Access to Medical Cannabis from a Patient's Perspective

Patients feel they have been criminalised, demonised and misunderstood by a medical system that has been built around the dissemination of education on the harms of cannabis but not the benefits.

Carly Barton | Prominent patient & advocate. Founder of Cancard and Carly’s Amnesty

Medicinal cannabis patients in the UK have been consistently let down. For many years patients feel they have been criminalised, demonised and misunderstood by a medical system that has been built around the dissemination of education on the harms of cannabis but not the benefits. This rhetoric stems from the stigma that bled across the pond during the ‘war on drugs’ which initiated in America. Patients in the UK sit patiently watching the US system pirouette and embrace this powerful medicine.

While cannabis experts and researchers in the US have worked hard to undo some of the damage caused by negative media and marketing campaigns, the UK interestingly is still very much holding on to old outdated values that the initiators no longer preach.

I have often heard MP’s state when discussing cannabis in the US that they will not be following the trajectory of a country who allowed the opioid epidemic to run rampant in their communities. This argument closes the door on emerging evidence that cannabinoids may have become the antidote to the opioid crisis. There has been a spectrum of research arising from state-run studies showing a massive shift in opioid dependence and deaths since access to cannabis was improved, but in choosing to accept some evidence and not others we are victim to confirmation bias. This has prevented a willingness to explore potential and evidence of results post-reform. Stigma, fear and the lack of ability to reconsider firmly held beliefs are still the biggest block to ensuring that patients have access to this medicine. As much as it is essential that we re-educate and re-brand cannabis as a medicine, the fact is that even with endless resources we are still swimming around trying to change minds that have been solidified not by research, but by years of conditioning and emotional responses to that conditioning: it is a stigma soup.

I deal with patients all day every day who commonly deal with several revolving barriers to these medicines. Firstly, in a recent poll 89% of patients felt that they could not speak with their GP about their cannabis consumption. The vast majority of these patients reported that they felt unsafe due to previous experiences where their doctor informed them that they disapproved of the treatment. In some cases, doctors have even threatened to call the police and social services. Another common concern is that they would have restrictions to access to mental health services if consumption was included on their notes (currently a patient is required to have three months without cannabis usage to access CBT and NHS Mental Health services).

Secondly, intuitional guidance has been extremely conservative and hampers the re-education of our GMC registered specialist clinicians. Patients often report that they have spoken with their specialists about cannabis. The most common reaction is one of apathy. As clinicians are aware that they are unable to prescribe, there is currently no need for professionals to increase their knowledge basis or understanding of the applications of cannabis as medicine. Therefore, patients often experience an attitude of indifference.

Next, private clinics are becoming more visible within the community, however there are blocks here also. Cost is a massive factor which leaves many in a situation whereby they cannot afford to buy access to medicine that comes with legal immunity from prosecution. This leaves patients who are less affluent in the position whereby they are living in fear of arrest if they choose to consume the medicine that keeps them well. In addition, there have been hundreds of cases whereby patients who can afford a prescription have reported that they have gone back to illicit market products due to product suitability. There are thousands of strains of cannabis and often patients have spent a long time ascertaining which cultivars suit their treatment. Often suppliers will opt to produce cultivars that produce high yields. These strains are often associated with what a patient would consider to be sativa-like with uplifting terpenes. While these strains are tolerated by some, most medicinal cannabis patients prefer the more calming cultivars with indica-like terpenes. There have been numerous reports that patients have experienced unwanted side effects from legally prescribed cannabis because of the lack of suitable cultivars. With private clinics only having access to a handful of these strains, patients often find themselves in a position where the legal route is unsuitable for them as the illicit market provides a library of choice.

Beyond access we have inherent issues in our institutions that wrap around families and daily life in the UK, institutions who have yet to adapt their policies to avoid a medicinal cannabis patient from being discriminated against.

We often see cases in family court around childcare concerns, work drug testing, outdated laws on intoxication levels whilst driving, lack of access to counselling and NHS services, limitations on work possibilities if a patient has a historical charge for possession. The list goes on.

Patients in this country are trapped by the collision of unsuitable systems built into institutions that are inflexible and led by fear of trying something different, albeit one that many countries have achieved with great success. Doctors are in fear of their jobs and the harms they have been conditioned to accept. MP’s are in fear of losing their position and making a jump that might bring criticism. Patients are in fear of stigma, arrest and the implications of consuming their medicine openly. The NICE guidelines are not going to change. Cannabis is a poly-compound and cannot be squeezed into a system designed for single substance medicines. Randomised controlled trials are not suited to this medicine and are likely not going to be the route to change. Guidelines, reports and research can and should be produced to provide education and to build a platform for future development of access and industry. But reports have never been the best way to challenge fear and stigma when there is a reluctance to examine new evidence. This requires individual critical thinking to the point of admitting that perhaps they have been wrong all along....