Pain is the neurological response to something being wrong in the body. It may be experienced as a stabbing, throbbing, or aching, with the duration of such feelings varying greatly. Affecting one in every five adults, chronic pain is known to have severe impacts on everyday life. Cannabis is one of the medicinal options that may be considered for the effective prevention and limitation of such pain. Allowing for a significant improvement in quality of life, cannabis may be preferred to other medicines as it has fewer undesirable side effects.
People can experience pain as a result of an accident, injury or operation. It occurs when the brain receives messages from the spinal nerves, signalling to your brain (via the spinal cord) that it should take action. It can then start to heal the damage and protect the body from further harm.
There are 32 pairs of spinal nerves that tell the brain where the pain is coming from, prompting the body to take action in this localised area. Pain may be a necessary barrier to long-term damage in the event of exposure to fire, extreme cold, and other dangers.
Chronic or long-term pain is defined as any pain that continues for 12 weeks or longer. More than a defence mechanism, the brain can (incorrectly) continue to transmit pain signals throughout the body. This can be distressing, severely limiting what the sufferer can do in their daily life.
Pain can be treated in the short-term with pain killers. However, this is not suitable for chronic pain due to the risk of addiction. The National Institute for Health and Care Excellence (NICE) states there is “little or no evidence” that Ibuprofen, as well as aspirin and opioids, work for chronic pain either. Instead, exercise, self-help techniques and acupuncture are the preferred routes prescribed to those experiencing chronic pain.
The endocannabinoid system has connections with both ascending and descending pain pathways, with cannabinoid receptors present at all three levels of pain processing. Medical cannabis has been shown to reduce pain, anxiety, and improve sleep in patients with chronic pain. In general, patients with neuropathic pain or fibromyalgia report greater improvements after taking medical cannabis than patients with other types of pain such as inflammatory pain. Also, high-THC and balanced THC:CBD preparations appear to be more effective than high-CBD ones. Observational studies have also shown that some patients with chronic pain have been able to reduce their opioid dose or stop entirely after taking medical cannabis for a period of 6-months.
When introducing medical cannabis, the general recommendation is to ‘start low, go slow’. For the majority of patients this means starting with a CBD-predominant preparation and slowly increasing the THC dose if needed until symptom control is achieved. However, in some cases, a more rapid approach may be needed (e.g if patient has used cannabis recreationally in the past; if patient has tried CBD already without success; if pain is extreme). In these cases, a balanced THC:CBD preparation may be the starting point for medical cannabis treatment. Consensus pain guidelines recommend not exceeding 40mg THC daily. Once the medical cannabis dose has been optimised, the patient reports improvements, and uses less as-needed medication to control their pain, then opioid tapering could be considered if applicable.
Yes. Cannabis-based medicinal products (CBMPs) have been legal since the 1st of November 2018, when they moved from a Schedule 1 product to a Schedule 2 product. This reflects their potential for medical use.
Cannabis-based medicinal products, also known as CBMPs, can be prescribed by private consultants, when appropriate, within their specialty area when there is unmet clinical need.
In the UK cannabis medicines are accessed primarily via private clinics. However, any specialist physician can prescribe cannabis medicines. GROW® is here to provide education and support to any specialists looking to prescribe or just to find out more.
There are 3 licensed medicines which contain cannabinoids – Epidiolex for some forms of epilepsy, Sativex for multiple sclerosis (MS), and Nabilone for chemotherapy-induced nausea and vomiting (CINV). However, only a handful of prescriptions have been issued in the NHS to date.
Most cannabis-based medicinal products (CBMPs) are instead unlicensed, and they must be written on a private prescription, typically issued by private clinics specialising in medical cannabis treatment.
Cannabis medicines come in multiple forms; flowers, often referred to as herbal cannabis (to be vaporised, rather than smoked), oils (taken under the tongue) and capsules. Cannabis medicines come in high-THC, high-CBD and balanced varieties.
Smoking medical cannabis is illegal. Medical cannabis can instead be taken in different forms depending on the desired speed of onset and duration of action, which is discussed between the patient and their doctor.
It’s important to find a clinic that works for you. Most importantly you need to find a Doctor that specialises in your condition. For example, patients with pain will need to see pain specialist, while those with a mental health condition must see a psychiatrist.
It’s important for patients to know they can use any pharmacy that supplies the appropriate medicines in the UK.
Some clinics have a preferred pharmacy but will be able to send prescriptions to others if needed. If patients have any questions about available medicines, they can contact IPS Pharma.
To speed up the process, patients should bring a copy of their medical records. These are then forwarded to the clinic in advance of the first consultation.
No. Cannabis-based medicinal products (CBMPs) are only prescribed by GMC-registered specialist doctors. As they are medicinal, CBMPs are regulated by the Medicines and Healthcare products Regulatory Agency (MHRA); which ensures the safety, quality, and effectiveness of medicines in the UK.
Over-the-counter (OTC) CBD products can be purchased without a prescription in pharmacies, health food shops, or online. These may come in forms such as oil tinctures, capsules, or vapes. They are not medicinal products as they are regulated by the Food Standards Agency (FSA) as a food supplement, with a 0.3% limit on THC.
Patients are free to seek a second opinion from another clinic. Patients should ensure the clinic has communicated their reasons for deciding not to prescribe. It may be that they feel you should try other medicines before trying cannabis medicines, or that they need to see more information about your medical history before they are happy to prescribe.
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