The recent surge in recreational (non-medical) use of nitrous oxide (N2O, also known as ‘laughing... more The recent surge in recreational (non-medical) use of nitrous oxide (N2O, also known as ‘laughing gas’) often by inhaling it from balloons, has attracted the attention of some politicians with calls to control its possession under the United Kingdom (UK) Misuse of Drugs Act 1971 (currently selling, but not possession, for recreational use is controlled under the Psychoactive Substances Act 2016). Meanwhile, the recreational use of nitric monoxide (NO) as delivered by alkyl nitrites, also known as ‘poppers’ has also raised concerns, but unlike N2O, its use was not controlled under the 2016 Act. To inform future-decision making processes and ensure that any such decisions are based on the best evidence, Drug Science conducted a Multi-Criteria Decision Analysis (MCDA) about N2O and poppers to compare the overall harms of these two drugs to the harms of 20 drugs previously evaluated and published by Nutt et al. The group assessed harm scores for N2O and poppers on the original 16 harm c...
A 49-year-old woman was diagnosed with an ER + , PR-, HER2 + , BRCA- invasive ductal carcinoma wh... more A 49-year-old woman was diagnosed with an ER + , PR-, HER2 + , BRCA- invasive ductal carcinoma which progressed metastatically to include bone, liver, and lymph node involvement. Standardised care included a 26-month treatment period with targeted chemotherapy and a ketogenic diet. The patient also began a course of cannabinoid-based therapy, consisting initially of a titrated high-dose protocol of mixed cannabidiol (CBD) and d9-tetrahydrocannabinol (THC) chemotypes, as well as psilocybin-assisted psychotherapy at macro and intermittent micro-doses. At the end of the five-month treatment period PET/CT investigations revealed no evidence of metastatic disease and chemotherapy was withdrawn. A one year follow up CT investigation concluded no evidence of residual or recurrent disease. A recurrence of disease was noted at 18 months follow up. Over these 18 months the cannabis regimen was titrated down to 60% of the initial protocol. This was subsequently increased to the initial dosing ...
bring about change democratically in the shortto medium-term, we need to take the genuine uncerta... more bring about change democratically in the shortto medium-term, we need to take the genuine uncertainties surrounding the effects of liberalization seriously, and pursue a strategy of incremental change. Moving toward a fully legalized and regulated market for recreational drugs is, indeed, necessary to end the myriad of harms caused by the war on drugs. However, we do not yet have access to the evidence we need to answer the broad range of questions we need to answer to both allay the genuine concerns opponents of liberalization have, and implement a liberalized regime in practice. I have suggested there are two ways to gather this evidence: monitor the effects of legislative change or pursue policy trials. However, in neither case will policy change occur without substantial and directed efforts. Although increasing amounts of the population support liberalization to some drugs, notably cannabis, in order for this to lead to actual policy change the issue of drug reform needs to be made salient to both policymakers and citizens. A crucial way of doing this is documenting the harms caused by the war on drugs, as Racial Justice Requires Ending the War on Drugs so eloquently does. What is needed now is concerted activism to take the message to as many people as possible.
Randomised controlled trials (RCTs) have long been considered the gold standard of medical eviden... more Randomised controlled trials (RCTs) have long been considered the gold standard of medical evidence. In relation to cannabis based medicinal products (CBMPs), this focus on RCTs has led to very restrictive guidelines in the UK, which are limiting patient access. There is general agreement that RCT evidence in relation to CBPMs is insufficient at present. As well as commercial reasons, a major problem is that RCTs do not lend themselves well to the study of whole plant medicines. One solution to this challenge is the use of real world evidence (RWE) with patient reported outcomes (PROs) to widen the evidence base. Such data increasingly highlights the positive impact medical cannabis can have on patients’ lives. This paper outlines the value of this approach which involves the study of interventions and patients longitudinally under medical care. In relation to CBMPs, RWE has a broad range of advantages. These include the study of larger groups of patients, the use of a broader range...
BackgroundPrescribed cannabinoids are now legal in the UK and increasingly being used for a varie... more 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 ...
Cannabis has been legalised for medical use in an ever-increasing number of countries. A growing ... more Cannabis has been legalised for medical use in an ever-increasing number of countries. A growing body of scientific evidence supports the use of medical cannabis for a range of therapeutic indications. In parallel with these developments, concerns have been expressed by many prescribers that increased use will lead to patients developing cannabis use disorder. Cannabis use disorder has been widely studied in recreational users, and these findings have often been projected onto patients using medical cannabis. However, studies exploring medical cannabis dependence are scarce and the appropriate methodology to measure this construct is uncertain. This article provides a narrative review of the current research to discern if, how and to what extent, concerns about problems of dependence in recreational cannabis users apply to prescribed medical users. We focus on the main issues related to medical cannabis and dependence, including the importance of dose, potency, cannabinoid content, ...
Background: Despite an increasing body of research highlighting their efficacy to treat a broad r... more Background: Despite an increasing body of research highlighting their efficacy to treat a broad range of medical conditions, psychedelic drugs remain a controversial issue among the public and politicians, tainted by previous stigmatisation and perceptions of risk and danger. Objective: This narrative review examines the evidence for potential harms of the classic psychedelics by separating anecdotes and misinformation from systematic research. Methods: Taking a high-level perspective, we address both psychological and psychiatric risks, such as abuse liability and potential for dependence, as well as medical harms, including toxicity and overdose. We explore the evidence base for these adverse effects to elucidate which of these harms are based largely on anecdotes versus those that stand up to current scientific scrutiny. Results: Our review shows that medical risks are often minimal, and that many – albeit not all – of the persistent negative perceptions of psychological risks ar...
ObjectivesTo report the findings of a case-series of 10 children suffering with intractable epile... more ObjectivesTo report the findings of a case-series of 10 children suffering with intractable epilepsies in the UK to determine the feasibility for using whole-plant cannabis medicines to treat seizures in children.SettingThis study was conducted retrospectively through collecting clinical data from caretakers and clinicians on study outcome variables. Participants were recruited through the MedCann Support and End our Pain charity groups which are patient representative groups that support children who are using medical cannabis to treat their epilepsies. Medicines were prescribed to patients by clinicians in both National Health Service and private medical practices. Follow-up calls were conducted throughout the period January 2021 to May 2021 to keep data recorded up to date.ParticipantsTen children, 18 years old or under, with intractable epilepsies were recruited from two charities. There were no limitations on diagnosis, sex or ethnic origin.InterventionsParticipants were treate...
Background Scientific and anecdotal evidence suggest that whole plant cannabis extracts are effec... more Background Scientific and anecdotal evidence suggest that whole plant cannabis extracts are effective in reducing seizure frequency in individuals with a range of epileptic etiologies. We report a case series of 10 individuals using CBMPs in the UK to treat their conditions. Methods In this retrospective study, we report on patients (aged 2-48) with severe, intractable, childhood onset epilepsies using combined cannabinoid therapy. Carers of patients provided details through the charity ‘End our Pain’ and these data were subsequently analysed. Our primary objective was to assess changes in monthly seizure frequency pre and post initiation of CBMPs. We also report on previous and current AED, CBD:THC daily dose, quality of life and financial costs associated with CBMP private prescription. Change in monthly seizure frequency were assessed using a Wilcoxon Signed-ranks test. Results Of the 10 patients enrolled in the study there was an 97% mean reduction in monthly seizure frequency p...
We present a review and analysis of the ethical considerations in off-label ketamine use for seve... more We present a review and analysis of the ethical considerations in off-label ketamine use for severe, treatment-resistant depression. The analysis of ethical considerations is contextualised in an overview of the evidence for ketamine use in depression, and a review of the drug's safety profile. We find that, based on current evidence, ketamine use for severe, treatment-resistant depression does not violate ethical principles; however, clinicians and professional bodies must take steps to ensure that guidelines for good practice are enacted, that all experimental and trial data are made available through national registries, and that the risk potential of ketamine treatment continues to be monitored and modelled. We conclude with a set of key recommendations for oversight bodies that would support safe, effective, and ethical use of ketamine in depression.
Despite the legalisation of cannabis based medicinal products (CBMPs) in the UK in November 2018,... more Despite the legalisation of cannabis based medicinal products (CBMPs) in the UK in November 2018, today there remains a scarcity of NHS prescriptions, and many patients continue to face unsustainable financial costs to acquire their medicines. Following on from our previous quantitative study highlighting the effectiveness of CBMPs to treat severe intractable childhood-onset epilepsy, for the present study, we used a narrative, open-ended approach to interview parents/carers of these patients. 11 families were interviewed to understand their current situation in more depth, and to contextualise the previous findings. Although these families have found CBMPs to be the most effective treatment for their child’s condition, access to these medicines remains severely restricted, causing serious challenges in their day-to-day life. Participants discussed a broad range of issues associated with medical cannabis. These included the regulation and policy surrounding medical cannabis, the ang...
Fish is traditionally considered a healthy and pure food. However, with the development of modern... more Fish is traditionally considered a healthy and pure food. However, with the development of modern aquaculture, a range of potentially controversial issues are emerging. These could significantly impact the future success of the industry. In the absence of in-depth data on lay perceptions on farmed fish and fish farming, this paper utilises media representations as a proxy for public opinion. Media representations of aquaculture were investigated in Germany, Norway and the UK over a five-year timeframe (May 2002 to May 2007). A total of 1049 articles from both broadsheet and tabloid newspapers were analyzed with the qualitative software Atlas/ti. We compare the article framings crossnationally, focusing in-depth on four major analytical themes which emerged: the environment, the economy, human health and trust/regulation. Despite general similarities, these themes are represented with different salience and foci across the countries of analysis. These divergent media representations ...
The recent surge in recreational (non-medical) use of nitrous oxide (N2O, also known as ‘laughing... more The recent surge in recreational (non-medical) use of nitrous oxide (N2O, also known as ‘laughing gas’) often by inhaling it from balloons, has attracted the attention of some politicians with calls to control its possession under the United Kingdom (UK) Misuse of Drugs Act 1971 (currently selling, but not possession, for recreational use is controlled under the Psychoactive Substances Act 2016). Meanwhile, the recreational use of nitric monoxide (NO) as delivered by alkyl nitrites, also known as ‘poppers’ has also raised concerns, but unlike N2O, its use was not controlled under the 2016 Act. To inform future-decision making processes and ensure that any such decisions are based on the best evidence, Drug Science conducted a Multi-Criteria Decision Analysis (MCDA) about N2O and poppers to compare the overall harms of these two drugs to the harms of 20 drugs previously evaluated and published by Nutt et al. The group assessed harm scores for N2O and poppers on the original 16 harm c...
A 49-year-old woman was diagnosed with an ER + , PR-, HER2 + , BRCA- invasive ductal carcinoma wh... more A 49-year-old woman was diagnosed with an ER + , PR-, HER2 + , BRCA- invasive ductal carcinoma which progressed metastatically to include bone, liver, and lymph node involvement. Standardised care included a 26-month treatment period with targeted chemotherapy and a ketogenic diet. The patient also began a course of cannabinoid-based therapy, consisting initially of a titrated high-dose protocol of mixed cannabidiol (CBD) and d9-tetrahydrocannabinol (THC) chemotypes, as well as psilocybin-assisted psychotherapy at macro and intermittent micro-doses. At the end of the five-month treatment period PET/CT investigations revealed no evidence of metastatic disease and chemotherapy was withdrawn. A one year follow up CT investigation concluded no evidence of residual or recurrent disease. A recurrence of disease was noted at 18 months follow up. Over these 18 months the cannabis regimen was titrated down to 60% of the initial protocol. This was subsequently increased to the initial dosing ...
bring about change democratically in the shortto medium-term, we need to take the genuine uncerta... more bring about change democratically in the shortto medium-term, we need to take the genuine uncertainties surrounding the effects of liberalization seriously, and pursue a strategy of incremental change. Moving toward a fully legalized and regulated market for recreational drugs is, indeed, necessary to end the myriad of harms caused by the war on drugs. However, we do not yet have access to the evidence we need to answer the broad range of questions we need to answer to both allay the genuine concerns opponents of liberalization have, and implement a liberalized regime in practice. I have suggested there are two ways to gather this evidence: monitor the effects of legislative change or pursue policy trials. However, in neither case will policy change occur without substantial and directed efforts. Although increasing amounts of the population support liberalization to some drugs, notably cannabis, in order for this to lead to actual policy change the issue of drug reform needs to be made salient to both policymakers and citizens. A crucial way of doing this is documenting the harms caused by the war on drugs, as Racial Justice Requires Ending the War on Drugs so eloquently does. What is needed now is concerted activism to take the message to as many people as possible.
Randomised controlled trials (RCTs) have long been considered the gold standard of medical eviden... more Randomised controlled trials (RCTs) have long been considered the gold standard of medical evidence. In relation to cannabis based medicinal products (CBMPs), this focus on RCTs has led to very restrictive guidelines in the UK, which are limiting patient access. There is general agreement that RCT evidence in relation to CBPMs is insufficient at present. As well as commercial reasons, a major problem is that RCTs do not lend themselves well to the study of whole plant medicines. One solution to this challenge is the use of real world evidence (RWE) with patient reported outcomes (PROs) to widen the evidence base. Such data increasingly highlights the positive impact medical cannabis can have on patients’ lives. This paper outlines the value of this approach which involves the study of interventions and patients longitudinally under medical care. In relation to CBMPs, RWE has a broad range of advantages. These include the study of larger groups of patients, the use of a broader range...
BackgroundPrescribed cannabinoids are now legal in the UK and increasingly being used for a varie... more 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 ...
Cannabis has been legalised for medical use in an ever-increasing number of countries. A growing ... more Cannabis has been legalised for medical use in an ever-increasing number of countries. A growing body of scientific evidence supports the use of medical cannabis for a range of therapeutic indications. In parallel with these developments, concerns have been expressed by many prescribers that increased use will lead to patients developing cannabis use disorder. Cannabis use disorder has been widely studied in recreational users, and these findings have often been projected onto patients using medical cannabis. However, studies exploring medical cannabis dependence are scarce and the appropriate methodology to measure this construct is uncertain. This article provides a narrative review of the current research to discern if, how and to what extent, concerns about problems of dependence in recreational cannabis users apply to prescribed medical users. We focus on the main issues related to medical cannabis and dependence, including the importance of dose, potency, cannabinoid content, ...
Background: Despite an increasing body of research highlighting their efficacy to treat a broad r... more Background: Despite an increasing body of research highlighting their efficacy to treat a broad range of medical conditions, psychedelic drugs remain a controversial issue among the public and politicians, tainted by previous stigmatisation and perceptions of risk and danger. Objective: This narrative review examines the evidence for potential harms of the classic psychedelics by separating anecdotes and misinformation from systematic research. Methods: Taking a high-level perspective, we address both psychological and psychiatric risks, such as abuse liability and potential for dependence, as well as medical harms, including toxicity and overdose. We explore the evidence base for these adverse effects to elucidate which of these harms are based largely on anecdotes versus those that stand up to current scientific scrutiny. Results: Our review shows that medical risks are often minimal, and that many – albeit not all – of the persistent negative perceptions of psychological risks ar...
ObjectivesTo report the findings of a case-series of 10 children suffering with intractable epile... more ObjectivesTo report the findings of a case-series of 10 children suffering with intractable epilepsies in the UK to determine the feasibility for using whole-plant cannabis medicines to treat seizures in children.SettingThis study was conducted retrospectively through collecting clinical data from caretakers and clinicians on study outcome variables. Participants were recruited through the MedCann Support and End our Pain charity groups which are patient representative groups that support children who are using medical cannabis to treat their epilepsies. Medicines were prescribed to patients by clinicians in both National Health Service and private medical practices. Follow-up calls were conducted throughout the period January 2021 to May 2021 to keep data recorded up to date.ParticipantsTen children, 18 years old or under, with intractable epilepsies were recruited from two charities. There were no limitations on diagnosis, sex or ethnic origin.InterventionsParticipants were treate...
Background Scientific and anecdotal evidence suggest that whole plant cannabis extracts are effec... more Background Scientific and anecdotal evidence suggest that whole plant cannabis extracts are effective in reducing seizure frequency in individuals with a range of epileptic etiologies. We report a case series of 10 individuals using CBMPs in the UK to treat their conditions. Methods In this retrospective study, we report on patients (aged 2-48) with severe, intractable, childhood onset epilepsies using combined cannabinoid therapy. Carers of patients provided details through the charity ‘End our Pain’ and these data were subsequently analysed. Our primary objective was to assess changes in monthly seizure frequency pre and post initiation of CBMPs. We also report on previous and current AED, CBD:THC daily dose, quality of life and financial costs associated with CBMP private prescription. Change in monthly seizure frequency were assessed using a Wilcoxon Signed-ranks test. Results Of the 10 patients enrolled in the study there was an 97% mean reduction in monthly seizure frequency p...
We present a review and analysis of the ethical considerations in off-label ketamine use for seve... more We present a review and analysis of the ethical considerations in off-label ketamine use for severe, treatment-resistant depression. The analysis of ethical considerations is contextualised in an overview of the evidence for ketamine use in depression, and a review of the drug's safety profile. We find that, based on current evidence, ketamine use for severe, treatment-resistant depression does not violate ethical principles; however, clinicians and professional bodies must take steps to ensure that guidelines for good practice are enacted, that all experimental and trial data are made available through national registries, and that the risk potential of ketamine treatment continues to be monitored and modelled. We conclude with a set of key recommendations for oversight bodies that would support safe, effective, and ethical use of ketamine in depression.
Despite the legalisation of cannabis based medicinal products (CBMPs) in the UK in November 2018,... more Despite the legalisation of cannabis based medicinal products (CBMPs) in the UK in November 2018, today there remains a scarcity of NHS prescriptions, and many patients continue to face unsustainable financial costs to acquire their medicines. Following on from our previous quantitative study highlighting the effectiveness of CBMPs to treat severe intractable childhood-onset epilepsy, for the present study, we used a narrative, open-ended approach to interview parents/carers of these patients. 11 families were interviewed to understand their current situation in more depth, and to contextualise the previous findings. Although these families have found CBMPs to be the most effective treatment for their child’s condition, access to these medicines remains severely restricted, causing serious challenges in their day-to-day life. Participants discussed a broad range of issues associated with medical cannabis. These included the regulation and policy surrounding medical cannabis, the ang...
Fish is traditionally considered a healthy and pure food. However, with the development of modern... more Fish is traditionally considered a healthy and pure food. However, with the development of modern aquaculture, a range of potentially controversial issues are emerging. These could significantly impact the future success of the industry. In the absence of in-depth data on lay perceptions on farmed fish and fish farming, this paper utilises media representations as a proxy for public opinion. Media representations of aquaculture were investigated in Germany, Norway and the UK over a five-year timeframe (May 2002 to May 2007). A total of 1049 articles from both broadsheet and tabloid newspapers were analyzed with the qualitative software Atlas/ti. We compare the article framings crossnationally, focusing in-depth on four major analytical themes which emerged: the environment, the economy, human health and trust/regulation. Despite general similarities, these themes are represented with different salience and foci across the countries of analysis. These divergent media representations ...
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