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The medical cannabis industry is in a precarious situation. The fledgling market is experiencing rapid growth across Europe, indicative of surging demand.
However, in countries like the UK, where it remains largely segmented from the national health service, the majority of patients are still reliant on private clinics for access to treatment and must pay out of their own pockets.
As such, the onus also falls on these private companies to expand access to the thousands of patients who could benefit from medical cannabis in the country.
One of the most impactful ways of doing this, and a crucial step towards integrating cannabis into mainstream healthcare, is the expansion of the base of conditions for which cannabis can be prescribed.
Expanding conditions
According to data from Prohibition Partners, chronic pain conditions, including neuropathic pain, cancer-related pain and pain from systemic and immunological conditions, are by far the most common conditions for which medical cannabis is prescribed across Europe.
Of the 16 European countries that have legalised some form of medical cannabis that are tracked by Prohibition Partners, 12 prescribe it for some form of chronic pain.
In the UK, while chronic pain is not specifically mentioned, as with any other ‘unlicensed medicine,’ it is down to the clinician to determine the most appropriate medication or course of treatment to prescribe for a patient.
This means that cannabis can be prescribed for a very broad range of conditions, provided they have enough clinical evidence of its efficacy and safety.
According to a Volteface report exploring the UK medical cannabis sector, more than 40,000 specialist clinicians are eligible to prescribe in the country, but only around 100 (0.25%) are actively doing so.
As these doctors are the ‘gatekeepers’ to expanding access to cannabis-based medicines, supporting them to prescribe is crucial for more patients to be able to benefit from the treatment.
UK-based medical cannabis clinic Releaf prides itself on leading this charge. Its medical director, Dr Sue Clenton, told Business of Cannabis: “When medical cannabis was legalised in 2018, the public perception – understandably – was that it was reserved for people with severe, life-limiting conditions, particularly children with intractable epilepsy, as those cases led to the law change.
“However, as real-world evidence has developed, it has become clear that medical cannabis can provide symptom relief for a much broader range of conditions. Many of these conditions, while not traditionally considered ‘serious,’ still have a significant impact on people’s daily lives. For example, multiple sclerosis is more serious than menopause, but both can benefit from medical cannabis.”
This forms part of an ethos that focuses on the needs of patients actively seeking alternative treatments, rather than simply chasing growth in prescription numbers.
Pushing to move beyond treatment of more commonly prescribed conditions like chronic pain conditions, Releaf now provides a list of over 40 conditions cannabis has been shown to help with.
Some of the most common medical cannabis applications in the UK, according to the company, are mental health concerns such as anxiety, depression, and PTSD, a relatively new field for which there is a growing evidential base.
Another encouraging space is the treatment of ADHD, which often brings other mental health conditions such as anxiety, depression and insomnia along with it.
After being diagnosed with ADHD at 20 (following a misdiagnosis years earlier), Georgia felt that her prescribed conventional medications were falling short.
Following years of treatment with antidepressants for a while, SSRIs, and beta-blockers, Georgia sought out an alternative medication that didn’t bring the raft of negative side effects with it.
Georgia was prescribed medical cannabis, and now uses a vaporiser with a different strain for daytime and nighttime usage.
“With my ADHD, it’s really difficult to explain, but if I’m working on my laptop, it feels like everything around me is shouting at me – like every little thing is a massive distraction,” Georgia said, adding that she hopes to cut out pharmaceutical medications altogether.
“My daytime flower option makes me feel like I’m in the zone, and it almost makes there’s just like a black sheet around me, and there’s nothing else going on – which, for someone with ADHD, is so weird because that is just not my life. That is not my norm.”
Other conditions, including gastroenterological and neurological conditions, sleeping disorders, and as a complementary cancer support therapy option, are also increasingly common.
Support for cancer treatment and the relentless side effects of chemotherapy is one of the most impactful and important uses of medical cannabis.
Louise, who was diagnosed with breast cancer in 2022, was prescribed an array of steroids, anti-nauseants, antihistamines and anti-reflux medication just to treat the ‘horrendous’ tiredness, nausea, vomiting and diarrhoea brought on by chemotherapy.
After two-and-a-half years of daily pills, weight loss and increasingly complex prognoses, Louise was desperate for a ‘break’, and decided to reach out to Releaf to discuss a possible prescription.
“The first big change that I noticed was my sleep. It seemed to calm my mind and helped me sleep much better at night”, Louise explained.
“I used to take the antianxiety tablet Lorazepam at night to sleep, and I’m not taking those any more. Lorazepam was something I never really wanted to take because it can be an addictive medication.
“I’m happy to have found a medicine that helps without being so hard on my body, so I’m able to just get on with life. It’s a much more manageable and comfortable way to go forward into the future.”
Dr Clenton added: “Medical cannabis is prescribed by specialists for symptom management where other treatments haven’t worked or aren’t well-tolerated. We are not treating the underlying cause of these conditions, nor do we claim to prevent disease progression or offer cures.”
The need for evidence and the industry’s responsibility to gather it
Dr Steve Hajioff, a former chairman of the British Medical Association (BMA) and a member of the Quality Standards Advisory Committee for the National Institute of Health and Care Excellence (NICE) who wrote the foreword to Volteface’s report, says it is time for the medicinal cannabis industry to ‘reflect’ and ‘adapt’ to address the concerns of clinicians on the frontline of prescribing.
“Most ordinary, working doctors want to see decent evidence that something is effective, who it is most effective for, and that it is safe. When doctors query why the cannabis industry is not being held to the same standard, they are not being ‘blockers’, they are being even-handed and acting in what they are certain is in the best interests of their patients.
“Rather than blaming others or claiming exceptionality, the industry needs to reflect and see how it can adapt to deliver the reassurance necessary for mainstream practice.”
This sentiment is well understood by Releaf, who notes that while ‘real-world evidence exists to support the management of symptoms related to these conditions’, clinical trials have been difficult given the severe restrictions that remain around cannabis.
“The evidence base is growing, and we are contributing to this evidence,” Dr Clenton continued.
Releaf’s Research Director and Rheumatologist, Dr Hanna Gul, added: “To demonstrate our commitment to delivering excellent patient care, we have implemented patient-reported outcome data collection to generate real-world evidence, using 15 health-related quality of life and disease-specific questionnaires. This can demonstrate a response to treatment over time. The results of this work will be published in peer-reviewed journals.”
It is also working with the University of Leeds to launch a clinical trial into cannabis’s potential to treat long-Covid symptoms.
“}]] According to data from Prohibition Partners, chronic pain conditions, including neuropathic pain, cancer-related pain and pain from systemic and immunological conditions, are by far the most common conditions for which medical cannabis is prescribed across Europe. Read More
