Soapbox
Patrick, 84 this year, is nothing short of a minor miracle. A
bright, intelligent and curious man, had he not been such a heavy and
committed drinker, his life might have been very different. He has
always lived in the street where he grew up in the pitiful poverty of
the 1930s. In spite of his sharp intelligence he never broke free from
the impoverishment inherited from his parents. A few years back we were
sure he would die. Following time in hospital and the discovery of an
aggressive carcinoma he returned home with a palliative care package to
die. But he didn’t die, he lost a lot of weight as expected and he
became very frail, yet he rallied. He stopped – or was stopped –
drinking and came off his seven daily medicines. In January, while
collecting his nutritional drinks to keep up his weight, his daughter
asked if I sold “cannabis oil” as Patrick had run out. Since his
cancer diagnosis he had found out about and was taking “cannabis oil”
three drops daily under his tongue.
“It’s a miracle” she confirmed “And
only £50 for 15 mls”.
“Cannabis oil” consumption is only one aspect of a wider use of
“medicinal cannabis” to treat a wide range of conditions. Such has been
the pressure on the Irish Government a private member’s Bill to
legalise “medicinal cannabis” is currently before the Oireachtas. The
debate on the issue is mainly based on testimony from users about the
alleged medical benefits. In the UK, however, the situation is less
sympathetic with a strict legal ban on certain cannabis products and
more recently a decision to categorise “cannabis oil” as a medicine
severely restricting its supply.
The case of a Tyrone child suffering from a severe form of epilepsy
and being treated with “medicinal cannabis” in the US has been
highlighted in the Irish Times. His mother claims she is unable to
return to Ireland because the treatment is “illegal” and her son needs
it. Mother and son are in dire straits. They are living in the US
where medicinal cannabis is legal but costs $50 a day and that’s before
the medical and living costs. So “medical cannabis” is becoming a
medical and political hot potato at the moment and for those who, like
me when I was asked to supply it, haven’t a clue what it is, here is the
idiots’ guide.
Quality
There are many strains and varieties of the plant known as Cannabis sativa.
Hemp is the variety mostly associated with fabric manufacture whereas
marijuana is a variety associated with dope.
This difference is down to
the various amounts of each of the 70 or so cannabinoids that have been
identified. In simple terms; hemp has very little delta 9
tetrahydocannabinol (THC) – the dope molecule – but, a reasonable amount
of cannabidiol (CBD). This might be; 0.2% or 2% or 4%; it is a bit hit
and miss. To be classified as “hemp oil” the plant must not produce
oil with more than 0.2% THC. A European directive allowed for this
position and the consequential development of a medically focused
“cannabis oil” market regulated as a food product. That was until MHRA
spoiled the party and decided that, since medical claims were being
made, “cannabis oil” is a medicine and products offered for sale
therefore must have a medicines license. At this moment, as “cannabis
oil” disappears from the health food shops, it is important to
understand that because of lack of regulation, they could contain
anything and any amount of CBD and some might actually be fake
containing only olive oil.
Efficacy
Mostly anecdotal reports or poorly designed trials are the basis of
efficacy claims across a range of conditions; cancers, cognitive
conditions, nausea & vomiting, autism, sleep disorders, glaucoma,
MS, pain & inflammation, Lymes disease and epilepsy; just to mention
a few. Cannabis, it seems, has the real potential to become the
universal panacea.
For most conditions, based on the science, it is fair to say that
cannabis treatment lacks evidence of efficacy and where efficacy has
been scientifically demonstrated it is only a weak effect and is
generally no better than currently available medicines.
Safety
An issue seldom considered by the many who have rushed into this
lucrative market is that of patient safety. All cannabis products have
potential to cause not only acute toxicity but also long-term problems.
This is well established for cannabis and its impact on the developing
and immature brain and is linked to triggering of schizophrenia. Yet we
have no way of knowing this risk with the information currently
available.
Patrick might not have much to lose but his demise has been blocked
most likely by his lack of booze and his medicines rather than his daily
drops of cannabis oil. Younger patients, especially those using higher
doses and different ratios for epilepsy, for example, might suffer
significant consequences in the future.
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