As a pharmaceutical supplier we are eager to learn about the adoption of prescribed medicinal cannabis in the UK so we sat down for a chat with an expert (socially distanced over Zoom of course).

Carl Holvey is an experienced healthcare professional, and a partnership director and chief pharmacist at Sapphire Clinics – The UK’s first CQC (Care Quality Commission), registered medicinal cannabis clinic. We discussed his first-hand experience with successful clinical outcomes and what’s next on the agenda for Sapphire Clinics…

Harriet: So Carl, we’re interested to understand more about prescribing practices, your experiences with medicinal cannabis and the patient access issues in the UK.

So firstly, how did Sapphire clinics first become interested in medicinal cannabis?

Carl: I think Sapphire Clinics did because of the restricted nature of cannabis access in the UK.

The NHS will only allow cannabis to be used for a limited number of indications, but from the clinical evidence and use across Australasia and North America, we know that cannabis has a big potential to treat a plethora of medical illnesses.

So we think that by providing a service to patients that provides access to medicinal cannabis, will improve the health and wellbeing of a significant portion of the population. So it’s a really exciting and new medical therapy to be involved in. And personally I’ve been in the NHS for 20 years, so to work in medicinal cannabis where we’re driving the use of a brand-new therapy to improve patient’s physical and mental health, it’s really exciting.

Harriet: Exactly how long has your organisation been educating/ studying medicinal cannabis therapies?

Carl: So the organisation was set up, in April 2019 and we saw our first patients in December 2019 which now feels like a lifetime ago!

It’s been a really speedy journey to start treating patients. We set up the UK cannabis registry, in the summer of this year to ensure that we are collecting real world evidence for the use of these therapies so we can provide clinical evidence for the NHS and other parties to show the benefits of these medicines and maybe even help with licensing of some of the whole plant extracts.

As part of our educational offering, the company sets up the Sapphire Institute and the Institute offers free education to healthcare professionals to ensure that they have a good grounding in the use of medicinal cannabis to support patients and help provide care plans for them.

If they’re not directly in providing the therapy and the medicines of medicinal cannabis then at least they’re able to support that patient when they’re being treated for other illnesses – and they’ve got a good knowledge about cannabis to take on board that’s part of the care plan.

Lots of healthcare professionals still aren’t aware of how cannabis interacts with a lot of current standard therapies and they can be significant drug interactions, which means, standard therapies need to be adjusted and taken into consideration.

Harriet: Thank you. What type of cannabinoids do you typically prescribe to your patients and what are the most common reasons?

Carl: Okay, so I’ll start with the reasons first:

We will prescribe for a range of indications for which there’s already clinical evidence.

So we prescribe for mental health disorders, anxiety, autism, OCD, Tourette’s, we’ll prescribe for gastrointestinal problems, such as: inflammatory bowel disease and irritable bowel syndrome. Neurological disorders such as treatments resistant to epilepsies or spasticity in MS or what’s also known as dystonia in Parkinson’s, chronic migraine and cluster headaches.

We prescribe cannabis for pain, and that can be for a range of conditions that are associated with chronic pain, such as Elhers-Danlos syndrome, Fibromyalgia and arthritis.

Harriet: The list is endless; we really could go on forever about the benefits of medicinal cannabis and what relief it can provide for patients with varying conditions.

What would you say your specialty is in treating?

Carl: So the organisation was set up, in April 2019 and we saw our first patients in December 2019 which now feels like a lifetime ago!

So I think where our specialty at Sapphire is, looking at disorders that have failed to respond to standard therapy. We look at all of those indications that may lead to a new avenue of treatment and hope for patients that are not responding to those standard therapies

Harriet: So you truly believe that it improves clinical outcomes for patients?

Carl: Yeah and I think that’s one of the reasons why it’s exciting to work in medicinal cannabis. We find patients that have had no significant improvements and they’ve gone for 20-30 years and not responded to standard therapy until they start this alternative treatment.

I mean, not every patient that has come to us as has had a positive effect, they haven’t responded or they’ve had adverse effects, which means treatments being stopped. But we have seen those kinds of ‘Lazarus moments’ where people have had life-changing, medical interventions, which is really, really nice to see.

Harriet: That actually brings me quite nicely onto my next question. Is there an experience that stands out in your mind of a time where you have witnessed a huge improvement to a patient’s health and wellbeing?

Carl: There’s loads! I think one of the most fun stories of mine which I like to tell, is a patient we have who suffers with severe pain. He is a competitive fisherman, works for the NHS and carries heavy tools, suffering with pain and still carrying on with his normal job, but sadly couldn’t engage with his love of fishing anymore. We started the cannabis treatment, his pain dropped significantly. He was able to go back to competitive fishing; his hands were less spastic, so he was able to use his hands more in his job and it was just really lovely to see such an improvement

Harriet: Wow, amazing. I guess it’s what keeps you doing what you do when you’re that passionate about results.

So what is your opinion about self-medicating with cannabis and what are the risks?

Carl: Ah well, there are many groups of patients that promote self-medicating and I can understand why they do it because some people struggle with the cost of medicinal cannabis. However, the cost has come down significantly and hopefully that has opened up an opportunity for a lot of the population that can now benefit from it.

I think British companies now have more cannabis available, so the costs have come down from what was thousands of pounds a month

The average patient is probably going to pay around £130, but some patients pay less than £40 a month for their therapy.

Harriet: I guess it depends on the severity too?

Carl: Yes. Also how sensitive they are to the cannabis, because the strain is so big some people don’t need that much to get the positive effect.

Harriet: Also the way in which it metabolises in everybody’s body is different I imagine.

Carl: Exactly.

Harriet: Have your patients had difficulty obtaining a prescription for cannabis prior to seeing you at Sapphire?

Carl: Yeah. I think, access to medicinal cannabis is very restrictive in the UK.

As a pharmacist, if I wanted to get small amounts of cannabis from North America for a patient, the restrictions on that are the biggest compared to any other medicine in the UK. Some class A medicines I can have a supply for a patient, sometimes litres and no government agency would bat an eyelid at, whereas medicinal cannabis:

– It has to be prescribed by a specialist doctor
– Approved by the home office
– Approved by the MHRA

That could be just 10ml of cannabis, which is unheard of compared to other medicines.

So having access to cannabis through a clinic, which provides people with medicines that are produced to good manufacturing and distribution practices that are an assured quality, there’s no contaminants, patients are no longer putting themselves at risk from engaging in supply sources that are illegal. So it provides them with a safe way of having access to a medicine, which they could potentially benefit from.

Harriet: Thank you, so finally, what would you recommend for a sceptic curious about using medicinal cannabis? What is your advice to someone that is considering it, but might not have the confidence or may not know enough about it? What would you suggest?

Carl: We have a lot of those patients and those people come to coming to us…

I think the first step is finding out more information, and a good way of doing that is just getting in touch with the clinic. Clinics have trained healthcare professionals that advise and support people through the process and give them information about cannabis and potential treatments.

So there’s a lot of information on the internet but unfortunately in the UK the rule stipulates that cannabis cannot be promoted to the public because it’s classed as an unlicensed medicine, which means it’s illegal to promote it to the public.

So the public would need to come to healthcare professionals or come to the sources that are trusted to get that information – it’s not fully available, unfortunately.

I think there’s so many myths about cannabis in the media, it’s propagated by the media, that cannabis is a dangerous, unsafe drug. It does have its con reasons why you shouldn’t have cannabis, but the benefits and the reasons why it should be used in certain indications is not easily understood by the public because it’s not in a format that’s directed to the public because as healthcare professionals, we’re not allowed to do that

If you enjoyed reading our blog and want to learn more about how medicinal cannabis has delivered great results in specific conditions such as rheumatoid arthritis please visit here