CBD and Medical Cannabis – Special report
Posted on December 7th, 2023 to Medical Cannabis
Medical cannabis Q&A
Professor Mike Barnes is a Consultant Neurologist and medical cannabis expert.
A leading authority on cannabis medicine, Prof. Barnes helped to bring Sativex, the first medical cannabis drug, to market in the early 2000s.
Prof. Barnes also wrote the first NHS prescription for medical cannabis for Alfie Dingley, who lives with a rare form of epilepsy.
We called Prof. Barnes to learn more about how cannabis medicine is helping patients in neuro rehab and beyond.
What does the UK’s medical cannabis landscape look like in 2023?
Medical cannabis was legalised in November 2018. Since then, it has slowly become more socially and clinically accepted.
Now, around 29,000 people are prescribed medical in the UK, albeit privately and not on the NHS.
The UK medical community have been slower to prescribe cannabis than our colleagues in parts of Europe like Germany, Malta, Switzerland, let alone North America.
But we’re slowly catching up.
How can medical cannabis support neuro rehab?
Cannabis has a very solid evidence base for a number of conditions, mainly as a treatment of symptoms rather than a cure of disease.
In can certainly help pain. Around 60 per cent of cannabis prescriptions worldwide are for chronic pain.
Pain can be a problem after brain injury or neurological deficit like multiple sclerosis.
There is also strong evidence that cannabis can help with anxiety, which is another issue commonly associated with various chronic neurological conditions.
In addition to that, cannabis may help to improve appetite, which can be an issue with some degenerative conditions like Parkinson’s disease.
In certain cases of MS or brain injury, cannabis may help muscle problems like spasticity while with Parkinson’s disease, it can reduce stiffness and sometimes spasm.
There’s also some evidence that cannabis is a neuro protector.
One study from the US found that when chronic long term cannabis users had a brain injury, morbidity was lower because some of the cannabinoids can protect the brain.
Of course, I’m not saying that people should use cannabis on the off-chance that they have a car accident. But it’s worth acknowledging its potential neuro-protective benefits.
What about ageing?
Cannabis for ageing population can be useful for several things.
Pain becomes more common as you get older, whether it’s arthritic pain or pain for neurological conditions such as stroke. So pain is number one.
Anxiety is also a problem of increasing ageing, particularly for those who have a long term conditions or terminal diagnosis.
Anxiety can be alleviated by cannabis, particularly CBD. CBD can also help with sleep.
Cannabis can also help to stimulate appetite, which is a difficulty for some older people.
Older people will of course suffer from general aches and pains and many of these can be alleviated by legal, over the counter CBD.
But if a commercial CBD product doesn’t help, medical cannabis might.
These medicines contain other cannabinoids such as THC which will provide additional benefits.
It’s worth noting that elderly people need not worry about getting high from a medical cannabis product containing THC. For a properly prescribed product, the THC high will be counteracted by CBD.
But I would still advise trying over the counter CBD in the first instance.
Does medical cannabis offer benefits to women’s health?
CBD can be very helpful for a general improvement of quality of life. That of course includes various women’s issues.
For the menopause, it can help to improve sleep and reduce anxiety. For painful conditions, it is particularly helpful for endometriosis and fibromyalgia, the latter of which is much common among women than in men.
Are there any potential maternity or fertility complications from cannabis-use?
If you’re pregnant or breastfeeding, it’s best to avoid any cannabis medicine. Having said that, there is no known foetal syndrome associated with cannabis.
There is some evidence that babies of cannabis users are slightly smaller. But there is no evidence of any significant foetal abnormalities occur regularly.
What about sexual health benefits?
There is early evidence that CBD with or without some additional THC can improve sexual libido. This may simply be due to reductions in anxiety or pain. But some research suggests that actually improves sexual performance.
Is there much in the way of innovation when it comes to cannabis delivery systems?
Cannabis is mainly taken as a flower or an oil. But there are certain delivery methods that are more acceptable to the patient and a doctor than others. Vaping, for example.
We’re starting to see devices that not only deliver the medicine but collect data about what is being used, the dosage and so on and feeds this data back to a central database.
This data can be very useful to support research like Drug Science’s Project Twenty21.
There are other less common forms of delivery emerging, such as patches, suppositories and pessaries. However, these are difficult to make for cannabis because it likes fat.
That said, advances in technology might make these more readily available in the future.
How have perceptions changed since medical cannabis was legalised?
The public has now genuinely accepted that cannabis has a useful role in medicine. And indeed, many countries are opening the door to recreational use as well
But there remains a big reluctance among some very conservative medical professionals, not just in the UK but abroad as well
We are beginning to see that breaking down slightly. We’ve just seen the first NHS referral to a private clinic, for example.
It will break down slowly but surely as more evidence accumulates.
Overprescription of opioids remains a contributing factor, with a 2018 analysis revealing a decline in opioid prescriptions when medical cannabis dispensaries opened.
Find out more about Professor Barnes’ work at profmichaelbarnes.co.uk
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