I
t’s a grim Wednesday afternoon in
central London. Horizontal wind
whips rain around with umbrella
inverting intensity. Hooded patients
dash from car doors into Harley
Street’s many famous clinics.
Nestled among them is the fl agship
Medical Cannabis Clinics site. It is one
of seven such medical centres in the
UK, spearheaded by clinical director
and prominent medical cannabis
advocate, Professor Mike Barnes.
I’m here to meet consultant
psychiatrist Dr Anup Mathew who’s
kindly agreed to talk to me on his fi rst
day in the role.
“I’ve always had a holistic approach
with looking at alternatives
to standard pharmacological
medications,” he says.
“I started looking into cannabis and
the leader of this is the Medical
Cannabis Clinics. I contacted them,
went on a training programme, spoke
to the team and here I am.”
Cannabis interacts with the
endocannabinoid system, which
we are only now developing an
understanding of despite a long
history of cannabis-use. We currently
know of the CB1 and CB2 receptors,
but there may be more and,
potentially, more applications for
medical cannabis.
“It’s looking like it affects multiple
pathways. It works exceptionally well
for pain and nausea,” Dr Mathew says.
“They have potentially identifi ed
another receptor, CB3, but there’s a
lot more work to be done.”
Unlike the NHS where medical
cannabis is only prescribed for a
handful of conditions, doctors at the
Medical Cannabis Clinics prescribe for
everything from stress and anxiety to
MS and motor neurone disease.
Patients needn’t have exhausted all
the standard medications in order
to access it, but Dr Mathew says that
some will have tried illicit forms of
cannabis that were either ineffective
or tempered by side-effects.
Attitudes to cannabis among the
medical community are changing,
albeit slowly. However, it remains
a highly contentious issue in the
psychiatric fi eld despite the huge
demand for new drugs.
Patients are crying out for
86
medications that do not come with a
high addiction potential like opiates
or benzodiazepines such as Valium,
Dr Mathew adds.
He believes that the confl ict with
cannabis within the psychiatric
community is due to a lack of
understanding.
“We have always been taught that
cannabis causes psychosis and there’s
not an understanding of where that
comes from. As a trainee you’re left
with that knowledge, but it’s not
explored any further,” he says.
“But when you dive into the
research and look at receptors and
pharmacological reactions, you
understand that there is a use for this
medication.
“If there’s any history of psychosis,
schizophrenia or bi-polar, you have to
be very careful.
“We’re not currently seeing patients
with that history. Not to say that they
wouldn’t benefi t from it, but we don’t
want to cause any issues before we
can even show the benefi ts.”
Dr Mathew follows what he calls
a ‘start low, go slow’ approach to
prescribing, starting with CBD-
only at the beginning, with the
concentration depending on
the condition, the patient’s past
experience and the severity of
symptoms. In most cases, patients
just require CBD, but a smaller ratio
of THC can be added later.
But this all happens only after
patients have undergone a thorough
assessment process. Doctors will
have detailed patient history, letters
from GPs and medical records to
work with. They then talk through
the options with the patient in a
consultation and submit a plan
to clinical governance. Only once
this is given the green light will the
medication be ordered.