Consultant in Pain Medicine

Cannabis Medicines For Pain

CANNABIS MEDICINES FOR PAIN

medical cannabis


What are
Cannabis-based
medicines?

Perhaps you have much been in severe pain for a long time, and have tried various treatments without success, or perhaps the side effects were just too much? Then you may wish to consider the now legal, cannabis-based medications.

 
Only about 1 in 4 people find conventional medicines to be really helpful for their pain, even after several have been tried.

As a Consultant in Pain Medicine, I’ve prescribed conventional pain medications for many years, and some less commonly used conventional medications for pain, such as flecainide. Of course, I’m always delighted when these work for patients, but the problem is that conventional pain medicines often have significant side effects, and don’t really help the pain.

Sedation can be a big problem and many people have told me that they ‘feel like a zombie’ while taking them.

In addition, some conventional pain medicines can generate dependency, including opioids (such as tramadol), antidepressant medicines, gabapentin, and pregabalin.

Overall, many people simply can’t tolerate the burdensome side effects of conventional medicines, which often produce more problems than they solve.

For these reasons, I became interested in cannabis medicines as an effective treatment for patients, when they became legal in 2018. And as an early adopter of this treatment, I’ve gained a wealth of experience in the field, and am considered to be a leader for other Doctors.

Cannabis medications are perfectly legal, they are pharmacy grade, and we aim never to cause sedation or overly-elevated mood.

How does cannabis help with pain?

  • In the late 1980’s scientists discovered the endocannabinoid system. It’s a network of receptors on the cells of our bodies, endocannabinoid molecules which help bring normality back to our bodies, when we’ve been injured or stressed.

  • The endocannabinoid system is important for balance of cells and organs, and they regulate our neural and immune systems, and, sleep, mood and even appetite.

  • These bind to our endocannabinoid receptors found mostly in the nervous system and immune system, but sometimes, we simply don’t produce enough of these substances to be effective. We now understand that the substances found in the cannabis plant can supplement the actions of anandamide and 2AG, and we can use this natural effect to help with long-term pain and the exhaustion, low mood and sleeplessness than can go along with it, without causing the adverse effects that go with conventional pain medicines.

  • It also seems that cannabis medicines are much less likely to cause dependency than many conventional pain medicines.

  • The effects we are creating should not be at all like those of recreational cannabis use, and we aim to have no side effects at all.

  • Cannabis oil’ that you can buy ‘over the counter”, only contains CBD, which is a very weak cannabinoid, and only a few people can be helped by this. The difference is that prescribed cannabis medicines contain THC, and most people need only a very small amount of this to have a beneficial effect, calming the over-excitable nerve cells, reducing pain.
  • Additionally, because being in pain can lower our mood and induce anxiety, the mood-boosting and anti-anxiety effects of cannabis can additionally help with pain relief.

  • Part of this effect is carried out by the terpenes, which are chemical components also found in the cannabis plant.

  • One of my particular areas of interest is finding the right cannabis medicine for each patient, by choosing the right terpene blend for each individual. For example, the Cannabis Sativa medicines contain terpenes which may be more energising (and therefore better suited to help with pain during the day), while Cannabis Indica medicines are more calming, (which may aid sleep).

What conditions can be helped with medical cannabis?

Cannabis-based medicines can be very helpful for people who are suffering with fibromyalgia, particularly as the cannabinoids actually work in the nervous system (unlike many traditional pain medicines).

Many people with fibromyalgia find it difficult to fall into a deep sleep at night and their muscles never relax and repair themselves. Cannabis can help to reduce muscle tension and can calm the nervous system, permitting restful sleep. This often results in less pain being experienced the next day, and over time, pain levels overall.

  • Migraine – Cannabis medicine actually seems to prevent the mechanisms that lead to a migraine attack, and many people find they have no have far fewer episodes of migraine.

  • Multiple sclerosis pain – cannabis medicines have been shown to reduce the nerve pain and painful muscle spasm of MS, while lifting the mood and improving sleep. In fact, there are one or two licensed cannabis medicines specifically for MS.

  • Tumour and cancer pain and palliative medicine – often enables patients to reduce their opioid drugs and to be more awake to spend time with their family, and doing enjoyable things.

  • Arthritis and rheumatological pain – in addition to relieving pain, cannabis medicines also seem to have a useful anti-inflammatory effect.

  • Ehlers Danlos-related pain – cannabis medicines can help to stabilise the overexcitable central nervous pain pathways, reducing pain and symptoms. I have particular experience with Ehlers Danlos.

  • Gynae pain – I’m currently involved in a trial of therapy to see if cannabis medicines can help with period pain, and I would welcome new patients who would like to try this novel and safe approach. There is only evidence to suggest that cannabis medicines may be helpful in endometriosis, by reducing the number of endometrial cells, that grow outside of the womb.

  • I also have a specialist interest in pelvic pain in women and in men, and so often ‘gynae’ pain, can be due to pelvic floor spasm, or pelvic nerve entrapment. Cannabis medicines can be a useful supplement, whilst these conditions are being treated.
  • Bladder pain – and bladder irritability can be such a drain on a person’s life. When conventional approaches have been tried and are still not providing a solution, it is well worth trying cannabis medicines to reduce bladder sensitivity.

  • Nerve pain – is very often helped by a prescribed combination of… .and so often without the sedation and dependency issues, so often associated with conventional nerve pain medicines, such as gabapentin and tramadol. Cannabis medicines are particularly well tolerated by older people, who may simply not be able to use conventional medicines, which can so badly affect their memory and clarity of thought. I’ve so often weaned patients off their gabapentin and amitriptyline and have ‘met them properly’ for the first time, to begin cannabis medicines with them.
    Of course, we don’t have to stop helpful pain or any other medicines before starting cannabis medicines, and, often, cannabis medicines can make it easier for someone to come off their morphine, oxycodone, or other medicines.

  • Abdominal pain – is a very complex matter. It often results from over-activity or under-activity of the small and large bowel, which of course have their own complex nervous systems, as is the case in irritable bowel syndrome. In addition, the lining of the bowel can become inflamed in conditions such as ulcerative colitis and Crohn’s disease.

  • By carefully prescribing the right blend of cannabis medicines for you, we can up-regulate or down-regulate towards normality, and it is now widely accepted that cannabis can have an anti-inflammatory effect on the gut, which can be so useful in ulcerative colitis and Crohn’s disease.

Who isn't suitable for cannabis-based medications?

Cannabis-based medicines are prescribed after careful assessment of your clinical situation, and they aren’t suitable for everyone.

People with a personal or close family history of psychotic illness such as schizophrenia and mania should not receive cannabis treatments, and they are also strongly contra-indicated in women who are pregnant or breastfeeding.

People who’ve recently had a stroke, or a heart-attack, or who are suffering from heart problems, or liver disease, need very careful consideration.

Some occupations (e.g. being a pilot or an HGV driver) may mean that it’s not advisable to take cannabis-based medicines.

How is medical cannabis taken?

Cannabis-based medicines can be taken in a variety of ways. New users can generally begin with a CBT:THC oil, which is placed under the tongue.

Those who have smoked cannabis tin the past, or who need higher doses of CBT and THC, may be started on vapourised cannabis medicines, in the form of a pen vapourised cannabis, or in the form of pharmaceutical vapourised from cannabis flower.

l initially prescribe low-doses of the cannabis-based medicine to start off with, while a person continues with their current prescribed medications. It is safe to combine the two in the majority of cases, but not if a person is taking blood-thinning medications such as warfarin, or one or two other medicines, which we can discuss.

How long does it take for the cannabis medicines to start working?

Vapourised cannabis starts to take effect within a few minutes and lasts for 2-3 hours.

Oil-based cannabis has a slower onset of action (around an hour or two), but a longer duration (around 6 or more hours).

But cannabis medicines take a long time to build up in your body, and it’s really only after two or three months of adjusting the dose and prescription for you, that we expect to see real benefit.

The cannabis dosage is gradually increased after assessing progress, and after 2-3 months, we can consider reducing some of your other pain medicines.

What can I expect?

What are the potential sided effects of cannabis-based medicines?

Any medication has the potential to produce side effects. We aim not to cause side effects by carefully prescribing cannabis medicines, but occasionally, patients may notice one or two of the following side effects, particularly in the first week or two of starting the medication, and fading with time. Possible side effects include:

Dry mouth
Slight increase in heart rate
Dizziness
Sleepiness
Tummy upset
Appetite changes
Mood change, often for the better

Thankfully, careful dosing can mitigate the risk of most side effects, and many patients find cannabis-based medicines far more tolerable and effective than traditional pain medications.

Frequently Asked Questions

Is medical cannabis addictive?

In my experience, most patients choose to stay on their cannabis medicines because of their beneficial effects. Those who have not experienced any benefit, have been able to stop their cannabis medicines without any difficulty. In addition, I have heard of patients who have chosen to stop their cannabis medicines for a week or two (for example, when travelling abroad), without any adverse effects, other than a return of the symptoms that the cannabis medicines were helping.


Will I become ‘high’ taking medical cannabis?

So, you are unlikely to get ‘high’ or alternatively, overly-sedated. And if you do, we will immediately alter the dose of your medications, or you can stop them. But don’t forget, the cannabis medicines can often lift your mood appropriately, if your pain or lack of sleep are causing low mood. The dose of the active ingredient (THC) in cannabis-based medicine is generally much lower than quantities typically used in the recreational use of cannabis.


Is medical cannabis legal?

Yes. In November 2018, the UK home office amended the regulations of the 2001 Misuse of Drugs to legalise ‘cannabis-based products for medicinal use in humans’. This enabled specialist doctors like me to be able to legally prescribe cannabis on case-by-case basis, when other pain treatments had proven unsuccessful.


What’s the difference between cannabis-based medicines, and CBD products you can buy over the counter?

The cannabis plant contains many kinds of active chemical components.

Two of the main components are THC (tetrahydrocannabinol), which is the ‘psychoactive’ substance in cannabis-based medicines which can help with pain, and CBD, (cannabidiol) which is not a psychoactive substance.  Taken in ‘recreational’ doses, THC can induce a euphoric state or a ‘high’.

CBD oils/gummies/pills which can be purchased don’t contain THC, and are therefore are not proper, prescribed cannabis medicines.

What’s the difference between medical and ‘street’ (recreational) cannabis?

 There is a huge difference between medicinal cannabis, and street cannabis obtained on the black market. Medicinal cannabis is produced with very strict quality control, and we know exactly the quantity of the individual components that make up the medication.

Street cannabis is totally unregulated, and it’s impossible to know for sure its concentration of THC, which may lead to higher-than-expected dosing, and potentially harmful effects. In addition, street cannabis contains almost not CBD, and it’s CBD that gives cannabis medicines a much more balanced and controlled effect.

Medical-grade cannabis is produced under very clean conditions, while street cannabis can harbour high levels of bacteria and fungi, and insecticides.

Cannabis medicines and driving

Can I drive whilst taking cannabis-based medicines?

 The DVLA advises that patients shouldn’t drive if they feel impaired whilst taking medications, including cannabis-based medicines. Through careful dosing and monitoring, most of my patients do not experience drowsiness and are able to drive.

Cannabis medicine users are advised to keep a copy of their prescription of their prescription and my clinic letter, to show Police, if they are stopped. Police are mostly aware that exceptions are made for drivers who are using medically-prescribed cannabis, but only if they are able to drive safely.

What is a Cancard?

A Cancard is a kind of medical ‘ID’ which is commonly recognised by the Police in the event that you are stopped and drug-tested by them.

It provides evidence that you are consuming cannabis for medical reasons, but this is not guaranteed.

You are still advised to inform the DVLA and your motor insurance that you are using cannabis-based medicines.

How can I obtain cannabis-based medicines?

It starts with a consultation.

During our clinic appointment, I’ll be listening carefully to everything you want to say, so I can understand your pain, the treatments you may already have tried, and your whole situation. We’ll discuss whether cannabis-based medicines may a good treatment choice for you.

UK regulations require me to anonymously present your case to our MDT (multidisciplinary team) for their approval, prior to prescribing cannabis-based medications.

Next, I prepare a prescription, which you may choose to have dispensed at a specialist pharmacy of your choice, or, like many of my patients, you may prefer for me to send the prescription for dispensing at one of the several specialist cannabis pharmacies I work closely with. They will contact you directly to take payment for the medications, and to arrange delivery to you via courier.  

After commencing on your cannabis-based medication, we will meet for a review after two weeks, and then monthly after that, so that we can discuss how you are responding, and I can listen carefully to, and answer any questions you may have.

The medications are started at a low dose, and then we build them up gradually, adjusting both the constituents and quantities to find the most optimal treatment blend for you. It takes around three months for the cannabis medication levels to build up in the body, and for their full effect to be realised.

You will also have access to our specialist nurse, who is highly experienced at supporting patients undergoing medical cannabis treatment.

What happens next?

Cannabis-based medicines are controlled drugs.

This means their use must be reviewed frequently, and I am only permitted to prescribe a month’s medication at a time.

I work with a network of organisations who manufacture medical cannabis, and unlike many UK-based cannabis clinics, I am not ‘tied’ to a single producer. This means I have able to prescribe a very broad range of medications from the best manufacturers, and I can prescribe the very best medications to suit your needs.

What will this cost?

The appointment fee is £150, and I believe in giving all my patients plenty of time to talk about their pain, and how they are responding to the medications. The medications cost from around £225 per month.

I’m one of the UK’s most respected and experienced prescribers of cannabis-based medications. I speak at national and international conferences about the use of medical cannabis to treat painful conditions, and my peers refer to me as the ‘David Attenborough’ of cannabis medicine.

The appointment fee is £150, and I believe in giving all my patients plenty of time to talk about their pain, and how they are responding to the medications. The medications cost from around £225 per month.

I’m one of the UK’s most respected and experienced prescribers of cannabis-based medications. I speak at national and international conferences about the use of medical cannabis to treat painful conditions, and my peers refer to me as the ‘David Attenborough’ of cannabis medicine.

Dr Ordman has given me fantastic support in coping with pain associated with a cancer diagnosis. He has helped me to transition away from other pain medications and cannabis medicine has reduced my pain considerably. Before meeting him I found it hard to access information about cannabis and did not know who I could trust. Dr Ordman is very knowledgeable, not just about cannabis, but analgesia generally, and that made me feel very reassured to give it a try. He is easy to talk to and he and his support team are very responsive and helpful.

Medical cannabis can provide excellent pain relief for many painful conditions and can significantly improve the quality of people’s lives.

 If you’ve be suffering from severe pain and conventional medications haven’t worked for you, cannabis-based medicines may be an option. Do get in touch to book an appointment.