Cannabis Health News by gary-aspectpublishing.co

Covering cannabis medicine and wellbeing products from every angle

Stretching the boundaries of the CBD craze

Brain tumours and cannabis - the search for evidence

ISSUE 02 / Q1 2020

How CBD saved my sex life

Your guide through Britain's changing landscape

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WELCOME

Cannabis Health is delivered every quarter to people across the UK interested in the potential health benefits of cannabis medicines and wellbeing products. It is supported by an editorial panel of experts and aims to provide clarity, balance, insight and inspiration. Our editorial panel members include: Hannah Deacon, who successfully campaigned to enable her epileptic son Alfie Dingley to legally receive cannabis medicine. Today she continues to campaign to help more families access medicinal cannabis in the UK.

Professor Mike Barnes, who obtained the first medicinal cannabis licences in the UK for Sophia Gibson and Alfie Dingley, and has been involved in efforts to assist many others.

We are currently offering a limited number of free annual subscriptions. To claim yours visit www.cannabishealthnews.co.uk For advertising enquiries contact gary@aspectpublishing.co.uk Send your stories and opinions to andrew@aspectpublishing.co.uk Also on the Cannabis Health team: Andrew Mernin, editor andrew@aspectpublishing.co.uk Gary Wilding, commercial manager gary@aspectpublishing.co.uk Aimee Thompson, head of design

Our editorial content is also supported by: The Medical Cannabis Clinicians Society, an independent community of medical cannabis pioneers â&#x20AC;&#x201C; the first prescribers of this treatment in the UK. This expert-led, not-for-profit community, is dedicated to bringing this safe, legal and effective medicine to people living with chronic conditions.

aimee@aspectpublishing.co.uk Contributors: Ethan Sisterson, Deborah Johnson, Peter Jackson. Cover image courtesy of Freepik

For regular updates on all things medical cannabis visit cannabishealthnews.co.uk

WELCOME

Editor's comment Cannabis Health is your new essential update covering cannabis health and wellbeing issues from every angle, writes editor Andrew Mernin.

The very existence of this magazine owes much to the cast of healthcare decision makers who have collectively made such a mess of opening up access to medicinal cannabis in the UK. Almost 18 months after the landmark legislation change that meant doctors could prescribe medical cannabis for the first time, little has changed for families affected by chronic and life-threatening conditions. Many are faced with a choice between missing out on a potentially life-saving treatment, or pursuing it privately and undergoing financial hardship in the process. In the meantime, doctors are receiving mixed messages about when and how to discuss medical cannabis with their patients, and need more support in building their knowledge base amid growing patient interest in such treatments. Cannabis Health magazine began as a platform to provide a voice to families frustrated by lack of access to medical cannabis, and to help provide clarity and balanced opinion to anyone interested in it, on either side of the patient/doctor divide. However, we have since expanded our remit to also focus on the many exciting wellbeing possibilities of CBD and other cannabis-derived products. As a journalist there can be few more exciting places to cover right now than the burgeoning markets building up around cannabis products - whether they are in cosmetics, fashion, supplements, drinks or pet food,

to name just some of the emerging applications being found for cannabis. The resurgence of a plant that was used for everyday health and wellbeing needs thousands of years ago, but demonised in the 1950s, is a remarkable story of the modern age and one we aim to cover thoroughly, colourfully and with a commitment to being balanced and unbiased. We hope you'll join us on the journey as a magazine subscriber, and check us out online too for daily updates at www.cannabishealthnews.co.uk. Until next time, happy reading! Andrew Mernin Editor, Cannabis Health andrew@aspectpublishing.co.uk

Cannabis Health is owned and published by H&W Media Ltd, 11 Lansdowne Terrace, Gosforth, Newcastle upon Tyne, NE3 1HN. DISCLAIMER: This publication is intended for an 18+ audience. The comments and opinions given by contributors, quoted sources and interviewees are not the views of the editorial team or publisher unless otherwise stated. This is an editorial magazine, not a peerreviewed medical journal. Anyone interested in accessing medicinal cannabis is urged to consult their GP first. Cannabis Health cannot accept liability for any issues or comments raised by individuals featured in this publication.

CONTENTS

2 4 I N S E A RC H O F T H E 2 0 ,0 0 0 Landmark study that could put 'more evidence' calls to bed

08 N E W S

2 6 PAW S F O F T H O U G H T

Campaigners fight back, Parkinson's trial, retail fears, industry updates and more...

The rise and rise of CBD-infused pet-food

3 4 YO G A PA R T Y London gym stretches the boundaries of the CBD craze

28 W H E R E T H E R E ' S A W I L L ... The little boy inspiring a revolution in cancer research

CONTENTS

3 8 I B RO K E T H E L AW

4 2 A V I E W F RO M I R E L A N D

Ex-cop's journey to save her son

Battle goes on for the indomitable Vera

6 2 B RO K E N S YS T E M Renowned US doctor assesses British prognosis

4 6 U N D E R T H E C OV E R S How cannabis saved my sex life

NEWS

Israel boosts UK medical cannabis access BOL Pharma has made history by completing the first shipment of medical cannabis from Israel to the UK. BOL is reportedly the only Israeli company to comply with international regulations and the first to obtain approval for exporting medical cannabis products, manufactured under strict conditions. Astral Health, a specialist import and distribution company, brokered a strategic partnership with BOL, which is Israel's largest and leading manufacturer of GMP (good manufacturing practice) certified medical cannabis products. The import marks the start of a new era for the UK medical cannabis industry after a period of reliance on irregular and unreliable pharmaceutical grade product coming into Europe from Canada and antiquated systems bringing in product from the Netherlands. "This is truly welcome news and a real breakthrough for the Israeli medical cannabis market," BOL Pharma CEO Dr. Tamir Gedo said. "The Israeli cannabis industry has a huge competitive edge in the global arena, compared to many countries trying to enter the cannabis sector. "Further opening of the market to exports will enable Israel to become a world leader in the coming years."

This medical cannabis shipment will be used to treat patients in the UK with treatment-resistant epilepsy, and marks the first of many shipments the company will make over the coming months from Israel. The shipment comes after changes led by the Israeli government in its resolution from January, enabling BOL to operate as a leading exporter of cannabis and its derivatives. “These are exciting times which symbolise a true breakthrough for the Israeli medical cannabis market,” said Hagai Hillman, BOL Pharma’s founder. He added that Israel is at the forefront of the life science industry throughout the western world in terms of regulation, research and product development, and quoted BOL’s ongoing “advanced clinical studies for various indications, including pain syndromes, oncology, orthopaedics, neurology, gynaecology, autism and paediatric diseases". "Harnessing the developing exports will allow us to continue benefiting children and severely ill patients around the world," he said. Read more global stories on medicinal cannabis online at www.cannabishealthnews.co.uk.

NEWS

Skincare revolution takes off CBD-infused cosmetics sales set to explode 09

Small indie makeup brands are stealing a march on larger cosmetics firms in expanding into the CBD skincare market, research shows. A new report suggests that the CBD skincare market is projected to generate ÂŁ734m in annual sales by 2024. It explains that cannabis, with its antioxidant and anti-inflammatory effects, is disrupting the traditional beauty market and supply chain as consumer demand skyrockets for innovative natural cosmetics products. The report, produced by cannabis market intelligence and consultancy organisation Prohibition Partners, finds that smaller indie brands have driven recent developments in the CBD beauty market, as multinational companies remain wary of CBD's complicated legal status. It also shows that select brands are exploiting the interest surrounding cannabis-derived CBD oils to sell beauty products containing low-CBD hemp seed oil, in a practice known as "weed washing". Continued consumer education will be vital to ensuring the longevity of the CBD beauty market, the report concludes. Prohibition Partners' managing director Stephen Murphy, said: "Cannabis and CBD are rapidly being integrated into a wide spectrum of mainstream consumer products, being used in everything from pet food to skincare. "Thus far, the disruption we've seen in the beauty industry is nothing short of remarkable, attracting

attention from high-street retailers, global brands and indie entrepreneurs. "Consumers are looking for new and exciting products derived from natural and sustainable sources and cannabis continues to fit this mould, driving product demand through the roof." "There are constant questions on the longevity of this trend but with the ability to act as a natural antiinflammatory agent and an antioxidant, cannabis is becoming one of the most disruptive forces in the beauty and personal care industry in the last two decades." A separate report by Market Watch from November 2019 estimated the overall global CBD cosmetics market to be valued at over ÂŁ451m, with North America the biggest market currently. See more cannabis products industry stories online at www.cannabishealthnews.co.uk.

NEWS

The good, bad and "daft" of new CBD guidance 10

New rules for companies selling CBD products in the UK could unfairly punish smaller, artisanal brands, one expert warns.

The Food Standards Agency’s (FSA) move to better regulate the CBD market also includes dosage recommendations which have been described as “absurd’ and “based on no evidence”. Some cannabis industry bodies have welcomed the FSA’s recent intervention, however, describing it as a muchneeded step towards clearer regulation in the UK CBD market. The FSA has given the CBD industry a deadline of 31 March 2021 to submit valid novel food authorisation applications. A novel food is defined as a type of food that does not have a significant history of consumption or is produced by a method that has not previously been used for food. While hemp-based foods have been consumed for thousands of years, and are deemed non-novel, the novel food status of CBD extracts was confirmed in January 2019. After 31 March next year, only products which have submitted a valid application will be allowed to remain on the market. The authorisation process ensures novel foods meet legal standards, including on safety and content, the FSA says. Local authorities enforce the novel food legislation and have been advised that businesses should be able to sell

their existing CBD products during this time provided they are not incorrectly labelled, are not unsafe to eat and do not contain substances that fall under drugs legislation. In addition, the FSA has advised those who are pregnant, breastfeeding or taking any medication not to consume CBD products. It has also recommended that anyone takes no more than 70mg a day unless under medical direction – advice which has been questioned by one expert. “This is daft and totally without any evidence whatsoever. None,” says Professor Mike Barnes, chair of the Medical Cannabis Clinicians Society. He adds: “Since the efficacious dose in adults is about 60100mgs that makes no sense. The FSA suggests not taking CBD with any other medication despite an excellent safety profile. They say they draw from a recent report from the Committee on Toxicity, which suggests nothing of the sort.” Professor Barnes also has concerns about the potential impact of the new guidelines on the UK’s burgeoning CBD retail market. “This could decimate the CBD industry. It will remove a good medicine from hundreds of thousands of people

NEWS

who are benefitting from it. “The sellers can’t make medical claims now but nevertheless it is a medicine that helps so many people with pain, anxiety, sleep and appetite, let alone epilepsies. Some CBD can be prescribed but that, as we know, is so tricky and frankly impossible on the NHS and very expensive privately. “For sellers to apply for novel food authorisation, it will be very expensive and very time consuming. This plays into the hands of 'big cannabis' who can afford the potential cash flow issues and expenses, and it just drives the small artisanal guys off the shelves.” Peter Reynolds, head of Canna Pro, a trade association for UK cannabis, CBD and hemp businesses, also has misgivings about the FSA’s latest actions. He told the press: “In one sense this announcement is good as now the industry knows where it stands. It was in 2017 that I first started talking to the FSA and they have changed their minds repeatedly, shifting its position over and over again. Finally, they have now actually done something. “The maximum recommended dose for CBD food supplements is 200 milligrammes. So, the differences are so vast they are just absurd. “The whole thing is preposterous. The FSA have failed to respond to any correspondence from CannaPro for the past six months. They obviously feel under pressure to do something. They have used the phrase 'novel', but these products are not novel. I think anybody selling whole CBD extract products can just continue. The crucial part is that if they really had any genuine concern about safety, how could they possibly give people only a year to submit an application?” Another UK body, the Cannabis Trades Association (CTA), was more welcoming of the news, however. In a statement, it said: “Although [we] duly welcome a route to compliance for the industry and its members, we are still of the opinion that natural products (not isolates or synthetic forms) do not fall under the scope of the novel food schedule. “The CTA fully supports regulation as it ensures consumer safety and gives clarity to the processes required for its members’ products to remain in stores across the country. We are continuing a full review process including legal aspects and avenues into the current and proposed regulations for CBD in the UK, whilst maintaining close relationships with relevant authorities and stakeholders. In reality, not all members will be affected by the proposed legislative changes. “Further to the highlighted safety concerns, the CTA agree that CBD as a food supplement should not be administered in high daily doses (above 200mg), and consumers should always seek approved medical guidance if taking other

medications or during pregnancy. “We also maintain our position that CTA members' products are compliant and continue to pose no safety concerns to those consuming within the set guidelines. “In summary, although we do not agree in full with all that is being proposed, we believe it is a positive step towards ensuring consumer safety and that CBD will be on the shelves for many years to come." Explaining the FSA’s stance, its chief executive Emily Miles said: “CBD products are widely available on the high street but are not properly authorised. The CBD industry must provide more information about the safety and contents of these products to the regulator before 31 March 2021, or the products will be taken off the shelves. “Also, we are advising that CBD could be risky for vulnerable groups, and suggesting an upper limit of 70mg a day for everyone else taking the product. “The actions that we’re taking are a pragmatic and proportionate step in balancing the protection of public health with consumer choice. It’s now up to industry to supply this information so that the public can be reassured that CBD is safe and what it says it is.” Professor Alan Boobis, chair of the Committee on Toxicity, said: “My committee has reviewed the evidence on CBD food products and found evidence there are potential adverse health effects from the consumption of these products. We are particularly concerned about pregnant or breast-feeding women and people on medication. “We don’t know enough to be sure about such a risk but I am pleased with the sensible and pragmatic approach the FSA is taking. The committee will continue to keep these products under review in the months ahead.”

NEWS

Drinks makers tap into cannabis surge 12

The global market for drinks containing cannabis is expected to be worth £2.1bn by 2025, with Canada leading the way in developing new products...

A report by Grand View Research suggests that the majority of companies in the sector are based in Canada owing to the legalisation of cannabis for medical and recreational purpose in the country. By type, non-alcoholic drinks represented the largest and fastest growing segment in 2018, while beverages infused with the CBC cannabinoid are estimated to grow fastest over the forecast period. In Europe, the Netherlands holds the largest market share owing to the presence of cafes and restaurants dedicated to cannabis consumption and cannabis tourism. Key players operating in the global market include New Age Beverages Corporation, The Alkaline Water Company, Phivida Holdings Inc., Koios Beverage Corporation, VCC Brand, Dixie Brands Inc, Keef Brand, Hexo Corp, Aphria and Canopy Growth. Rising popularity of wellness drinks is also expected to support demand over the forecast period. The legalisation of cannabis for medical and recreational purpose has had a strong impact on the sales of alcoholic drinks, the report explains. As a result, many alcohol manufacturers are investing in the growing

trend of marijuana-infused drinks. For example, Lagunitas, Heineken’s fast-growing California beer label, has launched Hi-Fi Hops, which is a cannabisbased beverage with zero calories or carbs and infused with cannabidiol (CBD) and tetrahydrocannabinol (THC). In 2017, Constellation Brands, the third largest beer manufacturer in US entered into a partnership with Canopy Growth to develop cannabis-infused beverages. The report states: “Consumers are shifting their preference from soft drinks to wellness drinks leading to increasing sales of cannabis beverages. Low sugar content in drinks is the major driving factor for the growth of the market. “Also, consumers prefer these beverages as an alternative to cannabis smoking and consumption of marijuana-infused chocolates, cookies, brownies and confectionaries like gummies and candies. Off trade sales channels, such as hotels, cafes, restaurants, clubs, and lounges, are expected to boost the popularity of the product among consumers.” Strong demand for cannabis beverages from millennials is also anticipated to drive the market growth, the report adds.

NEWS

Parkinson’s and medical cannabis study kicks off A partnership between Australian and US-based organisations is aiming to discover new insights on medical cannabis use among people with Parkinson’s disease (PD). Australian medicinal cannabis company Zelira Therapeutics is working with America’s Parkinson’s Foundation to gather insights from people with PD about their understanding of and use of medical cannabis and hemp-derived therapies. Zelira is assisting in the development of a survey to understand the current use and perceived benefits of medical cannabis among people with PD. The results will be reviewed, and will possibly pave the way for a future clinical trial on the safety and efficacy of medical cannabis use by people with PD. Zelira will also incorporate survey insights to inform the future development of clinically validated medical cannabis and hemp-derived CBD medicines for people with PD. It will also provide guidance to people with Parkinson’s regarding various cannabinoid-based and hemp-derived treatment alternatives. John Lehr, president and CEO of the Parkinson’s Foundation, said: “Many people with Parkinson’s disease

are seeking help with their symptoms by trying various forms of medical cannabis. “The volume and frequency of questions the Parkinson’s Foundation receive from people with Parkinson’s regarding the safety and impact of medical cannabis and CBD has led us to examine this public health issue more fully, and to seek collaborations with leaders in the field from academia, government, advocacy groups and industry to provide the most accurate information possible. Zelira Therapeutics, a leader in disease-specific medical cannabis therapeutics, has committed to helping people with Parkinson’s understand the role that medical cannabis might play in managing their daily symptoms.” Tom Borger, chief business officer at Zelira, said: “The challenge for people with Parkinson’s is clear, as there is a lack of definitive studies informing clinicians and patients with Parkinson’s about the safety and efficacy of medical cannabis. One of the objectives of the survey and this collaboration is to provide guidance to people with Parkinson about the need for clinically validated medical marijuana and hemp-derived CBD medicines that might address their symptoms.”

NEWS

Families fight back against system failings Parents head to the Capital to make their voices heard at Westminster.

Parents of children with severe epilepsy held a protest at Westminster recently over the governmentâ&#x20AC;&#x2122;s failure to open up medical cannabis prescriptions on the NHS. In November 2018 new legislation was introduced, supposedly allowing doctors to legally prescribe medical cannabis for certain conditions. The move proved a false dawn for many parents seeking access to potentially life-saving products for their children with severe epilepsy, however. Private prescriptions have been readily available, although they can cost families thousands of pounds per month, prompting some to take drastic measures such as putting their family home on the market and launching charitable foundations just to enable them to make ends meet while treating their children. But the NHS prescriptions that families were expecting have not materialised, almost 18 months on from the legislative change. In response, around 20 families gathered at Portcullis House in central London to pressure the government into ensuring the medicine is given to those who need it. A Department of Health and Social Care spokesman said: "We continue to work hard with the

health system, industry and researchers to improve the evidence base for other cannabis-based medicines." Last November, NHS England said access to Epidyolex, which contains only the CBD extract, had been fast-tracked to be available from January this year. The medicine was recommended for use on the NHS to treat two rare types of epilepsy, Lennox-Gastaut and Dravet syndromes. Many parents, however, want to see other products, including those containing THC, also accessible on the NHS. They are calling for a judicial review of NHS rules and National Institute of Healthcare and Excellence (NICE) guidelines. Online at cannabishealthnews.co.uk: Meet the families leading the fight for access to medical cannabis.

NEWS

A helping hand for patients seeking medical cannabis A new national charity which will provide financial support to patients of modest means wishing to access medical cannabis has been launched. The Sapphire Medical Charity provides grants to patients who have a verified clinical need for medical cannabis but have financial limitations. Its trustees include England rugby star George Kruis, Conservative grandee Sir Mike Penning and co-founder of Families4Access and CPASS Basia Zieniewicz. Sir Mike Penning said: "I was delighted to play a role in achieving the law change of November 2018 which saw cannabis re-scheduled allowing it to be prescribed by specialist doctors. "But [over] one year on, the number of patients actually getting access is pitifully small. Private clinics are playing their part in widening access, but it’s essential that everything is done to make sure people on more modest incomes can get access. "That’s why I am delighted to be a prospective trustee of this new charity. It is heart breaking to meet the patients and their families who are in such desperate need of this medicine but who are having to either go without, struggle to raise enormous sums of money to pay privately or break the law to achieve access. I know that the public continue to be moved by the distressing cases

that feature regularly in the media of patients and their carers being denied access to medical cannabis and having to raise thousands of pounds to fund it privately whilst still having to cope with the condition itself." George Kruis said: "I know from my own personal experience with solely CBD products just how beneficial medical cannabis can be. "This is a rapidly developing field of medicine and I’m delighted to be part of this ground breaking foundation. "I know that medical cannabis works and it’s really important that financial barriers are reduced as much as possible to allow suitable patients to access it. “I fully believe that mainstream medical cannabis should be available for athletes. "I personally believe it is a substance that is not performance enhancing and carries many benefits such as providing a natural method for pain relief” Lorna Bland, a medical cannabis patient said: ‘Medical cannabis has been life changing for me, and I’m very fortunate to be able to afford it. "However, many can’t, so I welcome the plans to set up this new charity to support patients in need, and wish it well." See more at www.sapphirefoundation.co.uk.

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NEWS

CBD confusion reigns in the UK – poll

One in five Brits wrongly believes that CBD is illegal, according to a study highlighting widespread confusion about cannabis products.

CBD, short for cannabidiol, is a chemical compound found in plants from the cannabis family that has no psychoactive effects. Yet, more than a fifth (21 per cent) of survey respondents believe CBD is illegal and addictive (22 per cent), while 7 per cent believe it can give you ‘the munchies’ – suggesting many still confuse CBD with THC, the psychoactive ingredient in cannabis. CBD is completely legal and non-addictive and can’t get you high, contrary to what 14 per cent of people in the poll believe. Positively, nearly seven in 10 survey respondents (68 per cent) recognised that CBD has health benefits, with over half (59 per cent) saying they assumed it could help with a medical condition. Additionally, more than four in 10 (41 per cent) know it can be prescribed by doctors following former Home Secretary Sajid Javid’s announcement in 2018 that specialist hospital doctors would be able to legally prescribe cannabis-derived medicinal products. The survey of over 2,000 UK adults was commissioned to discover whether the recent spate of headlines regarding CBD had made a difference to people’s understanding and found that 64 per cent of respondents don’t believe it can be sold in shops.

NEWS

As a relatively new wellness trend, a report by the World Health Organisation in 2017 found that CBD could possess numerous health benefits to relieve chronic pain, anxiety and insomnia. While the survey uncovered a number of people who recognised these health benefits, almost half of the population (48 per cent) reported feeling confused and divided on whether you could refer to CBD as ‘medicine’. Nicola Webster is from Vape UK and was part of the team behind the research. She said, “It’s a real shame that research into the true potential of cannabis and, in particular, cannabinoids like CBD, has been stunted by socio-political factors. Our prejudices and fears towards cannabis have been ingrained over many years. I believe this has led to the kind of misinformation and confusion we see in the results of our study. It is positive to see that a significant percentage of UK adults recognise that CBD has health benefits. However, it’s also obvious that many people are still conflating CBD with THC. As the industry grows, it’s vital that the correct advice is provided, and more empirical studies are conducted, so that people can make sensible, well informed decisions about how CBD could help with their particular health concerns.”

It’s a real shame that research into the true potential of cannabis and, in particular, cannabinoids like CBD, has been stunted by socio-political factors. 19

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oils, edibles and drinks and each method has its benefits. Oils are quick and effortless; edibles taste nicer than oils and drinks can be enjoyed at almost any time, in almost any situation. Drinks are especially interesting because they’re arguably the most enjoyable way to consume CBD, but only if done right! 23

A quick rundown: Little Rick is our sparkling CBD beverage. We have three flavours, Raspberry Coconut, Piña and Mint & Lime. Our drinks are high strength CBD drinks which also contain other cannabinoids. So, alcohol or no alcohol? Little Rick is non-alcoholic and often seen as an alcohol alternative. This is because, by nature Little Rick achieves similar goals to having a glass of wine in the evening but rather without the calories, hangover or future health concerns. We wanted to spruce it up a little, why do you think we chose popular cocktails for our flavours? We suggest that Little Rick definitely can and should also be used as a mixer with your favourite spirits. We have even published our own simple cocktail recipes! Oils, edibles or Little Rick? With so many choices for how to take CBD, and so many brands selling their version, people are overloaded with options (…CBD toothpicks anyone...?) Well, CBD is on trend right now and let’s just say some people got a little carried away. Many products aren’t designed with CBD consumption or absorption in mind, though I will admit I haven’t worn CBD infused clothes yet and shouldn’t assume. The most common CBD consumption methods include

Don’t put all your eggs in one basket Before producing our first round of drinks last year, we spent around a year in research and development. During this time, we realised CBD alone is not the only reason why this trend began. In fact, leading Israeli medicinal cannabis firms also put huge benefits down to the terpenes found in hemp plants. Although everyone talks about CBD, other nonpsychoactive cannabinoids should not be forgotten, such as CBG and CBC. Each with their own properties and publicised benefits. We decided not to isolate CBD and instead Little Rick contains the terpenes, flavonoids and other cannabinoids from hemp. So why do they love Little Rick? Little Rick stands out next to other methods and drinks by the incredible bioavailability of the CBD. We create tiny balls of CBD, called liposomes, which are immersed in each drink. These liposomes allow the CBD to be absorbed up to 4x more effectively compared to oils, edibles and other drinks. On top of a better absorption rate, Little Rick has the highest levels of CBD in any drink, with a whopping 32mg per can. Fancy a CBD tipple? Buy online @ www.littlerick.co.uk Use discount code ‘HEALTH10’ for 10% off From Charlotte Nielsen, co-founder Little Rick

NEWS

“The rest of the world is so far ahead of us it’s embarrassing” 24

After being famously sacked as the government’s chief drugs advisor by then-Prime Minister Gordon Brown in a dispute over the legal classification of cannabis, Professor David Nutt is making headlines again…

He’s now a prominent campaigner for the acceptance of cannabis as a vital medicinal product, and leader of Project Twenty21; the biggest medical cannabis patient trial in Europe, which aims to engage 20,000 patients by the end of 2021. The project is spearheaded by the body he founded to drive independent research into drugs, Drug Science. Its aim is to gather the evidence which will convince policy makers and prescribing bodies of the need to bring medical cannabis into greater use – something which still has not happened, despite the law changing on November 1, 2018, to allow cannabis-based products to be available on prescription. “Like most other people, we thought the job was done when the Chief Medical Officer said that cannabis, of course, is a medicine and the Home Secretary moved it from schedule one to schedule two, and then we thought we could move on to campaigning on other drugs,” says Nutt. “But after a few months, it became clear that nothing was happening. And we got more and more irritated, like many parents and patients, and we thought, ‘What can we do?’ If other people aren’t going to get on and do it, then maybe we can. This is the vision of Project Twenty21. “The rest of the world is so far ahead of us, it’s embarrassing. Our aim is for NICE and other regulators, expert groups, consensus groups and guideline groups to come to the conclusion that we have already come to – that cannabis is a medicine and it works.” Within the first few hours of the project being launched

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in November, 4,000 people had signed up. As well as offering the opportunity to patients with conditions including chronic pain, epilepsy and MS to try cannabis treatments, the project will cap the prices of medicine at £150 per month, far less than many people who are able to secure a prescription are currently forced to pay. There is also provision for 1,000 free treatments to ensure the trial is as inclusive as possible. The project is backed by the Royal College of Psychiatrists, British Pain Society, United Patients Alliance, three medical cannabis companies and a host of experts and campaigners. Nutt is all too aware of the ongoing controversy surrounding cannabis – a factor he attributes to being ‘largely’ the reason for his dismissal from his government post in 2009 – but is committed to changing the stance of the medical profession. “Every doctor knows that every time you prescribe any drug to any patient, you are doing an experiment. I believe there is no medicine in the medical world that you can guarantee will work when you prescribe it. So every time you prescribe, it’s an experiment. “And how do you judge the efficacy? You look at outcomes in that patient, because that’s what you care about. So that’s what we’re doing here. We will get clinical effectiveness data and will look at adverse events. “We know that one of the great concerns that many doctors have is that these drugs are viewed as being very dangerous – this comes from doctors and other people telling the world that this is the case, even though they don’t know, because that’s what the government’s told them to do. “It’s very difficult when you have 50 years of telling the world that cannabis is illegal because it’s a very dangerous medicine. It’s quite hard to change that mindset. That narrative becomes quite entrenched, particularly among older people, older doctors. “But we think if we collect good data on adverse effects, we will be able to bust this bubble of hysteria around the claim that it’s going to cause schizophrenia.” As well as the evidence on medical benefits it is hoped the trial will collect, Nutt also points to the vast cost savings for the NHS that can be made. “It seems to us from what we can do in other countries that medical cannabis is going to save the health service a lot of money. We have examples of single patients saving their NHS Trust £20,000 a year through buying their own medicine, and those examples will be found across the country,” he says. “It’s currently relatively expensive, and then there is the absurd bureaucracy that’s been built up to actually prevent people getting access to this ‘dangerous’ drug.

We are beginning now to get governments to understand the human costs involved. For example, the cost of being a carer is vast. This can help to show that cannabis is an extremely cost-effective approach to many disorders. “We are working with Martin Knapp, Britain’s expert on the value of medicine. He is helping us design the protocols to make sure we can get the right economic outcomes to finally put the nail in the coffin of the idea that medical cannabis is going to break the NHS.” As well as changing perceptions and policy alike, Nutt is determined to save desperate patients from resorting to the drastic measures many currently are being forced to take. “If you’re not getting it prescribed, which most people aren’t, then you are breaking the law. You’re going to the black market, and that has a number of very, very serious problems,” he says. “You can get arrested. There are court cases still going on with people who are using legal cannabis, it’s outrageous, a complete waste of taxpayers' money, but it’s happening. “Worse than that you don’t know what you’re getting. Because there’s no quality control. You’re exposed to people who are often rather unpleasant and potentially dangerous. You may get contaminated products. So it’s not just a failure of medicine. It’s also making things worse because you’re forced into a very difficult and dangerous underworld. “Medical cannabis is still out of reach for far too many. Patients don’t deserve any of this, and the situation with prescribing desperately needs to change. Through Project Twenty21, we hope to work towards achieving that.” Professor Nutt was addressing an audience at an event hosted by the Medical Cannabis Clinicians Society in London.

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Would nine out of 10 cats prefer CBD? 26

A surge in sales of cannabis products for animals is shaking up the pet food industry, as Ethan Sisterson reports. Cannabis-based health and wellbeing products have become big business in recent years, as consumers seek to manage various conditions and boost their fitness with CBD. And now our furry friends are getting in on the act, led by change-makers in the US pet products industry. According to research body Brightfield Group, America’s CBD market will be worth almost US$24bn by 2023 – and seven per cent of sales will come from the pet market. Evidence of the benefits of CBD products for animals is also growing, and many pet owners – like Joey DiFrancesco of New York – are duly responding.

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Joey runs online retailer LolaHemp, which sells CBD oils for pets. He was inspired to set up the business after witnessing the impact of CBD on his own dog, Lola. He says: “Our Chihuahua had a horrific phobia of noise. Every time it thundered she would run under my mother’s bed and repeatedly shake. “So she was one of the first dogs we tested our CBD oils on, and it completely takes the edge off for her. During harsh thunder storms, she can actually hang on the couch with us and she’s not nearly as scared.” Anxiety is one of many doggy problems CBD products can reportedly help. Another is arthritis, with studies suggesting that CBD can relieve pain, thus dramatically improving life quality for older pets. In a 2018 study by Frontiers of Veterinary Science, 80 per cent of the dogs experienced “significant” pain relief and increased mobility when given CBD medication. Joey says: “The best application we’re seeing for CBD is for older and disabled dogs and those with joint pain and arthritis. Thousands of older dogs are benefitting from better management of that pain. “Dogs that could not get up and down stairs previously seem to have a whole new burst of energy. They’re acting like their young selves again.” Joey says he also has anecdotal evidence – from many happy customers – of the impact of CBD on animals with epilepsy who suffer seizures. “We’re seeing dogs that used to have seizures every day, week or month having a lower frequency of seizures. Since they started using our products, some dogs have stopped having them altogether. “We have a great success story about a working dog who was having severe seizures while keeping out different types of predators from its owner’s crops. Since she was on our products, she stopped having seizures and was able to go back to work.” Joey believes CBD can also help to manage allergies in dogs and to calm aggressive dogs down, making interaction with humans and other dogs much easier for them. Joey stresses that CBD is not a definitive treatment for epilepsy, with his findings based only on customer feedback rather than clinical research. But there is some evidence to back this up, with one small study finding encouraging results when using CBD oils to treat dogs with epilepsy. Dr Stephanie McGrath of Colorado State University gave 14 dogs two daily doses of CBD oil for 12 weeks. The results showed a significant decrease in the number of seizures over this period. Because CBD products are cannabis-based, many pet owners are reluctant to use them, partly in fear of side effects to their animal; and also perhaps because of the

America’s CBD market will be worth almost US$24bn by 2023 – and seven per cent of sales will come from the pet market. general taboo that can cloud anything connected to the c-word. Owners may understandably be hesitant to give their pets something that, in many countries, is considered toxic to animals. Research into this issue, however, suggests a low chance of side effects for animals. A study published by the Veterinary Information Network, for example, showed that 80 per cent of dogs that were given CBD to help relive pain and anxiety experienced no adverse effects. Dr. McGrath’s aforementioned study also notes that owners observed no major changes in their dog's behaviour. While research into the benefits and possible dangers of cannabis-derived pet products remains limited, there is no shortage of demand for them. In a 2019 survey, 11 per cent of dog owners and eight per cent of cat owners revealed they had given their animal either CBD or hemp supplements in the past. The findings, by market research group Packaged Facts, coincides with the reported 63 per cent of vets in the US who say they are asked about the availability of these products at least once a month, according to the Veterinary Information Network. It is not only household pets that are seeing the benefits of CBD-based animal products. Californian company Phyto Farmacy, for example, is marketing CBD oils for pain relief in farm animals, particularly horses. In the UK, there are currently no CBD products authorised for veterinary use. According to the Veterinary Medicines Directorate (VMD), however, a veterinary surgeon may prescribe a legally obtained human CBD product “under the provisions of the prescribing cascade”. Until September 2018, CBD shops in the UK were able to supply pet owners with products for their animals. But the VMD then announced its firm stance on the issue and trade was halted. The VMD believes veterinary products containing (CBD) are veterinary medicines and should be regulated as such.

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Where there’s a Will, there’s a way 28

Brave William Frost was given less than six months to live when his terminal condition progressed. Then his parents discovered CBD, and a special diet, and everything changed. They’re now on a crusade for the truth about cannabis medicine’s potential as a cure for childhood brain tumour, as Andrew Mernin reports.

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The Frost family were reluctant tabloid headliners in spring 2017. ‘Tot shocks docs,’ declared the Sun newspaper. ‘Boy’s aggressive brain tumour shrinks thanks to CANNABIS compound, parents claim,’ it continued. The boy in question, William, now seven, did indeed experience remarkable results in tackling a terminal condition after taking cannabis oil. But the Frosts were somewhat uncomfortable with their moment of red top heat. The message that ‘cannabis cures cancer’, as the story seemed to pronounce to the world, could be dangerous and misleading; and the column inches devoted to William didn’t reveal the full picture of his journey. Dad Stephen has since made it his mission to help uncover the true facts about the potential role cannabis can play in fighting paediatric brain tumours. The family’s charity, Make William Well, has helped to raise £100,000 to support ground-breaking research on the topic; and Stephen is now a regular speaker at insightsharing events focused on childhood cancers and their possible links to cannabis treatments. “It’s been so much of a rollercoaster over the last few years that our emotions are almost blunted or exhausted. You can’t really describe how it feels,” he says over the noise of a busy café, near the family home in North Tyneside. “We were basically told he had a brain tumour and probably

The family’s charity, Make William Well, has helped to raise £100,000 to support ground-breaking research on the topic

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had five years to live. It was utterly devastating.” It all started innocuously with little signs; the type fretted over by young parents but downplayed by doctors. William was 18 months old and had just started nursery when he began experiencing sickness and teething issues commonly seen in toddlers. But he was also finding balancing unusually difficult for a child of his age, and walking with his head tilted to one side. After several trips to the GP, he was referred to the local eye, ear, nose and throat (EENT) department. But his parents felt a looming sense that his condition was more serious than the speculated ear problem. “My wife had been on the headsmart.org.uk website, which supports the early diagnosis of brain tumours, and William had some of the symptoms. Then one night I picked him up and he threw up on me for no apparent reason. That was it, we thought there was something seriously not right here. “We went to accident and emergency and after a week of tests in which they could find nothing wrong with him, they finally agreed to do an MRI scan. That’s when they found the tumour. “We were told it was terminal and that there was a five year survival rate. If he had surgery and they could get it out then he might have a chance at longer than that. But if they didn’t, then it would be much shorter.” The tumour was around the size of a golf ball, near to the centre of his brain. It was diagnosed as a ‘grade three anaplastic ependymoma of the fourth ventricle’. Within days, William was taken into surgery at Queens Medical Centre, Nottingham, and the tumour was removed. Due to its proximity to critical nerves, however, he was left with partial paralysis on his left hand side. This meant he couldn’t move this side of his face, or swallow properly, and had to be tube fed. Because of the grade of the tumour there was a significant chance it would likely come back so further treatment was required. William started chemotherapy, but was unable to tolerate

the full planned 13 months of treatment. He was already deaf in his left side, possibly as a result of surgery, and was beginning to lose high tone hearing in his right side, likely due to the chemotherapy. Treatment therefore ceased after nine months. But the family received the welcomed news that tumour had been “fully resected” and there was no sign of regrowth. Stephen says: “I don’t think the outlook ever really changed but we were hopeful. We pushed the idea that it could return to the back of our minds and hoped that we’d got it. As a parent, if you’re told its fully resected and your child’s had chemo too, you kind of hope that that’s it. But obviously the cancer was a particularly nasty one. “He was still a bit wobbly on his feet at the time, but he made a good fight of doing the things other children get up to at that age, like going to playgroup and so on.” When his balance problems worsened, their underlying fears that the tumour would regrow were realised – and this time it was in an even more precarious place, tangled around the brain stem. The only option was a “very risky” surgery, which successfully removed most, but not all, of the tumour. The family were then told that William could be considered for Proton Beam Therapy in America. This is a less damaging form of radiotherapy than that offered in the UK. Yet, although the NHS had approved funding, the centre in America ultimately denied treatment him due to his tracheostomy and the possible complications of travelling to America. In the meantime, the tumour had regrown exponentially since the surgery. William was fast-tracked onto a six week course of radiotherapy during which sickness was a constant issue. But the tumour was increasing in size and, despite going through another round of chemotherapy, it’s growth could not be stopped. Doctors gave the family the heartbreaking news that there were no other treatment options available. “They said, ‘unfortunately that’s it’

We went to accident and emergency and after a week of tests in which they could find nothing wrong with him, they finally agreed to do an MRI scan.

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and they gave us details of a hospice. We were told that William only had six months maximum left and wouldn’t live to see Christmas.” And so began a desperate hunt for alternatives beyond what was available on the NHS. One glimmer of hope was that William’s tumour had the correct profile for the ketogenic diet to possibly have an effect. This is a high-fat, adequate-protein, lowcarbohydrate diet sometimes used to control severe childhood epilepsy. But Stephen and his wife’s search also brought them to CBD. “We didn’t know at the time if it was possible to go down the THC route, or how we could get hold of it, or CBD that we could trust. This was in 2016 before CBD had become readily available. We spoke to our consultant who couldn’t recommend it and said not to bother with it because it hadn’t been through preliminary trials.” Ignoring this advice, they found a private clinic offering a synthetic CBD treatment, which they decided to try in conjunction with the ketogenic diet. “This was the only way we could get hold of what we could trust was CBD and they charged us a lot of money for quite a small amount.” Then six months after being told nothing more could be done for William, they noticed an improvement in his condition. An MRI scan revealed that his tumour had shrunk to around a third of its original size. “We don’t know what worked exactly, but we know the tumour shrank. Was it the CBD? Was it a combination of this and the ketogenic diet? Radiotherapists even argue that it could be delayed effects from the radiotherapy, which would be surprising given how long after the radiotherapy it occurred. We don’t know whether there was a synergistic effect between the CBD, the diet and the delayed effects of the radiotherapy.” The tumour remained stable at its reduced size for around 18 months until scans showed that it had started growing again. William underwent another surgery, removing almost all

This was the only way we could get hold of what we could trust was CBD and they charged us a lot of money for quite a small amount.

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of the tumour, before more chemotherapy. He continued on cannabinoids and the ketogenic diet and, by late last year, his scans were clear. He now takes a non-synthetic CBD product containing more cannabinoids than his previous regime, with the aim of killing the remains of the tumour. He is also undergoing metronomic chemotherapy (lower dosage with less side-effects) continuing on the ketogenic diet alongside his dad. “We hope this will keep it under control but I’ve also read certain lab-based studies that suggest it can actually be killed by cannabinoids. That’s the hope.” The family’s charity, Make William Well, has teamed up with Brain Tumour Charity to raise funds for vital research that could ultimately shape treatments for other children like William. It has helped to raise over £100,000 for ongoing research led by the Children’s Brain Tumour Research Centre at the University of Nottingham. The research aims to answer the question: Is there a role for cannabidiol in the treatment of children’s brain tumours? The researchers say: “CBD is widely used by brain tumour patients, sometimes with considerable success. But, we need to objectively understand how CBD affects the cells, and why the results patients and families are reporting occur. “This knowledge is essential in order to determine what the therapeutic dose of CBD might be. Without this, clinicians or families may inadvertently be too conservative or liberal in their dosage, and not achieve optimum results for the patient.” Stephen is hopeful that other cannabinoids, including THC, might also be included in such research in future. “From the outset in pushing for this, our aim was to get all cannabinoids researched so that eventually they can be issued free of charge on the NHS once they’ve gone through the clinical trials.” Specific areas of the soon-to-be-concluded lab-based studies include to what extent oxygen levels in tumour cells treated with CBD, have on markers within the cell which indicate the beginning of the process of cell death. Also, some patients are taking cannabis oil as an adjuvant therapy (applied after an initial cancer treatment) for their brain tumour. The treatment is to take the oil for CBD three days on and three days off. But it is not yet understood how this action affects tumour cells. Furthermore, the researchers have investigated in further detail how CBD affects the cell receptors, to better understand the effect the drug has on tumour cells. According to the researchers: “This research could have considerable clinical benefits, and therefore it is very important that any conclusions we draw are able to stand up to international scientific scrutiny. To achieve this, we are now in the process of detailed examining all

of our data from the project.” The findings are expected imminently, from a study which is underpinned by global collaboration. Lead researcher Professor Richard Grundy visited The University of Western Australia as part of the study to learn first-hand about their CBD research studies focussing on medullblastoma. He spent time with Dr Clara Andradas Arias, an international Post-doctoral Researcher in the Brain Tumour Research Lab at Telethon Kids Institute in Perth. This international collaboration has enabled the sharing of data on how CBD affects cells in paediatric tumours. Further studies include a planned ketogenic diet and CBD clinical trial, which is hopefully taking place this year. More generally, as UK health authorities continue to call for more evidence of the medical benefits of cannabis, Stephen would like to see investment in “adaptive clinical trials”. These are trials in which modifications in response to the participant’s outcomes and other factors such as side effects are allowed after it has begun, without its validity or integrity being questioned. They are distinct from ‘double-blind, placebo-controlled clinical trials’ which are considered the gold standard in medical testing and typically relied upon by the pharmaceutical industry to prove the benefits of new drugs. Doctors and campaigners who advocate medicinal

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cannabis argue that such trials are not compatible with cannabis medicine. They argue that the plant is too complex and is not a single molecule pharmaceutical product that these trials are designed for. They also point to the growing body of observational and case study data supporting the use of medicinal cannabis to treat various conditions. Stephen says: “Why are such clinical trials the gold standard? They take too long, are too expensive and clearly haven’t been very good in terms of coming up with effective treatments for childhood brain tumours. Adaptive clinical trials, which are far cheaper and produce faster results, should be carried out on a multitude of cannabinoids. This way more children could be given the opportunity of sooner access to paidfor quality assured medicinal cannabis products under close clinical supervision. “I believe the current system of gold standard trials has failed our children – only one drug has ever been specifically developed to treat a childhood brain tumour. There are hundreds of papers written about cannabinoids and the evidence that it works in the lab is overwhelming. But there just aren’t the gold standard clinical trials. “There are just four drugs that have ever been developed specifically for childhood brain tumours, the rest are hand-me-down treatments from adult cancers, which are very different biologically to their childhood equivalents. We are cutting, burning, and poisoning our children with decades old inappropriate approaches when cannabinoids are starting to be shown to be potentially effective but are currently a long way off being prescribed on the NHS. “I believe there needs to be a sea-change in the way we go about looking for childhood cancer cures and I believe that pushing for adaptive clinical trials is the way forward.” While continuing to push for research, Stephen

is also regularly contacted by parents of other children facing similar challenges to William. “I try to help, and I get a lot of questions about dosages, but I would never recommend one thing or the other. There’s generally massive confusion out there about cannabis medicine. "A lot of people think, like I did before we went through all this, that the whole medicinal cannabis campaign is just led by people wanting to legalise marijuana for recreational use. They don’t see the evidence which proves that it can work on brain tumours, certainly in the lab. For whatever reason, the clinical research isn’t getting done and that’s now why we’re campaigning. “Its one thing getting it legalised, but without the research you’re still not going to know about the dosages or sideeffects. If I was a doctor I wouldn’t want to give a drug that hadn't been through clinical trials. Also, different cannabinoids could have different effects on different cancers. This is where the research needs to go and in a way that reflects the complexities of the plant. “What we want to do with Make William Well is to say ‘there is a potential new advancement here, let’s get the focus on kids.’ Three years ago I didn’t think we’d have a chance of getting a research study done, yet we proposed it, the centre agreed to it and we helped to raise the funds to do it. After that we didn’t think there was a cat in hell’s chance that we’d ever be looking at clinical trials, but now that’s hopefully realistic as well.”

To donate to Make William Well visit www.makewilliamwell.com. See Cannabis Health online, at www.cannabishealthnews. co.uk, for updates on medical cannabis research projects including those supported by the Frost family’s campaign.

I believe there needs to be a sea-change in the way we go about looking for childhood cancer cures and I believe that pushing for adaptive clinical trials is the way forward.

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Stretching the boundaries of the CBD craze With CBD taking the wellness industry by storm, one gym is bringing it to your workout â&#x20AC;&#x201C; and it could be the next big thing. Sarah Sinclair reports.

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In a green-lit gym studio in London, as house music pulses in the background, office workers stiff from too many hours hunched at their desks lay face up on yoga mats. Men and women of all ages have hotfooted it from work – and they’re all here for one thing; the CBD oil patch. London fitness chain Gymbox launched its ‘Cannabliss classes’ last year and its members can’t get enough. 36

It has been described as ‘CBD yoga’, but don’t be fooled; this is not just for typical yogis. Cannabliss is aimed at anyone who works out hard, sits down at a desk all day, or both, and, if you’re injured, you’ll reap even more rewards. According to Gymbox’s marketing manager Rory McEntee, the 45-minute sessions are a cross between a functional training and a holistic retreat class. They feature a combination of equipment including lacrosse balls, foam rollers, yoga mats and, of course, the CBD patch. CBD oil does not contain the psychoactive THC element of cannabis associated with the ‘high’. Focused TLC At the beginning of each class participants are given the patch to put on their “trigger point”, a part of their body which needs a bit of extra care and attention, such as the lower back or shoulder. The patches are entirely optional, but instructors are yet to see anyone turn them down. The patch takes around five to 10 minutes to kick in, so in

the meantime attendees begin the first part of the class: 20 minutes of trigger point work on the upper body, using either the ball or foam rollers, followed by lower body stretches. Then, with everyone comfortably ‘in the zone’, they move onto the final 20 minutes of upper and lower body stretching. While its name and the artful-looking hazy photos on the gym’s website suggest otherwise, this is not just about unwinding after the nine-to-five. It’s a recovery-focused class, centred around pain relief. The deep stretching combined with the CBD patch to help with inflammation, offer “a joint approach to aid recovery”, the company says. Pain-killing properties Rory explains: “The class is dedicated to pain relief. It’s for people who are working out constantly, or who might have some tightness from sitting down too much or having a bad posture. “Ultimately the CBD oil patch helps to reduce pain in problematic areas. All our instructors are highly trained

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on these features and the benefits of CBD oil, they are there to educate people about it.” Research shows that CBD has proven health benefits, and can help with a variety of conditions, including joint pain, migraine, psoriasis, acne, anxiety, depression, pain and inflammation. And it’s the latter two that Cannabliss really hones in on. “You have the anti-inflammatory benefit from the oil patch, which complements the stretching,” says Rory. “Using the lacrosse ball and the foam rollers with the CBD oil really helps to improve your posture and tightness, which can be caused by training or sitting down too much. It opens up your whole body.” As awareness of its wellbeing benefits grows, in the last two years CBD has emerged as a major global health trend, making its way into the mainstream by way of high street chains such as Holland & Barrett, Boots and The Body Shop. It can now be found in beauty products, beers, teas and even pet food. It has even been named one of the fastest growing industries in the UK, with research from the Cannabis Trades Association finding that the number of CBD oil users doubled in 2017 and, at the last count, stood at 250,000. It was surely only a matter of time before CBD made it into the exercise studio. Gymbox, a particularly forward-thinking fitness school, has duly obliged. Other classes it provides include ‘extinction training’, which “brutally exposes body and mind to the harsh realities of our future world”. Gymgoers are urged to: “Experience the scorching heat, restricted air, extreme conditions and lack of water in a programme that makes our need to survive suddenly, terrifyingly real.” Also on the timetable is the “braingasm holistic retreat” that promises to blow your brain, with the help of repetitive beats and experimental meditation techniques. “We’re always trying to stay ahead of the curve in terms of putting on innovative and unique, creative classes,” says Rory. “We look for what trends are happening in the industry and we try to put something on that members also want to participate in.”

A movement, not a fad And it seems they really do want to participate. The five classes, across its five clubs – which were initially put on as a trial – have become so popular they have been kept on the timetable indefinitely, and are regularly booked up advance. “The response has been brilliant, and no-one has ever turned down the patch. Everyone is trying it and experiencing the class in the way it was intended. “We’ve seen a huge mix of people coming too. People who may not be interested in a specific yoga class, who are more into lifting weights, have attended and the feedback from them is that it’s really opened their minds to the fact that CBD oil is more acceptable and mainstream now.” Rory is quick to quieten any suggestion that it could all be a gimmick, with members reporting real improvement in their problem areas. “Our classes are never put on just for the sake of putting on something different, there are real benefits behind it,” Rory continues. “The members have felt real benefits in terms of pain relief and inflammation from various areas of the body, which is something that they haven’t got from searching for it themselves. It’s something they would recommend doing more of.” With others in the fitness industry likely to follow suit, if Cannabliss is anything to go by, CBD at the gym is going to be the next big thing. “It’s something which is now moving into the mainstream. “We tend to launch a class, and we’ll see our competitors and other brands following suit a year or so later, so if my experience is anything to go by, I would expect to see this in a lot more gyms and copycat brands trying to replicate what we’re doing.” By then of course, Gymbox may have found new possibilities for how CBD can enhance our exercising experience. “We’re looking at new and different ways to evolve it in the future. “I think it’s going to increase in popularity going forward and, as long as the fitness and wellness industry continues to shed light on the natural sources of remedy and recovery training, which we’re trying to do, there are endless possibilities of the classes that we can take this to. “We’re going to continue to innovate and come up with new ideas.” “In terms of where we’re going to take it next? I’d say watch this space.” For more information visit https://gymbox.com

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“I just wasn’t ready to give up on my son” ‘Drug smuggler,’ ‘social services risk’ and ‘good cop turned bad’ were just some of the accusations thrown at Lisa Quarrell during the fight to save her son’s life. But it was all worth it, she tells Andrew Mernin.

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Lisa Quarrell was well acquainted with the police officer’s knock. She’d delivered it many times during 10 years on the force. The difference this time was that she wasn’t outside in a hi-viz jacket, with her patrol car parked on the street. She was inside, freaking out about the consequences of her decision to become a drug smuggler. Not that she had any regrets. The cannabis oil she sneaked in from the Netherlands saved her youngest son Cole’s life, she believes. Cole has ‘uncontrolled focal epilepsy’, a severe form of the condition. His seizures began at three months old and, by age one, he was confirmed as drug resistant. The only option, according to his doctors, was brain surgery. “They said Cole having seizures was part of his life and we had to manage it,” says Lisa, 38, from East Kilbride. Aside from drugs, other considered interventions included the high fat, low carb ketogenic diet – which can help to reduce seizures in some children. Doctors also discussed a technology called vagus nerve stimulation (VNS), also known as a ‘pacemaker for the brain’. Ultimately neither were deemed suitable and surgery was all that remained. The procedure to remove some brain tissue was carried out when he was two – but like the drugs was unable to stop the seizures over the long term. “This became our life: Cole would have seizures most nights, through the night and some during the day. His development was affected really badly. “He did have a good run for a few months where he wasn’t having that many seizures and he managed to go to mainstream school. “But then he took a dip, the seizures got more frequent, more aggressive and more damaging and the school were talking about him going to a special education school. “Then I put a post out on Facebook to say I was running out of options for Cole. Was there anything in the world that could help him? “Everything that came back was about cannabis oil.” Having served in the police for a decade until Cole was one, Lisa only had bad opinions of cannabis. “Everything I thought I knew about cannabis was very negative. Not just because I’d dealt with drug dealers, but also the psychosis side of cannabis misuse. “But looking back, what I saw was probably the wrong type of cannabis, which was street cannabis that was mixed with all sorts. “Also, those people were on prescription drugs, cannabis and alcohol and already had underlying mental health problems. That was always my experience. Its different if you understand the workings of the plant and what good it does and how to use it.

“Its about being educated. I still get people today saying to me ‘you don’t know what the future holds for your son. You could be giving him this and he could end up really damaged with mental health problems when he’s a teenager’. “My answer to them is ‘you’re right I don’t know, but science tells me he’ll be ok’. Also, he wouldn’t have made it to seven never mind 18 had I not given him cannabis oil. “At one point he wasn’t eating and doctors were talking about tube-feeding him. A week after getting him on cannabis oil he was eating Domino’s Pizza!” A turning point on Lisa’s journey towards giving her son cannabis oil was a dream trip to Disneyland Paris last year, which turned into a nightmare. “He started having frequent seizures and by the time we came back he could hardly walk. Then he started having something called Todd’s paralysis after every seizure, which is like a stroke; he couldn’t walk or talk for up to an hour after every seizure. “The paralysis began lasting most of the day which meant he couldn’t go to school.” With Cole’s speech, vision, movement and memory all deteriorating, he faced an uncertain future – and was lined up for invasive testing. This meant drilling up to 16 holes into the six-year-old’s skull to allow electrodes to be inserted into his brain. He would then be bedridden and under analysis for up to nine days to assess his suitability for brain surgery. “Then I was told that was it for Cole. He would continue to deteriorate and die if I didn’t look at a second brain surgery operation. They said the tissue removed in the first surgery was the tip of the iceberg and the damage to Cole’s brain went deeper and wider as it got into his brain.

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“They couldn’t remove the tissue because they’d have to remove practically half his brain. So I was told that the only option was to disconnect one side of the brain from the other. “That would leave him partially sighted and paralysed down one side. At this point I had a wee boy that had been riding a two-wheeler bike, loved football, could walk, talk, run, laugh and have a pretty full life other than his seizures. There was some development delay but it didn’t stop him from having a full life. “I thought ‘I’m not ready to give up on him yet’. I couldn’t put him through an operation that was my choice, leaving him paralysed for the rest of his life. I simply couldn’t do it. That’s when I decided to take cannabis oil seriously.” Lisa joined support groups, met with leading medical cannabis experts and even consulted the black market. But old habits from her days on the beat die hard. “To be honest I was looking for the negatives. I was looking everywhere for someone to confirm what I believed cannabis was but couldn’t find it.” She initially bought CBD oil containing the legal trace amount of THC from a clinic in Barcelona. “Within three days of taking it, Cole stopped getting paralysis after every seizure and within 10 days his walking fully recovered, having previously walked as though he had lost his balance. “He was back at school and I’ve got videos of him running around my living room. But the seizures had only reduced from about 12 to eight a night.” Lisa believed she was on the right track, however, and set her sights on accessing ‘full-plant’ extract cannabis medicine. She began a very public campaign to give Cole and other children in Scotland access to medicinal cannabis. This was just a month after the November 2018 UK legislative change that made medical cannabis with THC technically legal for prescription – a decision which almost 18 months on has still barely improved access. Lisa turned to politicians in search of support and found it from Dr Lisa Cameron MP and MSPs Linda Fabiani and Monica Lennon. They demanded answers from Westminster and the Scottish Parliament. A victory of sorts saw Cole being chosen among 10 UK children to trial the CBD drug Epidiolex – which after various delays he eventually received in February this year. Although many children have had good outcomes with the medicine, it did not have the desired effect for Cole. “He was paralysed again, couldn’t speak, sit up on his own or swallow. He was really sick and in March was rushed to children’s hospital.”

Lisa, the law-abiding ex-bobby, then did something she never could have imagined in her blue-light days. “I flew to Holland with his medical records and smuggled cannabis medicine back into Scotland,” she says. The new medicine, Bedrolite, contains nine per cent CBD and less than one per cent THC. Without an official prescription from UK doctors, she was “unsupported” so had to micro-dose Cole on the oil. “It took about two to three weeks before we noticed any difference because he was so ill, and because the dosage was so small.” Cole started on a drop twice a day, which Lisa was told to gradually increase every 10 days. “Because things got so bad for Cole, I started increasing it every week and then every four days because I know that it was making him better.” Then his recovery picked up. “On April 5th he stood up on his own and started to walk. By the 11th of April he was running again. He started speaking again and now Cole’s the best version of himself he’s ever been. He’s dreaming for the first time. We just went back to Disneyland recently and it was like the first time he’d been there.” In May, the BBC aired a documentary filmed months earlier; in which Lisa said on camera that she had smuggled cannabis into the country and had no regrets about saving her son’s life. “Of course the papers got hold of it. For about a week there were headlines like ‘ex cop drug smuggler’. There’s no way a journalist wasn’t going to jump on it, let’s be honest, it was a great story,” she laughs. It wasn’t funny at the time, however, when two detective sergeants paid her a visit. “They said that criminally they weren’t going to investigate me but because I had children, as a single mum, and had admitted to smuggling illegal substances in and given them to my son, then I would have to be investigated for child protection issues.” A lengthy process ensued in which Cole’s GP, hospital consultants and school teachers were asked their opinion of Lisa as a parent. A panel ultimately decided not to pursue the case. Lisa finally received the relieving news on Cole’s seventh birthday, after weeks of nervous anticipation. Cole’s medicine is now entirely above board, secured via a private prescription and a Scottish importer. Instead of paying upwards of £600 per bottle from importers who charge a significant mark-up, this individual charges £158 – the same cost as buying it over the counter in Holland. Even on this lower rate, Lisa is forking out around £880 a month for Cole’s medicine. This could spiral to

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Pictured: Lisa and Cole

almost £3,500 with an importer charging the standard commission. “The importer has been a life-saver to be honest. He doesn’t charge any families any commission, he charges exactly what it costs him and so he’s not making money out of sick children.” Cole was the first child to have his medicine legally imported into Scotland. His mum and the importer then supported other families in following the same route. The pair also recently spoke at the Scottish Parliament about the desperate need to open up access to cannabis medicine for children. This triggered a cross-party support letter signed by MSPs from every party asking the health minister, Jeane Freeman, and first minister, Nicola Sturgeon, to fund cannabis medicine for families that need it until it is readily available on the NHS. “I showed the MSPs a video of Cole when he got so sick that he couldn’t even say ‘I love you mummy’. I showed them one of him having a seizure and then from every couple of days after the cannabis medicine, standing, walking, running, riding his bike, jumping, climbing, playing football. Every MSP was so moved and there wasn’t a dry eye in the room.” The letter, sent in September, has not yet been acted upon; but Lisa is hopeful of an eventual breakthrough. “There’s no getting away from the issue. It ticks all the boxes and it’s got cross-party support,” she says. In meantime, Lisa is wrapped up in Cole’s ongoing progress. The running, jumping and belting footballs in the park are the the obvious signs of improvement. But then there are the subtle changes that only loved ones behind closed doors see. “He’s been having flashbacks from when he got sick,

which is weirdly a good thing because it means his brain is working properly. “Previously he was always quite subdued and didn’t show much emotion, he didn’t sleep long enough to dream and didn’t have any excitement or big reactions to anything. Now he’s screeching so much from everything he finds exciting that he’s nearly lost his voice. His wit and sense of humour have also got so much better. “He now talks about when he was sick and how he never wants to be like that again.” At the time of writing, Cole has had no major seizures since April, and just two minor ones in that time, lasting less than 10 seconds each. At his most poorly he was having 10 to 15 every night and sometimes during the day. Lisa’s hope for the months ahead is that he can stop taking the one pharmaceutical drug remaining in his daily routine and rely purely on the medical cannabis. “That drug is toxic and has had the side-effect of preventing his adult teeth from forming in his gums, which is giving him toothache almost fortnightly. “He’s on a small dose but the doctors won’t consider taking him off it just yet until they know more about the cannabis.” Raising awareness of cannabis medicine among healthcare professionals and politicians has become something of a crusade for Lisa. She has presented Cole’s story to them at several official gatherings and works closely with the campaign group Medicinal Cannabis Reform Scotland to open up access for families. “I tell doctors and nurses about what medical cannabis can do and say ‘don’t take my word for it, go and find out for yourself’, and that’s what they’re doing.”

INSIGHT

A view from Ireland 42

“This is something that can help children, but it’s being withheld, which is completely wrong” – tireless campaigner Vera Twomey shares her story with Cannabis Health...

“Those words will stay with me forever,” says Vera Twomey, remembering one of the darkest chapters of her life. It was the day that doctors delivered an incredibly bleak outlook for her baby daughter Ava after being diagnosed with Dravet Syndrome, a rare form of epilepsy.

INSIGHT

She would never walk or talk, they said, and might not live beyond the age of three. She would also be in residential care for the rest of her life. This life trajectory then began to take shape as predicted, with Ava suffering multiple seizures a day and enjoying few of the joys of life that other little girls could. But eventually her mother could no longer stand by and watch Ava try yet more pharmaceutical drugs with no sign of a solution. She decided to try medicinal cannabis, beginning her fight against the medical, political and societal barriers stopping her daughter and others access a potentially lifesaving treatment in Ireland. “There are other families being told the same sorts of things as we were. People might wonder why I continue to stay involved in the issue. But those words stay in my mind. The delivery of what Ava’s future was going to be is something that I will never forget and I will carry with me for the rest of my life. “You wouldn’t wish any parent to hear that. But if there is something that can help a child, and it’s being withheld, then that’s wrong. There is no justice with that at all. So I try to do what I can.” After securing medical cannabis in the Netherlands, and proving its dramatically positive impact on Ava, Vera has campaigned tirelessly to liberate access to the treatment. She even walked from her home in Cork to Leinster House in Dublin in protest to ask health minister Simon Harris for help in person. But Ireland, like the UK, has moved frustratingly slow for the families desperate to try such medication. Vera has become a figurehead of action for this frustrated group. In 2018 she was a winner at the People of the Year awards, which recognise people in Ireland making a real difference to the lives of others. She used her acceptance speech, broadcast by RTE, to make yet another plea to the Irish government to legislate for medical cannabis usage. “The winners were chosen and voted for by ordinary people like ourselves so I was very honoured. There was an astonishing amount of people voted for us. So I guess in voting for me they were voting for support of medical cannabis. It really helped to raise the profile of the cause.” Watching on in the audience was Irish Prime Minister Leo Varadkar. “I actually bumped into him at the back of the room before the awards. I asked him what was going to happen with medicinal cannabis. Unfortunately he was quite dismissive of me. I had not planned on addressing Leo Varadkar directly from the stage but after I’d spoken to him I was quite upset at his reaction.

There was an astonishing amount of people voted for us. So I guess in voting for me they were voting for support of medical cannabis.

INSIGHT

“He said the legislation was going nowhere. So I addressed him directly from the stage. The reaction was overwhelming. People stood up and applauded, it was so special and I think their response reflected the general view in the country that it’s time for medical cannabis to be taken seriously and given the legitimacy that it deserves.” In May last year, a letter published in the Irish Times by a collective of doctors warned that Ireland was “sleepwalking into the legalisation of cannabis”. The doctors, clearly opposed to liberalisation, pointed to a “campaign of misinformation” about cannabis medicine. Vera says “It was the usual kind of ‘trojan horse’ fearmongering type of language. It’s just very disappointing to see professionals coming out with those kind of remarks.” “There is a limited number of doctors coming out to speak on the subject of medical cannabis. The Irish Times has quite frequently taken up the comments of the doctors who are opposed to the introduction of medical cannabis. “There are many consultants interested in medical cannabis, but I believe there’s a lack of education to help them to come to an educated conclusion regarding the treatment. So its very difficult to criticise doctors for not coming out and speaking more publicly about the treatment.” The following month, Ireland’s health minister Simon Harris signed legislation allowing access to cannabisbased products for medical use on a pilot basis for five years. The Medical Cannabis Access Programme allows medical consultants to prescribe medicinal cannabis to patients that have failed to respond to standard treatments for spasticity associated with MS, intractable nausea and vomiting associated with chemotherapy and severe, refractory (treatment-resistant) epilepsy.

Access in the months that followed was limited, as it has been in the UK. “The programme was announced but they had not attached any products to it, so it wasn’t functioning. Not a single patient has been prescribed anything under the programme. This is further confusion for consultants in this country. “There were families I spoke to that were being told by consultants that they couldn’t prescribe until the programme was up and running properly. “This isn’t correct as they could apply under an individual license for a patient. We can’t place the blame at the door of the doctors because there are mixed messages being sent and they don’t have a clear programme to apply under.” Finally in December, came a move that had been promised in autumn. The first two products, made by Canadian and European pharma firms respectively, were approved for use in the scheme, subject to licenses. Progress otherwise has been in short supply; leaving many families in desperate limbo, waiting for access to the potentially transformational treatment. “It’s been total confusion amongst parents. If they want to apply through the individual licensing system, the consultants aren’t sure whether they can or cannot. Then, if they do apply, they are still seeking advice and information which maybe difficult for them to source regarding dosage or interaction with other medications. “It’s a human right to have access to reasonable medical care for yourself or for your family member. We got a tremendous amount of support for Ava to access her medication and she’s proven how successful it can be. So I feel that other patients out there deserve the opportunity that Ava has got. There is room for people’s suffering to be removed under this medication. “I’m not suggesting it could be removed for everybody

There are many consultants interested in medical cannabis, but I believe there’s a lack of education to help them to come to an educated conclusion regarding the treatment.

INSIGHT

We were given no hope at all of what Ava could achieve, but we didn’t accept what they told us and I want the book to give hope to other parents and patients in a similar situation – I want people with any condition to know that you don’t have to accept verbatim what you’re told.

but people deserve the option without going through the tremendous amount of trauma that we went through. People are ill themselves or looking after people that are very sick and you shouldn’t have additional pressure. It’s just another medication but its still being treated with kid gloves on. “Obviously there has to be responsibility for all types of medication but it shouldn’t be made so difficult for patients and doctors.” Vera recently published her book, ‘For Ava: An incurable illness, A reluctant activist, An ongoing campaign.’ Her family’s emotional journey is helping to inspire others in similar circumstances: One reviewer writes: “As a mum fighting to access medical cannabis for my son Vera’s book inspires me to continue the fight." Vera says: “I wanted a written record for my children in future to see how brave their sister was and what she went through. Also, their mummy was on the phone a lot and going to a lot of meetings, so I want them to know when they’re older why I was doing that. The other reason is that I think hope is incredibly important. “We were given no hope at all of what Ava could achieve, but we didn’t accept what they told us and I want the book to give hope to other parents and patients in a similar situation – I want people with any condition to know that you don’t have to accept verbatim what you’re told. Doctors can be wrong and with love and determination you can turn the situation around, into something so much better.” As the book title suggests, Vera’s battle to help open up access to medicinal cannabis in Ireland goes on – and she continues to support other parents in similar situations. Much of her time, though, is devoted to her children. Ava, now 10, is attending school and, at the time of writing has only missed three days of classes since the new academic year started in September. She no longer takes any pharmaceutical medication, with just CBD and THC medication in her daily routine. The family travels to Holland every three months to collect her Bedrocan medication, using an individual license. This treatment is not yet included in the products lined up for inclusion in the Irish government’s access scheme. “She is chatting, she’s funny, she’s determined, she’s engaging with her brother and sisters, she is so loving and loved and just a wonderful little girl to be around. Her progress continues. “The seizures of course would have done catastrophic damage to her development but she’s moving forward and the most important thing is that she’s a happy.” Vera’s book is available in paperback and on Kindle via www.amazon.co.uk.

LIFEST YLE

Sex and cannabis â&#x20AC;&#x201C; a match made in heaven? While the topics of sex and cannabis are, for many people, uncomfortable to discuss, the fact Jeanette did so one night while out with her girl friends transformed her life. Deborah Johnson reports.

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Long-term MS sufferer Jeanette had battled with pain on a daily basis for many years. She had come to accept that many activities, including sex, would often have to be endured rather than enjoyed.

“Everything was just painful,” she says. “Having sex was painful, and I was rarely in the mood. I think the fact I wanted to feel sexy and great about myself but just couldn’t added to the situation. “But of course this isn’t something you can discuss with people – ridiculously, I even felt embarrassed to Google search it – so in terms of finding a solution, that was never going to happen,” she remembers. Then, on a rare night out, with inhibitions gradually dissolving in red wine, she broached the subject with her mates. “The mask slipped and I just had let it all out. Ordinarily I’d never discuss my sex life with anyone, but that night I’m so pleased I did. “One of my friends asked whether I had tried CBD. I remember thinking she must be mad to suggest something like that to me. I’m a 40-something woman with kids, and cannabis was something I tried once and hated at university – but after thinking about it for a while, I thought it’s worth a try as there must be more to my life than this.” Having plucked up the courage to buy CDB, Jeanette is now among the rapidly rising number of people worldwide becoming more vocal about the effectiveness of cannabis in boosting their sex lives. Although known for generations as a traditional herbal aphrodisiac, with use in India and China as far back as the seventh century, it is increasingly becoming known for the role it can play in sex; and not just for those battling chronic pain.

Some studies have linked it with an increased libido, for example. Research from Stanford University found that women who used a cannabis product daily had sex an average of 7.1 times in four weeks, compared to an average of six who did not use the product. For men, it was 6.9 times compared to 5.6 for non-users. Although the 2017 study did not explicitly state cause and effect, its findings have been said to show a direct link between cannabis and sex drive. Increased use of CBD for sex is reflected in the multitude of cannabis-based products being released into the market targetted at delivering bedroom benefits. Some are claimed to help to relax both partners and eliminate anxiety to make sex more pleasurable. Therapists also point to cannabis’s role as a vasodilator, increasing blood flow everywhere in the body, including to the genitals, meaning an increase in blood flow, oxygen, and even sensation to those areas. Peter Barsoom, founder of 1906, a business which specialises in cannabis edibles, explains: “Our body’s natural endocannabinoid system is key in regulating things like pleasure, pain, relaxation and homeostasis. “When it is activated by the cannabinoids in cannabis, it can leave users feeling relaxed with increased pleasure and decreased pain. This can lead to increased arousal and make sex even more enjoyable. “For others, the reason is the increased pleasurable sensations that can arise with cannabis. This effect can make sex feel even more enjoyable.”

LIFEST YLE

Jeanette believes in these claims, and that cannabis products should be more readily available, and more openly discussed, to benefit people like her. She says: “I have to say, CBD has changed my life, and certainly my sex life. From not really wanting to even think about sex, for the first time in so many years, I can enjoy it. “I am having sex regularly and am enjoying it – the fact I’m even saying that is fantastic. The effect CBD has on my pain is like nothing I could have imagined. “Being the age I am, with the menopause on the horizon and me worrying about being ‘past it’, I feel like I have a new lease of life.” Jeanette’s story helps to articulate the effectiveness of cannabis in helping people with chronic conditions. But some sex therapists also advocate the use of CBD products to help women who have had, or are going through the menopause, and older people in general who are looking to improve their sex life. Ashley Manta, a “sexuality coach” from the US is a leading advocate of the effect cannabis can have on older people and those in pain. “Cannabis is so useful for seniors, because it addresses the common things that get in the way of intimacy. For folks whose bodies are ageing, one of the more common things is pain. Whether from arthritis, stiffness or an injury, pain can be very distracting when it comes to pleasure,” she told Forbes.com. “For folks who have pain, cannabis-infused topicals are

useful because they don’t cause the head high, and they don’t make you feel like a zombie like opioids can. “You can apply them directly to the places that hurt, elbows, knees or hips, and that can take a lot of the edge off. Then you can feel more embodied and present with your partner. “A lot of folks I speak to do not want to get high. And I tell them you don’t have to. If you want to use cannabis for the rest of your life and never get high, there are so many ways to do that – and benefit sexually.” While experts point to the benefits cannabis can have in sex, however, they are equally keen to stress the fact that low doses are key. Dr Jordan Tishler is instructor of medicine at Harvard Medical School and president of the Association of Cannabis Specialists. He advises that as cannabis can have a different effect on every user, with insufficient research-based evidence to date to give any definitive answers about suitable doses or quantity, each person must find their own level through starting with a very low amount. “At really high doses of cannabis, people can withdraw enough into their own head that they essentially forget what they are doing, and it’s no longer a mutual experience, and often just ceases to happen,” he says. “Sexuality occurs most between the ears. It’s a mental and emotional thing. People get very fixated on genitalia, but that’s only the end result. A lot of things have to go right for it to work.”

COMMENT

I fought for my little boyâ&#x20AC;&#x2122;s life and helped change the law 50

Hannah Deacon hit global headlines leading a campaign to change the law around the use of cannabis, which allowed her son, Alfie Dingley, to become the first patient in the UK to receive a permanent cannabis licence. Here, she shares her hopes that more patientsâ&#x20AC;&#x2122; lives can be changed through the use of the medicine.

COMMENT

There's a lot of fear and stigma around cannabis and we need education to overcome it. I’ve seen my son's life changed because of it, so I want every doctor possible to be educated and be able to prescribe to help their patients live better lives. My little boy Alfie was born in 2011. The first four months were fine but then he started to become very poorly and was in A&E a couple of times with a high temperature and sickness. I had a lot of anxiety, convinced that there was something wrong with him. But I couldn't really pinpoint it; I suppose it was mother’s instinct. May 2012 is etched into my brain. I was woken at midnight by a scream and I ran into my little boy’s room to find him having a huge seizure. I'd never seen a seizure in my life. No one in my family has epilepsy. No one in my family has any sort of autism, nothing of that kind. I just thought I was going to be like everyone else and have a baby and go back to work after a few months. But no, that was the day my life changed forever. I rushed Alfie to a local hospital where the doctor said: “Don't worry, it's a febrile convulsion. He's got a temperature of 40, it's fine, he’ll get over it.’’ But already I felt dread. And I was right. He carried on having seizures lasting up to five minutes every 20 minutes. They rushed around in the hospital; they followed the epilepsy protocol, but within 24 hours we were moved to the intensive care unit. Alfie was on a life support machine and carried on having seizures every 20 minutes. We went to another hospital for two weeks where he was to be on and off life support. At that moment, I started to become a confident mother. Before then, I thought: “What do I know? I'm just his mother.’’ I had thought my sister knew better, my mother knew better and that the doctors knew better. Then it hit me – “Actually, I know better, I'm his mother.’’ I went to the doctor and I said: “If you don’t move him, he’s going to die’’. Within the hour, he had a bed for us at Great Ormond Street Hospital. I am incredibly grateful, because that decision saved Alfie’s life. They did every test again. He had a test called polyclonal bands, which is an intricate test taking take blood and brain fluid. Alfie had a really high level of white blood cells. All other tests were normal. So they gave him intravenous Misprednisolone. They told me: “If this doesn't work, I don't think you're going to get to take him home.’’ To go from a point two nights previously where we just had a baby to facing this was incredibly traumatic. I never forget those days when I'm talking to families, because I get it - I know how hard it is. That's why I'm such a massive advocate for this medicine.

Alfie and Hannah

Luckily the steroids worked and we took him home. They said that he had immune responsive epilepsy, that it was probably just a virus, that we should go home and rehabilitate him and it was likely that he would never have another seizure again. He lost every skill: he couldn't sit, he couldn't suck, he couldn't eat, he couldn't do anything. He was eight months old when it first happened and he was nearly a year old when we got out of hospital. Unfortunately, it did recur, every eight months until he was four. So, every eight months, I was taking him in an ambulance and he’d spend two weeks in hospital with them trying to stop the seizures. Every time the doctor said: “We don't want to use steroids because they're really dangerous.’’ And every time we went back to using steroids, as that was the only thing that worked. We thought that was bad, then, aged four, it started happening every three weeks. Every three weeks I was back in an ambulance with him, hoping to God that he wouldn't die. He reached the age of five and it started to happen every week. He had absolutely no quality of life. I had no quality of life. I couldn't leave the house. I live on a road with a school at the end, and I used to watch the mums take their kids to school every day. All I wanted to do was be that mum who could take my little boy to school. And I couldn't be. I was at home with him when he had the seizures and we had to deal with side effects of coming off the steroids. Basically, your child is a drug addict; your child is a zombie; your child is not safe to leave the house on his own because he's already got learning difficulties. He was also dependent on pharmaceuticals. That was the life that

COMMENT

At that moment, I started to become a confident mother. Before then, I thought: “What do I know? I'm just his mother".

we had. And it was awful. In 2016, I just thought to myself: “Right, I can top myself at Beachy Head, or I can actually stand up and fight and refuse to believe the doctors when they say there's nothing they can do.’’ Could we find something to replace the steroids? What do steroids do? They regulate your immune system, so I needed to find something natural that would regulate Alfie’s immune system. I started to research cannabis. Cannabis for me was something that you did at college and had Jaffa Cakes afterwards and laughed at. To me it was not a medicine, it was something people used for fun. As I researched, I began to think there might be something more to it because people kept saying it worked. Then I learned about the endocannabinoid system. I watched a YouTube video by the wonderful Professor David Nutt about the endocannabinoid system. I realised I could learn about that and I didn't have to be a doctor. In January 2017, when Alfie had tried his last anti epileptic which made him have seizures every single day, I resolved: “Enough is enough. I have to fight for this and I want to use cannabis with my son.’’ I went to our paediatric neurologist and told him I wanted to use medical cannabis with Alfie. “I don't want to break the law but I want to go to another country and I want to try and save him.’’ He replied: “If you talk to me again about cannabis, I’m going to report you to social services’. That was the end of that relationship. I found another neurologist who was absolutely wonderful and I'm immensely grateful to him. We were trying to stop the use of steroids, trying 15 combinations of anti epileptics, which either made him worse or did

nothing. I spoke to him about medical cannabis and he said: “You have no choice. I understand it. I get it. If you need to try this for yourself and if it works, I’ll help you get a prescription.’’ In January 2017, we started a petition, to the government and the Prime Minister to allow us to use medical cannabis subscription. I also set up a Just Giving page and Alfie’s Hope campaign on Twitter and Facebook, and I blogged a lot about my experience as the parent of a sick child. In the UK, we talk a lot about the carers of the elderly or young carers, which is important, but I think the parents of disabled children are forgotten. We’re full time carers, we have babies and think that they'll go to school when they’re five, and we’ll go back to work, but our babies remain babies. Often, they remain babies for the rest of their lives. I talked a lot about that through Alfie’s Hope, about what you believe is going to happen as a parent and the reality of having a child with a disability. I talked about that and about the need for using cannabis with my son, we got lots of followers and we managed to raise a lot of money. We went to Holland that September, and I found a paediatric neurologist by chance in The Hague. He was doing a small pilot study of 14 children using Bedrocan products, and kindly gave Alfie a place. We were just in the right place at the right time and I was mad enough to move my whole family to the Netherlands. It was frightening, four of us going off to the Netherlands. We didn't know anyone, we didn't have any family. We had been hugely reliant on our network of family and friends and we were going without any of them but I followed my gut instinct. That's one thing I've learned through this whole journey: the mother instinct is the most powerful thing and it must always be listened to. We were prescribed Bedrolite initially, the high CBD, low THC product, and the first five weeks it did absolutely nothing, which was difficult. But then, when we got to 150 milligrammes of CBD, Alfie went 17 days without a seizure. We gradually increased the dose and he went longer and longer, until, after five months in Holland, he had gone 41 days without a seizure, which was amazing. For these 41 days, we were a normal family who could go to the park or go to the shops and he was in a much better mental state. I felt like a normal mother sometimes. Cannabis is not a miracle drug because it’s not a cure. But, it felt like it was a miracle for us. When you take your child in an ambulance into hospital with 150 seizures a week, going 41 days without a seizure, is a miracle, because it's a life changing experience. We had an excellent report from our paediatric neurologist, who said there was conclusive evidence that this worked for Alfie. We had gone from using huge

COMMENT

amounts of steroids and pharmaceutical drugs, to pretty much nothing. Alfie did have clusters still, but it was once every month or 40 days, not every week. It’s about giving the patient and the family a quality of life. However, in February 2018, we ran out of money, so we came home. We were lucky that through Baroness Molly Meacher, who's a great advocate for medical cannabis subscription, we met Peter Carroll, who runs the End Our Pain campaign. He said he could help us with the campaign. I said: “This works, we need a prescription on the NHS, but I didn't know how to run a campaign. I don't know how to get on telly. I need someone to support me with that.’’ They were brilliant. He told me that these campaigns are like a roller coaster with lots of ups and downs and he was right. It was exciting, but also stressful and at times upsetting, because there were people who were trying to stop us doing what we were doing - but then came March 18, 2018, which was the day we met the Prime Minister Theresa May. I didn't know I was going to meet the Prime Minister. I took my petition to her, we had tea, and she said that we could apply for licensing and could apply to the Home Office, which was an incredible step forward. I think she probably regrets allowing us to do that now, because that opened the floodgates, but it was a big step for us and we got a foot in the door in the right places. Unfortunately, the doctor who supported us and wanted to support us with the licence, was blocked from doing so by the trust, which was an indication of how it was going to go with everyone else. That's when we met Professor Mike Barnes, who stepped forward and kindly led the licensing team. He had worked with the Home Office before. This is something that had never been done before, and they were very helpful. But by June, they were saying that there was stuff missing,

I didn't know I was going to meet the Prime Minister. I took my petition to her and we had tea.

but they couldn't tell us what it was, because then they'd be helping us to do the licensing application. I don’t think they actually really knew what else they wanted, they just didn't want to give us the licence because it frightened them to death. I went on the Today programme with John Humphrys and we talked about my meeting with Theresa May and the fact that we are a vulnerable family with a sick little boy, who had actually become very poorly again, because he wasn't on his product. I felt like she had played me. I wasn’t an MP, I wasn't trying to play chess and I wasn’t a business person, I was just the mother of a very poorly child and we just needed a licence, we just needed to be allowed to have this prescribed on the NHS. Within three hours, I had a phone call from Home Office minister Nick Hurd. He said: “Hannah, today you and I have changed history.’’ I cried my eyes out because he actually said it: we would receive the permanent licence to allow our little boy to have cannabis procedures used in Holland. It was on the national news that day it was absolutely wonderful to be part of that. There are other advocates that have had a major role in this law change and we mustn't forget them, but I feel very honoured to be part of helping the law to change. This journey has been fulfilling for me personally, because when I went to Holland, I felt like I was the only mother in the world with a sick child. I was alone. I was isolated. I was frightened. The most frightening thing is to face your child's death and I never wanted to do that, so that's why I fought. Through this journey, I've met some of the most amazing parents, and I want to say thank you to them. To doctors, I want to say this: all of you must remember why you became a doctor, to help people live better lives. This product gives these families better lives, and I'm having to spend anything between £2,000 and £4,000 a month to access this medicine and that is wholly wrong. These families have evidence, they have been doing this for six months, sometimes longer. Their children have gone from having hundreds of seizures a day to very few, their children’s quality of life is improved. That is evidence and we must remember that. We don't need to do randomised control trials for these families. They should be accessing funded product on the NHS. Instead of enjoying their families and their children, they are sitting at home, worrying about where the next money comes from. I urge you - if you're a doctor or physician - please talk to these families, please learn from them, please listen to them, because their experience has been dreadful. They have been ignored by their MPs, their doctors, by the Department of Health and the Prime Minister. They've all turned their backs on them. Through education I want to see doctors prescribing.

LIFEST YLE

How CBD is charming the catwalk world The latest fashion phenomenon making waves is nothing to do with the style of clothing being worn â&#x20AC;&#x201C; but rather its content.

LIFEST YLE

The use of CBD in clothing is the latest big talking point to hit the industry, with one New York company infusing the product in a range of luxury activewear for women, in what is hailed as the first fashion range of its kind in the world. 56

Acadaba has devised a means of combining its clothing fabric with up to 25 grams of 99.9% pure CBD, using micro encapsulation technology to layer capsules into the fibre, which then break open during exercise, releasing CBD onto the skin and which is then absorbed into the endocannabinoid system. The company claims its range, which includes sports bras and leggings, is about “prerecovery” – a preventative measure against workout-induced muscle pain and soreness. Through CBD being released while exercise is taking place, they say, the recovery has already begun. The concept is proving popular – although, if social media can be regarded as any measure, it appears to be questioned as much as welcomed by experts and users alike. The manufacturer of the fabric itself, Devan Chemicals, is looking to launch a range of bed sheets and pillows in the near future. According to Seth Barum, CEO and co-founder of Acabada, who has worked in the textile industry for over three decades, his business is a revolution for the fashion and fitness industries alike. Being based in New York, one of the fashion capitals of the world, he realised the apparent need to bring together the focus on fashion with the changing perceptions of CBD and growing awareness of its positive health properties. Through enabling an active ingredient in recovery to start working during the workout itself, he believes the

potential for this emerging industry is huge. Explaining how they created the CBD infusion of clothing, Barum says: “If you look at a knit under a microscope you’re going to see thousands of fibres, and the microcapsules bond to these fibres, they’re at all different levels within the fabric. “These different levels hold the microcapsules and as you’re moving you’re actually breaking the ones that are the highest, or on the surface,” adding that each product should give out CBD for up to 40 wears and washes. As clients approach this milestone, they can choose to recycle their CBD-infused clothing sustainably through the upcycling program of Acabada, where recycled synthetic fabrics will be replenished. However, despite the undeniable inventiveness of such a range, experts remain on the sceptical side. Darria Gillespie, a US-based doctor, believes the lack of regulation and understanding about exactly how it is working is an issue. “When we do things where we release medications into your bloodstream, we know exactly how much someone is going to absorb over a given time point. With activewear, there’s absolutely no way to regulate how much someone will get,” she says. “There’s no way to know if you’re getting too much or too little, or what else is in the product.” Dr Ziva Cooper, of the UCLA Health Cannabis Research

LIFEST YLE

CBD firm goes off-piste in new partnership A cannabis products firm and the official kit supplier to the US ski team have announced an unlikely partnership.

Initiative, also has doubt over the effectiveness of such a concept, pointing to the lack of clear evidence. ”Given that we don’t even know if topical CBD can permeate the skin and have meaningful effects on the body, we definitely don’t know if CBD in clothing would have that effect,” she wrote in a blog. “What we do have evidence of are from people’s reports that when they use topical cannabidiol they have alleviation of certain symptoms, especially related to pain and muscle soreness. We also have evidence in animal models that CBD might help decrease inflammation, but that is very different from the indications for which people might be using this athletic wear.” However, Acabada remains adamant that its products work, and certainly there is anecdotal evidence from many women online who claim its leggings have helped them power through their barre classes in ways they previously couldn’t – while their claims seem to have little evidential base yet, the business remains adamant it has founded a new ‘movement’ in fashion and health. “We are about passionate, empowered women who are taking recovery and wellbeing into their own hands,” proclaims its website. “We’re cultivating a community who are committed to living their best lives. Adding a daily dose of CBD to your wellness regime may help support your body function at its best, preparing you for whatever life throws at you.”

CBD Universe, a private label manufacturer and distributor, and Spyder, a global ski and performance brand, have partnered up to create a hemp-infused product line built for an active lifestyle. The new Spyder CBD Collection features a range of products infused with CBD derived from hemp and combined with “tough” ingredients designed to withstand the elements. Its creators say the products can help to aid in recovery. The collection includes body lotion, cooling muscle balm, hydrating face cream, lip balm, sunscreen and the “Essentials Travel Set”. Justin Pentelute, CEO of CBD Universe, said: “Anyone who spends extended periods of time outdoors knows how varying conditions can affect your skin, muscles and joints. “Spyder is the most trusted brand within the ski community, among athletes and active consumers globally and CBD Universe’s topical CBD-infused products are a natural extension for this storied brand.” All products are infused with pure cannabidiol (CBD), the non-psychoactive compound derived from the hemp plant. Topical application of CBD is increasingly recognised for its effects on reducing skin and muscle inflammation, which may ease pain for active users. Daniel W. Dienst, executive vice chairman at Authentic Brands Group, owner of Spyder, said: “CBD Universe is a highly-respected pioneer in the industry, and we’re excited to launch the Spyder CBD Collection through this partnership. “This new line of topicals can meet the needs of elite Olympic athletes, weekend warriors and everyone in between, which creates a great opportunity to bring these world-class products to the market.” The Spyder CBD Collection is available now at Spyder. CBDUniverse.com.

COMMENT

A hundred medications in one â&#x20AC;&#x201C; and they work 58

Dr Dani Gordon is a leading specialist in clinical cannabis medicine who has practised widely in this area in her native Canada. Here, she shares her experience of how she has pushed the boundaries to show that cannabis can help transform the lives of people with chronic conditions.

COMMENT

Dr Dani Gordon

These are people who have really been failed by the medical system

I've been combining botanical medicines with conventional drug therapy for the last 10 years of my practice in Canada, and about four years ago, I added cannabis. I had the same troubles as we’re having in the UK - the stigma around what my colleagues may think and what my college might think. Of course, when you smoke cannabis, that's not a medical use. But cannabis is a medicine and I've used it successfully with thousands of my patients when other drug therapies have failed them. Yes, cannabis is a drug but it’s also a botanical medicine which has had thousands of years of traditional use. It’s different from other drugs because it's a multifunctional, multi-target medication. Doctors often say to me, if you're new to cannabis, how can it work for so many things, it must be a snake oil. Well, it's not a snake oil, but it's 100 medications in one and it works on our endocannabinoid system and it also works on our other neurological systems. It's really important to say that I've not cured any of these conditions with cannabis permanently, but I see patients in a complex care practice, and I don't just think in terms of cannabis, we work on their lifestyle, I teach them how to calm the nervous system and meditate and, and we also use drugs. But these are people who have really been failed by the medical system. Often when they get to me they're suffering from such a wide array of chronic symptoms that are not well managed. They have massive side effects and are massive burdens on the system. We're just not really well equipped with our western medicine and pharmaceutical drugs to handle a lot of these chronic disease symptoms and cannabis really does help. As doctors at medical school, we learn how to prescribe pills. Even an oil, which is a liquid form, for an adult is a bit weird for us. With cannabis, it’s the same plan but it’s complicated. There have been different varieties cultivated over years and years. There have been high THC, very low CBD varieties that have been cultivated for the recreational market, and there have been hemp varieties, which basically produce CBD preferentially over THC. Medical cannabis has THC and CBD, which are synergistic, they help each other in the body. On its own, I don't recommend THC for treatment. Some of my colleagues in Canada do that, but I personally don't think it's a good idea because people can have side effects. But if you put a little bit of CBD in there, or a lot of CBD in many cases, then it buffers the side effects. I first started getting interested in THC about nine years ago, when I used to do a recurring local surgery for complex care in a small rural community. Many of the people there grew it and were really healthy even at 90 years old. It’s interesting because it has a lot of antioxidant properties and anti-seizure properties,

COMMENT

Some of my patients suffer from chronic depression, so I'll add a little bit of an uplifting strain of vaporised cannabis, a very small amount in the morning to help them with their morning motivation.

and I use it sometimes as an add-on for some of my autoimmune patients. But in the UK, we just have to start with the basics because that's really all we have right now. So when I train doctors here we really focus on CBD first. Oils are the most common form here, both on the medical cannabis side, which you can prescribe from a prescription pad, and from the high street where you can find CBD oils. We also have a lot of different forms of cannabis, more so in North America than we're seeing here, but this is why it's so complicated because there are so many different modes of use. You can also use cannabis as a tea for medical purposes, although it's not as predictable as far as how much you have to take to get a desired effect consistently. One of the things that we're moving towards in the UK is the labelling of the products. Medical products generally in Canada specify the amount of THC in milligrammes per millilitre and the amount of CBD, and we're going to see the same thing in the UK. You will know how much CBD or THC you're getting per millilitre of oil or, if it's a capsule, which is going to be coming soon, you're going to know, for example, if there are two milligrammes of THC and five milligrammes of CBD per capsule. That's really important

because that's what we understand as doctors. In the UK, we only really know about THC and CBD percentages on the products, which give people an idea of what to look out for. So, on one side would be a product that has no CBD and only has THC. I like to use a base of a high CBD product first in most cases, especially if a patient is naive to cannabis. CBD is anti-inflammatory and it works together with THC. For cannabis for anxiety, I start with high CBD, a ratio of 25 to one, meaning really minimal THC product. The reason I do that is because, although some of my patients may be medicating their anxiety with high THC, and they may be getting short term benefits, sometimes they're getting what's called a rebound effect to their anxiety. Cannabis and sleep are really interesting. I do a lot of work with people who have had terrible insomnia for years and no one can figure out exactly what's wrong with them. Interestingly, CBD alone often makes them more wakeful and that's because in some people we think CBD messes with the sleep/wake switch in the brain. Although I wish that everyone could take a hemp, pure CBD product and get better, that is just not the case. That being said, I have some patients who do find that hemp CBD helps with their sleep. The typical prototype of this patient is usually someone who is very stressed and CBD can potentially help with regulating the HPA (hypothalamic-pituitary-adrenal) axis. So it might just help reduce their cortisol, which may help their natural sleep/wake cycle in their sleep rhythms. And maybe that's why it's helping their sleep. Again, these are all practical things I've had to figure out over doing this for years. With CBD and stress, a lot of patients will be using overthe-counter products. Itâ&#x20AC;&#x2122;s a very safe thing. If patients are wanting to try it on their own, if itâ&#x20AC;&#x2122;s under 100 milligrammes a day, it's really safe. I also see a lot of patients in my practice who, as with the fibromyalgia, migraine and IBS cluster, are difficult to treat. Again, I find high CBD products really helpful. Some of my patients suffer from chronic depression, so I'll add a little bit of an uplifting strain of vaporised cannabis, a very small amount in the morning to help them with their morning motivation. It was actually one of my patients who turned me on to this and reluctantly I agreed to give that option a go, and it really works for them. So I've

COMMENT

done that for quite a few people now. Meanwhile, everyone is different when it comes to Parkinson's symptoms. We’re treating the whole person and, for the rigidity of the tremor, THC seems to be the most important. But if you give someone too much THC with Parkinson's, their blood pressure can drop really quickly, so you have to be really gentle with them. Therefore, usually I use a high CBD oil as a base again, and I find it does help with their agitation, mood and anxiety. These are things that a lot of that patients are reporting. Also, I would use a higher THC oil before they go to bed to help with their sleep lifecycle disruption and restless leg syndrome. But every patient is different. This is why when you look at the research that has been published so far about Parkinson's and cannabis, it's really mixed, because it's mixed clinically too. I'm honest with my patients and say this is an educated guessing game. It’s more complicated than just giving someone a pill. In every situation, it’s really important to tell patients that this is not a cure, they just don't take it temporarily, then they get to stop taking it. Unfortunately, it doesn't work that way. It's really important to tell patients up front about this because it's expensive, although hopefully that will not always be the case. Although every patient is slightly different, it is important to break it down and say 'if you do this, you’re going to be pretty safe'. I have to say this is a really well tolerated medication. This medication has literally changed my patients’ lives. Instead of making people more lethargic, people go back to work. People have long term disability who never thought they would be able to leave their houses, but then they go out and begin a part time job, their relationships improve. It’s incredible. In four years of using this over thousands of patients, I've only taken one person off cannabis medicine. And it wasn't because of side effects, it was because of cost, in the sense that their workplace wouldn't cover it under their benefits anymore and they didn't want them to go to work on it even though they were not intoxicated. Instead, we had to put them back on high dose morphine, which is completely ridiculous in my opinion. But that’s a whole other discussion. Dani Gordon was addressing an audience at an event hosted by the Medical Cannabis Clinicians Society in London.

In every situation, it’s really important to tell patients that this is not a cure.

OPINION

UK’s “broken” system needs urgent repair 62

Dr Frank D’Ambrosio has advised the UN on medical cannabis and prescribed it to over 10,000 patients. Here’s his take on the UK’s failure to provide access to the medicine.

OPINION

“It’s a dire situation”, says Dr Frank D’Ambrosio of the current plight of UK families struggling to access medicinal cannabis. It’s also indicative of a “broken system”, he believes, since the UK is the biggest producer and exporter of legal cannabis on the planet, “yet the citizens have no access to it”. As one of the world’s leading campaigners for policy reform on medical cannabis, D’Ambrosio is well placed to comment on the UK picture. He spent 30 years as an orthopaedic spine surgeon in California, witnessing thousands of patients in chronic pain. After 20 years in the field, he realised he had an office full of patients addicted to opioids. Six years ago he stopped prescribing opioids and convinced 90 per cent of his patients to move to the cannabis plant. He’s since treated over 10,000 patients with opioid addiction and successfully transferred them over to the use of cannabis. In 2018 he addressed the World Health Organisation – which directs international health within the United Nations’ system – telling its drug dependence committee not to fear cannabis. He says: “In the UK we’ve essentially had the legalisation or allowance of medical cannabis prescriptions as approved by Parliament. This was then given over to the medical societies which actually formed a roadblock. So it has really done nothing and the NHS has so far issued no prescriptions. “The only way people can get access cannabis is to go to private clinics where they are paying between £1000 and £2000 a month. If you’re very rich that’s fine but this is ultimately a two-tiered medical system with regards to cannabis. “There are plenty of families with children with epilepsy who can’t afford £2000 a month. They’re essentially doing fundraising every month, just to get their children medicine. I can’t imagine that this was what they hoped would be the result of allowing medical cannabis to be

available to citizens in the UK, or if it was, then it was a pretty duplicitous experiment.” The situation is all the more bewildering for families given that the UK produces and exports more cannabis medicine than any other country, according to the UN. A report published last year showed that the UK produced 95 tonnes of legal cannabis in 2016, putting it ahead of Canada in top spot. That UK production accounted for 44.9 per cent of the world total at the time is largely down to production of GW Pharmaceuticals’ cannabis-based medicine, Sativex. D’Ambrosio says: “If you have a country that’s exporting so much, why can’t patients get access to it? And why can’t you have other companies come in to lower the cost and make it more accessible? It seems incredibly hypocritical that it’s okay for people in the countries you are exporting to to access it but not the citizens of the UK.” Some argue that the jackhammer to the medical profession’s “roadblock”, might be yet more research into cannabis medicine’s efficacy. For all the existing studies and anecdotal evidence that exists, the Department of Health and other official bodies continually point to the need for an improved “evidence base”. D’Ambrosio says: “I think the move by Parliament in November 2018 to legalise medicinal cannabis was smoke and mirrors. They punted it from their lap into the lap of the medical societies knowing full well that they would stop it there.” Last August, the National Institute for Health and Care Excellence (NICE) said it was “unable to make a recommendation about the use of cannabis-based medicines for severe treatment-resistant epilepsy because there was a lack of clear evidence that these treatments provide any benefits”. On the same day, NHS England and NHS Improvement issued a report setting out a series of measures to help remove barriers to the appropriate prescription of medical cannabis on the NHS.

In the UK we’ve essentially had the legalisation or allowance of medical cannabis prescriptions as approved by Parliament.

OPINION

Among them were several steps aimed at speeding up the generation of research linking cannabis with various conditions. Aside from research, pricing is also an issue that needs to be addressed, says D’Ambrosio. “I think there’s enough evidence out there already, if you take evidence from other countries. But also, the cost is just so prohibitive. If you only have one producer of medical cannabis in the country, the price is going to essentially be fixed. “Over time, if you had two or three more companies come into the UK, to be able to compete, that would lower the price and then all of a sudden, you’ve got the studies that will fulfil the requirements of what is a medicine according to the NHS, and you bring the price down.” In September, D’Ambrosio visited 10 Downing Street to deliver his report on the UK’s medical cannabis landscape as it has emerged over the last two years. This follows two

visits to MPs and patients in the UK last year. He will also soon be releasing the full results of an online survey of patients he has conducted. The study is ongoing but based on responses from the 4,700 patients questioned to date, the top five reasons for using medical cannabis are for: anxiety, depression, headaches, sleep problems and as an alternative to opioids. At the time of writing, a further 15,000 to 20,000 people are due to be surveyed in the coming months. “One of the big negatives aimed at cannabis is that it’s addictive. The reason people say it’s addictive is because when you stop using cannabis, you may become anxious, depressed and unable to sleep. But that’s not really addiction, because the top three reasons for using cannabis in the first place are because you’re depressed, anxious and you can’t sleep.” Despite the current lack of access to medical cannabis in the UK, the Californian does see some signs of positive change – but not nearly enough. “Children with severe epilepsy are slowly starting to be treated via Great Ormond Street which is admirable. However, a whole host of other patients are being left by the wayside. “The UK’s spiralling opioid addiction can be handled by the adoption of non-addictive medical cannabis as an alternative to opioids. Domestic supply is the way forward for people as a way of beating the prohibitive cost from profiteering pharmaceutical companies.” Raising medical cannabis awareness on both sides of the doctor/patient divide might also help to improve access. Most doctors have had little to no formal training in cannabis medicine, while many are also understandably influenced by somewhat restrictive guidelines from official bodies such as the Royal College of Physicians and the British Paediatric Neurology Association. An added complication is the fact that cannabis is an

The UK’s spiralling opioid addiction can be handled by the adoption of non-addictive medical cannabis as an alternative to opioids.

OPINION

unlicensed medicine, meaning that the doctor, rather than the manufacturer, must take full responsibility for it should something go wrong. “GPs are getting more and more comfortable with cannabis medicine because they know the science behind it. As well as educating GPs, it’s about educating patients. They will then go back to their MPs and say ‘this is what we want, how can you make it happen? Open up the doors for the GPs to play their part’ – and don’t hang the threat over them of losing their medical licence if they use cannabis.” In California, D’Ambrosio’s patients have been able to legally access medical cannabis for 23 years, while recreational cannabis was legalised there in late 2016. “Has it been a resounding success? It depends who you ask. In my practice, I’ve seen medical cannabis help so many people that I could not be a stronger advocate for it. But there are different agendas, for example taxes are being attached to cannabis, because you can get it both from a medical facility and in shops recreationally. “The problem with taxation is that there are some people who are so against taxation that they’re turning back to the underground black market. So it’s a work in progress. “I always tell people that I live my life beta, because I am always going through changes. And I think that’s exactly what cannabis is going to be going through for the rest of our existence. It is always going to be in beta, we’re always going to keep tweaking and figuring out what the next move is.” The UK medical cannabis model is certainly a work in progress, as is Britain’s burgeoning cannabis wellbeing products sector. The UK CBD market will be worth almost £1bn per year by 2025, the Centre for Medicinal Cannabis (CMC) predicts. Does this help or hinder the cause for better access to medical cannabis prescribed by doctors?

D’Ambrosio says: “In an ideal world, accessibility to CBD which is non psychoactive and has well documented beneficial effects to health, wellbeing and recovery, is good. I think what’s going to be a problem, just from speaking to some of the law enforcement officials I met in the UK, is that a lot of the CBD products are not considered THC free. “The definition of CBD oils sold on the High Street is that they have less than 0.2 per cent THC and that’s why they can sell it. I can see the National Crime Agency cracking down and saying if it has any THC in it at all then this is a dangerous drug and you’re going to get into trouble. I wouldn’t be surprised in the next one or two quarters if you saw CBD products being taken off the shelves.” Such drastic action has been speculated in the past, although the pace of growth in the sector – and the sheer weight of resistance from consumers and trade bodies – would make it a hugely divisive and controversial move. While D’Ambrosio is following the UK situation closely, his mission to liberate access to medicinal cannabis goes beyond these shores and his native US. He is the chief medical officer of London Stock Exchange (NEX) listed Block Commodities, which holds medical cannabis growing licences in Africa. “The company’s plan is to build cannabis economies on the African continent. The first country we’re working in is Sierra Leone. “We’re not only looking to create a cannabis economy where we can export cannabis oil from, to countries that are willing to accept the product; but more importantly it is to grow cannabis so that the residents can use the cannabis as medicine. There’s been an enormous increase in the importation into Africa of Tramadol. “It’s quite addictive, and it can be lethal so we want we want people to be able to grow the medicine and create an economy to not only build the financial welfare of the family, but also the medical welfare of the people.”

In an ideal world, accessibility to CBD which is non psychoactive and has well documented beneficial effects to health, wellbeing and recovery, is good.