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Weeding Out the Truth
- Equal Lives
- 34 minutes ago
- 6 min read
The cannabis sativa L plant is one of humanity’s oldest known medicines, and at the time of writing, is legally used as medicine in fifty-seven countries, including twenty-seven European countries; thirty-eight US states; Canada; Australia; New Zealand; eight African countries; Lebanon, Sri Lanka; Thailand; and indeed, the United Kingdom.
Cannabis that has not been prescribed for medical reasons remains a Class B controlled drug under the Misuse of Drugs Act 1971, and is still tightly controlled in scientific research settings.
However, in November 2018, following the high-profile campaigns of two mothers of Alfie Dingley and Billy Caldwell, two children with epilepsy, UK lawmakers reclassified cannabis-based medicine as having ‘some medicinal value’, which allowed for its prescription in specific situations.
In the following year, just 18 prescriptions were issued through the NHS, and only 135 through private clinics. Since this time, the popularity of private cannabis-based medicine has expanded, with 75,000 patients having received private prescriptions for a wide range of health conditions, from doctors on the Specialist Register of the General Medical Council (GMC).
We have heard from people who feel they are being discriminated against as they use their prescribed cannabis, with business owners, landlords, local authorities, employers and police forces having been offered little or contradictory guidance on navigating this complex topic. We have also heard from people who say they are prohibited from accessing prescription cannabis due to cost or ease of access.
It is estimated that 1.77 million people across the UK use illegal, ‘street’ cannabis for the management of a wide range of health conditions. Unregulated ‘street’ cannabis offers no certainties in the strength of the cognition-altering compounds, nor guarantees of safety in growing practices. Additionally, synthetic cannabinoids can be mis-sold as cannabis and have been responsible for many deaths in recent years.
Given the inconsistent access to cannabis-based medicine, alongside the discrimination and stigma frequently experienced by medicinal cannabis users, this is very much a disability rights issue.
What is hindering the provision of more cannabis-based medicine through the NHS?
What are the barriers to prescription cannabis-based medicine from private clinics?
How does cannabis work within the body?
What are the harms and benefits of cannabis as a medicine, and how do they compare to other available medications?
Where did the stigma around cannabis-based medicine come from?
What are your rights as a medical cannabis user?
In this blog series, we’ll explore these questions and weed out the truth!
History of medicinal use
The cannabis sativa L plant evolved around 28 million years ago on the Eastern Tibetan Plateau. It is a relative of the common hop plant and was first domesticated in China around 4000 BCE, for use as a food, and for making paper, rope, and fabric.
The plant was later used for medicinal purposes; cannabis was mentioned in the ancient Chinese pharmacopoeia around 2700 BCE, in relation to its management of over a hundred health conditions.
Records exist of the plant’s medicinal use among ancient Egyptians, Assyrians, Indians, Romans, Greeks, Persians, and South American cultures for a variety of applications, including pain relief, anti-inflammation, mood enhancement, wound healing, digestive issues, epilepsy, fever, dysentery, as well as period and labour pains. It is rumoured that Queen Victoria used cannabis medicine for the management of period pains.
Over time, the plant became more psychoactive, altering the cognition of its users, likely through a combination of humans choosing to propagate plants with these properties (genetic engineering) and ideal growing conditions.
Currently in the UK, cannabis-based medicine can be prescribed through private clinics for the management of a wide range of health conditions and disorders, each with varying standards of evidence supporting their use. These conditions include:
MS
Cancer and chemotherapy-related appetite loss and nausea
Epilepsy
Chronic pain conditions like fibromyalgia, endometriosis, and arthritis
Parkinson's Disease
Migraine
Crohn’s Disease
Psychiatric conditions such as anxiety, obsessive compulsive disorder (OCD), and eating disorders like anorexia, bulimia and Binge Eating Disorder (BED)
Neurodevelopmental disorders like ADHD, Autism and Tourette’s.
How does cannabis work in the body?
Within all of us is a brain and body-wide network of chemical signals and receptors, called the Endocannabinoid System (ECS). This system plays a role in many processes, including appetite, pain sensation, sleep, memory, mood, and immune response.
Our bodies naturally produce molecules called endocannabinoids, which bind to cannabinoid receptors in the brain, central nervous system, immune system and peripheral tissues, triggering the release of brain chemicals (neurotransmitters).
Naturally occurring cannabinoids can be found in breast milk, supporting the development of the newborn, not to be confused with plant cannabinoids deliberately consumed, which are dangerous in pregnancy. Early research suggests that the body’s naturally occurring cannabinoids may be implicated in the phenomenon of ‘runner’s high’; the elation felt following aerobic exercise, rather than endorphins, as previously believed.
Cannabis plants contain over a hundred compounds called phytocannabinoids, which mimic the body’s naturally produced endocannabinoids, of which THC and CBD are the most clinically relevant.
THC (Δ⁹-tetrahydrocannabinol) is the main psychoactive component in cannabis, which binds to the brain’s cannabinoid receptors and produces feelings of relaxation and euphoria; it is the compound responsible for the 'high' experienced.
CBD (cannabidiol) has anti-psychotic and anti-inflammatory properties, and mitigates negative side effects of THC such as anxiety, hunger and sedation. CBD products are sold legally as food supplements in the UK without a prescription, but it's important to note that their sale is unregulated and their quality and content are unknown.
Cannabis of both the illicit and medicinal varieties can cause side effects, as do all drugs. Common side effects include sleepiness, difficulty concentrating, blurred vision, increased appetite, decreased appetite, dry mouth, anxiety, fever, vomiting and nausea. Less common side effects include psychosis, fainting, changes in heart rate, changes in blood pressure, tummy pain and the mouth or teeth changing colour.
Cannabis-based medicine is not recommended for those with heart or liver conditions and should never be used by pregnant people, as THC can damage foetal development. Children and adolescents should never use cannabis (unless in cases of intractable epilepsy), as THC-use affects developing brains. High THC use can reduce sperm count and disrupt ovulation temporarily. It also increases the onset of cognitive decline in old age.
Through growing choices and conditions, 'street' cannabis these days contains far higher concentrations of THC than it did in the past, increasing by 14% from 1970 to 2017. Those with a predisposition for schizophrenia are at a much higher risk of psychosis through high-potency cannabis use.
Methods of administration
Prescribed cannabis can be administered through numerous methods. Dry herb vaporisers heat the cannabis flower (buds) enough (160–220°C) to release its active compounds without burning the plant material. The user inhales the vapour, and it typically reduces symptoms in a matter of minutes and lasts for 2-4 hours.
The downsides of inhalation are that it can irritate the throat and lungs, because inhaling any particulate matter has this effect. Those with poor dexterity and fatigue may struggle to maintain the cleanliness of a vaporiser, as sticky residue builds up quickly. Additionally, this is not a discreet method of administration, as the exhaled vapour has the pungent, unmistakable smell of cannabis. Additionally, the cost of vaporisers can be prohibitively expensive for many people.
Oils are a popular option for those who want a more steady, sustained release of the medication. The oil is placed under the tongue (sub-lingually) and is left there for a few minutes to enter the bloodstream before being swallowed. The effects can typically be noted within 15-45 minutes and last between 4-6 hours. This method of administration is discreet, it’s easier to dose accurately and does not involve the lungs.
Another method of consumption is edibles, usually gummies. These take longer to kick in, as the gummy must travel through the stomach and intestines before being processed by the liver. Once the liver has metabolised the THC, the compound it has become crosses the blood-brain barrier more easily than inhaled THC, which can make the effects more potent.
Edibles last much longer (6-8 hours). They offer the same discretion as oils and don’t involve the lungs either, but do tend to contain beef gelatine, which is unsuitable for those who don’t consume animal products.
No prescriber of medical cannabis in the UK will recommend smoking as a method of administration, due to its health consequences. Smoking prescribed cannabis in the UK makes that consumption automatically illegal, even if it has been legally prescribed.
In the next blog in this series, we’ll explore the barriers to legal prescription in the UK.
Written by Arianne at Equal Lives