UK Medical Cannabis Access – Understanding the Process

In the United Kingdom, medical cannabis is an unregulated medication. This indicates that it has not undergone enough clinical studies for the government to award it commercial authorisation. As a result, cannabis is rarely prescribed by the NHS. The National Institute of Clinical Excellence regulates the drugs prescribed by the NHS, and it is their mission to enhance medical treatment based on scientific evidence. Due to the lack of traditional clinical studies, NICE has determined that there is a lack of acceptable evidence supporting medicinal cannabis.

Despite the fact that the NHS seldom prescribes medicinal cannabis, expert doctors can privately issue a prescription if they feel it is in your best interests and you meet the qualifying conditions. It is a huge risk for doctors to administer off-label medications, which require special insurance coverage and more scrutiny from regulatory inspectors. As a result, fewer doctors are prescribing medicinal cannabis than there is demand for it. If you are a specialist consultant reading this and are interested in becoming a cannabis prescriber, please contact us so we can chat about the procedure of prescribing unique pharmaceuticals off-licence with us.

In the UK, there are now just a few medicines on the cannabis-based therapeutic goods formulary. Due to a scarcity of locally cultivated vegetables, clinics are entrusted with obtaining and importing items grown mostly outside. The supply chain follows the well-established path of pharmaceutical importation, which is a time-consuming and highly regulated operation. Because the shelf life of flowers is shorter than that of typical man-made single-molecule compounds, along with the fact that it is an off-licence drug, only tiny quantities may be imported at a time.

The availability, variety, and pricing of products are determined by the number of patients who seek them. The more people that sign up, the more stock clinics may import to meet the verified clinical demands of their patients. So, if people want medical cannabis clinics to supply a wide selection of items, they should start utilising them. It will allow them to communicate with patient care teams and consult doctors to assess what types of things are deficient or in demand in the UK.

Medical cannabis treatment techniques in the United Kingdom

We’ll look at the various sorts of products, delivery systems, and administration techniques that are now available in the legal UK medical cannabis market below. As we enter the fifth year of legal medical cannabis in the UK, the cannabis-based therapeutic medicines available have vastly improved from those provided to the inaugural group of patients in 2018/19.

Cannabis flowers 
By far the most prescribed items on the market are cannabis flowers. Because smoking medicinal cannabis is illegal, the doctor will instruct you to vaporise the cannabis flowers. For most individuals, inhalation is the quickest route to symptom alleviation. Among the various alternatives, it has the highest level of bioavailability.

THC and CBD, which are phytocannabinoids (cannabinoids found in plants), imitate endocannabinoids (cannabinoids generated by the body), are easily absorbed by the body, and penetrate the blood-brain barrier. Cannabinoid receptor sites may be found throughout the human body and play important functions in every major biological system and organ.

The flowers given are carefully selected cultivars that are commercially viable and fit the demands of patients for one or more ailments. This might be based on the ratios of THC and CBD, another cannabinoid, or the terpene profile. They are cultivated under controlled circumstances and subjected to rigorous laboratory testing to guarantee that they do not contain dangerous chemicals or impurities such as mould, bacteria, heavy metals, pesticides, or fungicides. For shelf-life considerations, they must be dried to 10% moisture and sterilised using irradiation or another means.

Strain names can occasionally be a source of controversy among business organisations. Cannabis-literate patients who depended on unregulated cannabis sources prior to medical cannabis legalisation have encountered strains that work well for them (and those that do not). Many of these strain names, however, are unacceptable for medical use and have been modified to be more acceptable. Doctors want to reassure patients that the medicines are safe and effective, and cannabis-naive patients who are new to cannabis medication may be concerned by non-medical titles. Some strains have been produced by legal manufacturers for medicinal and commercial purposes.

Vaporisers of dry herbs 
A dry herb vaporiser is a device that is powered by electricity. They can be battery-powered for mobile usage, or they can be mains-powered for fixed use. In the end, they both provide the same result: hot air extraction of cannabinoids for direct inhalation.

The dry herb vape was created to avoid the detrimental consequences of combustion. Because the temperature is regulated, clinical testing has shown that vaporising is approximately 40% more efficient than smoking and does not degrade any THC. Storz & Bickel, the makers of the Crafty, Mighty, Plenty, and Volcano devices, is the only medically authorised vaporiser brand on the market. Every component and method in the production process satisfies the test requirements.

Dry herb vaporisers are now readily accessible and come in a variety of styles from various manufacturers. The general feature is that they heat up a standard-size dosage of herbal medical cannabis flowers in a temperature-controlled chamber. The gadget will remain turned on for a predetermined period of time, resulting in a consistent administration. The patient may manage how much vapour and cannabis they inhale by adjusting the intensity, pace, and number of times they inhale while the device is turned on.

Patients should evaluate symptom alleviation after vaping medicine to see if they need to change the strain or dose with their doctor at their next consultation.

Because portable dry herb vapes have a limited battery life, it is best to keep a portable battery device or a set of spare pre-charged batteries on hand at all times if the device can switch out batteries. You could also be able to get a battery with a higher power capacity and a longer lifespan.

Cannabis extract 
Cannabis oil comprises the active elements (THC, CBD, and other cannabinoids, terpenes, and so on) extracted from cannabis in a concentrated form. Cannabis oil is an oleoresin that contains resins, terpenes, and sesquiterpenes, as well as other naturally occurring pharmaceutically active compounds.

Cannabis oil can be extracted using solvents, pressured gases, or mechanical procedures; however, in commercial pharmaceutical medication, solvents such as ethanol and pressurised gases such as CO2 are the most commonly used choices. Cannabis oil has a thick viscosity, is golden in colour, and rises in transparency as purity increases.

Although cannabis oil is hydrophobic and requires an emulsifier to disperse in aqueous solutions, it is adaptable and may be infused into an almost limitless variety of products. It can be vaporised and consumed orally, sublingually, as a suppository, or topically.

Cannabis tinctures for sublingual use 
Sublingual tinctures are an ancient means of delivering precise amounts of botanical extracts or medicinal ingredients. A sublingual tincture in the context of medicinal cannabis comprises cannabis oil concentrations diluted in a carrier oil. The carrier oil might be a seed oil or an oil extract like MCT, which stands for Medium Chain Triglyceride. MCT has two advantages over seed oils: it takes longer to go rancid, resulting in a longer shelf life, and some studies show that it has a higher degree of bioavailability than seed oils.

Tinctures need the use of a pipette to give one or more drops to get the desired or recommended dosage. The intensity of each drop is determined by the amount of active ingredient in the solution in relation to the total product volume. A 10 ml container holds 200 0.05 ml drops, whereas a 30 ml bottle has 600 0.05 ml drops.

Sublingual tinctures function by exposing the cannabis to the membrane skin under the tongue and the gums, which are quickly absorbed. Tincture received by this membrane skips the liver and enters the circulation immediately. The advantage of this is that the cannabinoids’ effects are felt within 10–15 minutes. Delta-9 THC is also responsible for the impact.

The tincture can be ingested after several minutes of keeping it in the mouth, allowing for dual oral action. THC is processed by the liver once it is consumed. It metabolises into 11-hydroxy-delta-9-tetrahydrocannabinol, which is 12 times more active than delta-9 THC and takes 45 minutes to an hour to take action.

Epidyolex is the only authorised CBMP tincture that contains CBD isolate. The drug that has gone through clinical trials is intended to treat the children’s seizure disorders, Dravets syndrome, Lennox-Gastaut syndrome, and tuberous sclerosis complex. It can be used as a supplement to other medications.

Capsules of cannabis oil
Cannabis oil capsules, also known as cannacaps, are similar to sublingual tinctures in that they contain cannabis oil in a carrier oil tailored to deliver a particular amount of cannabinoids. The difference is that they are encapsulated in a gel-based tablet that is to be ingested, which means that the cannabinoids are digested and metabolised by the liver before entering the bloodstream.

Cannanis oil capsules have the advantage of being available in greater single dosages than tincture drops and avoiding having to taste the cannabis oil, which may be earthy, peppery, and harsh. Because of its increased potency, 11-hydroxy-delta-9-tetrahydrocannabinol is also particularly useful for patients suffering from chronic pain.

The disadvantage is that cannabis’ oral bioavailability might be rather poor in some people, making it useless for some patients. They can take 45 minutes to an hour to take effect, so individuals seeking quick relief may find cannacaps ineffective. However, some individuals find that a combination of inhaled and oral cannabis adequately relieves their pain.

Vapes with cannabis concentrate 
Concentrate vapes mix cannabis oil and terpenes in a cartridge designed for use with a vape pen battery device. THC is present in cannabis oil, and terpenes provide modulation that can influence the outcome of symptom treatment for individuals with various diseases. Terpene profiles can be produced naturally from cannabis or created using pure terpenes extracted from fruit and other sources and reassembled to imitate strains.

The cartridge contains a heating device known as an atomiser. Cartridges are comparable to e-cigarettes in technology; however, these cartridges are engineered to function with the viscosity of cannabis oil and with materials that fulfil medical-grade criteria. Holding and releasing the activation button controls the duration of the inhalation. Some vape pen devices time off after a certain number of seconds to produce a consistent, modest dosage every time.

The pros of concentrate vapes include their ability to be inconspicuous, since they do not attract as much attention as dry herb vaporisers. They are ready to use with the press of a button, and reloading is as simple as using magnets or a tiny screw thread. Because of their regulated dose distribution, they are appealing to many patients seeking effective, hassle-free pain and anxiety relief. They also have a lesser odour, which fades faster than flowers in a dry herb vape.

Lozenges of cannabis 
Lozenges are another product that may be developed by combining cannabis oil with other standard ways of administration. Cannabis lozenges have just become accessible in the UK medical cannabis market, sparking speculation that more novel oral products are on the way. Cannabis lozenges are hard-boiled, gelatin- or pectin-based treats that contain a predetermined amount of THC, CBD, or both. They may be sucked or swallowed whole, resulting in a delayed release as they disintegrate in your mouth over time.

The advantage of lozenges is that they are discreet and simple to use without drawing attention to the fact that you are taking medicine. Another less visible advantage is that they are useful for individuals who have difficulty swallowing medications or who cannot tolerate the flavour of sublingual tinctures.

Buccal sprays of cannabis, THC, and CBD can also be ingested as mouth sprays. The buccal and sublingual mucosal membranes are the intended routes of delivery. Buccal skin refers to any skin that touches the teeth inside the cheeks and beneath the lips. This administration route is used by just one CBMP, Sativex, which is manufactured by GW Pharmaceuticals, which was acquired by Jazz Pharmaceuticals. It includes a THC:CBD ratio of 1:10%. In June 2010, the MHRA granted Sativex marketing authorisation, enabling specialist consultants to prescribe it as an add-on medicine for symptom alleviation of spasticity in multiple sclerosis.

Cannabis-based therapeutic drugs are not currently accessible in the United Kingdom

The following are some cannabis-based therapeutic medicines that exist and are accessible in other countries but have not yet been imported or manufactured in the United Kingdom. If doctors identify a higher and true therapeutic demand for these types of medications, clinics and pharmacies will be able to take the required steps to begin incorporating them into their formularies.

Transdermal cannabis patches 
Transdermal patches, commonly known as transdermal delivery devices (TDD), are not currently accessible on the medical market in the United Kingdom. They have numerous layers with various membranes to preserve the drug, keep the active chemicals in place, and increase skin permeability. The goal of a transdermal patch is to deliver modest amounts of activated cannabis to the skin during a scheduled release period.

Topical cannabis balms 
Topical cannabis balms are creams or ointments that include cannabis oil as one of the primary active components. They function locally, according to hypotheses, by interacting with cannabinoid receptors on the skin’s surface and within the tissue. Balms have one benefit over patches in that they may cover bigger regions at once. Because topical cannabis balms do not reach the bloodstream, they have no harmful impact on cognition.

Wafers made with cannabis 
Wafers are one of the least recognised methods of delivering cannabis. They are dissolvable pills that melt in the mouth in 5 to 15 seconds, allowing the majority of cannabinoids to be absorbed.

Wafers and other buccal drugs are widely used in medicine because they provide a non-invasive technique to rapidly transfer chemicals into the circulation.

Cannabis suppositories 
Suppositories are another ancient form of medicine administration. Suppositories are big tablets that are meant to absorb readily when placed into the rectum with an applicator that assures proper placement. They require the active component formulation to be injected 10 cm into the rectum. The drug is absorbed straight into the circulation after being inserted into the rectum, bypassing the liver.

Vaginal suppositories are pills that are put into the vaginal canal to give medicament to the affected region. The vaginal epithelium, or epidermal membrane inside the vaginal canal, has the same qualities as the inside of the mouth and beneath the tongue. It provides a great environment for gradual, consistent, and high rates of absorption due to its large surface area.

Inhalers for cannabis 
The objective is to administer a metered amount of medicine with one puff of an inhaler, similar to how steroids are supplied to asthma sufferers. The consistency of the cannabinoids, the quantity of the dose, the efficiency of the device, and, of course, funding are all issues, but research has shown limited encouraging results for managing pain through medical cannabis use.

Roundup of CBMPs
Every month, the library of items now accessible in the UK grows. The larger the number of patients in the UK who receive a prescription, the greater the variety of products available. The variety and quality of flowers are expanding as more doctor-patient encounters raise awareness. Product prices will gradually fall as the number of patients grows and order volumes increase. The quantity of new items being developed for the market is also increasing. New developments continue to raise the prospect of discrete, hassle-free administration alternatives, with observers unaware that it is cannabis treatment.

Don’t let the stigma associated with medicinal cannabis keep you from receiving appropriate therapy. Releaf offers customised monthly packages, medical cannabis professional consultations, and a one-of-a-kind medical cannabis card for protection, all depending on your medical cannabis prescription.