‘As a 55-year-old grandmother, I’m not your typical illegal-drug user’

Amanda Lowe is not your typical illegal-drug user. Yet, for several years, the respectable 55-year-old grandmother, who lives in Alton, Hampshire, and used to work for the Bermudan government, found herself buying cannabis from local street dealers. 

"It was very scary," she recalls. "I didn't know who I could trust and I was constantly looking over my shoulder, and afraid of the police knocking on my door."

Diagnosed with breast cancer in 2012, Amanda smoked cannabis to ease the unbearable pain she felt after having had a bilateral mastectomy and reconstruction operation, which left her feeling as though she had a truck on her chest.

Prescription painkillers, such as morphine, left her feeling woozy, out of control and unable to function. It was only in 2020, with the Covid lockdown – which meant she couldn't go out and buy cannabis anymore – leading her to feel virtually suicidal, that she learnt there was an alternative: legal medical cannabis.

Now, instead of smoking three joints a day, without knowing what strain she's taking or whether it will be effective, she uses a vape containing dried cannabis flowers, which have been prescribed to her, in a specific dose, by a doctor.

"Within 30 seconds, I can feel the pain lift off me," she says. "I'm singing. My whole body feels relaxed and, for a little while, I can get on with my day-to-day life."

Like Amanda, approximately 20,000 people in the UK are currently accessing cannabis legally through specialist clinics to ease their pain and treat chronic conditions or mental-health disorders. Yet a YouGov poll, published at the end of last year, found that, alarmingly, 1.8 million people are still using illicit cannabis for health reasons, a figure that is actually up on the 1.4 million who said they did so in 2019.

Knowledge gap

Even though it's now more than four years since medical cannabis was rescheduled, making it legal to use when prescribed by a registered specialist doctor, a huge proportion of the population remains ignorant of this.

The YouGov survey found one in four of those using illegal cannabis to treat a medical condition didn't know they could access it legally. And a study by specialist prescriber Sapphire Medical Clinics, soon to be published in the Journal of Cannabis Research, revealed that 48 per cent of the UK population remains unaware that medical cannabis is available on prescription.

Since 2018, cannabis-based medicinal products, in the form of oils and dried flowers, have legally been prescribed for a variety of conditions, most commonly for chronic pain, but also for anxiety disorders, PTSD, depression, migraine, multiple sclerosis (MS) and epilepsy.

How it works

Medical cannabis works by targeting the endocannabinoid system, which is the body's own system of cannabis-like molecules and receptors, acting as a "dimmer switch" on pain and mood pathways. Unlike recreational cannabis, it is manufactured to pharmaceutical standards and has to meet strict safety requirements.

Street cannabis is often contaminated with harmful bacteria or mould, which can cause potentially harmful infections, or may be cut with other chemicals. Medical cannabis also contains lower levels of tetrahydrocannabinol (THC), the element that produces the "high" or "stoned" sensation.

"Many of our chronic-pain patients used strong opiate-based painkillers prior to medicinal cannabis, which left them feeling drowsy, 'out of it', 'zombie-like', and unable to perform normal daily routines," says Dr Simon Erridge, head of research and access at Sapphire Medical Clinics, and a clinical research fellow at Imperial College London.

"Many also experienced weight-gain, depression and anxiety. The most common side effects for medical cannabis are dry mouth, increased appetite, fatigue and sleepiness – but 80 per cent of patients enrolled in the UK Medical Cannabis Registry study don't report any adverse effects."

'There was a strange crack in my life'

Chris Cowan, 45, an account manager from Banbury, Oxfordshire, has been using cannabis – first illegally and now legally – to help his PTSD-related depression and anxiety since his youth. He says he tried antidepressants on several occasions, but they made him feel tranquillised and caused him to lose sensation in his genitalia, as well as a loss of sexual desire.

"For me, buying cannabis wasn't recreational, like it was for my friends, but medical," he recalls. "I needed it to function normally. But while I was obtaining it illicitly, there was always a strange sort of crack in my life – on the one hand, I was a normal professional, getting married, interacting in society. And on the other, I was going off in the evenings to buy illegal drugs from dealers, putting myself in danger of violence and at risk of being arrested and getting a criminal record, which could have been the end of my professional career."

When a friend told him cannabis had become legal for medical prescription, he researched online and self-referred to a private clinic. His GP knew nothing about medical cannabis, so didn't want to advise or refer him.

He now pays about £250 a month for his treatment – about the same as he was paying for street cannabis. He uses it in both oil and flower form, vaping during the day and taking it under his tongue at night.

"It's much healthier than illegal cannabis," he says. "I don't have to smoke it, and with the illicit cannabis, it would be quite rare that I would find a strain that would actually alleviate my condition. It also made me intoxicated, which the medical cannabis doesn't. It really calms me down, takes away the anxious feeling in my stomach, and allows me to intellectualise my thoughts in a logical way."

Access to medication

Patients who feel they would benefit from medical cannabis can either ask their GP for a referral, or refer themselves to a specialist cannabis clinic. An expert doctor will then assess their medical history to decide if they are eligible – they must first have tried licensed medications for their condition. They are followed up four times a year.

However, there is limited access via the NHS (to date, only a few prescriptions have been given, for children with treatment-resistant epilepsy), and though licensed cannabis-based medications have been approved by the National Institute for Health and Care Excellence (Nice) for MS-associated spasticity and chemotherapy-induced nausea, in reality they are only available through private clinics, and health insurers rarely reimburse patients.

For chronic pain, Nice found that there was sufficient clinical evidence of efficacy, but did not find it to be cost-effective. But even if patients are willing to pay, it's unlikely that their GP will refer them.

One issue that may be deterring doctors from referring patients who could benefit from medical cannabis is a dearth of published research. Funding promised when the legislation was changed in 2018 never materialised, partly because of the Covid pandemic.

Research and studies

There have been some positive studies, including a review published in the British Medical Journal (BMJ) in 2021, which issued a weak recommendation for the use of medical cannabis for chronic pain, and called for further research.

"Whilst medical cannabis is not a panacea and is not going to be the right option for everybody, we have published research from the UK Medical Cannabis Registry in the Expert Review of Clinical Pharmacology (Jan 2022), which demonstrates changes with respect to pain severity, pain interference in day-to-day living and general health-related quality of life," says Dr Erridge.

Dr Leon Barron, a London-based GP and the founder of the Primary Care Cannabis Network and co-founder of the Medical Cannabis Clinicians Society, says the tide is turning, with more GPs becoming aware of the uses of medical cannabis, and being open to learning about it: "We did a survey, interviewing more than 1,000 GPs across the UK, and found attitudes vary. Some GPs do still have a personal prejudice against it, which is often based on mistruth.

"We need to standardise the conversation amongst GPs and make sure that when they discuss this subject with their patients, they're coming from an informed position based on scientific facts and evidence.

"I personally believe that the UK has missed an opportunity to allow GPs to initiate scripts for medical cannabis and for it to be available through the NHS. GPs make up the majority of prescribers in more established medical-cannabis markets, such as Canada and Germany, and are prescribing for a wide range of conditions, from chronic pain, sleep disorders, anxiety and mood disorders to end-of-life care.

"Medical cannabis is an extremely safe and effective treatment, which can drastically improve overall quality of life, particularly for those people who have failed to respond well to more conventional treatment pathways."

He is currently compiling a cannabis directory to help patients and GPs easily find trusted, independent prescribers of cannabis-based medicines.

For Amanda, medical cannabis has been a lifesaver. "It takes away my pain and allows me to breathe – and with my vape, I can use it whenever I need it. There's no 30-minute wait for it to kick in, like with traditional painkillers.

"Getting cannabis legally is also such a weight off my mind. I don't have to worry about sourcing it anymore; I don't have to worry about whether what I'm taking is any good; I don't have to worry about the police knocking on my door. It's a game-changer, and people who could benefit from it should know about it and be able to get it, too. There shouldn't be a stigma."