Category: Uncategorized

On Friday, May 20th Cancard Member Andy Baines was given a six month community order at Grimsby Court, for the offence of supplying hundreds of patients, including minors, with high quality cannabis medicines – free of charge. Andy could have faced years in prison, but instead the court took a different, sensible approach.

The Cancard community is delighted that our heroic member Andy will not see the back of a jail cell for his brave, admirable and life saving work.

Andy is in our eyes neither a patient or a criminal, he is a cannabis scientist with a huge heart who has saved many lives selflessly receiving no financial or reputational gain. Andy was found with almost a kilo of cannabis, thirty plants and a significant amount of cannabis oil that was destined for the homes of terminally ill patients who had reached out to him for help, many of whom were cancer patients. Andy was charged with both supply and production of a class B drug under the Misuse of Drugs Act 1971.

Cancard has been supporting Andy since the organisation was made aware of this unique case and the failings of his initial legal team. Andy was appointed Cancard solicitor who challenged the judge to make a compassionate decision. Upon ruling the judge gave a lengthy speech about how Andy should be applauded not punished. We are truly thrilled for Andy, who can now get on with his life after a traumatic two years.

After the ruling, Hannah Sampson, Andy’s solicitor said:

Hundreds of letters of support for Andy were submitted to the court highlighting his selflessness, bravery and impact in his work. We will be sharing some of these anonymously in the coming days. Andy was not a drug dealer, nor a criminal, he did not make money, but was driven by a passion and determination to help people. The letters are testament to the positive impact he has had on hundreds of suffering patients.

To those who wrote to the court defending Andy, we would like to extend our warmest gratitude – this made a huge difference to both Andy, and the outcome of the court case.

We are eternally proud of Andy, but remain frustrated that people like Andy are even hauled in front of a judge in the first place. We will continue to campaign to ensure the safeguarding of patients, and will always support patients wherever we possibly can.

The Judge, CPS and police force were united – at least to some extent – in the belief that this man is not a criminal, and that a custodial sentence did not fit the “crime.”

Whilst Andy will undergo a six month community order, this will only amount to a few check-in’s with probation, he will not be expected to do any community service.

This is a landmark case due to the sheer amount of cannabis that was seized and the fact that Andy openly admitted to supplying to minors and adults, submitting all of his well-kept records. Cancard hopes that cases like these might prove to be a catalyst for improving the lives of patients who cannot afford a private prescription. It certainly highlights that even judges are not immune to common sense.

We of course cannot openly condone illicit activities, but it is evident to all that Andy is one of the good guys. What he did is truly phenomenal and it would be wrong to ignore this – on behalf of everyone you have helped, thank you for risking everything for us Andy.

Until there is an affordable, safe supply of safe, quality cannabis for all suitable patients, Cancard will continue to engage relevant policy makers to improve the lives of patients.

We wish to give our heartfelt thanks to all involved in the case, including the CPS and Lincolnshire Police who have rightfully shown proportionate compassion when considering Andy’s case. Andy’s solicitor, consultant for Mackrell, has worked tirelessly, to ensure this outcome – thank you Hannah Sampson for everything.

Lastly, thank you to all Cancard members for fostering this kind, humane and caring community. We massively appreciate each and every one of you. This is another massive step towards safe, affordable access – made possible by our fellow patients.

The Cancard team

Recently Cancard was approached to give evidence in a Home Affairs inquiry into the Misuse of Drugs act 1971 and it’s efficacy.

The committee calling for evidence said:

‘The focus of the inquiry will be on illegal drug use and its effects on society and the economy.

The inquiry will consider the UK’s legislative framework on drugs and UK drug policy. The framework refers to, for example: the Misuse of Drugs Act 1971; the Psychoactive Substances Act 2016; and, where relevant, any subordinate legislation made under these Acts.

In particular, the inquiry will consider the Misuse of Drugs Act 1971 and its efficacy today. It will assess what impact the Psychoactive Substances Act 2016 has had since it came into force. The inquiry will also look at the impact of drug use in the UK, and at approaches to drugs adopted elsewhere.’

Our submission is in full below:

DRU0023 – Drugs

Witnesses: Carly Barton, Cancard

Committees: Home Affairs Committee

In this article we will explore the appetite for law change within the criminal justice system, focusing on the recent data that has been produced following the launch of Cancard, a policing tool – utilised nationally, that aids use of discretion for cases of simple cannabis possession for medicinal consumers.

The general attitude of law enforcement in the UK around the consumption of cannabis has significantly changed in the past two years. Despite there being a lack of Home Office/police guidance around the law change in 2018 that brought about a private access route for medicinal consumers, Cancard has seen a dramatic uptake in engagement from forces who have felt the pressures of criminalising patients for whom this model doesn’t fit.

The general attitude of law enforcement in the UK around the consumption of cannabis has significantly changed in the past two years. Despite there being a lack of Home Office/police guidance around the law change in 2018 that brought about a private access route for medicinal consumers, Cancard has seen a dramatic uptake in engagement from forces who have felt the pressures of criminalising patients for whom this model doesn’t fit.

In polling and through patient disclosures we were able to ascertain that medicinal consumers in 2018 were still frequently being charged, fined or issued a cannabis warning which impacted their ability to travel to certain countries and to pass CRB checks for employment or volunteering roles. In data from 2021 we have found that 98.8% of stops and searches have resulted in patients carrying their medical ID not facing a criminal record nor having their medicine confiscated. It is important to note that while discretion has always been an option for officers on the street, historically we have never seen this tool being utilised at such a high rate.

We will also touch on the situation for patients requiring the use of cannabinoid therapy and how, for many, the illicit market is providing a much more effective service than the private market can under the current regulatory system.

The scale of the situation

The latest and most in-depth data we have available with regards to medicinal consumption was conducted via a Yougov study in 2018. This research showed that 1.4 million people in Britain are currently consuming illicit market cannabis to treat a medically diagnosed condition. If we compare the condition lists that are currently being covered by private clinics in the UK against the list of reported conditions surveyed patients are using cannabis for, we can safely estimate that a little over 1.1 million of these people already qualify for a private prescription based on their diagnosis*.

A little over 10,000 private prescriptions have been written in the UK since 2018. A huge number of these (estimated at approx 71% from polling data) held that prescription for less than 3 months. Polling data shows that there are three main reasons for this:

The product selection did not meet my needs. I returned to the illicit market

The cost was prohibitive. I returned to the illicit market

The supply chain was unreliable. I returned to the illicit market

Throughout their prescription journey patients frequently reported the following:

Mouldy products leading to health issues including breathing difficulties and allergies

Products containing visible pests including spider mites and gnats

A chemical taste

Long delays with medicine arriving (reports from 1 week to 6 weeks)

Badly stocked product leading to frequent prescription product changes that were less suitable

*with room for clinical decision making

The evolution of the illicit market and how it is meeting need

The current state of the illicit cannabis market is fraught with contradiction. Demand is currently being met by two very different types of supplier: those involved in organised crime and those who would be considered to be specialist caregivers in many other countries.

Organised crime is something that impacts our communities. This comes with rising levels of violence, friction for control of geographical areas, child and human trafficking, theft of electricity, anti-social behaviour in housing areas, a pathway for European (mainly Albanian) gangs. Patients are very aware that this is an issue and generally would much rather not engage with any market that is causing harm.

On the other hand, particularly since international law changes, access to educational courses, better research and international patient advocacy, the illicit market has an arm of suppliers who are nothing short of specialists in this area. Many of these suppliers charge little in the way of fees for their service. They will often provide clean, safe medicine that has been grown organically, extracted, lab tested and blended to a ratio to suit the condition that is being treated. These caregivers are forging a path to an underground market that is often much more sophisticated than products available in dispensaries in legal countries. Police are often in a position where they are having to investigate a supplier to determine intent and gather evidence for the CPS to make a charging decision.

In terms of ease of access within this market, patients will often request a ‘menu’ of available products via a text message. These products will be a mix of flower, concentrates, oils, topicals, capsules and edibles and will often contain information about genetics, how the plant was grown, terpene profiles, likely effects, and occasionally lab test results. They will often receive a same or next day service to their front door, ongoing support, advice and a range of other products available to try.

It could be argued that prohibition and the current legal regulations around cannabis has generated a perfect space for organised crime to thrive whilst better legal regulations could see our knowledgeable experts acknowledged as such and given the opportunity to create small businesses and consultancies. This is a far cry from being considered to be drug dealers and could lead to sharing and expanding knowledge for the benefit of millions of patients.

The uptake of Cancard – stats for 2021

Cancard, a medical ID that demonstrates that a patient has a condition for which they are using cannabis medicinally, has seen 50,000 patient registrations in a little over 12 months. All of those patients have been medically qualified and undergone passport style ID checks in order to be part of the scheme. All Cancard holders are given support in the event that their consumption has an impact on their lives or if they are investigated criminally. The scheme is supported by the National Police Chiefs Council, the Police Federation, the Police Foundation and many other policing organisations. Every force in the UK has received a briefing and the project is now a national scheme.

The main drug offence recorded in the recent Drug Crime: Statistics for England and Wales 2020/2021 report was possession of cannabis. This amounted to 63% of all drug offences in the year. This is an increase of 20% from the previous year. After drunk and disorderly, possession of cannabis was the second most common offence for which the offender received a monetary sanction. Many also received a criminal record. Cannabis consumption may be on the rise, this could be due to laws changing in other countries and also due to a better understanding of its medicinal properties. Policing this is becoming problematic.

A recent research paper by the Taxpayers Alliance demonstrates that approximately 200 million pounds per year is spent on policing cannabis alone. When looking at the wider context of cost saving and based on cost savings to the NHS, police and courts, legal aid funds, prison budgets etc the estimated saving to public money would amount to £891.72 million annually. This is not taking into consideration any generated income that would come with a regulated market, which has been estimated in a report by Health Poverty Action to be worth between £1bn-£3.5bn to the treasury in tax revenue per year.

Law enforcement are not immune to balance sheets and common sense approaches. The vast majority of cannabis cases that are dealt with are ‘offenders’ who are non violent, not involved in any other crimes and hold cannabis for personal use only. Prioritising the criminalisation of these people does not add up financially or morally: this is the current attitude of law enforcement in the UK. Cancard has given officers on the beat an appropriately regulated tool with which to justify use of discretion in cases where no harm is being caused, at least initially for those who have a medical condition.

The scheme has been met by police with enthusiasm and positive input generating policing partnerships, training programmes and greater visibility of potentially vulnerable medicinal cannabis patients.

In 2021 Cancard published the following results:*

The police have been supported this year (2021) to opt for discretion over criminalisation for 1400 people with health conditions who are consuming cannabis medicinally.

Social workers and families have been supported in almost 300 cases that have resulted in keeping families together in 100% of cases.

Interventions in social housing eviction cases have resulted in 103 families retaining their houses through community resolution, education and equipment donation.

98.8% of stops and searches have resulted in Cancard patients not facing a criminal record nor having their medicine confiscated.

The implications of this de facto decriminalisation against Home Office guidance for medicinal consumption could be significant. It suggests that those in uniform who have first hand experience of policing in this area feel that the time is right for change.

*data as of December 2021

Moving forward

There have been many suggestions for pilot schemes, regulation changes and access improvements made by various organisations in the past year. To conclude, below is a summary of one route which may be a viable opportunity to follow the lead of the police and make sensible and appropriate moves towards a more acceptable market for cannabis consumers in the UK.

Access:

In order to improve access and accountability of suppliers a first step towards evidence gathering and reducing harm for marginalised groups would be to initiate a national trial for those patients who are already benefiting from illicit market cannabinoids. This could be introduced via an online pharmacy who could hold a formulary of expanded products. Patients could opt in via self certification/medical evidence of diagnosis similar to registration for Cancard. This would provide:

Lower cost for patients

Stable genetics

Real world evidence generation

Harm reduction

Moving 1.4 million people away from the illicit market

Access to advice and support via a buddy system of caregivers

An ID card for the benefit of police and other third parties

Supply:

With imported products that are currently on the private market it is clear that both the pricing structure and the quality of these products is unacceptable for most. In order to develop a quality range of licensed products that could feed into this trial cultivation, licenses must be more accessible. A cooperative community owned cultivation model at a number of smaller sites across the UK could see:

Access to employment

Better quality products with room for research and development

Less dependence on imports

Less dependence on the illicit market

Specialist knowledge sharing

The beginning of a UK industry (to also include hemp)

Educational centres

University partnerships

Small scale trials of wattage limits on a grow your own model

While there are hundreds of possible avenues to expand access and increase research it would seem that the best route would be to ‘on-board’ existing medicinal consumers and provide them with trial products to generate required evidence for confidence building. With the recent MHRA draft guidance on randomised real-world evidence to support regulatory decisions – it would seem that the time is certainly right to explore options to apply these protocols to a medicine that doesn’t readily fit within a randomised controlled trial model. I would suggest that the time has also come to stop criminalising patients, caregivers, specialists and experienced cultivators and instead provide a framework for them to generate an industry that will contribute towards the health of the country and the individuals that live within it.

https://researchbriefings.files.parliament.uk/documents/CBP-9039/CBP-9039.pdf

https://d3n8a8pro7vhmx.cloudfront.net/taxpayersalliance/pages/9387/attachments/original/1526051770/Cannabis_Legalisation.pdf?1526051770

https://irp-cdn.multiscreensite.com/51b75a3b/files/uploaded/Centre%20for%20Medicinal%20Cannabis%20%7C%20YouGov%20MC%20Paper%20v3.pdf

https://www.healthpovertyaction.org/change-is-happening/campaign-issues/a-21st-century-approach-to-drugs/uk-cannabis-reform/

By Carly Barton
Are criminal gangs ruining our chances for a homegrown future? We talked to two ethical suppliers to find out.

What are we talking about?
Firstly, let’s define what we mean by ‘organised crime’. There are often two types of cultivators of cannabis, the first is small home-growers who could be seen as similar to the local farm shop stall -they cultivate with care and often support a couple of patients providing good quality plants and extracts to support their health conditions.

The second kind is the much more nefarious, organised, profit-driven cannabis farm which is potentially causing damage to the case for the home-grower.

With the institute of economic affairs estimating that the current illicit UK cannabis market is worth over £2.5 billion, opportunities exist for large organised crime groups to profit from this area. Sadly, we are all familiar with the stories of young children, hopeful immigrants and even vulnerable adults becoming enslaved in a situation whereby they become entrapped as grow-keepers for organised crime groups who are involved in the mass cultivation of cannabis, the cuckooing of locations and the transportation of large amounts of cannabis over county lines.

Photo credit: Educare

More recently, we are hearing of cannabis farm theft which involves armed gangs being tasked with raiding these cannabis farms to take the plants and profit from their exploits. Scenes of bloodshed and loss of lives have resulted from these violent attacks between the defenders of the farm, usually those who have been enslaved, and the armed gangs. As recently as this month, Vice magazine have detailed a number of these known cases. Because these are ‘criminal on criminal’ offences, they are largely undetected by authorities unless injury or homicide occurs. For many involved in cannabis farms, the fear of the criminal gangs is far greater than their fear of the police.

The vice article indicates that some home-growers are also being targeted by armed gangs who use heat sensors and other intelligence to locate smaller cannabis grows. These gangs are breaking into homes and stealing plants leaving the victims of these crimes in a terrifying position: if they report the break in, the authorities have evidence to prosecute for the cultivation of cannabis. It is indeed a sad day when the judicial system supports these violent crimes in favour of the armed criminal who has forcibly entered a property, caused distress to families in their homes and stolen their invaluable medicine.

Placeholder
We often hear from the prosecution service and some members of parliament that cannabis ‘causes harm to communities’. There is an alternative argument that would suggest that the prohibition of cannabis is of more harm to communities because the current regulations are criminalising people for taking a substance that contributes positively to their health. But is there truth to the statement in another context? Is organised crime involvement and damage causing a blockade for a review of the regulations around home growing? Is the dark, exploitative edge of this market spoiling the chances for experts with better intentions in this space? We think so.

Let’s talk
We spoke to two home growers, one (person A) is a supplier of high-quality medicine for his own and others’ medicinal consumption, the other (person B) creates bespoke medicine for patients with different conditions. Both of these growers dedicate their time, energy and resources to supporting patients.

Interview #1
Person A is a cancer patient living with chronic pain.

Photo credit: Devinkk

Q: You have been cultivating your own medicine for many years, how has that been? Do you still enjoy the process?

A: I feel so very grateful to be able to cultivate a plant that has so many healing properties. I grow my plants with love and care because they are the only thing that help me with the chronic pain. I always grow organically and although this adds to the cost, it gives me the knowledge that my cannabis is as safe as possible. I feel much more connected to my plants than I do to a white opioid-derived pill prescribed by my consultant. Being able to grow puts me in a position where I feel more responsible and more proactive about my own health and my own healing. I feel that this is really powerful for the healing process because I am providing myself and others with a clean and safe product, free from contaminants. I tend to grow from seeds and cuttings. Over the years I have tried many different strains and I have found that some work better than others. Now that I have selected my most pain-relieving strains, I tend to grow these regularly. I grow cannabis to keep the cost down for my personal use.

Q: The majority of your product treats your health and additional product goes to a supplier who provides medicine to the wider community. Is it important to you how it is used?

A: It is very important to me that the cannabis is consumed by those whose health is improved by it.

We all have an endocannabinoid system which regulates many aspects of our health so you could say that anyone consuming cannabis will get these effects in their endocannabinoid system. For me though, I want the medicine to go to patients who need it. I personally support a number of epilepsy patients and cancer patients. I give the rest to a supplier who uses it to make products such as oils and topical balms for a number of patients treating cancer, endometriosis, multiple sclerosis and spasticity, Parkinson’s Disease, rheumatoid arthritis, Crohn’s disease and FND.

Q: How do you feel about organised crime grow operations? Do you feel this is in any way disrespectful to the plant?

A: I am fearful of organised crime and its impact on people and there are some terrible stories about this. I feel that the love, respect and care that I put into my grow, by making it organic and keeping it well cared for, enhances its healing properties. Plants in illicit cannabis farms are grown in fear and for profit. There are very different intentions behind my grow compared to an illicit cannabis farm grow. I would like to be able to grow my plants safely without the worry of having my medicine taken away by a criminal gang or by the police. This is why I would welcome some kind of regulation or license for growing on medicinal grounds. This could help to put an end to organised criminals using the plant and the people for profit which I find disrespectful to the plant. The plant was not intended to be used as a mechanism for profit. It grows freely in many regions around the world.

Q: How much would it change your life if the law around home cultivation changed for the better?

A: My life would be transformed for the better. Cannabis has kept me alive and has helped me to be able to manage my pain for years now. I am frustrated that I would be treated as a criminal when I am trying to heal myself and support others in their healing.

Interview #2
Person B is an expert in supporting people with terminal cancer diagnoses.

Photo credit: Blinder films

Q: Can you tell us a bit about what you do and who you supply?

A: I help people who the medical profession have written off. Those who have been told by their consultants that there is nothing more that can be done to help them -that their cancer has spread so widely and is so aggressive that they should go home and get their affairs in order because their medicine can do nothing more for them.

Q: In many other countries you would be considered an expert in your field, how does it feel to be considered a criminal in the country in which you call home?

A: It is incredibly frustrating! I am supporting patients and their families who are given the worst possible news. These people need help and I am compelled to support them. I have spent much time studying and working with doctors in other countries where cannabis is a popular and successful treatment for patients with cancer. They have shared their knowledge and expertise with me so I always have a doctor to contact if, and when, I need. I ensure that the oil that I make is lab tested and is of a high standard so that I know that my patients have good quality medicine. More recently, I have had conversations with doctors treating patients in the UK and have found that some are receptive to me talking to them about cannabis and cancer. In some cases, I have been allowed into hospitals to treat patients with cannabis oil and have discussed this with their consultant. This was before the pandemic. I also teach people to make their own medicine. It is far better to use a product that has been grown with care so I do recommend home growing, but sometimes, the patient doesn’t have enough time to grow their own and I need to use cannabis that is sourced through people that I know. I would be extremely reluctant to use cannabis of an unknown origin.

Q: Given the option, would you like to operate legally and pay taxes? If so, do you feel organised crime is causing issues in getting that kind of regulation over the line?

A: Quite simply, yes and yes! Organised crime causes many issues which invite comparison to the work that I do which is quite different! Since supporting patients, there have been many successes and changes to their outcomes thanks to this wonderful plant and its healing properties. This plant is and can be miraculous. Much evidence about medicinal cannabis and cancer is suppressed in the UK, yet widely available in other parts of the world. This adds to the stigma of cannabis. Many of my patients consume cannabis as a last resort but if they had consumed it earlier, along with making other lifestyle changes, it is likely that their disease may not have progressed to the point of stage 4.

Q: What are your hopes for the future?

A: I don’t want to be seen as a criminal for helping and supporting people to recover from disease. While we have large groups of organised criminals profiteering and enslaving others for further monetary gain, the narrative will not change. I would like to see home growers, for medicinal purposes, having the freedom and the safety to be able to grow and make their own medicine.

Summary
It is clear that there are many good and genuine souls in the cannabis space who take legal and personal risks to help and support people with a range of conditions.

There are many patients who attribute their improvement in health to these knowledgeable individuals who have given them hope at a time of despair. There are also those who would cast aspersions over these individuals, claiming that they have had no medical training, but when all hope feels lost and medical treatments fail -the responsibility of healing often falls to the patient and their close family and friends. Desperate to try anything, they will trustingly reach out to the community online. Because this whole area is underground and unregulated, we often hear stories of individuals claiming to have these good intentions yet are offering to sell cannabis online without delivering the support or the quality products that they take payment for. This makes it incredibly difficult to find the ‘real’ experts because many are working as stealthily as possible to maintain their privacy and freedom but there is a real need for these genuine experts. While the law does not support them and their work, they must remain underground.

Finding a genuinely knowledgeable and caring supplier is far more difficult than joining a facebook group and asking for an oil maker. Stigma around cannabis still plays a huge part in the issue of cannabinoids and health in the UK -and this is institutional- it is tied up in the training of doctors, healthcare, government, pharmaceuticals, investment and capital. In the UK, you can practice herbalism after studying and completing a four-year diploma. This enables you to support patients with a range of medical issues and to prescribe and suggest a range of herbal tinctures and preparations to support their healing yet you cannot legally support people with cannabis – one of the very first plants recognised for its healing properties.

On the most simple level, if we look at the intentions behind the people who are trying to help others and are trying to make a change, we can gain a clearer understanding. Similarly, if we look at the intentions behind organised crime and cannabis farms, we can see that profit and gain are the driving force behind the cannabis farms involving cruel exploitation of vulnerable people. At Cancard, if we were given the choice to choose an ethically sourced and locally grown product, we would certainly choose this option over a product of unknown origin.

The opioid crisis is often spoken about in the USA, but are there similar overprescribing issues in the UK?

As a nation, we are in a great deal of pain. Both physical and emotional pain lead us to seek relief and in our desperation to ease this pain we may look beyond the GP surgery. Statistics show that the UK has the largest reported opioid-using population in Europe. This is reflected in the rise of prescribed pain medication and also in the rise of opioids sourced on the street.

The pain experienced by our nation has led to a dramatic rise in opioid dependency, overdose and death. Last year, (2019-2020) in the UK:

50 million prescriptions for opioids were written

Opioid overdoses have increased by 87% to 12,000

Opioid deaths have increased by 41%, to 2,000 each year

In the USA, the harm-related opioid statistics are proportionally far worse and in 2018, the Opioid Crisis Response Act was passed by the US senate in an attempt to tackle their spiralling opioid predicament. Programmes were funded and agencies mobilised with a funding pot of $7.9 billion.

Interesting information has since emerged from the USA and Canada indicating the association between county level cannabis dispensary counts and opioid related mortality rates. This report suggests a relationship between the increased prevalence of cannabis dispensaries and a reduction in opioid related mortality rates.

Often referred to as the ‘opioid-sparing effect,’ the use of cannabis in conjunction with opioids has been found to provide effective pain relief alongside reduced opioid consumption. Studies indicate that this occurs primarily due to a synergy in the analgesic effects between opioids and cannabinoids. With the reduction of the opioid dose comes the lowering of the physical dependency. A recent study exploring the link between states with operational dispensaries and opioid usage within those states, indicated that in states where cannabis is legal, there is a significant decrease in opioid prescribing, opioid overdose and mortality rates.

So let us head back across the pond to the UK and consider the steps that are being taken to address our opioid crisis. Although medicinal cannabis can be legally prescribed for chronic pain conditions, it is currently not yet openly prescribed to support patients with specific opioid dependency although these patients may be the very ones to present with chronic pain or depression and anxiety.

Over the past few years, NICE (The National Institute for Health Care and Excellence) has been working on new guidelines for the assessment and management of chronic pain. They highlight a particular group of patients with chronic primary pain defined as those having ‘pain with no cause’ stating that there is little or no evidence that treating such conditions with painkillers makes any difference to quality of life, pain or psychological distress.

Interestingly, many patients experiencing chronic pain, be it primary (pain with no cause) or secondary (pain caused by an underlying health condition) report that, over time, opioid analgesics cause the feeling of pain to increase. There is evidence to suggest that if you take opioid medication for four weeks or longer it makes us more sensitive to pain -leading to its increase- known as opioid-induced hyperalgesia. This is because opioids provide relief by blocking pain but the body increases the number of pain receptors to allow the pain signal to return. Opioid use also reduces the body’s ability to create and use natural endorphins meaning that the body’s natural response to pain is disarmed. If we then look at how opioids also mask emotional pain and trauma, a reduction in opioids can lead to amplified physical and emotional pain.

Could cannabis be a support to those who are considering reducing their opioid intake? There is much evidence to indicate that this is indeed the case, but accessing medicinal cannabis in the UK, currently, for this specific need may prove to be difficult. Reducing opioid use comes with many warnings and withdrawal symptoms can be challenging and sometimes dangerous to manage, especially if someone is attempting to do this without support. We hear of stories detailing how people have begun to consume cannabis and have, naturally and slowly, reduced their intake of opioids to a point where their dose is so low that they have been able to take the final step of freeing themselves from their opioid consumption.

With this new approach to opioid prescribing from NICE, it becomes more clear that there is potential to develop an opiate withdrawal programme in conjunction with cannabis -but is this something that would ever be considered by the cannabis clinics in the UK or even by NICE?

There are many success stories detailing how cannabis has helped many to reduce, then end their opioid use enabling them to lead fuller lives. Carly Barton is one of these. Her experiences and her story continues to give hope to those who are at the mercy of prescription or street-sourced opioids. There is a light and, following on from this article, we will share Carly’s guide to opioid withdrawal.

Guide: to supporting opioid withdrawal with plants by Carly Barton

Carly introduces her regime for supporting opioid withdrawal with natural medicines and companion practices.

Many patients struggle to tolerate opioids long term. Research shows that although opioids can be helpful for acute pain, they are not the best tool for chronic pain patients as they are less effective over time with a high addiction profile, the UK’s NICE guidance now reflects this view. In some cases, patients demonstrate an increased sensitivity and pain responses to usually benign stimuli, such as light and sound, as a result of opioid induced hyperalgesia. Which is a long-winded way of saying that, for some, opiates can make pain conditions worse.

Before and after withdrawal – photo taken 3 months apart

If you are considering withdrawing from opiates in favour of more holistic approaches. This process isn’t an easy one and I am mindful to remind you that it is best done very slowly, over a long period of time. Titrating down your dose will make the experience much less stressful for you and for your brain.

Understanding what happens during withdrawal

During opiate withdrawal, the brain experiences chemical changes that cause some pretty hectic chemical stress responses. The physical side-effects of your body withdrawing from a chemical it is dependent on can be quite distressing on its own, but from both personal experience and from anecdotal information from patients, the emotional/mood side effects can be even more significant and can lead to people giving up on giving up. This guide will hopefully help anyone wishing to utilise plant-based solutions throughout withdrawal and, in particular, should be a reminder of the chemical changes, so you are more at ease with the process and less distressed.

Let’s start by explaining what on earth is happening in the brain in terms of mood when we titrate opioids. When we consume opioids our reward centers in our brain receive a dopamine surge in our nucleus accumben. Dopamine is released when we experience pleasure, and a key driver for addiction is the need to feed those receptor sites. When we withdraw the drug, our dopamine receptors are expectantly waiting for another surge. When that doesn’t happen the chemical imbalance can cause issues with the processes for which dopamine is involved such as: attention, libido, memory, cognition, learning and sleep. Another neurotransmitter involved is serotonin, which is utilised for bodily processes such as pain sensitivity, sleep, appetite and cardiovascular regulation.

The locus coeruleus (LC) provides the sole source of brain norepinephrine in the mammalian forebrain, mediating a variety of brain functions and behaviours such as arousal, memory acquisition, attention, vigilance, and responses to stress. When we consume opiates, the norepinephrine locus coeruleus activity is very depressed, which means that the activity within these cells is inhibited often causing reports of a lack of emotional range. Patients will often report feeling ‘zombied’ or unable to connect to themselves. When the drug is withdrawn, the cells are reactivated and overly excitable, which can be incredibly overwhelming and unfamiliar, often leading to suicidal thoughts, depressive states and anxiety. This can, in some cases, be so overwhelming that people return to using opiates.

High magnification micrograph of the locus coeruleus

Thankfully, there is much we can do with plants to make this experience less stressful. The endocannabinoid system can act as a modulator for the stress-integrative LC-norepinephrine system and it can activate the neurotransmitter involved in producing dopamine. In particular, the Cannabinoid type 1 receptors can decrease stress-induced anxiety and modulate the excitability of the neurons as they are located in both the peripheral nervous system and the central nervous system. While the Cannabinoid type 2 receptors can target inflammatory responses, which can be helpful when dealing with the physical side effects of withdrawal. Strain choices play a really big role in this, and it is worth noting that cultivars that are more stimulating, can increase this activity somewhat. In making strain choices for opioid withdrawal, I would always advocate for a mid-range THC ‘indica’ dominant cultivar, to be taken alongside a high quality CBD product in order to activate the endocannabinoid system with balance.

In summary, the practical application potential of cannabis as a pain modulator, for which the opioids were originally prescribed, alongside its ability to aid side-effects, makes it the perfect companion in withdrawal support. With all of this in mind, it is hardly surprising that cannabis has been licensed for patients who have opioid dependency in several states in the US and clinics utilising cannabinoids in drug treatment are becoming increasingly popular.

What to expect

Day 1 – 2

You will begin to experience withdrawal symptoms during the initial 48 hours after taking your last dose. You will usually notice symptoms after around the eight-hour mark since the drug was last consumed due to the half-life of the drug. You can expect to experience discomfort in the form of muscle pain. After twelve to sixteen hours, you will experience a range of discomforting withdrawal symptoms including insomnia, diarrhoea, panic attacks and an increase in anxiety. At around the twenty four hour mark the anxiety can heighten, and insomnia can take hold, alongside some diarrhoea and temperature changes as the body enters detoxification.

Day 3-4

Reaching the 3 day mark, as symptoms intensify, is significant. Patients will often report day 3 as their worst day. Restlessness combined with aching muscles and lack of sleep can compound the ability to deal with the mood changes. The good news is that this is the peak at which the tide can turn for the better. Day 4 onwards, the brain chemicals start to balance out and the worst of the detoxification is over, although stomach cramps and shivering can linger for some.

Day 4-6

As day 4 transitions into day 5, you should notice an improvement in physical symptoms, and a lifting of mood. Some patients report an acceptance of their emotional state at this point. Once patients reach the day 6 mark, the acute withdrawal phase is over, although you may be left with some residual loss of appetite, mild anxiety and insomnia can persist for up to two weeks in some cases.

Preparing for withdrawal

Understanding that your mood and physical responses are being created by a chemical imbalance can be comforting in itself, you aren’t going mad, it is a process and one that will ebb and flow until it all calms down. It is absolutely essential, in my opinion, to ensure that you go into this mindfully and with the understanding that it will get better. Practising some meditation and working on some yoga stretches in the run up to your withdrawal can help to get you into the swing of self care and give you tools that can be utilised throughout the process.

It is also important to let those around you know that you are likely to need a bit of help and compassion throughout the coming weeks and ensure that responsibilities are taken care of so that the process of dealing with the side-effects can take priority.

Stocking up on some herbs that I will recommend in the next section, is also advisable. You may not have the resources to purchase all of them, so go with whichever resonate.

Hydration

Water

Water intake is incredibly important through a withdrawal, it may sound obvious or incidental, but it does play a really important part in detoxification. Ensure you are onboarding at least 2 litres of water per day, more if you are experiencing any sickness and diarrhoea. If you do experience this, it may be helpful to add some electrolytes into the mix.

Electrolyte supplements

Muscle aches

Magnesium

Magnesium can be incredibly helpful here. It can be found in many whole foods. Topical magnesium is incredibly helpful for restless legs and can be applied directly to the area of concern, but supplementing with oral magnesium is also advisable. Another great tool is magnesium sulfate, which is essentially epsom salts. This can be really relaxing for muscle stiffness and restlessness when used in a hot bath.

Note: If you experience any stomach upset with oral magnesium, you can supplement instead with topical applications and epsom salts.

Topical magnesium

Oral magnesium
CBD

Another great tool for muscle aches is CBD, utilising both oral CBD to keep inflammation at bay alongside topical CBD can be incredibly beneficial. I have recommended two products that personally helped me with my withdrawal and that I have seen the certificates of analysis for.

CBD Balm

CBD oil

Yoga

The need to stretch with restless achy muscles will come quite naturally, particularly on day 3 as you may feel that you are unable to relax. Some simple yoga stretches can bring down the aches and counteract some of the tension caused by inactivity.

This is a great channel that has free courses as well as routines for mood balance and particularly problematic muscle groups.

Yoga

Pain

Patients will often experience an increase in pain, particularly in the first 5 days of withdrawal. The tendency to utilise anti-inflammatories can be problematic for the stomach, which is often already compromised during detox.

Cannabis

A great tool for this is cannabis. Personally, I prefer vapourising using a dry herb vape. Vapourised cannabis is incredibly fast acting, easy on the lungs and can turn the tables on acute pain very quickly, relaxing tense muscles and alleviating neuropathic pain that patients often describe as like ‘electric shocks’.

This UK company provides a range of high quality vapourisers at various price points and they have a video demonstrating each piece of hardware.

Although vapourised cannabis is the most useful for acute symptoms, oils can be beneficial for more long-term coverage. Making a fat extracted cannabis oil is as easy as baking a cake! You can find my tutorial here.

Strains can be looked up on Leafly.com so that you can best understand the attributes of each.

Personally, I found that cultivars on the ‘Indica’ spectrum are better for calming the central nervous system and curbing overactive brain activity. It is always a good idea to add some additional oral CBD to balance out the effects of high THC cannabis, as recommended earlier.

Insomnia

This is a symptom that can be extremely distressing, we all know that feeling of not being able to tolerate what life throws at us without a decent night’s sleep!

Melatonin

Melatonin is a chemical that is naturally produced by the body when it starts to get dark, and it helps signal our sleep cycle. Withdrawal from opiates can significantly impact our ability to produce this effectively. Melatonin is not sold in the UK as it is not licensed for over the counter use. Luckily, it is easily ordered from other parts of Europe, and one of these before bed can help to supplement our brain with a naturally occurring substance.

Melatonin

Mood

Managing low mood can be difficult when you are also experiencing significant physical withdrawal symptoms. Below are some options for natural supplements that can help with this. Personally, I utilised all of these in combination. The L-Tryptophan and passion flower was particularly helpful for me.

Starflower/Borage oil

DLPA (amino acids)

L-Tryptophan with passion flower
Nutrition

As the body eliminates toxins and enters detoxification, it is incredibly important to supplement that with a healthy diet. This, however, can be problematic if you are experiencing loss of appetite. Although cannabinoids should help with this, it is always wise to make sure your body has enough vitamins to help you through.

Vitamins
Note: If you experience any stomach upset with Vitamin C, you can swap for low acid vit C instead.

B-100 Complex

Vitamin C

Moving forward

One of the benefits of being off opiates for me personally, is that I feel much more connected to my emotions, more in control and able to ‘feel’ the world around me. Following a few weeks of discomfort, I was able to express myself with much more colour and bliss.

Managing my pain moving forward, I still utilise many of the herbs that I have recommended in combination with a regime of cannabinoids to modulate my pain responses and calm symptoms that stem from my central nervous system.

I have made a note of my daily herbal toolkit below.

As well as consuming around 1-2g of vapourised cannabis, I also supplement with:

1000mg of Magnesium Citrate.

2000mg of Starflower/Borage oil.

Candida Complex.

40mg CBD oil.

Vegan Omega 3 Algae oil.

500mg Organic Moringa.

B-100 Complex.

Vitamin B12 sublingual spray.

Vitamin D sublingual spray.

200mg of psilocybin every Sunday.

Extras include:

Topical cannabinoids.

Turmeric.

DLPA.

I am not in any way advocating against the use of Western medicine -for some opioids and other pharmaceuticals work incredibly well. However, in my opinion, we as a country are over-prescribing these medicines where there are other less toxic alternatives.

One thing I have found on my health journey, is that our medical system can be incredibly paternalistic. This can promote an environment where the imbalance of power leaves the patient feeling less in control of their health. The drugs that we are prescribed are often drugs of which we have no understanding. They have names we can’t spell, they are generic white pills that we as humans struggle to connect with. The combination of these things, in my experience, puts our wellbeing at arms length and leaves us dependent on the advice of others when making choices about our bodies.

The transition to plant medicines, for me, changed that dynamic. Being able to grow or envisage growing these plants, experiencing their tactility and utilising their flexibility has helped me to reconnect and take responsibility for my own health with a newly found feeling of empowerment.

While you are going through your own journey in withdrawal, aside from utilising the tools in this guide, I think the best advice I can offer is to treat yourself with as much compassion as you can muster. Take each hour at a time and know that for every one of those hours, you are closer.

Good luck.