Medical Choices UK: Learning From Australia About Medicinal Cannabis Education
By Dr Julie Moltke
Meet the people behind the non-profit organisation, Medical Choices UK, Focusing on Medical Cannabis Education.
Sharlene Mavor – Medical Cannabis Research Australia (NFO) and founder of Medical Choices UK.
Sharlene is a Medical Scientist (BAppSc -Medical Laboratory Science) and co-founder/director of Medical Cannabis Research Australia who has been researching how Medical Cannabis may treat an ever-increasing array of disorders. Her university background in diagnostic pathology gives her the knowledge to understand disease processes in the human body.
She’s travelled to the US, Canada, Israel, Colombia and Chile to learn firsthand from the leading researchers and clinicians in this new field of cannabinoid science. She’s passionate about sharing this knowledge by educating medical professionals and patients under the banner of her NFO/charity Medical Cannabis Research Australia.
Tell us about Medical Choices UK, why was it founded, and what is the mission?
Medical Choices UK has been founded to meet a need, and that is to be a platform from which to educate not only health professionals but also patients, their carers, decision-makers/legislators and the general public. Education is key to not only introduce prescribers to this new family of plant-derived medications but also to reduce the stigma attached to its medical use, brought about by the confusion with its illegal adult or recreational use. Other primary aims for this non-profit are to advocate for easier patient access by presenting scientific evidence for safety, efficacy and economic value, and to share and participate in new clinical research showing evidence for more qualifying conditions for patient treatment.
I believe you are running a similar organisation in Australia, how has the journey been there so far?
Yes, I’m a current director and was a co-founder of Medical Cannabis Research Australia (MCRA), which was founded over three years ago, at around the same time as legislation was passed to legalise cannabis for medical use in Australia. My wish is for Medical Choices UK to be a sister organisation, that achieves much of what MCRA has managed to in Australia.
The journey has been difficult for patients, with our government implementing a ‘Prohibition-style’ access system.
Many hurdles have been placed in the way of patients, but slowly access has improved with more doctors prescribing and establishing efficacy for this medicine. Figures from July 2019 show 2300 prescriptions had been approved in Australia, and there is exponential growth in these figures every month. This is very encouraging, but of course, in no way reflects the true patient need, which would be in the tens of thousands, if not many more.
Medicinal cannabis education is a crucial element for the organisation
MCRA has spent the majority of its time either planning or running education in the form of seminars, to educate health professionals and patients, which we believe has helped increase the number of interested prescribers and has empowered patients to understand how medical cannabis may be able to help their condition and for them to have the confidence to ask their doctors to prescribe it. We have established MC prescribers, pre-clinical researchers, analytical scientists, pharmacists, prescribed patients, and economic and industry commentators, all present in their areas of expertise. Our seminars provide a well-rounded initial education around the scientific evidence for medical cannabis, but other organisations also have more formal and accredited education, which can take over where we left off – an absolute necessity!
We have run five rounds of seminars so far, and we are about to run our 6th in October, directed at patients and their carers.
With every round, our audience grows substantially, and we expect around 200-300 to each seminar this time, a reflection of our large social media following of nearly 8500 on Facebook and many more on the other ‘socials’.
With a lot of local and international media focused on medical cannabis, it’s obvious that the need and curiosity to know more about this medication grows daily and we have been well placed to help these people. Patients have driven change and mobilising them to approach their local politicians to change their mindset, and having scientists and charities like ourselves back them up with evidence will force more compassionate access.
I believe we fulfil a current growing need and we hope to grow the charity and expand our aims as medicinal cannabis enlightenment evolves.
How can the UK learn from Australia when it comes to granting UK patients access to medicinal cannabis?
The UK journey, I believe, will be very similar to that of Australia. The main impediments to patient access are onerous ‘Red Tape’ and cost.
Medicinal Cannabis (MC) in Australia is considered an experimental medicine
It is classed as a restricted and notifiable drug, so applications to prescribe must be granted Federal approval, as well as State approval if a significant amount of THC is present in the medication.
It is considered a medication of last resort and doctors must establish and prove that patients have exhausted all other drug options before they may be considered for an application.
Access to CBD (cannabidiol) is limited in Australia compared to the UK, and most prescriptions are private
An essential difference in Australia compared to the UK is that CBD medications (less than 0.3% THC) are considered medicinal cannabis and are scheduled by the government, therefore requiring a prescription. I believe the UK has a massive advantage in this regard – unrestricted access.
All prescriptions here are private, like the UK, except for a minimal number, which are granted through an inpatient system in some States.
Our equivalent version of the NHS will not include medicinal cannabis on its list of medications for much the same reason as the NHS states – virtually all of the medicinal cannabis medications have not gone through peer-reviewed Random Controlled Trials to prove effectiveness for a symptoms or disease and cost-effectiveness, compared to existing listed medicines, has not been established.
Access for specific symptoms and disease states has however been more liberal than we expected, as we have had prescriptions approved for chronic pain, chemo-induced nausea and vomiting, Palliative care, drug-resistant epilepsy, Multiple Sclerosis as well as PTSD, Autism.
The individual state’s Health Departments themselves decide who shall prescribe and have the last say (after Federal approval) in who qualifies for a prescription and some states have relaxed prescribing to allow general practitioners to apply for a prescription, while others require specialists or GP’s with specialist approval or support to prescribe.
GP’s in the UK should be able to prescribe
The UK can learn from Australia by understanding our evolution over the last three years. Better access comes about by working together with all stakeholders to educate medical professionals and patients. Lobby politicians with the science/statistics, demand compassion and ask for GP prescribing as soon as possible. Everyone who cares must get involved with this.
Use the media to highlight patient’s stories, over and over – this changes the public perception and reduces stigma.
Encourage industry to run pilot studies and other higher valued clinical trials – Australia now has over 30 ongoing reviews around MC. I genuinely believe the medical system MUST succeed and be embraced by medical professionals and the government before adult/recreation use is legalised. Otherwise true widespread medical acceptance will be seriously threatened. The rest of the world watches us.
Julia Piper - Chair of Medical Choices UK
BIO Dr Julia Piper is The founder and CEO of Private gp.com Ltd based in Leicestershire. She is a Functional Medical practitioner specialising in the healing of chronic complex illness. Her knowledge of functional medicine has moved her into the arena of cannabis medicine.
What is the next step for Medical Choices UK moving forward?
We have just started our first round of training seminars in the UK and will aim to do a series of seminars two or three times a year in different parts of the United Kingdom.
We aim to invite specialists, GPs, patients; advocates; and other specialists in cannabis, to speak at the seminars and to educate our audiences, in preparation for prescribing medically.
These MCUK events are an ideal opportunity to network and we would like to encourage the development of CANNABIS prescribing at many different levels, either in standalone clinics, as part of private or NHS general practice and also in specialist medicine. Currently, we would love to have links with research too and also consider how to fund that research, working with patients in most need.
How do you see the organisation contribute to granting patients access to medicinal cannabis?
MCUK would like to educate as many people as possible, including health professionals and patients, government officials and many others, about the benefits of cannabis. We want to network thoroughly and wholeheartedly and encourage knowledge of all the research that backs the use of cannabis in illnesses.
Apart from the front-facing seminars that we offer to health professionals and patients, we also try to be as creative as possible in the background.
Our networks will help the development of pockets of prescribing in the UK, which is highly evidence-based and tied into appropriate research.
We believe that it is teamwork that creates success in a changing and moving field such as the cannabis industry. We, therefore, want to get a strong network and team that together will be able to devise and deliver appropriate prescribing for patients.
Michael W Platt - Pain Specialist
Michael is an anaesthetics and pain medicine specialist based in London. He has been a consultant and honorary senior lecturer in pain medicine and anaesthetics since 1991. He is a professional and highly effective senior consultant in pain medicine and anaesthetics with over 23 years in senior clinical leadership and specialist roles. He recently became the medical director at Sapphire Medical Clinics a new tertiary referral clinic for medicinal cannabis.
How does chronic pain treatment look today? Can most chronic pain patients manage their pain with the currently available treatments?
Management of chronic pain varies throughout the country and internationally. The most successful units use multi-disciplinary approaches with medications, interventions combined with physiotherapy and psychology.
In most areas, there is often not a multi-disciplinary approach, with all the treatment being based on a single aspect - often physiotherapy, chiropractic manipulation and simple drugs - often involving opioids with their inherent dangers, or simply with complex interventions such as neuromodulation, but without physiotherapy and exercise back-up.
Very many patients are inadequately managed and become chronic patients, instead of getting better.
As a pain specialist, can you see medicinal cannabis having a place in the treatment of chronic pain?
There is an increasing body of evidence indicating that medical cannabis can have a very positive effect on many different types of pain - both acute and chronic. There are many patients with chronic pain who are accessing various cannabis compounds, both from health food shops (for cannabidiol) to street sellers providing vaping and smoking products.
Because they get relief, which is not offered by standard medications, they are willing to spend large amounts of money to access them.
Increasingly, research is exploring the ways that cannabis compounds reduce inflammation, inhibit neuropathic pain and relax muscle spasm - often through mechanisms not previously explored (e.g. binding to microglia).
In countries where medicinal cannabis is legal, and doctors are prescribing, how big a percentage of patients get efficient pain relief from medicinal cannabis?
All the data suggests that medical cannabis will have a marked effect on chronic pain, and help to reduce the burden suffered by the NHS, as well as the patients themselves.
A recent American study suggested that 62.2% of patients with chronic pain used medical cannabis products - much more than with other conditions.
The biggest demand for medical cannabis is coming from those with chronic pain, and it behoves us as practising clinicians to try and meet the demand, while working out mechanisms of action and benefits, using large observational studies.