Cancard responds to landmark case
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.
Mr Andrew Baines, Cancard member and cannabis specialist
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.
Hannah Sampson, Cancard solicitor, consultant to Mackrell
After the ruling, Hannah Sampson, Andy’s solicitor said:
“This ruling is unprecedented, I have never known anyone be handed a 6 month community order. You get 12 months if you steal a sandwich from Tesco. This case, perhaps, earmarks a wind of change. This case, perhaps, means that finally, the law will catch up with the enormity of what cannabis can do to save lives.”
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
Cancard gives evidence to parliamentary inquiry into the 1971 misuse of drugs act.
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.
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
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.
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
Real world evidence generation
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
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)
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.
Parkinson's and Cannabis
A brief introduction to how cannabinoids can be helpful for those with Parkinsons disease
World Parkinson’s Day (Sunday 11th April 2021) marked the beginning of Parkinson’s awareness month and Parkinson’s awareness week in the UK. At Cancard, we recognise that many patients with this condition experience symptomatic relief through the consumption of cannabis. Indeed, it is a qualifying condition for a medicinal cannabis prescription -making it an eligible condition for Cancard applicants who may be unable to meet the cost of a private cannabis prescription.
How can cannabis help?
Our bodies have an endocannabinoid system (ECS). This means that we create our own cannabinoids which bind to cannabinoid receptors in our bodies. The ECS is responsible for regulating many of the systems in our bodies, including sleep, mood and the central nervous system, and our cannabinoid receptors can be found throughout the body and the brain.
The basal ganglia, an area of the brain which controls movement, is affected by Parkinson’s. These areas of the brain contain high numbers of cannabinoid receptors. There is recognition that phytocannabinoids (or plant-based cannabinoids) bind to these receptors and some patients find that this leads to an easing of many of their symptoms such as tremor and stiffness.
The effects of cannabis and its symptomatic relief of Parkinson’s has been documented anecdotally by a number of Parkinson’s patients. We would like to share a popular clip of Larry whose tremor, amongst other symptoms, is notably improved and relieved minutes after the consumption of cannabis. We would also like to thank him for his bravery in allowing this clip to be shared online, giving hope to those with similar conditions who may be considering cannabis as a treatment option. Go Larry!
The top four self-reported cannabis strains for effectiveness in Parkinson’s are:
OG kush - and other kush dominant cultivars
Is organised crime ruining our hopes for a home-grown future?
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.
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.
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.
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.
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.
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 illicit market has had to adapt to meet the requirements of people consuming for health reasons. While there is still lots of darkness in mass cultivation for profit, we also have some truly wonderful souls in this space. These people go above and beyond to support people and provide excellent advice based on their many years of research and experience. It saddens me that these people are living in fear of criminalisation for stepping in where our health service hasn't been able to meet people's needs, or, hasn't embraced breakthroughs in understanding this medicine as efficiently as other countries. I would love to see these people offered the opportunity to share their knowledge and work in the space that is their specialism. I want them to be afforded the same respect as any professional working in an expert area. Unfortunately, movement on this issue is tough while we still have criminal organisations tainting the space with violence. Decriminalisation and regulation has been held up by nervousness around exploitation. We may never rid ourselves of the shadow of a criminal market that prohibition has created, but surely while the current situation is not being managed by perpetuating the rhetoric that is ‘the war on drugs’ - we have a duty of care to try. It would make sense to me to allow cannabis to be farmed and sold much like the produce from the local vegetable market. Kale has many medicinal and health benefits, but no one is beating anyone up to control the kale market. It would be great to see some kind of pilot initiative whereby licenses were granted on small community operations to trial the impact of providing a market that steers clear of the chaos of criminal involvement. I'm sure that given the choice, people would opt to purchase their medicine from an ethical supplier.'
The state we’re in: is there an opioid crisis?
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.