Why doctors have a moral imperative to prescribe and support medical cannabis—an essay by David Nutt

Nutt, David

doi:10.1136/bmj.n3114

Cited by 29 publications

(10 citation statements)

References 21 publications

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“…Cannabis-based medical products (CBMPs) are approved in over 40 countries and prescribed for a broad variety of conditions. In the UK, CBMPs became legal in November 2018, nevertheless prescribing here remains very limited ( 8 ). The National Institute for Care and Excellence (NICE) does not recommend the prescription of CBMPs for chronic pain.…”

Section: Introductionmentioning

confidence: 99%

Characteristics of People Seeking Prescribed Cannabinoids for the Treatment of Chronic Pain: Evidence From Project Twenty 21

Schlag

Lynskey²,

Fayaz

et al. 2022

Front. Pain Res.

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BackgroundPrescribed cannabinoids are now legal in the UK and increasingly being used for a variety of conditions, with one of the most frequent conditions being chronic pain. This paper describes the characteristics of individuals seeking prescribed cannabinoids for the treatment of chronic pain in Project Twenty 21, a UK based real world data registry of prescribed cannabis patients.MethodBy 1st November 2021 data were available for 1,782 people who had sought treatment with medical cannabis as part of Project Twenty 21. The most common diagnosis among this cohort was chronic pain with 949 (53.5%) of the cohort reporting a primary condition related to chronic pain. Medical and self-report data on the characteristics of these patients, their health status and type/s of cannabinoid/s prescribed are summarized in this report.ResultsOf the 949 people reporting chronic pain as a primary condition 54.7% were male and their average age was 42.0 years (range = 18–84). Patients reported a low quality of life and high levels of comorbidity: people reported an average of 4.6 comorbid conditions with the most common comorbid conditions including anxiety, depression, insomnia and stress. A range of cannabinoid products were prescribed with the most common products being classified as high THC flower (48.5%). The majority of patients also reported using at least one other prescribed medication (68.7%).ConclusionsConsistent with findings in other national and international databases, chronic pain was the most common primary condition in this real world study of prescribed cannabinoids. There was considerable variation in the types of chronic pain, comorbid pathology and in the characteristics of products being prescribed to treat these conditions. Together, this evidence supports the utility of real world evidence, as opposed to clinical trial approaches to studying the potential benefits of prescribed cannabinoids in treating chronic pain.

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Section: Introductionmentioning

confidence: 99%

Characteristics of People Seeking Prescribed Cannabinoids for the Treatment of Chronic Pain: Evidence From Project Twenty 21

Schlag

Lynskey²,

Fayaz

et al. 2022

Front. Pain Res.

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“…There is now acceptance that cannabis has demonstrable beneficial therapeutic effects in conditions including chemotherapy-induced nausea and vomiting, chronic pain, multiple sclerosis, anxiety, sleep disorders, and epilepsy, all within a satisfactory safety profile [ 35 ]. Here we report on the use of cannabinoids as a strategy for the clinical symptomatic management of EUPD and associated conditions in a case series of 7 patients in whom such a therapeutic approach has been implemented.…”

Section: Introductionmentioning

confidence: 99%

Cannabis-Based Medicinal Products in the Management of Emotionally Unstable Personality Disorder (EUPD): A Narrative Review and Case Series

Sultan

Mathew²,

Brown

et al. 2022

Brain Sciences

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Emotionally unstable personality disorder (EUPD) is a common mental health disorder, manifesting with a range of chronic and debilitating symptoms, including impaired social functioning, unstable mood, and risky impulsive or self-injurious behaviour. Whilst the exact aetiology has not been fully elucidated, implicated factors seem to include genetic factors, environmental causes such as trauma, and neurotransmitter deficits. The literature suggests that impaired functioning of the endocannabinoid system in key brain regions responsible for emotional processing and stress response may underlie the manifestation of EUPD symptoms. The National Institute for Health and Care Excellence (NICE) 2009 guidelines state that “no drugs have established efficacy in treating or managing EUPD”, and yet, patients are commonly prescribed medication which includes antipsychotics, antidepressants, and mood stabilisers. Here we present a case series of seven participants diagnosed with EUPD and treated with cannabis-based medicinal products (CBMPs). Participants were given an initial assessment and followed up one month after CBMPs prescription. Improvement in symptoms was assessed by the completion of ratified rating scales by the participant and psychiatrist. Our results indicate that CBMPs were effective and well tolerated, as six participants reported a noticeable improvement in their symptoms and functioning. Although promising, further research is needed to ascertain the long-term tolerability, efficacy, and dosing strategy for CBMPs in EUPD.

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“…In his article on prescribing medical cannabis, Nutt opines that prejudice and fear on the part of the medical profession are limiting factors to the prescription of these medications in the United Kingdom 1. In the real world, the issues are more about local medicines regulatory mechanisms and the multilayered interface between national and local policies in prescribing.…”

mentioning

confidence: 99%

Local regulatory systems hinder prescription of medical cannabis

Bradley

2022

BMJ

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Why doctors have a moral imperative to prescribe and support medical cannabis—an essay by David Nutt

Abstract: Medical cannabis has been legal to prescribe since 2018—yet just a handful of prescriptions have been made in three years. The reasons: stigma, fear, and an entrenched resistance in the medical profession that is harming patients, writes David Nutt

Cited by 29 publications

References 21 publications

Characteristics of People Seeking Prescribed Cannabinoids for the Treatment of Chronic Pain: Evidence From Project Twenty 21

Characteristics of People Seeking Prescribed Cannabinoids for the Treatment of Chronic Pain: Evidence From Project Twenty 21

Cannabis-Based Medicinal Products in the Management of Emotionally Unstable Personality Disorder (EUPD): A Narrative Review and Case Series

Local regulatory systems hinder prescription of medical cannabis

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