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A report reveals why UK doctors do not prescribe medical cannabis

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A new report gives insight into the many challenges preventing more doctors in the UK from prescribing cannabis medicines.

Doctors say in a landmark report today that cannabis must be treated like any other drug if we are to see mainstream prescribing in the UK.

The known unknowns of medical cannabis, Published by the drug reform agency Volteface, it collects the views of dozens of doctors in order to identify the main issues preventing the widespread prescription of cannabis.

This is the first time the opinions of specialist consultants have been highlighted in this way since the law was changed to allow them to prescribe medical cannabis in November 2018.

More than 40,000 medical professionals are qualified for this Prescribe cannabis across the UK, but according to the report only about 100 (0.25%) are actively doing so.

As these physicians are the “gatekeepers” to expanding access to cannabis-containing medicines, supporting them in prescribing is critical to more patients so they can benefit from the treatment.

Volteface has interviewed more than 40 professionals in a range of disciplines, incl Painand psychiatry, gastroenterology, rheumatology, and neurology in order to better understand their perceptions of medical cannabis.

A number of issues were identified including lack of governance, insufficient high quality evidence and physicians not having access to education or support in prescribing medicines.

Dr Steve Hagiof (left) Arjun Rajyagur (second right) and Dr Mark Smith (right) of SANA Healthcare and Katja Kowalski, Voltiface launch the report in Parliament.

High quality guides

Most of the doctors interviewed expressed interest in prescribing the drug, however, it is clear from the report that they wanted cannabis to be treated like any other new drug. This means meeting required evidentiary and regulatory standards, such as undergoing randomized control trials (RCTs), which are widely seen as the “gold standard” of scientific evidence.

Some believe that calls to treat medical cannabis differently and bypass these regulatory frameworks ‘undermine their credibility’.

“The first thing we need from my point of view is standard medical-grade evidence, so randomized randomized trials of a pharmaceutical-grade drug,” said Dr. Chris Deary, a neurologist interviewed for the report. “Once you have those, you’ll have something to work from.”

Most of them felt that way too Real world guide On medical cannabis he was ‘biased’ by ‘dominant prejudices’ among those in the cannabis community that ‘exaggerate the perceived benefits of the drug’ rather than ‘identifying its true efficacy’.

As a result, the report says, many of those interviewed viewed the medical cannabis sector with “suspicion.”

“We talk a lot about the evidence for cannabis, but it’s also about the type of evidence,” said Dr. Ewan Lawson, a GP featured in the report.

“Right now, we see the sector trying to build evidence with biased observational studies. The current model is giving cannabis to patients who want and want cannabis.”

perceptions between disciplines

Dr Richard Davenport, a neurologist, added: “You must understand the potential risks you are taking if you decide to treat it very differently from any other medication.

“It has nothing to do with doctors wanting to see cannabis fail, or depriving their patients of cannabis, which is how we’re portrayed sometimes. Some of the notable things that afflict children with epilepsy, are portrayed in an especially unsympathetic and difficult way that are really the evil doctors trying to deny patients medication, And they risk their lives, which is very easy to write about in the newspapers but is nonsense.”

despite of Epilepsy And being MS is an authorized indication for prescribing the drug, the report found that neurologists were particularly reticent about cannabis. Gastroenterologists also felt there was little evidence to support prescribing it in their specialty, while pain specialists showed more interest in and recognition of its efficacy.

Psychiatrists seem ‘open’ to their patients using CBD, but many have concerns about THC, particularly with regard to psychosis and treating people with complex mental health conditions. Many in this discipline believe that cannabis will be a safer and possibly more effective treatment when prescribed in combination with psychotherapy.

Allow GPs to start prescribing cannabis It is believed to be one way of opening up access, as has happened in other places such as Australia, where GPs have been allowed to write prescriptions since 2019.

However, Dr Mark Smith, a GP in the UK who has just returned from Australia where he was prescribed medical cannabis for three years, says the difference in healthcare system infrastructure here and in Australia could present a problem.

“There are huge differences that need to be ironed out,” he told Cannabis Health.

“Here, GPs only have a 10-minute appointment and you have to battle through patients. Whereas in Australia, they have twice as many practicing doctors per head of population and you can schedule your appointment, so it doesn’t matter if you have 45 minutes. We’re still a long way from that.” The resilience we’ve been thwarting.”

Dr Smith added:[Back here in the UK] All the specialists and medical practitioners I know are still completely clueless about medical cannabis, because it is not their business to know anything about it. They are not encouraged to look into it until they have absolutely no idea about the market. There is a lot of education we haven’t had yet.”

Lack of knowledge, education and support

Clinicians report a general lack of knowledge and training in this area, such as how cannabis affects their health endocannabinoid systemwhat formulations are available, the indications they may be prescribed and the various benefits and side effects.

Some have also been put off by the “bureaucracy” currently involved in prescribing and lack of infrastructure and support, and the report identified concerns about reporting them to the GMC and causing damage to their reputation.

“Physicians are just not sure how it works and have little understanding of the infrastructure and governance. Not knowing the practicalities is a huge barrier because we need to be sure of how it is prescribed and managed,” said Dr Ewan Lawson.

“Having specific indications is essential, it can’t just be fun-seeking – without a specific indication it comes very close to an entertainment product.”

According to the report, many physicians said stigma was not a “major barrier” to prescribing, but some of those cited struggled to distinguish between prescription consumption and recreational consumption.

“I think it’s very important to distinguish between therapeutic treatment and recreational use,” said a neurologist who asked not to be identified. “I think the egregious therapeutic use is people who like to get high out the door, it’s a problem… I don’t want to have a reputation that’s The doctor prescribes medical cannabis “because then you get all kinds of crazy people… who come in with a false diagnosis and want to prescribe some cannabis”.

Uncertainty about dosage and routes of administration was common, particularly with regard to cannabis flower. Many said they would feel more comfortable prescribing medical cannabis in pill form.

“In my view, medicalizing it requires making it available, either by injection, tablet or drink,” said psychiatrist Dr. Justin Pasquel.

“Vaping is a lot like a bong, and it also has effects on lung health. So I would be concerned about vaping-inhaling.”

Report author Katja Kowalski

Cannabis clinics – a major drawback?

Another key finding of the report is physicians’ reluctance to prescribe with a dedicated cannabis clinic, with many indicating they would be more comfortable prescribing than with their current practices.

The report states that “a clinic dedicated to a single product inherently creates prescribing bias, rather than encouraging an appropriate, balanced and ethical approach”.

An unnamed gastroenterologist commented: “Obviously if you go to that clinic, you’re going to attract people who want cannabis without any evidence. So, I’m a little concerned about these clinics and the bias and motives behind the people who run them.”

Katja Kowalski, the report’s author and chief operating officer at Volteface, said this was a “major barrier” to her research.

“Clearly, medical cannabis does not quite fit into the health care system. In order to see this change and become mainstream, we must see an expansion of options for physicians to prescribe outside of the cannabis clinic model,” she said.

“Nowhere else in medicine do we see single-drug clinics. In my research, this is a major barrier within the medical community, and something we need to address in the sector, to really expand trust among physicians to prescribe medications more broadly, and thus broaden access.” The patients “.

Where do we go from here?

The report concludes with some key recommendations to address problems with the current prescribing model. These include launching a physician-focused campaign, implementing more randomized controlled trials, and developing innovative tools to encourage prescribing in mainstream practice.

Dr. Steve Hajiv, former Chairman of the Board From the British Medical Association (BMA) and A member of the National Institute for Health and Care Excellence (NICE) Quality Standards Advisory Committee who wrote the introduction to the report said it was time for the medical cannabis industry to ‘reflect’ and ‘adapt’ in order to address the concerns of clinicians on the front lines of prescribing. .

“The enthusiasts who built the cannabis industry and the families in desperate situations who convinced policymakers to change the law have done an incredible job of getting us to where we are now. Enthusiasts are at the forefront of innovation and start processes that can make a dramatic difference, but they are often different than most people in the world. Coal face.

Most normal working physicians would like to see decent evidence that something works, for whom it is most effective, and that it is safe. This is true of every medication, surgical procedure, psychological intervention. When physicians inquire as to why the cannabis industry is not held to the same standards, they are not “preventing,” but rather acting equally and acting in what they are certain is in the best interests of their patients.

Many other medicines have plant origins. Vincristine, artemisinin, morphine, digoxin. All of these drugs have to prove their efficacy and safety, so it’s not unreasonable that potential prescribers of cannabis-derived therapies would want the same thing.”

Dr Hajev continued: “Instead of blaming others or claiming exception, the industry needs to reflect and see how it can adapt to provide the necessary reassurance to mainstream practice.

“[This means] Appropriate controlled trials (or at least some evidence that a particular product is consistently safe and effective for a given indication), strong governance so that prescribers know they themselves are not participating in unnecessary risk and generalization of prescribing in normal clinical practice. “

Dr. Hajiyev is now the Chief Medical Officer of the newly developed SANA Healthcare Company ScriptAssist, A new platform designed to simplify prescribing medical cannabis and support both private and NHS doctors through the process.

He added, “Having one drug clinics in place seems like an anomaly in the wider profession and there is a legitimate fear that a patient is not always receiving the treatment that is best for them at the time.”

“Build high-quality evidence, build governance, build equations around case-specific evidence of efficacy, and move toward delivery mechanisms that have been shown to be safe, consistent, and effective. Build all of that and the prescribers will come.”

You can read a file The full report is here

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