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Medicinal cannabis was legalised last year but so far, virtually no-one in the UK has been able to access it. Now, enough cannabis to treat 30 patients for a month has arrived in the UK from the Netherlands. Three patients with prescriptions, all to treat chronic pain, will receive cannabis-derived medicines immediately. Specialist doctors have been able to prescribe cannabis since 1 November - so what has taken so long? The new law moved cannabis from schedule 1 under the Misuse of Drugs Regulations - meaning it had no therapeutic value - to schedule 2. That category is for drugs which are controlled but have a recognised medical use and can be prescribed in certain circumstances. Cannabis-based medicines can come in the form of whole cannabis flowers, oils or capsules, or a single compound which can be isolated and extracted. The two main active ingredients in cannabis are cannabidiol CBD and tetrahydrocannabinol THC but a cannabis plant will contain hundreds of different compounds. Medicinal cannabis is currently unlicensed so doctors can prescribe it only if a patient has a need that can't be met by licensed medicines. Under the new rule, GPs are not allowed to prescribe cannabis-derived medicines. It has to be a specialist consultant, for example in neurology or paediatrics. Even getting the right prescription pads has been a challenge according to Hari Guliani at Grow Biotech, a consultancy which has worked with both doctors and importers. Prescribing cannabis is new to UK doctors and so it may take a while before they begin doing so, says Dr David McDowell, the pain specialist who prescribed cannabis for the patients receiving their medicines this week. The prescriptions are valid for 28 days and, at the moment, doctors are advised to prescribe a month's worth at a time. One of Dr McDowell's patients, who is set to receive his first supply of medical cannabis, suffers from Crohn's - a painful inflammatory bowel disease. He said he had been prescribed opiates in the past, which, he said, had made his condition worse. All the patients receiving cannabis this week are doing so privately. NHS England said that cannabis-based products would be prescribed only where there was 'clear published evidence of benefit' that couldn't be achieved by a licensed medicine. It said that where necessary, NHS Trusts could meet the cost but, 'the current position is that no cannabis-based products for medicinal use are routinely commissioned. In October , the National Institute for Health and Care Excellence NICE plans to publish guidelines concerning the medication, and the NHS will then use this to decide whether it will eventually fund the drug routinely for some patients. At the beginning of December, Carly Barton is thought to have become the first person to be given a prescription for cannabis but wasn't able to actually receive the drug because none had been imported. She told the BBC last year that she had been buying cannabis 'on the black market' instead of taking very strong opiates including fentanyl which she had been prescribed for pain. Last month, Charlotte Caldwell, whose son has a rare form of epilepsy and became the centre of a campaign to legalise the drug for medicinal purposes, told the Times she had been able to pick up a dose of cannabis. It's understood that an individual supply was flown in from Canada - but this week is the first time a stock of the drug has been imported. Other conditions cannabis might be prescribed for include multiple sclerosis and cancer. At every stage of the process, getting cannabis-based medicines to patients is very tightly regulated, adding to the delay. The first batch of legal cannabis has been shipped into the UK in the form of whole flowers, which contain more than one active pharmaceutical ingredient. This also makes it more complicated to get approval than importing a single compound like, say, morphine. While morphine is also a controlled substance, it has a well-established medical use, meaning processes are in place to import and regulate it. This batch coming from the Netherlands has been grown at a specially regulated site for cannabis for medical purposes and the export has to be approved by the Dutch government. Importers in the UK need to apply to the Home Office for a licence to bring in the cannabis from overseas. The whole process can take up to 28 days, so by the time it's completed, the prescription may have expired. These delays are why companies involved in the process of importing medical cannabis say its important to bring in a bulk amount. The bureaucratic hurdles are all there for patients' safety, says Mr Guliani at Grow Biotech. But bringing cannabis into the country in larger amounts can mitigate these delays, meaning when patients' supplies run out there's stock available and they don't have to have a gap in their treatment. Read more from Reality Check. Send us your questions. Follow us on Twitter. Skip to content. US Election. Medicinal cannabis: Why has it taken so long to get to patients? The new law. Why are so many countries now saying cannabis is OK? Reality Check: Does UK export the most legal cannabis? Cannabis pleas for epilepsy teen rejected. He described the current process as 'tortuous'. Getty Images. Charlotte Caldwell campaigned for medical cannabis to be made available for her son, who suffers from severe epilepsy. Campaigner's company sells cannabis oil. Whole flowers.
7 Potential Health Benefits of Cannabis
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Cannabis is a genus of plant that contains three varieties: Cannabis indica , Cannabis sativa , and Cannabis ruderalis. It is a flowering herb with a long, rich history of medicinal, recreational, nutritional, and industrial use throughout the world. With some countries, including Canada, having legalized cannabis, there has been a recent surge of worldwide attention on the plant. There is increasing interest in seeing the plant legalized for medicinal and recreational purposes in other countries and increasing excitement about the possibility of research on the medicinal uses and safety of cannabis, which legalization would make more accessible. The cannabis plant originated in central Asia, where people first discovered it at least 12, years ago, during the early days of agriculture. Initially, they would use cannabis by eating the nutritious seeds and creating rope and textiles from the hemp stalks. However, the first written record of medical cannabis use in China was nearly 5, years ago. Over the years, cannabis use spread across the continent and then the world, and many peoples continued to use it to treat a variety of ailments. Ancient Egyptians used cannabis to treat hemorrhoids and ease childbirth. Evidence from India shows documents dating back thousands of years praising its ability to decrease anxiety and increase happiness. There is evidence in many parts of the world of medicinal use of cannabis, but even more evidence of industrial use, with importance placed on hemp textiles. Throughout the 19 th century, it was a popular remedy in the United States. Consumers could purchase cannabis tinctures and other preparations from pharmacies, and use these products to treat a range of ailments. These included gastrointestinal diseases, mental illnesses, nausea, headaches, insomnia, asthma, epilepsy, menstrual cramps, and many other symptoms, diseases, and disorders. However, by the 20 th century, cannabis began to fall out of favour in North America. In , Canada was one of the first countries to add cannabis to its list of prohibited drugs, leading to a year prohibition on cannabis, ending upon legalization in October Throughout the mid th century, researchers found and isolated a variety of cannabinoids, allowing them to understand more about the function of cannabis. Subsequent research on this receptor led to the discovery of anandamide, a neurotransmitter that activated some of the same receptors as cannabis. In , researchers discovered another receptor in the endocannabinoid system, as well as more of these unique neurotransmitters. In , Canada introduced the Medical Marijuana Access Regulations, allowing individuals with certain diseases to access government-issued cannabis if their physician recommended it and they met established criteria. In and , two separate bills were introduced by the federal government with the goal of decriminalizing small amounts of cannabis, but neither of these succeeded. While public opinion of cannabis has gone through many shifts, in recent years, public interest in Canada has continued to grow. Now, with legalization of cannabis in Canada as of , we hope to see more research, dialogue, and deeper understanding of how cannabis works in humans. Cannabis is composed of many different substances, and more than of these are what we call cannabinoids. These, possibly along with other compounds known as terpenes, are responsible for the effects of cannabis. Cannabinoids most likely work by interacting with a complex system in the body called the endocannabinoid system ECS. Our bodies naturally produce a family of neurotransmitters called endocannabinoids, which interact with receptors located in the brain, muscles, fat, and digestive tract. These receptors are called cannabinoid receptor type 1 CB 1 and cannabinoid receptor type 2 CB 2. Scientists only recently found evidence of the ECS when they discovered CB 1 in , so research is still ongoing into exactly how it functions. However, most data find that it helps our bodies regulate pain, mood, appetite, gastrointestinal motility, memory, emotions, stress response, immune function, and more. When a person ingests the plant-based cannabinoids in cannabis, which are similar molecular shapes to endocannabinoids, they fit into the CB 1 and CB 2 receptors and trigger reactions that result in either very high or very low levels of specific neurotransmitters, which the cells of the nervous system, as well as other systems in the body, use to communicate with each other. The ECS is very important when it comes to medicinal cannabis, because changes in how the ECS functions might have an important relationship to the pathology of chronic conditions and could be tied to the efficacy of cannabinoids. The two most important cannabinoids, and the two that typically compose the majority of cannabinoids in cannabis, are deltatetrahydrocannabinol THC and cannabidiol CBD. THC is also the primary source of the negative psychological effects associated with cannabis use, such as irritability, anxiousness, and paranoia. CBD can help reduce convulsions, nausea, and inflammation. It might also lessen some of the negative symptoms associated with THC, especially anxiety and paranoia. When we develop cannabis to grow tall and strong with thick fibrous stalks that are low in THC we typically refer to it as hemp. People mostly use hemp seeds for food and its fibres for industrial purposes, such as for creating textiles and building materials, or for extracting CBD for medicine. When we breed it to have lush leaves and flowers that are high in cannabinoids, we use the flower buds for medicinal or recreational purposes. Some people refer to cannabis used this way as marijuana. Typically, Cannabis ruderalis is very low in cannabinoids, and only used for hemp. Plant breeders have created innumerable strains of cannabis, each of which has a different combination of cannabinoids, with variable potency results. The list of conditions that cannabis is purported to treat or cure is very long, and continues to grow, but the research is still lacking in many areas. This is largely due to cannabis being both stigmatized and illegal in most parts of the world for the past century, so research might increase as legalization becomes more commonplace. It is also difficult for researchers to conduct double-blind studies for most cannabis products because subjects might be able to determine whether they are on the active therapy or placebo. However, current research indicates that some conditions may be clinically improved by cannabis use. These include inflammatory bowel disease , multiple sclerosis, neuropathic pain , nausea and vomiting caused by cancer or chemotherapy, pediatric seizure disorders, and a wide variety of other illnesses. Here, we will focus on gastrointestinal symptoms and conditions that might be ameliorated by cannabis. Some research suggests that the ECS might play a role in gut health. In addition, research shows that levels of anandamide, an endocannabinoid, are much lower in the inflamed gut mucosa of those with IBD than in healthy gut tissue. Early research on the effects of cannabis on IBD is quite promising, but we still have far to go before we can definitively say that cannabis is an effective treatment for IBD. For example, before using cannabis, each individual took some sort of prescription medication to treat their disease. When using cannabis, nine individuals were able to cease all prescription medication use. They also reported a drop in daily bowel movements from eight to five per person, as well as a slight decrease in the number of surgeries required. However, the changes in more objective measurements such as surgery and prescription medication records point to the possibility that cannabis was quite beneficial for these individuals. It should be noted that individual responses can vary. You should discuss your specific situation with your physician and pharmacist prior to stopping any medication you take for a chronic condition. After this time, all the patients had smoked the full 50 g, and they saw improvements in their health. The subjects experienced significant improvement in pain, health perception, depression, social functioning, and ability to work. They also had an average weight gain of 4. These researchers support the idea that the benefits were the result of cannabinoids having anti-inflammatory, anti-motility, and analgesic effects. With only 13 participants, this study is too small to come to generalizations about most people, but it does show that cannabis might be effective for some individuals with IBD. However, the fact that the subjects knew they were taking the therapy may also have had an impact on their perception of improvement. It might be limited only to pain relief and increased appetite, but it might also help by reducing inflammation. We need more research on the topic before we can know for sure how cannabis affects IBD. While most research on cannabis and the gastrointestinal tract focuses on IBD, it might be helpful for individuals with other digestive illnesses. For instance, it seems to universally be effective at reducing abdominal pain. It can be especially useful for individuals taking opioid medications for abdominal pain, as research shows that cannabis helps patients cut down on or eliminate their need for opioids and provides a treatment with fewer side effects. Cannabis also helps individuals who have a difficult time eating enough by increasing appetite and it can help reduce diarrhea and nausea. There is quite a bit of evidence for many of these symptoms, so if you think cannabis might be useful for you, please consult your healthcare team to discuss the benefits and risks associated with its use. While cannabis seems to provide many benefits, it does have its drawbacks and side effects. Short-term side effects those that only affect you while the cannabinoids are in your body at higher levels can include short-term memory impairment, diminished motor skills, decreased reaction times, fatigue, anxiety, panic, increased heart rate, increased or decreased blood pressure, and dry mouth. These effects can make activities such as driving and operating large machinery dangerous, so avoid cannabis before any activity that requires quick thinking and sharp reflexes. Long-term side effects those that affect you after consistent cannabis use can include depression, anxiety, and dependence on or addiction to cannabis products. If you typically consume cannabis by smoking it, other long-term effects, including chronic cough, bronchitis, and lung infections, can also occur. You can avoid these effects by choosing other methods of administration, such as vaporization, ingestible oils, oral sprays, and capsules. In some cases, long-term cannabis use can cause a disorder called cannabinoid hyperemesis syndrome. Its symptoms include nausea, vomiting, and colicky abdominal pain that you can relieve temporarily by taking hot showers, or permanently by ceasing all cannabis use. Abrupt discontinuation of cannabis may cause withdrawal effects and the best method of stopping cannabis should be discussed with your healthcare team. In addition, there are certain individuals who should avoid cannabis products, whether recreational or medicinal. Individuals with a personal or familial history of mental illness should also try to avoid cannabis, as it might exacerbate certain mental health syndromes. However, in children with severe seizure disorders epilepsy , a neurologist or other neuro-specialist might recommend cannabis products that are high in CBD to reduce seizure frequency and severity. This is usually only done in cases where the epilepsy is so severe that getting the seizures under control is more important than any potential risks from cannabis and other pharmacological treatment options have been tried or considered. Cannabis can also interfere with your ability to make sound decisions and judgements, so it is important to avoid risky behaviour to prevent accidents. One other thing to be aware of is the interaction potential between cannabis and other medications, which can lead to increased or decreased blood-levels of various medications. Make sure to speak with your physician, pharmacist, or nurse practitioner if you are taking other medications along with cannabis. Overall, medical cannabis is generally safe. It has virtually no overdose potential, so it does not lead to overdose death, but it is important to be aware of the potential side effects and complications, which might lead to fatal accidents in individuals who behave recklessly while using cannabis. Going forward, with legal recreational cannabis in play, it is important to ensure that individuals who require medical cannabis still have ready access to it through their healthcare teams. This should include consultations on dosing and strain type with a physician, pharmacist, or nurse practitioner trained in medical cannabis. Individuals who require cannabis as a treatment for their disease or disorder should not have to guess at what to buy from a recreational dispensary. If you wish to try using medical cannabis, speak with your healthcare practitioner. You can get a medical authorization document from healthcare professionals, which you can use to purchase cannabis through licenced medical sellers rather than recreational sellers. While some physicians are wary about prescribing cannabis, many are comfortable doing so. When using medical cannabis, always follow the advice and recommendations of your healthcare team and make sure cannabis use aligns with the other prescription treatments you are taking. According to some research, men and women use and experience cannabis quite differently. Men are generally more likely to use and be dependent on cannabis, 15 and they are more likely to report positive effects such as improved memory and increased musicality. In addition, women are more likely to use cannabis medicinally in order to treat irritable bowel syndrome, migraines, anxiety, loss of appetite, and nausea. Cannabis was the first product to be traded online. Bhang is a drink that people in India have consumed in some variation for thousands of years, often during a Hindu spring festival called Holi. Making bhang involves taking leaves and buds from the cannabis plant, grinding them up, and combining them with milk, sugar, nuts, spices, and rose water, cooking until combined, straining, and then chilling it to serve as a cold beverage. Historically, canvas was made from sturdy hemp fibres. In what is now China, archeologists uncovered the grave site of a man who died 2, years previously, and was buried along with 28 ounces of cannabis. While rare, some individuals are allergic to cannabis. Symptoms are similar to other allergies, and can include itchy and watery eyes, sneezing, runny nose, rashes, hives, wheezing, shortness of breath, and even anaphylaxis. Medical Cannabis Cannabis is a genus of plant that contains three varieties: Cannabis indica , Cannabis sativa , and Cannabis ruderalis. Cannabis Animation Video. Sorry, your browser doesn't support embedded videos. Cannabis Presentation Video. History of Cannabis. Cannabinoids and the Endocannabinoid System. One Plant, Many Uses When we develop cannabis to grow tall and strong with thick fibrous stalks that are low in THC we typically refer to it as hemp. Medicinal Uses of Cannabis. Cannabis and IBD. Cannabis and Other GI Symptoms. Negative Effects of Cannabis. What would be the best method of administration for my needs? Will cannabis interact with any of the medications I am currently taking? Do I have any insurance coverage options for medical cannabis? What side effects are likely, and what can I do to reduce this? Are there potential interactions between cannabis and my other illnesses? If I choose to use medical cannabis, what steps do I need to take to begin and continue therapy? Accessing Medical Cannabis. Did You Know? Stockwell GA. Indian Hemp Cannabis indica seu sativa. Scientific American. Supplement No. July 2, Accessed Alger BE. Getting high on the endocannabinoid system. Ahmed W et al. Gastroenterology and Hepatology. Corey-Bloom J et al. Smoked cannabis for spasticity in multiple sclerosis: a randomized, placebo-controlled trial. Canadian Medical Association Journal. Ware MA et al. Smoked cannabis for chronic neuropathic pain: a randomized controlled trial. Ostadhadi S et al. Therapeutic potential of cannabinoids in counteracting chemotherapy-induced adverse effects: an exploratory review. Phytotherapy Research. Szaflarski JP et al. Cannabis, cannabidiol, and epilepsy—from receptors to clinical response. Epilepsy and Behavior. Naftali T et al. The Israel Medical Association Journal. Lahat A et al. Impact of cannabis treatment on the quality of life, weight and clinical disease activity in inflammatory bowel disease patients: a pilot prospective study. Keyhani S et al. Annals of Internal Medicine. Nielsen S et al. Borgelt LM et al. The pharmacologic and clinical effects of medical cannabis. Kim D et al. Inverse association of marijuana use with nonalcoholic fatty liver disease among adults in the United States. PLoS One. Government of Canada. Health Effects of Cannabis. Canadian Centre on Substance Use and Addiction. August Canadian Drug Summary. Cuttler C et al. Cannabis and Cannabinoid Research. Russo EB et al. Phytochemical and genetic analyses of ancient cannabis from Central Asia. Journal of Experimental Botany. Jiang H et al. Economic Botany.
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