CBD and medical cannabis - Special report
By Gordon Stribling
Medical cannabis Q&A
Professor Mike Barnes is a Consultant Neurologist and medical cannabis expert.
A leading authority on cannabis medicine, Prof. Barnes helped to bring Sativex, the first medical cannabis drug, to market in the early 2000s.
Prof. Barnes also wrote the first NHS prescription for medical cannabis for Alfie Dingley, who lives with a rare form of epilepsy.
We called Prof. Barnes to learn more about how cannabis medicine is helping patients in neuro rehab and beyond.
What does the UK’s medical cannabis landscape look like in 2023?
Medical cannabis was legalised in November 2018. Since then, it has slowly become more socially and clinically accepted.
Now, around 29,000 people are prescribed medical in the UK, albeit privately and not on the NHS.
The UK medical community have been slower to prescribe cannabis than our colleagues in parts of Europe like Germany, Malta, Switzerland, let alone North America.
But we're slowly catching up.
How can medical cannabis support neuro rehab?
Cannabis has a very solid evidence base for a number of conditions, mainly as a treatment of symptoms rather than a cure of disease.
In can certainly help pain. Around 60 per cent of cannabis prescriptions worldwide are for chronic pain.
Pain can be a problem after brain injury or neurological deficit like multiple sclerosis.
There is also strong evidence that cannabis can help with anxiety, which is another issue commonly associated with various chronic neurological conditions.
In addition to that, cannabis may help to improve appetite, which can be an issue with some degenerative conditions like Parkinson's disease.
In certain cases of MS or brain injury, cannabis may help muscle problems like spasticity while with Parkinson's disease, it can reduce stiffness and sometimes spasm.
There's also some evidence that cannabis is a neuro protector.
One study from the US found that when chronic long term cannabis users had a brain injury, morbidity was lower because some of the cannabinoids can protect the brain.
Of course, I'm not saying that people should use cannabis on the off-chance that they have a car accident. But it's worth acknowledging its potential neuro-protective benefits.
What about ageing?
Cannabis for ageing population can be useful for several things.
Pain becomes more common as you get older, whether it’s arthritic pain or pain for neurological conditions such as stroke. So pain is number one.
Anxiety is also a problem of increasing ageing, particularly for those who have a long term conditions or terminal diagnosis.
Anxiety can be alleviated by cannabis, particularly CBD. CBD can also help with sleep.
Cannabis can also help to stimulate appetite, which is a difficulty for some older people.
Older people will of course suffer from general aches and pains and many of these can be alleviated by legal, over the counter CBD.
But if a commercial CBD product doesn’t help, medical cannabis might.
These medicines contain other cannabinoids such as THC which will provide additional benefits.
It’s worth noting that elderly people need not worry about getting high from a medical cannabis product containing THC. For a properly prescribed product, the THC high will be counteracted by CBD.
But I would still advise trying over the counter CBD in the first instance.
Does medical cannabis offer benefits to women’s health?
CBD can be very helpful for a general improvement of quality of life. That of course includes various women's issues.
For the menopause, it can help to improve sleep and reduce anxiety. For painful conditions, it is particularly helpful for endometriosis and fibromyalgia, the latter of which is much common among women than in men.
Are there any potential maternity or fertility complications from cannabis-use?
If you're pregnant or breastfeeding, it’s best to avoid any cannabis medicine. Having said that, there is no known foetal syndrome associated with cannabis.
There is some evidence that babies of cannabis users are slightly smaller. But there is no evidence of any significant foetal abnormalities occur regularly.
What about sexual health benefits?
There is early evidence that CBD with or without some additional THC can improve sexual libido. This may simply be due to reductions in anxiety or pain. But some research suggests that actually improves sexual performance.
Is there much in the way of innovation when it comes to cannabis delivery systems?
Cannabis is mainly taken as a flower or an oil. But there are certain delivery methods that are more acceptable to the patient and a doctor than others. Vaping, for example.
We’re starting to see devices that not only deliver the medicine but collect data about what is being used, the dosage and so on and feeds this data back to a central database.
This data can be very useful to support research like Drug Science’s Project Twenty21.
There are other less common forms of delivery emerging, such as patches, suppositories and pessaries. However, these are difficult to make for cannabis because it likes fat.
That said, advances in technology might make these more readily available in the future.
How have perceptions changed since medical cannabis was legalised?
The public has now genuinely accepted that cannabis has a useful role in medicine. And indeed, many countries are opening the door to recreational use as well
But there remains a big reluctance among some very conservative medical professionals, not just in the UK but abroad as well
We are beginning to see that breaking down slightly. We’ve just seen the first NHS referral to a private clinic, for example.
It will break down slowly but surely as more evidence accumulates.
Find out more about Professor Barnes' work at profmichaelbarnes.co.uk
Market insights from a CBD insider
The UK’s CBD industry is evolving at a rapid pace.
Initially the preserve of head shops and specialist online retailers, CBD products are now commonplace in thousands of high street stores including Boots, Superdrug and Holland & Barrett.
Positive media coverage and word-of-mouth testimonials have helped to destigmatise CBD - and now millions of people from all walks of life are discovering it.
Wesley Cude entered the then-nascent CBD industry back in 2018, initially helping brands to find a compatible payment gateway and set up their website.
The status of CBD as a ‘high risk’ product limits how it can be sold online.
Wesley has since set up award-winning WordPress agency Cude Design, along with CBD marketplace, CBT Shop PT.
The latter offers CBD products ranging from oils and gummies to coffee and tea.
Wesley says: “Over the past five years, I’ve developed a deep understanding of the CBD industry and how it operates, both through my agency and The CBD Supplier.”
Wesley Cude
Wesley Cude
The £700m UK marketplace has expanded and diversified since the first products hit shelves in the late 2010s.
The CBD product portfolio now encompasses everything from edibles and e-liquids to hash and capsules.
Tinctures and gummies have maintained their status as the go-to formulations for millions, Wesley says.
But in recent years, enterprising CBD and vape shops have capitalised on the grey area of ‘CBD flower’ – raw, CBD-rich cannabis buds containing only trace amounts of intoxicating THC.
It’s a trend that began in the US, which continues to set the template for legal cannabis products.
The country also kickstarted a trend for so-called minor cannabinoids such as CBG and CBN.
CBG e-liquids have found a niche audience in the UK. However, CBN is a controlled substance. The compound is produced when THC degrades.
But despite this continual innovation, Wesley has witnessed a significant decline in the number of start-ups launching their own brands since the ‘green rush’ of 2018.
Back then, he explains, CBD was something of a novelty that the early adopters thought would be easy to sell.
However, that proved to be far from the case, with marketing restrictions presenting a significant challenge to retailers.
And in the intervening years it’s become increasingly difficult for new brands to make a name for themselves online.
Wesley explains: “The main brands hold a monopoly on search engines, so it is pretty hard for anyone else to generate valuable traffic.”
New regulations have further stunted the industry, Wesley says. Brexit introduced red tape and taxation for products being sent between the UK and EU.
Meanwhile, the reclassification of CBD as a novel food has brought its own set of problems.
The Food Standards Agency (FSA) brought CBD under novel foods purview in 2019 in an effort to clean up the so-called CBD ‘wild west’.
However, the marketplace could now be set further upheaval after the FSA greenlit plans to create a new functional food and supplement market.
If the plans go ahead, CBD could be integrated into cereal, bread and other common foods and legally marketed in the UK.
But Wesley says that it’s ‘hard to say’ what will happen next for CBD in the UK.
The legalisation of medical cannabis in 2018 led many advocates to believe that decriminalisation or legalisation of the recreational plant would soon follow.
In Europe, Malta legalised recreational cannabis in 2021. The drug is decriminalised in the Czech Republic and Portugal.
However, Wesley does not see the UK getting on board any time soon.
He says: “It would be hugely beneficial to the UK industry for regulators to take a more relaxed approach.
“We would likely see a huge increase in CBD Flower shops and a drop in prices across the industry.
“But do I actually expect that to happen? I don’t hold out much hope.”
The Labour party has shown little interest in relaxing cannabis laws should it be in power after the next election.
Once a proponent of decriminalisation, Labour leader Kier Starmer said in 2021 that he had “seen too much of the damage that sits behind drugs” to justify a change in the law.
EthicaCBD: "We're here for the right reasons"
The CBD industry is filled with business-owners who were inspired to launch their companies following their own positive experiences with the cannabinoid.
Many find it after years of searching to find something that works for their condition.
EthicaCBD founder, Olivier Reiner, is one such founder.
Olivier co-founded Medicanna in 2019, launching EthicaCBD two years later.
EthicaCBD has developed an array of CBD products, including tinctures, facial scrubs and sports gels.
Olivier developed back pains during his teenage years. He would often struggle to walk or even put his socks on.
But those older and supposedly wiser people around him said he’d get past those ‘growing pains.’ But he never did.
Olivier Reiner
Olivier Reiner
Olivier says: “[Then], in 2015 when I was 43, I had massive inflammation that felt like sciatica but 10 times worse.
“I had pain in my back, neck, fingers…basically everywhere. I underwent all sorts of tests with rheumatologists but nothing conclusive came from them.”
An MRI scan highlighted that Olivier’s sacroiliac joint was inflamed. Further blood tests revealed that he had Ankylosing Spondylitis.
Ankylosing spondylitis (AS) is a long-term condition in which the spine and other areas of the body become inflamed.
Pain, stiffness, swelling and fatigue are common in AS patients who can experience a severely impacted quality of life.
There is no cure for AS. All patients can do is try to manage their symptoms with medication and exercise.
One common treatment is through the use of TNF inhibitors. These drugs help to combat the inflammation that causes pain to swell up.
Olivier was recommended TNF inhibitors but was concerned about the potential side-effects.
He says: “My view was the anti-TNF drugs would work but act like putting a sticker over a rusty patch on a car.
“It will look good and solve the problem temporarily, but the rust is still there and eating away.”
Olivier began looking for alternatives, eventually finding a CBD tincture.
On experimenting, he found that it not only helped the pain but also eased his stress and improved his sleep.
However, after tests revealed high levels of mercury in his blood, he stopped using the product. After doing so, his mercury levels dropped.
Olivier had unwittingly been taking a potentially harmful CBD product.
But then Olivier’s osteopath, also a certified GP, introduced him to a more trustworthy CBD brand that helped mitigate the pain, making his tendons and muscles more supple.
Olivier says: “By this time I had decided that the only way to be sure that the CBD I was taking would be 100 per cent trustworthy, would be to make my own brand.
“That way I would know exactly what was inside my bottles.”
Olivier and business partner Ruarri Spurgeon put their heads together.
Both were intent on developing a CBD product that incorporated the best elements of a gel that Olivier had been using, but with added CBD.
After two years of development, the first EthicaCBD gel was born.
Now, Olivier can’t imagine life without it.
He says: “I am now skiing again better than ever, mountain biking and trying to beat my 14 year old at football.”
Olivier feels ‘lucky and privileged’ to have been able to design a product that not only benefits himself but his customers, too.
Among them, cricketing legend Sir Ian Botham who has become an outspoken advocate for EthicaCBD.
Olivier maintains that the success of the brand is down to the quality of its ingredients.
Each product is quadruple-tested, enabling EthicaCBD to maintain complete control of their extracts at each stage of the production journey.
Olivier says: “Because all of our raw materials are organically grown and sustainably sourced, and our cultivation and manufacturing processes are sensitively handled by experienced and knowledgeable individuals, every stage of our production is the best it can be.
“We also recognise that there are areas where we can be doing more and we are working hard to evolve the ethical responsibilities that we have as a company to strive to be better.”
Olivier adds: “We’re here for the right reasons. We’re not out to make a quick profit at any cost.
“Rooted at the centre of everything we do is a desire to create products that will improve people’s lives.”
Learn more about EthicaCBD at EthicaCBD.com
Savage Cabbage: "I often refer to myself as the 'Accidental Entrepreneur'"
Jade Proudman is the founder of CBD company, Savage Cabbage. The long-time CBD advocate is also a member of the All Party Parliamentary Group for Hemp and CBD.
The cross-party is focused on encouraging the development of fair, evidence-based UK regulations on industrial hemp and CBD products.
Jade explains how her CBD journey began.
Jade Proudman
Jade Proudman
“I had been dealing with very complex issues for a number of years, which had an enormous impact on my mental health.
“I was exhausted with battling my circumstances and wanted to give up.
“My husband Leslie encouraged me to watch the CNN documentary ‘Weed’ with Dr Sanjay Gupta that introduced Charlotte Figi and the Stanley Brothers.
“It showed me the incredible impact that whole plant hemp extract could have on people.”
Charlotte was the inspiration behind Charlotte's Web - the first true CBD brand that would both spawn an industry and give hope to countless individuals and families.
Diagnosed with Dravet syndrome, a rare but severe form of epilepsy, Charlotte endured up to 3,000 seizures a week. By the age of five, she was unable to walk or talk. She wasn’t expected to live past eight.
Conventional medicine did little to quell Charlotte’s seizures. Desperate for an effective treatment, the Figi family began exploring alternative medicines.
It was at this time that Charlotte’s mother Paige found a Denver dispensary that supplied a high-CBD, low-THC oil. She bought a quantity and gave Charlotte a small dose.
To the family's amazement, Charlotte was seizure-free for an hour. The dramatic result convinced them to persevere with the treatment which would reduce the frequency of seizures to just two or three a month.
By now, the success of the medicine was unquestionable.
The Figi family began working with Colorado-based siblings, the Stanley Brothers on the game-changing elixir that would become Charlotte’s Web.
Charlotte’s story opened minds around the world to the true potential of cannabis, Jane among them.
Jade says: “I reached out to the Stanley Brothers via Twitter and they sent me a care package. The change in how I felt was remarkable, and as they say, the rest is history!
“I often refer to myself as the ‘accidental entrepreneur.’”
Savage Cabbage is a UK distributor for Charlotte’s Web and offers the full range of products, including gummies, capsules, oils, creams and gels.
The company also sells Savage Cabbage-branded CBD. The brand is one of the oldest in the UK and builds on the Charlotte’s Web template, using whole plant, full spectrum CBD.
A Certificate of Analysis (CoA) is available for each batch, providing customers with peace of mind.
Each product contains all the cannabinoids, terpenes and flavonoids naturally found in cannabis. These compounds harness the body’s endocannabinoid system.
Discovered in the 1990s, the system is believed to play a role in regulating physiological and cognitive processes, including appetite, pain-sensation, mood and fertility.
Jade believes that more should be done to educate people about the potential benefits of tapping into the endocannabinoid system – and the limitations of CBD.
She says:
“There really does need to be a concerted effort to educate consumers en masse.
“Using CBD as part of a daily routine as a food ingredient is not going to regrow limbs or indeed make you live forever.
“What it may do is help you get more out of your day, feel energised organised and enthused by life.
“To me it goes without saying that if we use whole plant CBD daily, chances are we are going to notice some nice benefits to that.
“Ultimately, we all want to feel the best we can daily.”
Charlotte Figi sadly passed on April 7, 2020 at age 13 after being hospitalised with pneumonia.
But her story continues to inspire.
Three years on, the CBD market is thriving, as advocates like Jade continue to champion the whole plant extract.
Jade says:
“Charlotte’s story ignited this industry and without her and the Stanley Brothers I’m not sure we would have an industry like we see today.
“Interestingly, when Savage Cabbage was just starting out, Charlotte’s journey and experience is what brought people to us.
“They wanted to find out more, they had a reason to push themselves into this weird world of cannabinoids.
“Seven years on we still look after those same people that joined our community back in the early years, but many new customers are not necessarily aware of our little trailblazer.”
Community remains at the heart of Jade’s work with Savage Cabbage.
The company began with a mission of building a community rather than growing sales.
The model has clearly resonated with customers working, with hundreds championing the company on Trustpilot.
Jade says: “We are happy to be an educational resource to anybody who wants to ask us questions.
“Nobody will get a hard sales push from us.”
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