Medical Cannabis in the UK
What is medical cannabis?
Medical cannabis is a broad term that describes the use of cannabis as a medicine. Another term for medical cannabis that is commonly used is medical marijuana, though we prefer medical cannabis, as marijuana was coined by the US government and used to demonise the plant and the indigenous Mexican population who grew the plant as a staple crop.
History of medical cannabis
Cannabis oil has a significant history as a medicine and was used widely by the Chinese, it’s medical use is believed to date back 12,000 years. Up until the 1930’s, cannabis was routinely used by doctors and was commonly administered as a tincture. It is known that Queen Victoria used cannabis oil to ease her period pains.
Medical cannabis UK Law
Medical cannabis was legalised in the UK in 2018. This was in a large part due to mothers campaigning to allow their children access to medical cannabis. Despite the change in law, the attitudes towards medical cannabis from a large swathe of the medical establishment remains out of touch, and only people that can afford to access medical cannabis, are able to do so.
Despite steps having been made to allow patients with certain conditions to obtain medical cannabis, the medical community at large has a negative opinion towards cannabis-based medicines. Below is a quote from the NHS.
We fundamentally disagree with the NHS statement. Whilst it is true that there are CBD products where the quality of the product may be substandard, CBD food supplements are adhering to higher standards than the majority of food products in the UK due to their novel food status and FSA scrutiny.
Provided that you are buying CBD products from reputable brands whose products are included on the FSA’s approved list of CBD products, they will be required to undertake product testing to ensure that the product contains both the advertised amount of CBD and that the product does not contain more than the permitted level of controlled substances (THC, THCV and CBN).
It is certainly true that there are CBD products and brands who are making medical claims, and we would advise that anyone looking to buy a CBD oil should not buy from a brand doing so. Any compliant UK CBD brand will not make medical claims, and it begs the question, what other regulations are they ignoring or violating. However, this is not the case for a large number of CBD brands who take their regulatory responsibilities and safety of their customers very seriously.
We also strongly disagree with the final paragraph as cannabinoids have huge potential to treat a myriad of medical conditions. It is not surprising that the NHS would take this perspective, given its reluctance to offer cannabis medicine, despite their low risk and side effects when compared to pharmaceutical drugs, including those based on opioids.
The medical regulators also favour conventional drugs that have been through controlled multi-stage testing. Whist this rational is sound, anything that doesn’t fit into a suitable box is often dismissed. Cannabis being a plant, makes it more challenging to study and difficult to patent, which for big profit driven companies is a deterrent.
However, there have been double-blind, randomized, placebo-controlled, parallel group studies conducted on extracted cannabinoids. One example, is a study that was undertaken using a combination of CBD and THC as a treatment for neuropathic pain. The trial was considered to be successful, well tolerated, and with no safety concerns.
It is worth pointing out that CBD is the same compound whether consumed in a food grade CBD oil product, or purchased from a medical clinic. However, there are some difference and below is an explanation:
Manufacturing
In order to manufacture a medicine, the facility in which the medicine is produced and the supply chain must be GMP certified, not to be confused with good manufacturing processes, which is an expectation of all food producers/ manufacturers. The requirements to obtain this certification requires extensive documentation and processes, all of which must be auditable and verified. This makes every process more time consuming, onerous and expensive.
The other requirement when manufacturing a medicine, is that each batch needs to be identical (within a tight range) in order that the patient is able to accurately dose, in this case their medicinal cannabis. Supplements can have up to 30 compounds where as a medicine generally has no more than 3 or 4. However, it is important to note that compliant CBD products sold as food supplements will ensure that they have procedures in place to control the release and accurate dosing information of their CBD products.
Price
Medical cannabis is far more expensive to buy. Currently, anyone wanting to access medical cannabis has to pay for it. Despite what medical professionals will tell you, besides the more expensive manufacturing processes, and provided that you buy CBD oil from a reputable supplier, there is no difference in the CBD compound between a medical cannabis product and one sold as a food supplement.
Additionally, to access medical cannabis, there are upfront and ongoing consultancy fees to enable the continued use of medical cannabis.
THC (medical THC Oil)
The THC content is the primary difference, as CBD products sold as food supplements must contain less than 1mg of combined THC and other controlled substances. This is a very small amount and the FSA are currently discussing making this even lower to non-detectable levels. Medical cannabis is sold with varying ratios of THC: CBD, and generally someone starting on a medical cannabis path will have a much higher ratio of CBD:THC with a view to increase the THC amount over time.
Lab testing
Authorised medicinal cannabis treatments like Epidiolex have to undergo multi stage clinical trials to prove efficacy, which is very expensive and takes years to obtain. However unlicensed medicines, which are available in the UK though medicinal cannabis clinics have a far lower regulatory bar and it could be argued do not have to provide significantly more proof of safety or efficacy than the most compliant CBD brands currently do.
Reputable CBD oil companies will batch test their products at an accredited lab in order to guarantee both the CBD content and to ensure legal compliance of controlled substances. Additionally, raw ingredients should have undertaken full panel analysis to ensure that there are no pesticides, residual solvents, heavy metals or micro biological contaminants. Due to novel food requirements of CBD products sold as food supplements, manufacturers have been required to undertake toxicity studies on their raw materials.
Dosing CBD oil sold as food supplements
Because medicines have different safety profiles to food products, the dosage that a medical cannabis product can recommend is significantly higher than what a food supplement is allowed to. As previously mentioned, the cannabidiol compound is identical, whether from a medical or food supplement source and provided there are no other harmful ingredients or contaminants, the risk, if there is one, in real terms is the same. The difference is that a medicine has a different risk profile, and is allowed to pose a greater risk based on the risk/ reward profile of medicine, and regularity of use of food vs medicine.
Medical cannabis claims
Medical cannabis products are in the most part categorised as ‘unlicensed medicine’. This means that they have not been authorised by the MHRA for a specific medical condition. It is also the case that an unlicensed medicine will not be a first choice to a prescriber if there is an authorised medical alternative.
Currently the only company that has marketing authorisation for cannabis products is Jazz Pharmaceuticals (formerly GW Pharmaceuticals) for their Sativex and Epidiolex products. Sativex is a medical cannabis product containing roughly 50:50 THC: CBD and is used to treat MS sufferers. Their other medicine is Epidiolex, and is a CBD medicine approved for Dravet Syndrome (a severe form of epilepsy).
A difficulty with cannabis medicine is that the plant is complex and contains many beneficial compounds which work synergistically. This complexity is counter to the development of conventional medicines, which are created in a way that can be easily replicated and patented. Whilst there is a lot of efforts going into the study of cannabis medicines, the framework and regulations which exists to regulate medicines is challenging for medicinal cannabis.
Who regulates medical cannabis and CBD oil
Medicines in the UK are regulated by the Medicines and Healthcare Regulatory Agency (MHRA), whereas food products, including CBD oil are regulated by the Food Standards Agency (FSA).
Conclusion
Love CBD has long championed and advocated for the availability of medicinal cannabis and believe that everyone should be allowed access. Cannabis has been used for centuries for its medical properties, and unlike many opioid based drugs is far less addictive, dangerous and potentially harmful. You only have to look at the opioid epidemic going in the US, where countless numbers of people, through no fault of their own, have had their lives destroyed due to reckless over prescribing of opioid based drugs. In my opinion cannabis-based drugs should be a first choice for many patients and conditions due to the low risk and safety profile.
However, whilst I am a strong supporter of cannabis medicine, I strongly disagree with many of statements and public comments that come from the medical community official channels. It is worth noting that many medical professionals are far more open to conversations about alternative treatments, including CBD products sold as food supplements. They have undoubtedly heard anecdotal stories about the benefits that CBD as a food supplement is capable of delivering, or perhaps, have even experienced using CBD oil first hand.
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