SHOULD WE ALL BE USING CANNABIS?
GH examines the pros and cons of the drug
HOW CAN CANNABIS BE SOLD ON THE HIGH STREET? Along with many online outlets, high-street retailer Holland & Barrett is selling CBD oil. Short for cannabidiol, it’s one of the dominant compounds found in cannabis, and it’s popular – Holland & Barrett reported a 37% increase in sales between January and February this year. CBD products are legal to buy in the UK because they’re made from the leaves and flowers of hemp, a variety of cannabis plant cultivated to contain very little or no tetrahydrocannabinol (THC), the psychoactive compound that gives you a ‘high’. The presence of THC makes cannabis an illegal Class B drug. ‘More than half (68%) of CBD users are women,’ says Mike Harlington, chair of the Cannabis Trades Association UK. ‘There are now about 300,000 users in the UK, up from 125,000 in 2016.’
SO THIS TYPE IS LEGAL THEN, BUT WHAT’S IT GOOD FOR? ‘We know that it reduces anxiety,’ says Val Curran, professor of psychopharmacology at University College London. ‘And there is increasing evidence from trials that it may help reduce psychotic-like symptoms.’
‘There is also good evidence that CBD can help with pain, epilepsy and nausea during chemotherapy treatment,’ says Professor Mike Barnes, consultant neurologist and author of the 2016 All-party Parliamentary Group for Drug Policy Reform report. Preliminary research shows that it may have therapeutic benefits for those suffering with Alzheimer’s, Parkinson’s, rheumatoid arthritis, inflammatory bowel and Crohn’s disease and even cancer, but large clinical trials are needed.
You won’t find any health claims on the packaging, though. This is due to a legal ruling in 2016 that said CBD suppliers must have a product licence if they wanted to make medical claims. This is a lengthy and expensive process, so CBD suppliers get around this by selling it as a food supplement.
OKAY, ANY ADVICE ABOUT BUYING SOME? ‘Look for products that have been CO2 extracted, rather than solvent extracted, as they’re cleaner and won’t contain any solvent residues,’ says Harlington. ‘CBD comes in different strengths, but it’s not always a case of the stronger the better. Different strengths suit different people and
[continued from previous page] there’s no defined dose.’ According to the World Health Organization, CBD is non-addictive and well-tolerated with a good safety profile. ‘Some people may experience side-effects such as a slight drowsiness or a dry mouth, but they’re generally very mild,’ says Professor Barnes.
HANG ON, WHERE DOES MEDICAL CANNABIS FIT IN? Many European countries such as Germany, the Netherlands and Poland have laws that allow cannabis containing THC for medical use, as do 29 US states. But it remains illegal in the UK and possession could land you up to five years in prison. It’s also down as a Schedule 1 drug – which means it’s on a list of substances that have no medicinal value.
‘This is categorically incorrect,’ says Professor Curran. ‘Cannabis is an extraordinary plant that contains hundreds of ingredients – it’s potentially a medical treasure chest. However, it’s not a panacea – we need to know more about how it acts on the body for different conditions, but it’s hard to study when it’s a tightly controlled Schedule 1 drug. Allowing it for medical use would make research an awful lot easier.’
HOW DOES IT DIFFER FROM TEENAGE SPLIFF SMOKING? ‘A key point is that it’s possible to use medical cannabis without getting high,’ says Professor Barnes. ‘It can be taken incrementally and there are strains with a higher CBD content, which counteracts the high of THC. The majority of medical users aren’t using cannabis to get high, but to relieve symptoms of their condition. Neither does it have to be smoked – it can be administered in a variety of ways, including oil, vaping, capsules, oral sprays, skin creams, tinctures or edibles.’
Campaigns such as End Our Pain want the Government to allow access to medical cannabis for people with chronic conditions, so that they don’t have to risk being criminalised to ease their symptoms. ‘Street cannabis can contain very high levels of THC, which produces a significant high and unwanted side-effects,’ says Professor Curran. ‘If people want to buy it for medical purposes in the UK, they have no idea what dosage of the different compounds they’re getting. In contrast, countries such as the Netherlands provide medical cannabis grown in well-regulated conditions, labelled clearly with its CBD and THC content, so doctors can prescribe it with confidence.’
WHAT ARE THE BENEFITS? ‘Like CBD, people use medical cannabis to ease conditions such as chronic pain, anxiety, muscle spasms, nausea from chemotherapy and epilepsy, and there’s good evidence that it’s effective for these,’ says Professor Barnes.
But if CBD has health benefits on its own, why use something with illegal THC in it? ‘While CBD can have a therapeutic effect, combining it with THC and the many other ingredients in cannabis can make it even more effective for some conditions, such as chronic pain or muscle spasms. It’s known as the entourage effect,’ explains Professor Barnes.
There is one cannabis drug that’s licensed in the UK – a mouth spray called Sativex, which contains THC and CBD and treats muscular contractions in MS – but it’s only available on the NHS in Wales, as England and Scotland deemed it too expensive.
People use cannabis for a number of other conditions, such as cancer and insomnia, and one day there could be scientific backing. In 2017, the University of Oxford launched a £10m cannabinoid research programme, with the aim to develop new therapies for conditions such as cancer, chronic pain and inflammatory disease.
BUT CAN’T IT CAUSE ADDICTION, EVEN SCHIZOPHRENIA? ‘Like any medicine, we would expect doctors to exercise caution and weigh up the risks versus benefits,’ says Professor Barnes. ‘Cannabis is not devoid of risk so, for example, if a person has a family history of schizophrenia, it may not be prescribed. But also bear in mind that many of the studies linking cannabis to health problems relate to street cannabis with a high THC content.’
You shouldn’t drive or operate machinery after taking cannabis. It can also interact with some medications and side-effects can include tiredness, drowsiness, dizziness, faster heart rate and increased appetite, but ‘it is still generally well tolerated,’ says Professor Barnes. ‘The side-effects can pale in comparison to those of opioids and some antipsychotic and antiepileptic drugs.’