow specialist doctors to prescribe cannabis for chronic pain from next month. We know only too well the unmet burden of chronic pain and that pain is cited by our patients as a frequent reason to take cannabis.

While there are clear limitations in studying the effects of past illicit cannabis use, caution is required, as the evidence suggests that the prescribing of cannabis (containing the psychoactive and addictive tetrahydrocannabinol component) will provide little or no long-term benefit in improving pain and may be associated with significant long-term adverse cognitive and mental-health detriment.

We are also concerned that it will be difficult to deny cannabis prescriptions to patients in pain who might be coerced into diverting cannabis into the community where it will remain illegal and have street value.

We have suffered an opioid crisis and foresee history about to repeat itself. Ironically, the likely cost of medical cannabis will be greater than the saving achieved by the inexplicable decision of NHS England to restrict the use of the clinically effective 5 per cent lidocaine plasters.

We support the change in the law to encourage cannabis research. However, we are concerned that in the interests of political expediency, this mandate to allow prescribing of cannabis for pain relief is premature. That cannabis is an effective treatment for chronic pain is not supported by the evidence and may be associated with significant harm.

Dr Rajesh Munglani, consultant in pain medicine London; Dr Andrew Baranowski, consultant in pain medicine, University College London Hospitals NHS Trust; Dr Stephen Ward, consultant in pain medicine Brighton and Sussex Hospital Trust; Dr Arun Bhaskar, consultant in pain medicine Imperial College NHS Trust; Dr Cathy Price, consultant in pain medicine St Mary’s Portsmouth Solent NHS Trust; Dr Jonathan Bannister, consultant in pain medicine NHS Tayside Scotland; Dr Ilan Lieberman, consultant in pain medicine University Hospital of South Manchester; Dr Dalvina E Hanu-Cernat, consultant in pain medicine Queen Elizabeth Hospital Birmingham; Dr Pravin Dandegaonkar, consultant in anaesthesia and pain medicine; Calderdale and Huddersfield NHS Foundation Trust; Dr Sarang Puranik, consultant in pain management and anaesthesia Kingston Hospital, Surrey; Dr Mike W Platt, consultant in pain medicine Imperial College Healthcare NHS Trust; Dr Jon Valentine, consultant in pain medicine Norwich; Dr Teodor Goroszeniuk, consultant in pain medicine, London W1, UK; Dr Michael Coupe consultant in anaesthesia, pain medicine and intensive care Royal United Hospitals NHS FT; Dr Hadi Bedran, consultant in pain medicine St Georges University Hospitals NHS Trust; Dr Karen H Simpson, consultant in pain medicine Leeds; Dr Aditi Ghei, consultant in pain medicine, West Herts NHS Trust; Dr Kiran Koneti, consultant in pain management City Hospitals Sunderland NHS Trust; Dr Tim McCormick, consultant in pain medicine Oxford pain Management Centre; Dr Sadiq Bhayani, consultant in pain medicine University Hospitals Leicester NHS Trust; Dr Nicholas M Hacking, consultant anaesthetist, Lancashire Teaching Hospitals NHS Trust; Dr Joshua Adedokun, consultant in pain medicine, The Pennine Acute NHS Trust; Dr Neil Collighan, consultant in pain medicine East Kent Hospital NHS Trust; Dr Bela Vadodaria, consultant in anaesthesia and pain management The Hillingdon Hospital; Dr Fraser Duncan, consultant anaesthetist and pain specialist Birmingham; Dr Hoo Kee Tsang, consultant in anaesthesia and pain medicine, Royal Liverpool and Broadgreen University Hospitals NHS Trust; Dr Richard Gordon-Williams, APT, University College London Hospitals NHS Trust; Dr A Tameem, consultant in anaesthesia and pain management Dudley group of hospitals; Dr Marcia Schofield, pain sPecialist West Suffolk NHS Trust Bury St Edmunds; Dr Giancarlo Camilleri, consultant Ashford & St Peter’s Foundation NHS Trust Chertsey; Dr Joseph Azzopardi, consultant in pain medicine London; Dr Dick Atkinson, retired consultant in pain medicine Central Sheffield University Hospitals; Dr Basil Almahdi, consultant in pain medicine London; Dr Katharine Howells, consultant in pain medicine, RUH Bath NHS Foundation Trust; Dr G Baranidharan, consultant in pain medicine, Leeds Teaching Hospitals NHS Trust; Dr Philippa Armstrong, consultant in anaesthesia and pain medicine, York Teaching Hospitals NHS Trust; Dr Lourdes Gaspar, consultant in pain medicine Orthopaedic Hospital Oswestry; Dr Carolyne Timberlake, consultant in pain medicine Kings College Hospital NHS Trust; Dr Intazar Bashir, consultant in pain medicine Worthing; Dr Mark Sanders,consultant in pain medicine at Norfolk and Norwich University Hospital; Dr Andrzej Krol, consultant in pain medicine St George’s Hospital London; Dr Peter Hall, consultant in pain Management York Hospitals NHS Trust; Dr Susmita Oomman, consultant in pain and Anaesthetic Withybush General Hospital Hywel Dda NHS Trust; Dr Sue Jeffs, consultant in anaesthesia and pain Management Abergavenny Wales; Dr Murali-Krishnan, consultant in pain medicine Northampton; Dr Sabina Bachtold, ST7 pain medicine (APT)/anaesthesia London; Dr A Ravenscroft, consultant in pain Management Nottingham University Hospitals; Dr Sanjay Kuravinakop , consultant in pain medicine Dartford and Gravesham NHS Trust; Dr Nicolas Varela, consultant in pain medicine Royal National Orthopaedic Hospital NHS Trust; Dr Michael Atayi, consultant in pain medicine George Eliot Hospital; Dr Carl TJ Broadbridge, consultant in pain medicine and anaesthesia Salisbury District Hospital; Dr Ramy Mottaleb, Kingston NHS Foundation Trust; Dr Richard Sawyer, consultant in anaesthesia and pain management, Oxford University Hospitals NHS foundation Trust; Dr Rajesh Menon, consultant in pain medicine Calderdale and Huddersfield NHS Trust; Dr Jeremy Weinbren, consultant in Anaesthetics and pain medicine Hillingdon Hospital; Dr Paul Rolfe,consultant in pain medicine Cambridge; Dr Brian Culbert, consultant in pain medicine East Yorkshire Hospitals NHS Trust; Dr Rokas Tamosauskas, consultant in pain medicine Addenbrooke’s Hospital, Cambridge University Hospitals NHS Foundation Trust; Dr David Gore ST6 Advanced pain Trainee, Oxford University Hospitals; Dr Manohar Sharma, consultant in pain medicine The Walton Centre NHS Foundation Trust, Liverpool; Dr Jayne Gallagher, consultant in pain medicine Barts Health Trust London; Dr Raju Bhadresha, consultant in pain medicine and anaesthesia East Kent Hospitals University Foundation Trust; Dr Owen Bodycombe, consultant anaesthesia and pain medicine Gloucestershire Hospital’s NHSFT; Dr Ramy Mottaleb,consultant in pain medicine Kingston NHS Foundation Trust; Dr Christian Egeler, consultant in anaesthesia and pain medicine, Swansea ABMU HB; Dr Deepak Malik, consultant in pain Management University Hospitals Birmimgham NHS Foundation Trust; Dr Mohjir Baloch, consultant in pain Management Frimley Park Hospital; Dr Martyna Berwertz, consultant in pain medicine Sheffield Teaching Hospital NHS Foundation Trust; Dr Ron Cooper, consultant pain medicine & anaesthesia Causeway Hospital, Coleraine, N Ireland; Dr Ashish Shetty, consultant in pain medicine, University College London Hospitals; Dr S J Law, consultant in pain medicine West Suffolk Hospital; Dr M Mali, consultant in pain medicine Darent Valley Hospital; Dr S James consultant and Lead Clinician Chronic pain Services NHS Lanarkshire; Dr Sarah Aturia,consultant pain and Anaesthetics Milton Keynes University Hospital NHS Foundation Trust; Dr Henriette van Schalkwyk, consultant in pain medicine North Hampshire hospital Basingstoke; Dr Shamim Haider, consultant in pain medicine East Suffolk & North Essex NHS Foundation Trust Colchester & Ipswich; Dr Simon Thomson, consultant in pain medicine and Neuromodulation, Basildon; Dr Danielle Reddi, Locum consultant in pain medicine University College London Hospitals NHS Trust; Dr Thomas Samuel, consultant in pain medicine East and North Herts NHS Trust; Dr Arindam De, pain Management consultant University Hospitals of Morecambe Bay (UHMB); Dr Evan Weeks, consultant in anaesthesia & pain medicine Addenbrooke’s Hospital, CUHFT; Dr Ravi M Kare, consultant in pain Management and anaesthesia Norfolk & Norwich University Hospitals; Dr Niranjan Chogle, consultant in pain medicine Ulster Hospital, Northern Ireland; Dr William Campbell, consultant Emeritus and Past President British pain Society, Ulster Hospital Dundonald; Dr Subramanian Ramani, consultant in pain medicine Northampton General Hospital; Dr Adrian Searle, consultant in anaesthesia and pain medicine, Derby; Dr Sameer Gupta, consultant in anaesthesia and pain Management DRG Health Clinic Doncaster; Dr Diana Dickson, Retired consultant in pain medicine, Leeds; Dr Attam Singh, consultant in pain medicine West Hertfordshire NHS Trust; Dr James Wilson, consultant in anaesthesia & pain medicine Maidstone & Tunbridge Wells NHS Trust; Dr Sharmila Edekar, pain Specialist Glangwili Hospital Hywel Dda HB; Dr Bernard Nawarski, consultant in pain medicine Frimley Health; Dr Sridevi Ramachandran, consultant in pain medicine, Anglian Community Enterprise; Dr John Wiles, consultant in pain medicine The Walton Centre NHS Foundation Trust; Dr A T Arasu Rayen, consultant in pain Management, Sandwell and West Birmingham NHS Trust; Dr John Titterington, consultant pain Management, Leeds Teaching Hospitals; Dr Deepak Subramani, consultant in anaesthesia and pain Management George Eliot Hospital; Dr Ian D Goodall, consultant in pain medicine, Chelsea and Westminster Hospital NHS Trust; Dr Seshu Babu Tatikola, consultant In pain medicine & Anaesthesia, Hull and East Yorkshire Hospitals NHS trust; Dr Kevin Markham, consultant in pain medicine Surrey Heath Community pain Clinic; Dr Husham Al-Shather ,consultant in pain medicine Royal Berkshire NHS Foundation Trust; Dr K.Dhandapani, York Hospitals NHS foundation Trust York; Dr Chris Naylor, consultant in pain medicine, Southend University Hospital NHS Trust; Dr Sally Ghazaleh, Locum pain consultant Royal Berkshire hospital; Dr Bala Veemarajan ,Sherwood Forest Hosp NHS trust; Dr GR Towlerton, consultant in pain medicine, Chelsea & Westmister Hospital; Dr Mandar Joshi, consultant in anaesthesia and pain medicine, Aneurin Bevan University Health Board; Dr Ashish Wagle,consultant Anaesthetist and pain specialist Cwm Taf University Health Board Wales; Dr A Doger, consultant University Hospitals Birmingham & Associate Medical Director John Taylor Hospice; Dr Salmin Aseri, consultant in pain medicine & Anaesthesia; St Helens & Knowsley Teaching Hospitals NHS Trust; Dr George Harrison, consultant in pain medicine, Birmingham Queen Elizabeth Hospital; Dr Rashmi Poddar, pain consultant Kettering General Hospital; Dr Ashish Gulve; consultant in pain Management The James Cook University Hospital Middlesbrough; Dr Yaser Mehrez,consultant in pain medicine and anaesthesia Milton Keynes University Hospital NHS Trust; Dr Victoria Tidman, consultant in pain medicine University College London Hospitals NHS Trust; Dr Tacson Fernandez,consultant in pain medicine Royal National Orthopaedic Hospital; Dr Kim Carter, consultant Anaesthetist & pain Northampton General Hospital; Dr Anand Natarajan, consultant in pain Management Wirral University Teaching Hospitals; Dr Dominic Aldington consultant in pain medicine Royal Hampshire County Hospital; Dr Emma Chojnowska, consultant in pain medicine and anaesthesia Chichester; Dr Liza Tharakan, consultant in pain medicine and Anaesthesia; Royal Orthopaedic Hospital; Dr Moein Tavakkoli, consultant in pain medicine University College London Hopsital (NHNN); Dr Manojit Sinha ,consultant pain medicine King’s College Hospital NHS Foundation Trust; Dr Sanjay Varma,consultant in pain Management Sunderland Royal Hosptal Sunderland; Dr Shravan Tirunagari, consultant anaesthesia and pain Management, East and North NHS Trust Hospitals; Dr Monica Chogle, consultant in Anaesthetics and pain Northern Health and Social Care Trust Northern Ireland; Dr Subhash Kandikattu, consultant in pain Management, Peterborough City Hospital North West Anglia NHS FT; Dr Jan Rudiger, consultant in Anaesthetics and pain medicine, Redhill; Dr Arun Sehgal, consultant in pain medicine and Anaesthesia,Peterborough and Stamford Hospitals; Dr Matthew LLoyd Hamilton, consultant in anaesthesia and pain medicine, Homerton University Hospital NHS Foundation Trust, London Dr Athmaja Thottungal, consultant and Trust Clinical lead for pain management, East Kent Hospitals NHS Trust; Dr Rubina Ahmad, Title: Locum consultant, work place; Brighton and Sussex University Hospital NHS Trust: Dr Sean White, consultant in pain medicine, London pain Service; Dr Anup Bagade, consultant in pain medicine East and North Herts NHS Trust; Dr Tom Smith, consultant in pain medicine London; Dr Jason Brooks, consultant pain medicine Belfast Health and Social Care Trust; Dr Vinay Anjana Reddy, consultant in pain and anaesthesia University Hospital Lewisham; Dr S Murugesan, consultant in anaesthesia and pain management, Wrightington Wigan and Leigh NHS Foundation Trust; Dr Nancy Cox, APT, University Hospital Coventry and Warwick NHS Trust; Dr Ashwin Mallya, Northern Lincolnshire and Goole Hospital NHS Trust; Dr M Serpell, consultant & Senior Lecturer in pain medicine & anaesthesia Greater Glasgow & Clyde NHS; Dr Srinivas Bathula, consultant in pain Management Heart of England NHS Trust University Hospital, Birmingham; Dr Ann-Katrin Fritz, consultant Alain Management Norfolk & Norwich University Hospital; Dr Ashok Puttappa, consultant in anaesthesia and Chronic pain University Hospital North Midlands Stoke on Trent; Dr Tom Bendinger, consultant in anaesthesia and pain medicine Sheffield Teaching Hospitals; Dr Sumit Gulati,consultant in pain medicine and anaesthesia Walton Centre NHS FT, Liverpool UK;Dr Arun Natarajan, consultant in pain medicine Hillingdon Hospital; Dr Katrina Dick, consultant in anaesthesia and pain medicine Ayrshire and Arran; Dr Shefali Kadambande , consultant in anaesthesia and pain management University Hospital of Wales; Dr Nick Roberts, consultant in pain Management Kettering General Hospital; Dr Somnath Bagchi, consultant in pain medicine University Hospitals Plymouth UK; Dr Lakshman Radhakrishnan, consultant in pain management Royal Lancaster Infirmary; Dr Stephan Weber, consultant in pain Management BMI Goring Hall Hospital; Dr Kiran Sachane consultant in pain medicine NHS Lothian pain Service, Edinburgh Scotland; Dr James Blackburn, consultant in pain medicine, St George’s Healthcare NHS Trust; Dr Srinivas Bathula, consultant in pain medicine, University Hospitals Birmingham NHS FT; Dr Ravi Srinivasagopalan, consultant in pain Management and anaesthesia The Hillingdon Hospitals NHS FT; Dr John Goddard, consultant in Paediatric pain medicine Sheffield Children’s Hospital; Dr Chad Taylor, pain medicine consultant, Jersey (Channel Islands UK); Dr Udaya Kumar Chakka, consultant in pain medicine, Coventry; Dr Pallav Desai, Neuromodulation Fellow, James Cook University Hospital; Dr Azfer Usmani, Dartford and Gravesham NHS Trust; Dr Neal Evans, consultant in pain medicine Bucks Hosps NHS Trust; Dr Kanar Al-Quragooli, Associate Specialist in anaesthesia and pain medicine , Manchester FT; Dr Valentina Jansen, consultant in pain and anaesthetics Glangwili General Hospital Hywel Dda NHS Trust; Professor Emeritus Sam H Ahmedzai, University of Sheffield; Dr Mike Hudspith, consultant in pain medicine Norfolk & Norwich University Hospital;

Written by Peter Reynolds

October 26, 2018 at 9:46 am

Will I Be Able To Get Cannabis Prescribed On The NHS?

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With the publication of new regulations yesterday, it is now clear how cannabis will be available on the NHS starting on 1st November 2018.

Only consultants will be able to prescribe cannabis and it will be entirely up to each consultant to make a decision about individual patients.  The definition of cannabis-derived medicinal products is sufficently wide that both oils and herbal cannabis manufactured to GMP (Good Manufacturing Practice) standards will be available.

There is very little explanation included in the regulations but the intention is that prescribing guidance will be developed over time by NICE (National Institute for Health and Care Excellence).  The regulations prohibit smoking cannabis for medical use but if your consultant decides it is appropriate for you, they will be able to prescribe herbal cannabis for vaping.  Apart from Sativex, all cannabis products are unlicensed medicines described as ‘specials’, so your consultant is supposed to consider licensed medicines first.

There are no restrictions on which conditions cannabis can be prescribed for. Again, it will be up to your consultant to decide.

So this is marvellous news.  It is a fundamental breakthrough and its impact will be enormous but it will take time for it to start working effectively.

The law is no longer an obstacle.  The biggest problem now is that very few consultants have any knowledge of cannabis at all and most are probably going to be very reluctant to prescribe.  For the best part of a century, doctors, just like the rest of society, have been subject to a relentless flow of propaganda and false information about cannabis.  Changing this with medical training, helpful prescribing guidelines and overcoming unjustified prejudice and fear are the new challenges we face.

To begin with, a lot of people will be disappointed because their consultant will be unwilling to prescribe.  The first thing you can do about this is ask your GP to refer you to a different consultant but it may be some time before understanding develops and consultants are sufficiently informed.  Almost certainly there will be more resistance to prescribing herbal cannabis and it will be easier to get oil.

As ever, the best thing to do is gather evidence on the use of cannabis for your condition(s).  If you are well informed and prepared then you can help to educate your consultant.  There is now an enormous amount of evidence available online.  Just be careful to use proper scientific information and avoid the miracle cures and exaggeration that is still widespread.

Whilst not everyone will immediately be able to get the medicine they need, we are now on the correct path.  Instead of politicians imposing their ignorant opinions on you, your doctor will now be making the decisions and that is the way it should be.  In time the right to prescribe will be extended to GPs.  For now the truly wonderful news is that we are no longer engaged in a battle with the law. What it’s about now is patience and education.

Written by Peter Reynolds

October 12, 2018 at 2:05 pm

Posted in Health, Politics

Tagged with , ,

A Quick, Easy Guide to The New UK Arrangements For Access To Cannabis As Medicine.

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There’s already an awful lot of misunderstanding over the arrangements just introduced for medicinal cannabis and there’s no need for it because, to be fair, the government has been very clear.

There is an interim procedure which will be very, very difficult for most to achieve. You must have very strong support from your doctor and they, together with your local NHS Trust, must be prepared to put in a lot of work, form-filling and pay some substantial licensing fees. It’s all explained here.  If you don’t understand it, don’t worry. Your doctor will and it’s only if he/she is prepared to pursue this path for you that you have any chance at all.

There also seems to be an idea that there’s a list of conditions for which cannabis will be available.  There’s no truth in this at all.  It’s up to your doctor and if they pursue this interim procedure, they will have to make the case why cannabis will work for you.

For most people, you are going have to wait until the autumn when cannabis will be re-scheduled and available on prescription from your GP. It will then be up to you to persuade your doctor.  The biggest problem is likely to be that most doctors simply have no understanding of cannabis at all.  Now would be a good time to start gathering together all the scientific evidence you can find about using cannabis to treat your condition(s).

Something is going to have to be done about introducing some training for doctors. Since December 2017, the Royal College of GPs has had a set of guidelines ready to issue to doctors but it’s been sitting on them. These were authored by CLEAR, clinical information by Professor Mike Barnes with methods of use and harm reduction information by Peter Reynolds. We are urging the Royal College to make these available to doctors immediately.

Initially the products available are likely to be the Bedrocan range but we expect some of the Canadian companies will quickly make products available.  We also expect NICE to re-visit Sativex and reassess its cost-effectiveness. It must be time for some hard negotiation over the price. This is an opportunity for GW Pharma and Bayer to make a significant reduction which would be in their own long term interest.

Written by Peter Reynolds

June 30, 2018 at 3:39 pm

Cannabis for Medical Use And How The Royal College Of GPs Is Letting Us All Down.

with 3 comments

The last couple of weeks have brought an enormous breakthrough for those who need cannabis as medicine but with the release of the government’s interim measures for licensing, the difficulties of how this will work in practice are obvious.

Unless doctors are properly informed and educated about cannabis many patients are going to remain without any help and forced to continue in the illegal market.

The Royal College of GPs was supposed to have issued guidelines to all GPs by the end of 2017 but evidently politics have interfered. It seems that either there has been external pressure from government to hold back or there’s been internal wrangling with some senior doctors opposed to any information being released.

What is astonishing is that this directly contradicts a resolution of the RCGP Council last September when it resolved (unanimously according to reports) to publish guidelines on the use of cannabis as medicine.  This raises very serious issues about the governance of the Royal College and also an ethical issue in failing to enable doctors to fulfil their professional duty to patients.

It was at the end of 2016 that CLEAR first wrote to all the Royal Colleges suggesting that guidelines on the use of cannabis as medicine should be considered.  The letters went out from Professor Mike Barnes, CLEAR’s scientific and medical advisor.  We referred to evidence that about a million people were already using cannabis for medical reasons and particularly the explosion in the use of CBD products.  We acknowledged that clearly doctors couldn’t endorse the use of an illegal drug but certainly for CBD and because of the reality of what’s actually happening they needed to be properly informed.

Professor Nigel Mathers of the Royal College of GPs took up our proposal enthusiastically. Through 2017, Mike Barnes and Peter Reynolds of CLEAR attended a number of meetings at the Royal College and detailed plans were made.  A formal proposal was put to the council, the ultimate governing body of the Royal College at its meeting in September and approved.  It was agreed and announced that the guidelines would be on the college’s website by the end of the year. It was even reported in The Times.

Professor Mike Barnes, CLEAR Advisory Board

Mike Barnes produced the first draft which covered the endocannabinoid system and a summary of the clinical evidence including side effects and a risk/benefit analysis.  Peter Reynolds contributed a section on methods of ingestion and harm reduction.

Professor Nigel Mathers finalised the guidelines to make them compliant with the Royal College’s standards. It was his last project before retiring from his position as Honorary Secretary.

Then everything stopped.  Both Mike Barnes and Peter Reynolds followed up regularly but were fobbed off, given a variety of excuses until eventually six months had passed and we came to realise that there was a determination from somewhere to prevent publication despite what the council had agreed.

The extraordinary progress of the past few weeks leaves the Royal College stranded.  It has let down doctors and through them their patients.  It had every opportunity to be in front of these developments and to enable doctors to offer advice that patients are now clamouring for.

Mike Barnes said:

“It is a great pity that there has been this delay. Given the events of the last couple of weeks it is now really important that the RCGP lead the way and publish guidelines for their members, as the public will be asking more and more questions about the medicinal value of cannabis.”

Prejudice against and misinformation about cannabis has been rife for many years. At last that is changing and cannabis for medical use is going to be available legitimately in the UK.  We remain ready to assist the Royal College in ensuring GPs get the information they need.

Written by Peter Reynolds

June 29, 2018 at 9:40 am

Guidelines On Cannabis For Medical Professionals.

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In a new initiative, CLEAR’s scientific and medical advisor, Professor Mike Barnes, has written to the presidents of several Royal Colleges proposing the development of guidelines around the use of cannabis as medicine.

Professor Mike Barnes

Professor Mike Barnes

This is a tricky situation for doctors.  Surveys and individual reports from CLEAR members indicate that many doctors tacitly endorse their patients’ use of cannabis but clearly cannot recommend the illegal use of cannabis, however safe and effective it may be.

Professor Barnes’ letter refers to the recent APPG report, his own paper ‘Cannabis: The Evidence for Medical Use’ and says:

“…cannabis now has a reasonable evidence base for the management of chronic pain, including neuropathic pain, and the management of spasticity as well as in the management of anxiety and a use in nausea and vomiting in the context of chemotherapy.”

In conjunction with CLEAR, Professor Barnes has written to:

Royal College of Anaesthetists
Royal College of General Practitioners
Royal College of Paediatrics and Child Health
Royal College of Physicians
Royal College of Psychiatrists

His letter goes on to explain that about one million people are using cannabis as medicine:

“I do feel that doctors need guidelines to assist them when patients request advice on the use of cannabis…doctors should be properly informed about harm reduction advice and should be aware of the clinical evidence that is now guiding medicinal use in several other countries around the world.”

Our proposal is for an initial meeting to discuss the idea.  If one or more of the Royal Colleges is prepared to back this initiative, CLEAR will set up and fund a working group of clinicians and medical education specialists to develop a set of guidelines.