All-Wales Police Drug Expert Event

Friday afternoon, Sam and I found ourselves having the privilege of presenting to the All Wales Police Drug Expert Witness Meeting.

This meeting involved senior Police Drug-Enforcement Experts coming together for a day of education, reflection and strategy on all things related to substance use in society.

We found the experience hugely valuable in bridging the gap(s) between legislation, patient needs and necessary enforcement of law. We are grateful that we were able to bring our patient stories and clinical perspective to an audience that can now cascade learning on this new field of medicine to front-line officers.

That is not to say it was a one-way conversation - the 'crowd' remained highly engaged and opinionated, giving us plenty to reflect on ourselves!

Key take-away messages for us included the importance of safety, particularly whilst driving - it was a humbling reminder that our emergency service are exposed on a daily basis to roadside tragedies. Other concerns included the potential for diversion, counterfeits and verification of patient prescriptions - all difficult questions with few straightforward answers.

We are pleased to have been included in this conversation and will continue to support our patients, the medical industry and legal processes as best we can.

A final huge thanks to the all of the police and emergency services for the work you do - and YES, there are discounts for 'Blue Light Card' holders!

Wishing you Health and Happiness!

Dr Dave and Sam

The "Hybrid Patient" - Square peg round hole?

Not all patients are created equally and not all CBMPs suit all patients. It could be argued that a bespoke, individualised patient-led approach by clinicians is the only way to effectively prescribe CBMPs.

While this approach is distancing itself from the traditional ‘doctor knows best’ style of prescribing, some clinicians within the industry are advocating for prescribing guidelines to navigate the complexity of prescribing CBMPs. For example, under 25 years old not being prescribed flower over T25 or restricted monthly allowances e.g. 40/60/80g a month.

Yet, it is widely accepted (to anyone who has done an inkling of research) that the Endocannabinoid System is individual to each patient and what works for one with the same symptoms does not necessarily help another. With this in mind, how do clinics help and embrace the "Hybrid Patient" ?

The "Hybrid’ Patient" is eligible for a prescription and sources their medication both through a specialised pharmacy on prescription and from the illicit market. They do this because they perceive that Medical Cannabis (MC) may not meet their needs on quality, accessibility, consistency, choice or price, but want the medical supervision and protection from persecution and prosecution.

Some "Hybrid’ Patients" struggle medicating, as prescribed, using a dry herb vaporiser. This can be due to tobacco addiction or as some patients claim, they can't get the desired medical effects from vaping alone and find symptom control better managed by combustion or taking edibles.

So while listening and acknowledging patients’ experience of medicating with cannabis - how do clinics navigate the complexity of the "Hybrid Patient" while still treating them for their symptoms and adhering to strict prescribing regulations for unlicensed medications?

As clinics implement prescribing guidelines through MDT meetings, where does this leave the "Hybrid’ Patient" ? Some may answer: "Not my problem" - if they don’t adhere to clinic policy, then they can find a solution elsewhere.

Out of 1.8 million estimated medical users of cannabis in UK, we risk alienating many. Over the past couple of years, industry has improved access and consistency. Quality has had a marked improvement with some claiming to be better or exceed street quality. As patient numbers increase, prices are reducing and becoming more competitive with the illicit market. All these achievements to then potentially exclude the "Hybrid Patient" from accessing legal prescriptions.

The challenging answer is harm reduction - implementing an agreed treatment plan with the patient to not only improve symptom control, but to also reduce the risk to health. This is two fold: reducing and ultimately replacing combustion with legal administration methods and decreasing and eliminate the patient’s need or desire to access illicit cannabis.

The first approach can be done with kindness, patience and encouragement from the clinician and the clinical team. Tobacco addiction is one of the hardest substances to quit. The withdrawal alone is hell and lapsing is easy to do. It is wrought with failure. Once tobacco free, the next challenge for the patient is to move away from combustion altogether and embrace dry herb vaporising.

There are countless patients out there who have gone from spliffs to vaporisers and will vow that they could never go back to combustion. It’s a tough path, but if a patient succeeds, they invariably celebrate their achievement and enjoy better health overall. It’s not unusual when patients fully switch to vaporising their flower, they reduce their monthly prescription amount as they find they use less. Quids-in all round!

So Bob and Babs down the road, with their spare room grow, some may argue still beats the industry on accessibility. When particular products run out or when a prescription has been rejected or when meds turn up under par, or there’s a delay with the distributor…..Bob and Babs are there, ten bag/eighth in hand. The patient needs relief and they can deliver within the hour. Bob and Babs are nice, caring individuals, who take pride in their craft.

Not all illicit cannabis are produced by the likes of Bob and Babs. Within the illicit cannabis community, there are the legacy craft, artisan cultivators, which are far removed from the dodgy, county lines gang, electricity stealing back market producers. "Hybrid Patients" in desperation put themselves at risk to access the meds that they need. Whether that is putting themselves in physical danger meeting unknown people, or risk being scammed online by unscrupulous scallywags.

There’s the additional risk of consuming tainted, sub-par cannabis. Tales of synthetic THC or 'spice' sprayed on plants to give an extra ‘high’. Plastic beads found in cannabis to increase weight and profit. Urinating on plants in the belief it helps growth and potency.

The list of dodgy practices are most probably endless and scary to consider. All the while, the ‘hybrid’ patient is putting themselves at risk to obtain what they hope will be effective medicine.

Clinics have a duty of care to include "Hybrid Patients" and help them make informed, safe choices for themselves. By implementing more restrictive guidelines, such as monthly amounts, arbitrary prescribing perimeters and refusing to prescribe from other pharmacies makes the "Hybrid’ Patient" run for the hills… or rather into the arms of Bob and Babs... or even worse!

While the most hardened spliff-smoking patient may claim that tobacco ‘makes the spliff’, secretly deep down while all alone, they wish that they weren’t addicted to tobacco and they could wake up and not nearly die from coughing up the morning grollies to clear their airway for the next noxious, smoke filled inhalation. Having a conversation about tobacco addiction with the "Hybrid Patient" may be encouragement they need. Plant small seeds….

Clinics have a vital role to play in acknowledging the requirements of the "Hybrid Patient" and working in partnership to reduce risks and improve health outcomes. Above all, make them feel included and accepted and listened too and while ultimately, the consultant is the expert in their speciality, the "Hybrid’ Patient" is an expert in their health and their needs and sometimes, not always... they may already know what works!

Sam Ashton

Founder/CEO. Cannabis Clinic Cardiff

Seed Our Future Campaign

https://www.seedourfuture.co.uk/

Hello!

This post is to highlight the work of Guy Coxall, who is the main driving force behind 'Seed Our Future', a fabulous resource, which is (IMHO) the best UK resource for information relating to legal issues relating to cannabis and Cannabis-Based Medicinal Products (CBMPs).

www.seedourfuture.co.uk has loads of great information relating to Driving, Employment Law and Disability Discrimination - the best place on the net to find out the right information for your rights and protection in the UK!

I met Guy Coxall earlier in the year at a Cannabis-Themed Scientific Conference and he is a truly honorable gentleman and has great ambitions to change UK law for the better!

He also travels around the UK, supporting patients who have been victims of police harrassment, with no agenda but to serve others at his own expense.

His past actions give him the credibility to be pushing forward with the campaign he is now championing.  His goal is to support CBMP patients who find themselves on the wrong side of legal injustice and to challenge UK law to promote evidence-based policies.

Guy Coxall is asking for patients to register with their new service to benefit from their legal support via a £30 donation by 31st July 2024.  Think of this as a form of insurance, which you hope you will not have to use.

I would also urge all fellow cannabinoid-allies to register to support CBMP patients and the important work of 'Seed Our Future'.

Registration will also help Guy develop a team and to concentrate on the bright future he envisions for the future of UK Cannabis Policy.

https://www.seedourfuture.co.uk/product/patient-registration-payment/     

For a wider discussion and information on the 'Seed Our Future' Campaign, please view the recent 'Medical Cannabis Patients Association' Web Conference on YouTube;

MAIN GUEST:

Guy Coxall - Seed Our Future

GUEST SPEAKERS:

Mohammad - Patients Cann

Dr Sunny Nayee - Integro Clinics

James Smith - 4C Labs

Dr. Callie Seaman - Cannabis Industry Council

Professor Mike Barnes - Medical Cannabis Clinicians Society

https://www.seedourfuture.co.uk/product/patient-registration-payment/     

Wishing you Health and Happiness!,

Dr Dave Howells