SHOULD WE ALL BE US­ING CANNABIS?

GH ex­am­ines the pros and cons of the drug

Good Housekeeping (UK) - - Editor’s Note -

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.’

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