Over a Third of UK Doctors Would Refer a Patient to a Medical Cannabis Clinic, Poll Finds
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“Patients ask about it all the time at the hospital,” said one doctor. “I have people asking about it at the surgery,” replied another.
Like many of the 200 medical professionals that also attended the Royal Society of Medicine’s (RSM) seminar on cannabis last week, these doctors didn’t just want to hear about cannabis’ medical potential to satisfy their own curiosities, but those of their patients, too.
The patient patients
And patient interest in medical cannabis is at an all-time high in the UK. In a Sky News survey last year, 82 percent of those questioned believed medical cannabis should be legalized – an increase of 10 percent compared with a similar Sky survey from 2016.
But despite this enthusiasm from patients, doctors and health professionals, for the most part, have been resistant to prescribe the unlicensed medications since it became legal to do so last November. In a new poll of 1,009 UK general practitioners (GPs), only 37 percent said they would consider referring their patient to a private medical cannabis clinic. And that’s a figure the organizers of the RSM’s seminar woud like to increase.
“It has become clear that GPs are crying out for more education on medical cannabis, and rightly so,” said Dr Mikael Sodergren, the managing director of Sapphire Medical Clinic, which both organized the recent seminar at the RSM and commissioned the recent poll.
“Polling figures like those show that GPs simply haven’t had the education they want and need on medical cannabis,” he continued in a statement. “This is a worrying and frustrating barrier for potential patients. At Sapphire we want to lead the way in providing GPs education to promote better understanding of medical cannabis.”
Gathering the evidence
Along with the Academy of Medical Cannabis, Sapphire Medical Clinic is one of the leading groups in the growing movement to educate UK doctors on cannabis’ medical potential. So, what should doctors know?
“They should know about the various constituents of cannabis and what the differences are,” Dr Amir Englund, a speaker at RSM’s recent seminar and a postdoctoral cannabis researcher at King's College London, told Analytical Cannabis. “THC potentially [has] some medical benefits in some areas while it might be harmful in others, whereas CBD might be beneficial for something like psychosis, but seems to not have that much benefit for things like depression,” he added.
But despite this medical potential – and ample prescriptions across the pond – many UK doctors still feel too sceptical to take the plunge and prescribe. And as recent reports and reviews have demonstrated, that doubt is somewhat scientifically supported.
“There might be all sorts of benefits from cannabis,” Englund continued. “But the problem we see in research is all the hype that's being built around cannabis… with that comes a potential for a very strong placebo effect.”
“And that's one of the key sticking points when it comes to a field like medicinal cannabis research: a lot of studies don't have a placebo comparison, or [are] based on people who go to dispensaries and use for their own medical conditions and their own self-reports of cannabis.”
One recent review published in the Lancet Psychiatry, found little evidence to support medicinal cannabis or pharmaceutical CBD’s use to relieve depression, anxiety, attention-deficit hyperactivity disorder (ADHD), Tourette syndrome, post-traumatic stress disorder (PTSD), or psychosis.
Even among the RSM seminar’s panel, support for marijuana’s clinical efficacy was sometimes hard to come by. Dr Peter Irving, a consultant gastroenterologist, said that while many inflammatory bowel disease patients use cannabis as a medication, the drug’s effect on inflammation is still unclear. And Praveen Anand, a professor of clinical neurology at Imperial College London, told attendees that “the jury is still out on cannabis and chronic pain.”
Education, education, cannabis
Ultimately, while several of the speakers recognized the role of the endocannabinoid system in pain sensation and stress response, most concluded that more clinical evidence is needed before UK clinicians can be confident in cannabis’ safety and efficacy.
“That's one of the main things highlighted in [the Lancet Psychiatry’s] meta-analysis: there's not been enough clinical trials to say one way or the other if cannabinoids can be beneficial,” Englund added.
However, not every single scientific review into medical cannabis has been without an endorsement. One of the most comprehensive reviews ever undertaken into the plant’s medical properties concluded in 2017 that there was enough evidence to support treatment in three areas: to reduce nausea from chemotherapy, to treat chronic pain, and to reduce spasms from multiple sclerosis.
And while these conflicting conclusions could support the need for more placebo-controlled studies, organizations like Sapphire Medical Clinic can also cite the positive reports to evidence their prescription framework, which, along with many other conditions, supports treating chronic pain, chemotherapy-induced nausea, and multiple sclerosis with medical cannabis.
The clinic recently renewed its offer to work with the UK’s NHS, which, as an institution, has been reticent to prescribe medical cannabis to patients.
“I have first-hand experience of seeing just how life-transforming medical cannabis can be,” said Dr Michael Platt, Sapphire’s medical director, in a statement. “It’s not a silver bullet and it’s not for every patient. But it can and does work. We would be delighted to work with the NHS to bring our expertise to bear to a greater number of patients.”
Even if this offer is rejected and most NHS patients continue to be denied cannabis prescriptions, their cannabis curiosities are unlikely to be so easily blocked. Which is why events like Sapphire Medical Clinic’s seminar could be so valuable – because even if the proportion of doctors interested in medical cannabis doesn’t breach 37 percent, at least that group finally has some cannabis education.
“The fact is patients will come asking for medical cannabis and as GPs we are going to have to know how to signpost them to get more information,” said Dr Ruchira Karunadasa, a GP who attended the cannabis seminar. “Otherwise the reality is patients may self-medicate. We shouldn't fly blind and need more information to inform our practice, but it is really difficult to find.”