Despite the re-scheduling of cannabis-based medicines almost 2-years ago in the UK, patient access to medical cannabis remains extremely limited with only a few hundred scripts issued to date, predominantly within the private medical sector.
A lack of understanding of the endocannabinoid system (ECS) and lack of confidence in prescribing cannabis-based medicines are both clearly barriers to wider prescribing patterns.
Here, we explore why medical cannabis as a subject remains poorly understood by the vast majority of doctors within the UK.
The Endocannabinoid System - a missing subject in medical schools
There is a significant lack of teaching on the ECS and cannabis based medical treatments in UK medical schools. A recent report released by Conservative Drugs Policy Group surveyed 40 universities within the UK and found a paucity of teaching of cannabinoid medicine at undergraduate level. Almost half reported that they provide no pre-clinical teaching sessions at all on any of the five cannabis-related topics. Training on unlicensed and licensed CBPM was provided at 9% and 22% of medical schools respectively. Less than two in five medical schools reported that there was at least one session on the endocannabinoid system and less than half provided any teaching on cannabis as a risk factor for psychotic disorders. The average number of teaching sessions provided across all schools was less than 1 for every topic.
Why do doctors need to know about the endocannabinoid system and medical cannabis?
The lack of education for tomorrow’s doctors is quite remarkable when we consider the importance of the ECS and its role in a wide range of disease states and physiological functions including the modulation of pain, inflammation, mood and metabolism. We are discovering how both phytocannabinoids and/ or synthetic cannabinoids can play a vital therapeutic role in improving symptom control and overall quality of life. Research into cannabis as a medical therapy is now underway internationally at an unprecedented rate. Many people have already recognised the medical effects of cannabis and are utilising street cannabis for medical purposes, fuelling criminality and risking prosecution.
A void in education has meant that most UK doctors feel as though they are unqualified to answer their patient’s questions about medical cannabis - and some will find that their patients have more knowledge on the subject than they do
Studies and findings
Many organisations including Drug Science and King's College London, have carried out extensive research projects on cannabis-based medicines. UK university courses often teach students via real-life examples and current research projects but this does not seem to be the case for the endocannabinoid system and cannabis-based medicines. Unfortunately, despite a large number of research projects being carried out with UK universities, the findings from clinical research are generally not being translated into medical school teaching nor being applied to clinical practice. Countries who are further advanced in this field such as Israel and Canada demonstrate wider collaboration between academic research institutions, medical schools and clinical practice.
Why the lack of education?
The lack of formal education in the UK remains a difficult question to answer and is clearly multifactorial. There can be no question that a deep-rooted stigma associated with recreational cannabis is a major barrier to wider education. Cannabis has been highly politicised over the past century and it can be difficult to move away from existing preconceptions and beliefs. Despite a growing evidence base, the role of cannabis derived treatments (particularly unlicensed whole plant products) in modern clinical practice continues to divide opinion and progress is often hindered due to a negative bias about the harms of cannabis and cannabis- based products for medicinal use relative to potential benefits.
A range of learning modules on cannabis-based medicines are available to healthcare professionals, though none are currently mandatory for specialist practitioners. There remains a lack of NHS approved, evidence based accredited learning programmes available for doctors. A number of online based learning platforms do exist but care needs to be taken by doctors as some of these may have underlying conflicts of interest with positive bias.
Support for GPs
Most doctors still lack confidence in understanding cannabis-based treatments and how to safely prescribe these. Keeping up-to-date with advances in medicine and science is a professional duty and also forms part of GMC Good Medical Practice Guidelines. Cannabis-based medicines are no exception, as this duty is not limited to single pharmaceutical agents but all evidence-based therapies appropriate to a patient’s care. GP’s need to be further equipped in their understanding of the Endocannabinoid system, especially as more patients become aware of medical cannabis as a potential treatment option. Doctors should not be rejecting subject matter they do not know about and should not be coming from a place of ignorance when discussing cannabis based medical treatments with patients.
On a positive note, here at the Primary Care Cannabis network we have noticed an increasing number of GPS who are beginning to take a greater interest the ECS and cannabis-based therapies with an openness to learn and engage in dialogue.
The Primary Care Cannabis Network
The Primary Care Cannabis Network exists for GPs who want to learn more about medical cannabis, and how they can better support their patients.
At The Primary Care Cannabis Network, we are reaching out to and are working with other organisations and societies, so we can educate and advance scientific research.
The aim is to expand the knowledge of cannabis-based medical treatments and focus on academic research, education, key-papers and open discussions.
Given the importance of the ECS in health and disease, we believe it should be mandatory that undergraduate medical students and doctors in training in the UK are equipped with a basic understanding of the ECS and cannabinoid medicines and confidence in safe prescribing.
Our partnerships include The Medical Cannabis Clinicians Society, who have recently issued new guidance and recommendations for becoming a medical cannabis prescriber.
We focus specifically on the needs of GPs and are creating a community that will enable GPs to confidently work together and speak with specialists to understand the various regulatory pathways that exist within the UK.