Meet the women using medical cannabis for chronic pain
"With cannabis, I sleep through the night now."
March 10, 2023
Bonno
After I close my laptop for the day, and settle into my sofa with my heating pad, ice pack and a new Netflix show, I load my vape with a serving of cannabis, and feel the cloud of chronic pain lift, just slightly, the nausea subsides and the ability to still sit and rest, becomes easier.
I live in Amsterdam, a city predicted by a reputation for recreational drug use and sex work. I buy cannabis from a sweet older couple who run the local coffee shop (the dutch phrase for dispensary) in my neighbourhood. In line to collect cannabis is a man in a postman's uniform, a woman with a crutch, and some American students. There is no stereotypical drug user here. The Netherlands has decriminalised cannabis, and although it is an ongoing and complicated issue, for now, it is accessible to most, and helping me reduce my reliance on prescription pain medications for chronic, debilitating pain.
It is near impossible to sleep when your body fizzes with pain. It is difficult to work, to do chores, and, in general, live your life when movement and even stillness feel like a never ending battle with your body. Chronic pain — a symptom of a myriad of conditions, from endometriosis and fibromyalgia to myalgic encephalomyelitis (ME) and plenty more — is notoriously difficult to treat. Many of the people living with these conditions have a record of being failed by their doctors and medicine at large, which has detrimental effects.
A 2011 study(Opens in a new tab) cited that people living with ME, a chronic, incurable, multi-system disease hallmarked by physical incapacity and pain caused by a viral infection such as glandular fever or pneumonia, "has a greater impact on functional status and well being than other chronic diseases such as cancer." The most recent comprehensive survey of chronic pain was collected in 2017 and established 15.5 million people in England (Opens in a new tab)(34 percent of the population) live with chronic pain.
I’ve lived with ME for nearly six years, and have tried a lifetime's worth of treatments in the quest to feel just a little better, like high dose antidepressants and gluten free diets. I’ve also spent a lot of my own money on alternative medicine, because the NHS has no viable and safe treatment options available for this incurable disease.
Traditional medicine will pass out pills, but over time some people (myself included) build tolerance develop stomach ulcers, or become sick of the foggy brain and other side effects they bring. After a laundry list of drug prescriptions, I felt tethered to the pills that caused new symptoms of their own, and was open to trying yet another alternative that would let me escape the brain fog and sleepless nights.
"It is near impossible to sleep when your body fizzes with pain."
Cannabis is a drug known best for its recreational use, there are many connotations with cannabis that perhaps you harbour from your youth; trying it under the slide at a local park, at your first gig, or a weekend trip to Amsterdam.
Cannabis is a flower, a naturally grown substance that is being legalised in many countries around the world, European countries such as Portugal are decriminalizing cannabis, and acknowledging its role as a medicinal tool for many people.
However, in the UK, government scare tactics continue to tell us that weed is the first step to becoming a person with a drug addiction, and many members of the Conservative party want the drug reclassified as Class A group to match cocaine and ecstasy.
Presently a Class B drug under the 1971 Dangerous Drugs act, cannabis it is illegal to possess any amount of cannabis. At present, there are hundreds of people in prison for possession of a personal supply of cannabis. A first time offender will be issued with a warning, if caught again there is a £90 ($108) fine, but after that the police can prosecute an individual with a sentence of 28 days in prison.
The legal battle over cannabis
Nov. 2022 marked the four-year anniversary of a landmark legislation change you likely never heard about. In 2018, the government used a report from the Advisory Council on the Misuse of Drugs (ACMD) to change the scheduling (categorisation of a drug that determines the punishment for possession and harm potential) of cannabis. From Nov. 2022 medically prescribed unlicensed cannabis products were legalised for a limited list of conditions in the UK: Dravet syndrome, Lennox-Gastaut syndrome, multiple sclerosis, and nausea developed as a result of chemotherapy treatment.
The law change came about following two court cases of childhood epilepsy in which the families of Alfie Dingley(Opens in a new tab) and Billy Caldwell(Opens in a new tab), both aged six, alongside doctors and activists, proved that the plant, when ingested, drastically improved the physical condition of these children, and were issued with an "exceptional licence," to possess a THC based cannabis oil acquired in Canada.
However, despite much hope from those campaigning for the legalisation of the drug, the NHS parameters for prescription of cannabis remain extremely limited, with very few people able to access a regular prescription. In 2019 the NHS issued only 18 prescriptions for medical cannabis(Opens in a new tab). However, there is a much longer list of chronic health conditions that can benefit from cannabis, and can also be prescribed by private practices, which is creating a two tier access to the treatment.
Ivman whose surname will not be shared for privacy reasons, lives with a traumatic brain injury, or TBI, which causes insomnia and chronic pain. She splits her time between London and Portugal. While she has access to cannabis in Portugal — the country decriminalised personal possession of cannabis, so holding your own supply holds no legal risk — she cannot use it legally in the UK. She attempted to acquire an NHS prescription for the medication but was met with barrier after barrier: "My area, Southwark in London, will only prescribe it for cancer and epilepsy. Although my doctors were receptive after I really pushed and showed them my own research, they landed on the frustrating response that 'the country just isn’t there yet.'"
How medical cannabis works
Doctor and pain specialist, Dr. Neel Umapathy, who works with patients to provide medical cannabis for a range of conditions through the private practice, Mamedica in the UK, explains that medical cannabis prescribed by clinics has a calculated combination of CBD and THC, the two main components of cannabis flower, for the most effective pain relief.
Umapathy explains that: "Cannabis interacts and stimulates the body’s endocannabinoid system (ECS) which is made up of two main receptors: CB1 is located mainly in the brain and CBD2 which is mainly expressed in immune cells in the body." When THC interacts with this system, it binds to our receptors and blocks pain transmission — providing the user with pain relief. Umapathy also says that long term use of cannabis can reduce chronic inflammation in the body, which also contributes to pain reduction. He explains that for many chronic pain sufferers, "THC and CBD work in synergy to support in bringing balance to the body."
CBD oils have become popular in the last five years as a tincture sold in various health stores, but they are sold legally because they contain no or extremely low presence of THC, the component most known for giving a user the 'high' feeling. The strength of what’s sold on the high street and the lack of THC which Umapathy indicates is a necessary part of the plant for pain management, means the products available are nowhere near as effective as the doses prescribed by a medical professional.
So, where does that leave chronic pain sufferers seeking help? After over a decade of Conservative rule that has cut funding across the NHS and community led health services, combined with the ongoing pandemic crisis, The NHS has record delays for treatments and management of conditions like endometriosis. Many chronically ill people are using private care drugs like cannabis. Discussions in online disabled communities are more often about seeking private care both in the UK and abroad for endometriosis surgeries or experimental treatments being trialled elsewhere. A rise in general subscriptions to paid-for healthcare also demonstrates the UK citizens' need for better care, now.
Although cannabis prescriptions are extremely limited on the NHS, private practitioners like Umapathy, are able to prescribe cannabis for pain relief for many more chronic conditions than the four listed by the NHS. However, access to private healthcare is predicated on privilege, those who can afford to pay, and those who must wait in the NHS lines.
The way private clinics circumnavigate the strict NHS prescriptions rules is by diverting from NICE (the national institute that provides guidance for improving UK health and social care) guidelines for specific conditions NHS doctors are required to follow more stringently. The NICE guidelines are reviewed at a much slower rate than advances in medical studies, for example the endometriosis guidelines have not been reviewed since 2017, and list over the counter medication like paracetamol as an adequate pain management tool.
Private doctors can use their own judgement and more recent research, to offer a more tailored treatment plan,to individual patients, which includes trying experimental treatment offerings that are not listed as cures or management drugs for the specific illness a person is diagnosed with.
Jon Robson is an entrepreneur and the founder of Mamedica, one of the private medical clinics in the UK, prescribing cannabis for a wider range of chronic conditions. He spoke to Mashable in order to demystify the prescription process: “In order to receive a prescription, a person first completes an eligibility form online. From here, if they meet the eligibility requirements: the patient has tried two or more licensed medications or treatments which have not provided satisfactory benefit and has no previous record of psychosis and schizophrenia), then an online consultation with a specialist will be scheduled.”
Perhaps in part because of the cultural reputation of cannabis, Mamedica and other clinics impose a rigorous onboarding process before accepting new patients, including identification checks and evidence in medical records. Those with a record of psychosis and / or schizophrenia are more susceptible to future mental health issues whilst using cannabis, therefore there is reason to be cautious.
Following an in depth conversation with a specialist doctor combined with approval of eligibility, a prescription is issued. The prescription is then delivered to your door securely. In my own experience, there is much less rigour involved in acquiring a month of Codeine, which is legal and highly addictivethan what Mamedica and similar clinics ask of their patients, which could be another indicator of the wider view of what we understand as acceptable pain relief sources.
Endometriosis and medical cannabis
Happy (name changed for privacy purposes) is 25 and lives with endometriosis. She initially sought out an alternative to prescription opioids after a COVID infection flared her chronic pain and left her with a high tolerance for the drugs her doctor gave her, and a fear of future opioid addiction: "I felt really uncomfortable with the amount of Tramadol I was taking," she says. "I was hoping for something that would effectively replace my use of opiates and support the other pain management tools I was using, like pelvic floor physio and nerve blockers."
