Cannabis oil – is it a pain control option for mesothelioma sufferers?

Back in November 2018, the UK legitimised the use of cannabis oil and cannabis containing products for medicinal purposes.  The news came against a background of what seemed to be a rebranding of cannabis, with a number of countries around the world decriminalising and legalising it. At the time it felt as if there would be a marked increase in the numbers of people with mesothelioma and other cancers turning to medicinal cannabis, but this has not proven to be the case. It is still unusual to encounter a patient who uses medicinal cannabis.

However, further research into the use of medicinal cannabis has been positive. Just recently a multi centre clinical study reported in the British Medical Journal : Supportive & Palliative care – concluding that Medicinal Cannabis is a “safe and effective complimentary treatment for pain relief in patients with cancer”

So the question arises whether cannabis oil is now a realistic and safe option for mesothelioma sufferers when it comes to pain control.  How easy will it be to obtain and how can we combat the stigma associated with cannabis to ensure that those who have a need feel comfortable in asking and taking cannabis based medications?

What is medical cannabis?

The NHS website says that medical cannabis is a broad term for any sort of cannabis based medicine used to relieve symptoms.  There appear to be a number of products available to be prescribed, which include:

Is there any evidence that medicinal cannabis works?

The recent study examined the treatment of 358 patients with cancer over a period of 3.5 years. The results indicated a decrease in pain severity and pain interference. Those patients who took oral drugs with a balance of THC:CBD components benefitted the most. Medicinal cannabis was also effective in decreasing the overall medication burden, allowing patients to manage with lower doses of opioid based painkillers – and all their attendant often unpleasant side effects.

The study also suggested that medicinal cannabis – taken in this very controlled setting – was safe. Only 15 patients experienced any adverse effects, with 13 of them being minor. Typically sleepiness, fatigue and dizziness. 2 patients experienced severe adverse effects – pneumonia and and a cardiovascular event) – but these were felt to be unrelated to the use of medicinal cannabis.    

Previous studies suggested that the number of patients who reported a high pain intensity score reduced dramatically from 53% to just 4.6% after 6 months of treatment. Another study demonstrated that nabiximols (an oral / nasal spray with a balance of THC:CBD components) were more effective than a placebo in relieving pain for those with cancer.

There has also been a significant amount of anecdotal evidence which suggests that medicinal cannabis is helping people with a range of conditions.

The NHS obviously envisages that medical cannabis will mainly be prescribed to, and benefit those suffering with epilepsy, MS and people undergoing chemotherapy. However, an article in the British Medical Journal suggests that cannabis could be useful for the treatment of chronic pain as well.

There have been some high profile campaigns by parents of severely epileptic children which have led to widespread public sympathy and this led to the government’s decision to legalise cannabis for medicinal purposes.

Billy Caldwell, a 12 year old epilepsy sufferer from Northern Ireland, was experiencing awful seizures and was prescribed cannabis oil by a specialist in California. However, last year upon the family’s return from Canada, Billy’s cannabinoid medicine was confiscated at Heathrow airport.  This led to an absolute furore and Billy’s mother spoke on the BBC news and said that there was no sensible rationale why this should be the case when all of the traditional medical products that Billy had been prescribed, had not helped him.

In July 2018, Professor Mike Barnes, an expert in medicinal cannabis, secured an emergency licence for a cannabis drug for Alfie Dingley, another young epilepsy sufferer, whose epilepsy had responded to full extract cannabis oil, containing CBD and THC.  The Professor said that patients like Alfie who are suffering from severe epilepsy or other serious neurological and psychiatric conditions, as well as those suffering for chronic pain, have been “crying out for the kind of life changing treatment which medicinal cannabis products can offer”.  Indeed, only last month, in March 2019, he opened the country’s first private centre specialising in the medical cannabis treatments in the UK – The Beeches is based in Cheadle, in Cheshire. The Professor sees it as an important step forward for healthcare in the country, bringing the UK into line with other countries when it comes to pain control management.

We have all spoken to people with mesothelioma who have used cannabis oil for symptom relief. One lady explained she had started using cannabis oil to try and control her pain, when other prescription medicines had not helped.  She described the awful pain she had been in, how it had been almost debilitating and that whilst she wanted to enjoy her life for as long as she was here, she had been struggling to do so and live well due to her pain.  As a last resort she had sourced and started taking cannabis oil and said that she felt like a different person.  It had reduced her pain and she felt much more able to cope with her illness and get on her life, doing the things she wanted to do. 

However, in the discussion that followed it was clear that other patients were worried about how to access such medicines and a nurse shared her experience of a patient being embarrassed to raise it in consultation but on the way out, mentioning it and asking the question – “What about cannabis?”

Can mesothelioma sufferers access medicinal cannabis?

The scheduling of cannabis under the Misuse of Drugs Act 2001 was changed from a class A drug having “no medical value” to Part 2 and graded as a class B drug.

Only certain clinicians will be able to prescribe medical cannabis.  There are 800,000 specialist doctors on the General Medical Council register, who will be able to make that decision.  However, the rules are strict; in that they will only be able to prescribe it to patients who have an “unmet clinical need” i.e. that they have a condition which is not being helped by licenced products. 

Therefore, in theory, mesothelioma sufferers who have tried other forms of pain relief such as oramorph, which has not resolved their pain, could speak to a specialist about whether medical cannabis could be an option for them.

It’s still unclear whether in reality it will be this easy.  At this stage, there has not been that much research and only a handful of clinical trials into the benefits of using medicinal cannabis and there are few products available.  It is unlikely that specialists will have had much guidance or training on prescribing the products and understandably, many may worry about what will happen and what support will be available both to them and their patients if something went wrong.

In the context of a legal claim, those who do seek private treatment – including private prescriptions for medicinal cannabis – can seek to recover the cost if their claim is successful. The recent research may well help reassure medical professionals, as well as patients with mesothelioma and their families about the efficacy and safety of medicinal cannabis in the context of a controlled medical setting.

What’s to lose?

Legalisation of cannabis products for medical use may seem unlikely when the UK continues to wage a war on drugs.  However, the changes to the law are extremely minor.  We are a long way from adopting the approach of other countries – who have allowed the consumption and possession of cannabis for personal use and indeed, even allow people to grow their own. 

The government in this country has made it clear that it is a medical, not a political matter.  It is extremely unlikely that the use of cannabis will be legalised for recreational use.  Only specific products are available to be prescribed.

There is a small but growing body of evidence about the effect of medicinal cannabis. However, when you are desperate, you may be willing to try anything and understandably patients may ask themselves “what is there to lose?”

In my view patients should not worry or feel embarrassed to seek the advice of their doctor regarding the prescription of cannabis products rather than turning to the black market and buying products online which may contain anything.  Surely we need to encourage open conversations and where everything else has failed, and there is a genuine unmet clinical need, then cannabis products may have a role to play in pain control for mesothelioma sufferers.

Jennifer Seavor & Helen Childs