Updates

In this Updates section, you will find a selection of articles that appeared in our newsletter. For a complete overview, go to our Archive.

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Bedrocan starts a series of informative webinars

Bedrocan offers doctors, researchers and scientists an online platform to share their information and findings on medicinal cannabis with a wider audience. In a series of informative webinars of half an hour each, moderator Ole Heil from Bedrocan talks to all kinds of experts. Recent studies, experiences of doctors and patients and the effects of medicinal cannabis are discussed under the title “Bedrocan Series”.

Cannabis as medicine; the scientific approach

Bedrocan webinar

Bedrocan Series starts with Renger Witkamp, ​​Professor of Nutritional Biology at Wageningen University & Research, Netherlands, and chairman of the Institute Medicinal Cannabis Netherlands. He will talk about scientific research and the need for a Dutch Institute Medicinal Cannabis.

The informative webinar takes place on Thursday, 17 June at 12.30 pm (CET).

Cannabis as medicine; the effects on our brain

Bedrocan webinar

The second speaker in the Bedrocan Series is Matthijs Bossong, neuroscientist at Utrecht University Medical Center, Netherlands. Bossong will dive deeper into our endocannabinoid system and explain the effect on the function of the brain and psychiatric conditions.

This informative webinar takes place on Thursday, July 8 at 12.30 pm (CET).

More information about the Bedrocan Series, the guest speakers and the registration process can be found on the Bedrocan Series webpage.

Bedrocan proud partner of Institute Medicinal Cannabis

Reliable information about medicinal cannabis and it effects is not always easy to find. For that reason, Dutch pharmacists, doctors, companies and researchers have joined forces and set up a new partnership: the Institute Medicinal Cannabis Netherlands (IMC). Bedrocan is one of the proud partners of this new institute. The IMC aims to improve the provision of information about medicinal cannabis to patients and prescribers and strengthen collaboration in scientific research. Professor Dr. Renger Witkamp, professor of Nutrition and Pharmacology at Wageningen University, is the chairman of the IMC. Ole Heil, director Communications & Government Affairs at Bedrocan, is treasurer.

Thousands of patients

In the Netherlands, medicinal cannabis has been available to patients on a doctor’s prescription through pharmacies since 2003. Currently, about 10,000 people, with various conditions, make use of it every year. It is used, among other things, as a painkiller and as a symptom reliever in certain forms of epilepsy, MS and palliative care. Nevertheless, it appears to be difficult to find good and reliable information about the use and application of medicinal cannabis.

Bedrocan proud partner of the Institute Medicinal Cannabis

Renger Witkamp: “Unfortunately, we see a lot of incorrect information about medicinal cannabis. Many patients who may benefit from the product end up unnecessarily in the coffee shop or with illegal providers. Or worse, some doctors even actively refer their patients to this. The IMC aims to change this through good information. The IMC promotes that the treatment of patients who may benefit from medicinal cannabis takes place under the medical supervision of a doctor and pharmacist.”

Coordination of research

In recent years, more and more research has been conducted into the effect and application of medicinal cannabis. This is also the case in the Netherlands. Researchers are working on this at almost every university in our country. Because the research area is still in its infancy, there is still little collaboration and coordination. The IMC provides a platform to bring researchers together and join forces where possible.

Dr. Monique van Velzen, research manager of the Anesthesiology department of the Leiden University Medical Center (LUMC), is a board member of the IMC, in charge of research: “I notice that there is a great need for collaboration in the field of medicinal cannabis scientific research. Many studies, sometimes even within the same institution, overlap. And it is also difficult for researchers to find out what is and what is not allowed when it comes to cannabis, with many delays as a result. That is a shame, and we will soon change that with the IMC. By connecting researchers, we can learn from each other and streamline, coordinate and structure research.”

Substantive experts

The IMC is a foundation to which various partners and substantive experts have joined. In addition to a number of companies from the medicinal cannabis chain in the Netherlands, including pharmacies, these are doctors and researchers from the LUMC, UMC Utrecht, University Medical Center Groningen and Wageningen University & Research.

More information and contact details are available on the IMC website.

Tjalling Erkelens and MEP Alex Agius Saliba @Prohibition Partners Live

During the upcoming Prohibition Partners Live event, Bedrocan’s CEO Tjalling Erkelens will talk about the current state of the European medicinal cannabis market. He will discuss this topic with Maltese MEP Alex Agius Saliba, who recently launched the Medicinal Cannabis Alliance within the European Parliament. The session will be led by Alfredo Pascual, Vice President of Investment Analysis at FastForward and former International Analyst for MJBizDaily. During their discussion, they will touch upon the harmonisation of EU regulations, patient access and some of the latest developments in the European medicinal cannabis market.

More information on the program, tickets and speakers can be found at Prohibition Partners Live website.

The session with Tjalling Erkelens and Alex Agius Saliba will be aired on Wednesday 19th May at 2.30 pm UK time.

The whole event will last from Tuesday 18 – Thursday 20th May.

Tjalling Erkelens and MEP Alex Agius Saliba @Prohibition Partners Live

UMCG starts scientific research into cannabis oil and liver-cancer

The University Medical Center Groningen (UMCG) will start this year, 2021, a study on the effect of cannabis oil on liver-cancer patients who have exhausted all the avenues of treatment. The purpose of the pilot study, which will have 20 participants, is to see whether cannabis oil can reduce liver-cancer tumours. This is unique, as this type of study has not been carried out before. “It is pioneering in many ways”, said surgeon and lead researcher Maarten Nijkamp.

In three years from now, Nijkamp and his colleague Frederik Hoogwater, oncologist Derk Jan de Groot and gastroenterologist Frans van der Heide would like to be able to say whether medicinal cannabis oil has an impact on the growth, or rather the regression, of liver-cancer tumours. In this study twenty patients will be enrolled who all have come to the end of their standard treatment but still have a good liver function. The latter is important, because a functioning liver will ‘process’ cannabis oil on the basis of natural processes. As soon as the correct dose of cannabis oil has been determined and administration has started, a liver scan will be performed for every participant after three, six and nine months. Blood samples will also be taken to study the liver function and to check the presence of tumour markers. No later than in 2024 – or as much sooner as possible – the research team aims to present a clear conclusion.

UMCG starts scientific research into cannabis oil and liver-cancer

Anecdotal evidence

The idea for this clinical trial came up more than three years ago, when an UMCG patient with advanced liver cancer showed remarkable results upon using cannabis oil. The tumours in his liver started to disappear gradually after he started taking cannabis oil and now – five years following the diagnosis – he has been given the ‘all clear’. When comparable results were seen in a second patient, Nijkamp and his colleagues started to become excited. “We would have been equally excited if the patients had used fish oil”, tempers Nijkamp.

“However, cannabis and cannabis products are unusual. You only need to go on the internet to find a fair amount of anecdotal evidence for cannabinoids as a weapon in the fight against cancer. However, it is incidental and you do not know in how many patients the use of cannabinoid-based products did not have the desired effects. Then there is laboratory research that demonstrates that cannabis can have an inhibiting effect on the growth of liver-cancer cells. However, if you pour hot water or chlorine on cancer cells in a laboratory, you will see a comparable effect. In other words, you cannot state that cannabinoid-based medicines are able to cure cancer – in this case liver cancer – because there is no scientific proof. That requires a clinical trial with real patients. These two patients gave the topic ‘cannabis oil and liver cancer’ ‘meaning’ for my colleagues and me, because we are scientists as well as specialists. From a scientific point of view, we felt compelled to start up a trial. At the same time, we knew that it would be pioneering in many respects.”

Review

The set-up up of the trial presented a number of practical issues for Nijkamp and his team. First of all, the trial topic had to be approved and reviewed by various bodies, including the Medical Research Ethics Committee. Nijkamp: “Cannabis oil is not a registered drug and there are many unknowns. The wildest stories do the rounds, and we certainly did not want to fuel any fires with this trial. The review committee made sure that our trial complies with all the requirements imposed on such scientific research. At the same time, we needed answers to a number of questions. Such as: What are the substances that make cannabis effective? In what ratio are they required in the oil? Which dose is most suitable? Both patients used cannabis oil that contained THC and CBD, so that was our starting point.”

Good foundations

Then the team had to look for a manufacturer and supplier of the oil. “It is not difficult to obtain cannabis oil, but medicinal cannabis oil is a different story. For a trial like this one, the bar has been raised as high as possible”, said Nijkamp. “It goes without saying that the review bodies do the same. You need to have solid foundations: you need to procure material from a party with the right certificates for the production of your trial material. That is part of the requirements imposed on such a trial. You need to be sure that the trial material has a consistent composition, because otherwise you cannot make any statements about the results of the study. We knew that since a few years the Transvaal Pharmacy specialised in the responsible production of medicinal cannabis oil. They prepare that on the basis of standardised medicinal cannabis that is produced by Bedrocan under a contract with the Ministry of Health. The oil of Transvaal Apotheek is of a consistent quality and is tested by an independent laboratory. We knew that Transvaal Apotheek was working on obtaining certificates for the production of trial materials. That requires a significant amount of prior testing and review, and we had to wait for that to be completed. Then it was a case of selecting the right cannabis oil for the trial.”

Umcg 1024x667

Transvamix®

For this pilot study, a medicinal cannabis oil that was already part of the range of Transvaal Apotheek has been chosen. Nijkamp: “We used the composition of the oils that were used by both patients as the starting point. That was oil with a relative high THC content. Transvaal Apotheek makes the oil on the basis of the standardised plant varieties Bedrocan® and Bedrolite®; it contains 10 percent THC and 5 percent CBD and is known as ‘Transvamix®’. We will use that oil as the material for the clinical trial.”

Dosage

The dosage was another point of attention, because in that sense cannabis oil is not comparable to regular medication. According to Nijkamp it may well be a reason why there have been very few clinical trials with cannabis or cannabis oil thus far. “Again, we were pioneering. With regular medication – like painkillers for example – there is a set dose; you know what the medication will do at a certain dose”, says Nijkamp. “Cannabis or cannabis oil is another story. Every patient responds differently to the product and the amount of oil that is required to be effective, may differ from patient to patient. That makes a trial much more complicated. For every patient we will raise the dose on a daily basis until there are side effects. Then we go down to the dose without side effects. In theory that would give you the highest possible dose without side effects.”

Pilot study

As far as we know, the UMCG is the first research institute in the world to carry out a study of cannabis oil for liver cancer. “In this form anyway”, said Nijkamp. “There are various laboratory studies into the effect of cannabis on tumours. We know about studies about cannabis oil for brain tumours, but as far as we know there has been no follow up. It goes without saying that cannabis is also used by cancer patients for a positive effect on the quality of life during treatment. So, this is a real pilot study. The study will only tell something about the effect of cannabis on patients with liver cancer who still have a functional liver. As soon as we know that it works in one patient, we will have taken one step forward and we can start thinking seriously about further research. Patients with liver cancer and liver damage, for example and other types of cancer. We might be able to observe that cannabinoids – in this ratio and for these patients – make a positive contribution to the quality of life. On that basis, cannabis-based products could play a set role in oncology in the future.
The outcome could also be that there is no response in any of the twenty people. Then, to that point, we have done what was required from a medical-scientific point of view, but would still be faced with a mystery in terms of why both patients were cured.”

UMCG studies cannabis oil for liver cancer patients with no further treatment options

The University Medical Centre Groningen (UMCG), Netherlands, is to study the effect of cannabis oil on liver cancer patients who have exhausted all other treatment options. The aim of the study is to see whether cannabis oil acts as an anti-cancer agent that will shrink the liver tumours.

This article is based on an UMCG press release.

The study was started after two separate reports that patients with advanced liver cancer had seen  their tumours shrink after using cannabis oil. Now, two and five years  after their diagnoses, the tumours have completely dissapeared and the patients are cured. Although laboratory research shows that cannabis can curb the growth of liver cancer cells, a possible anti-cancer effect of cannabis oil  in patients cannot be explained as no scientific research has been carried out.

UMCG studies cannabis oil for liver cancer patients
Cannabis oil as made by the Transvaal pharmacy

Cannabis oil

The cannabis oil being used is produced by the Transvaal Apotheek, a specialist pharmacy with the certificates needed to produce drugs for research purposes. The oil is produced according to a fixed recipe with precise amounts of THC and CBD, two of the important substances contained in cannabis.

The pharmacy only uses medicinal cannabis produced by Bedrocan. The Ministry of Health, Welfare and Sport has commissioned Bedrocan to standardize and grow the plant pharmaceutically in order to guarantee a consistent composition of the cannabis oil.

Research design

The first step in this study is to determine the correct dose for each patient. Patients will be given the maximum dose of cannabis oil that can be given without causing side-effects. Blood tests will be carried out and images made of the livers of those taking part after three, six and nine months to see whether the liver tumours are responding. The blood will be tested for the presence of tumour markers and to check the liver function of the participants.

Patients with liver cancer who have exhausted all treatment options

This study is being carried out with the help of patients with advanced liver cancer, for whom best supportive care is the only remaining option. As cannabis oil is broken down by the liver, all participants must have a good liver function. Patients with severe liver cirrhosis (liver damage caused by the formation of scar tissue) will not be considered for the study unless the cirrhosis is not affecting their liver function. Patients willing to join the study can be referred to the UMCG by their specialist. A total of 20 patients can take part. The study will last approximately three years.

Switching cannabidiol is not recommended

The Dutch Medicines Evaluation Board (MEB) has added cannabidiol to a list of medicines for which switching is not recommended. This is in the interest of the patient because it concerns medicines of which incorrect intake leads to serious problems. Cannabidiol is used by patients with epilepsy.

The MEB list has been drawn up on behalf of the Dutch Ministry of Health, Welfare & Sport. In the Netherlands, cannabidiol, compounded by a pharmacist, can be prescribed according to the Epilepsy guideline from June 2020 in children (from 2 to 18 years old) with a treatment-resistant Dravet syndrome or in patients (from 2 years old) with a treatment-resistant syndrome Lennox Gastaut.

In the Netherlands, and several other countries, oil made from the pharmaceutical CBD-containing cannabis product Bedrolite is prescribed to these patients.

Brexit threatens Alfie
Alfie Dingley

Alfie Dingley

Patients in the Netherlands can obtain this oil from pharmacies on prescription from the doctor. Around the turn of the year, unrest arose in England because this product would no longer be available to English patients due to Brexit. The dire situation of several patients, including nine-year-old Alfie Dingley, hit the press in England and the Netherlands. The Dutch and English governments have now found a temporary solution.

Response of Health Minister

The Dutch Health Minister, Van Ark, endorses the MEB list. “After all, patients should not run any unnecessary health risks as a result of switching drugs,” the ministry said in response.

Bedrocan’s response

Bedrocan is pleased with this decision by the MEB and the minister. The Dutch cannabis producer produces various cannabis products that are processed as medicinal cannabis oil on behalf of the Dutch Ministry of Health. CEO Tjalling Erkelens: “The decision is in line with what we have seen and emphasized in practice for years; namely that our products cannot simply be exchanged by another product with a comparable amount of CBD. Medical cannabis is simply more complex than just CBD or THC. See, for example, the situation in England at the beginning of this year. Many epilepsy patients were in danger of getting into acute problems because they could no longer access cannabis oil from the Netherlands due to Brexit. Hopefully, the inclusion of cannabidiol on this list will eventually lead to European regulations that guarantee availability for the patient.”

Study: Medicinal cannabis can ease seizures in childhood epilepsy

The outcome of a retrospective study suggests a combination of CBD and THC-based products are effective in reducing seizure frequency in a range of epileptic conditions.

The study Ending the pain of children with severe epilepsy? An audit of the impact of medical cannabis on 10 patients shows that cannabis-based medicinal products (CBMPs) can offer patients significant relief from intractable epilepsy. According to the researchers, all ten patients used combined CBD and THC-based products (Bedrolite and Bedica), and the result was ‘statistically significant’. Of the ten patients enrolled in the study, 97% experienced a reduction in monthly seizure frequency after treatment with CBMPs.

The paper came out just before the British newspapers headlined about the struggle of English epileptic patients to get cannabis oil from the Netherlands after Brexit.

Despite the positive outcome of this study, authors Rayyan Zafar, Anne Katrin Schlag and professor David Nutt do not ignore the high costs and difficulties of accessing the treatments in the UK. “We highlight the inefficacy of the healthcare system in supporting these patients who bare great personal and financial burdens. We encourage specialist physicians and relevant bodies to permit easier access to these medications by those patients to whom efficacy has been shown.”

Maltese MEP Alex Agius Saliba launches Medicinal Cannabis Alliance within European Parliament

Europe should treat medicinal cannabis in the same way as opiates. That is MEP Alex Agius Saliba’s opinion, who, together with three other parliament members, founded the European partnership Medicinal Cannabis Alliance. The alliance will soon meet for the first time and, together with 35 affiliated members of the European parliament, will determine the European course in the field of medical cannabis. The Maltese MEP is already taking a position.

The fact that members work together is not unique. However, it is the first time that a partnership focuses exclusively on medicinal cannabis. Agius Saliba on this: “We keep our distance from recreational use. We want to stand up for patients’ rights and argue for European legislation that is the same in every Member State.” The 35 MEPs, mainly socialists and democrats from countries such as Portugal, Germany and Slovenia, responded to an email from Agius Saliba himself and his three supporters Robert Biedroń (Poland), Brando Benifei (Italy) and Maria Arena (Belgium). Agius Saliba is satisfied with the response: “It is a good number and a good start. This is a strong signal that there is a willingness to discuss medicinal cannabis.”

European legislation

According to the Maltese MEP, the lack of European legislation is a thorn in the side that makes trade between European member states hardly possible. He cites his home country Malta as an example. Medical cannabis has been allowed there since 2018, but patients were left without their medicine last year. “Purely because distribution in Europe is not well organised. Patients are the victims of this. They are not only without but also pay a high price for their medication. Good access and an affordable price for medicinal cannabis is a basic right for every European patient.”

Lancering van het Medicinal Cannabis Alliance binnen Europees parlement

Alex Agius Saliba

Usually, the Maltese MEP Alex Agius Saliba deals with digital affairs and employment. He sits on the Internal Market and Consumer Protection Committee and handles petitions. At 33, this lawyer by profession is relatively young but enthusiastic.

He became involved in the topic of medicinal cannabis through a 25-year-old Maltese woman who spent 400 euros a month on medicinal cannabis. “This condition prevents her from getting out of bed, and she has a difficult life.” He wants to push for lower prices and better availability.

Agius Saliba calls the lack of uniform rules the biggest obstacle: “I’m not pointing the finger at the industry but at ourselves. It is important to go for the highest quality, but the European bureaucracy creates high prices and makes access to patients impossible. I, therefore, advocate treating medicinal cannabis in the same way as opiates.”

European Medicines Agency

The trade-in commodities such as morphine and other opiates are regulated at the European level. To gain a foothold in Europe, drug developers must adhere to the strict safety and quality standards set by the European Medicines Agency. And that also applies to the pharmaceutical raw materials (APIs) with which these medicines are made. “I don’t see the difference on medicinal cannabis. If there is a medical reason why stricter requirements apply to cannabis, please let me know. But I don’t think there are any.”

The Medicinal Cannabis Alliance will soon meet to work on the positions further.

Why doesn’t Bedrocan export cannabis oils to the UK?

Bedrocan would like to give patients abroad better access to medical cannabis. However, it is not always easy to develop activities outside the Netherlands or export cannabis oils to the UK. Our Business Development team is exploring international opportunities but experiences all sorts of regulatory obstacles. We asked Business Development Manager Varun Arora why we are not active in the United Kingdom yet and how he looks at the current situation, in which, due to the Brexit, UK patients could no longer access medicinal cannabis oils from the Netherlands.

Wasn’t it frustrating to see that UK patients, including very sick epilepsy patients, could no longer obtain their cannabis oil like Bedrolite?

“The situation that emerged in the UK post-Brexit was unfortunate, but just last month we heard that the joint efforts of the Dutch and UK governments, supported by Bedrocan and the Dutch Transvaal Pharmacy, have paid off. Supplies of medicinal cannabis oils will continue at least until a permanent solution is in place.“

Why doesn’t Bedrocan export cannabis oils to the UK?

Why can’t Bedrocan export these cannabis oils to the UK?

“While Bedrocan’s name came up in some media reports, it is important to understand that Bedrocan actually has a limited role in the supply chain under the current regulatory framework in The Netherlands. Manufacturing of cannabis extracts and oils is not allowed here. It is only permitted in a research or a pharmacy setting. In the Netherlands, besides Transvaal Pharmacy in The Hague, there are a couple of other pharmacies that manufacture oils. However, they are only allowed to do this on a named patient basis. That means that pharmacies can only produce these oils for a patient that carries a prescription. While patients from countries like Ireland and Belgium, besides the UK, have been able to access cannabis oil products from The Netherlands, they have to travel to collect these products in person.“

So, Bedrocan is not allowed to produce cannabis oils, and for UK patients to obtain their medicine, they have to travel to the Netherlands?

“Yes, before 31st December 2020, patients from the UK could come to the Netherlands and get their prescriptions filled in. As the UK is no longer part of the European Union, prescriptions issued in the UK are no longer recognised in any EU country. The immediate issue of access has been solved for now, and a permanent solution is also being put in place whereby UK patients can access the oils in their own country.”

The aim is that oils like Bedrolite will become available in the UK. What should the UK government do to make this possible?

“While Brexit led to the present situation, I must also add that the UK has been slow in rolling out its cannabis program. Although the UK legalised access to cannabis in late 2018, it is only prescribed as a last-line treatment when all other treatment options have failed. Moreover, wholesalers are not allowed bulk imports and can only order on a named patient basis. This means wholesalers cannot keep inventory, and patients always face the risk of not getting their medicines in time. Last year, authorities in the UK allowed import of products with advance prescriptions. While this does ensure that patients never run out of supplies, it is again not a permanent solution. “

Why doesn’t Bedrocan export cannabis oils to the UK?

The allowance for bulk imports is important. What else needs to change to be able to start a business in the UK?

“The simple answer is that a lot has to happen on the regulatory front in the UK first before a commercial case can be built. Bedrocan has been in discussions with a potential partner, but without clear guidelines on how these products will be put in the NHS system, a robust business case cannot be built. Considering that the events post-Brexit have created a sense of urgency among British policymakers, hopefully, we would have a framework in place in due course that would enable us to build a robust supply chain for high-quality products with our potential partner for the UK market.“

What else makes it difficult to start a company outside the Netherlands?

“The fact is that there has been too much hype created when it comes to the size of the global medicinal cannabis market. Reality is that outside of The Netherlands, Germany and Italy, no market in Europe or for that matter anywhere with the exception of the United States and Canada, is big enough to justify the investments required to start a production facility. Moreover, in the markets that matter like Germany and Italy, Bedrocan already exports substantial quantities. As for the US, it is a no go because federally it is still illegal to produce cannabis. Finally, although a big market, Canada has a significant supply glut and a very different model from what is practised here in Europe. While Canada is a longer-term possibility, in the short-to-medium-term, we are mainly focusing on the core markets.”

What would make the UK or any other market attractive for Bedrocan to invest in?

“For Bedrocan to consider investing in any country outside the Netherlands, there should be a large enough domestic market. Besides the countries mentioned before, there aren’t any medicinal cannabis market that justifies the investments in setting up domestic supply chains. Perhaps the UK in the long term but as I explained, a lot has to happen on the regulatory front there before we can think about building a commercial case.”

Comprehensive clinical handbook on medical cannabis

It is often said that doctors have too little knowledge about medicinal cannabis. Two prominent American doctors, a clinical psychiatrist and an addiction specialist, agreed with this. For that reason, they decided to write a comprehensive book, with all their knowledge about medicinal cannabis, specially bundled for their colleagues: Medical Marijuana – A Clinical Handbook. The book came out in September last year, and Bedrocan spoke with one of the authors.

Dr Samoon Ahmad, professor of Psychiatry of New York University Grossman School of Medicine and a psychiatrist at Bellevue Hospital, the oldest American hospital in the heart of New York, initiated the writing. That this book had to be published came as no surprise to Dr Ahmad. He sees it as his responsibility to inform and educate others: “In Latin, the word doctor does not mean ‘teaching’ for nothing. Our role as doctors is not just about asking the right questions or making the right diagnosis. It is also about providing objective information so that individual patients can choose their own treatment.”

As far as Dr Ahmad is concerned, medicinal cannabis can no longer be ignored as a treatment. But he did not always share that opinion. He too, as he puts it himself, was biased: “During my training as a psychiatrist, cannabis was mainly regarded as a drug of abuse. In addition, in my work as a psychiatrist, I encountered a large group of patients with serious mental problems. Seventy to eighty per cent of those patients suffer from some sort of comorbid substance use. Among them, cannabis was at the top of the list.”

Private practice

In his private practice as a psychiatrist, however, he saw a completely different group of patients. Primarily well-to-do professionals with a depression or anxiety disorder, they also used cannabis, but without the addiction problems that he knew so well from his patients from the hospital in New York.

Comprehensive clinical handbook on medical cannabis

Dr Ahmad: “Their use of cannabis was comparable to drinking a good glass of wine during the weekend. I saw two different worlds, and I did not understand why cannabis had a negative effect on one population and not the other. And that caught me by surprise.”

Naive

“I was a naive doctor,” he admits promptly, but a curious one who went in search of literature on the subject. “Nobody taught me about the endocannabinoid system. Like any other doctor, I had to investigate myself. I was ignorant in that regard.”

In his search, Ahmad soon discovered that unbiased information and independent scientific research could not be found in one place or in one book. And so the idea for his own book was born.

Misinformation

Dr Ahmad worked on the book for two years together with Dr Kevin Hill, an addiction physician and Director of the addiction psychiatry department at Beth Israel Deaconess Medical Center in Boston. Finding the right information was not always easy. “You can hardly imagine how much misinformation is out there. It is worrisome to think that hundreds of thousands of doctors see the same thing when they have to look for good information about medicinal cannabis and don’t know enough to tell fact from fiction.”

In addition to the book, there is also a website called Cannabis Textbook that is updated weekly.

About the book

Medical Marijuana – A Clinical Handbook provides an objective view of the pharmacology of cannabis. The authors wrote the book, as they put it themselves, completely free of any bias, politics or preconceived beliefs. The reader will gain insights into the pharmacodynamics and pharmacokinetics of cannabinoids THC and CBD, including the molecular action of the cannabis-based drugs dronabinol, nabilone and Epidiolex (cannabidiol). The authors provide extensive data, including dosages, routes of administration and side effects.

Unique are the twelve chapters organised by organ system – from endocrinology to dermatology – which provide an up-to-date overview of the conditions that cannabis can help treat. Note that the clinical handbook was written by American doctors, which gives it an American touch. For example, the chapter on US cannabis regulations may be less interesting to non-US readers.

Medical Marijuana – A Clinical Handbook

Temporary solution found for UK epilepsy patients

Brexit had meant that some ´life saving´ cannabis oils, which are solely produced and dispensed by the Dutch Transvaal Pharmacy, were no longer able to be legally handed over on the basis of a UK prescription. This unfortunate outcome of Brexit, which made headlines in early January because many patients in the UK were left out in the cold, is being discussed by the Dutch and English governments. Now at least there seems to be a temporary solution for UK based epilepsy patients.

Medicinal cannabis oil
The pharmacist prepares medicinal cannabis oil at the Transvaal Pharmacy, the Netherlands

Six month reprieve

It was revealed on Thursday that the Dutch health ministry had granted a six month reprieve which allows the Dutch pharmacy to still prescribe the oils to UK residents on a receipt from a UK based physician. According to the Dutch ministry of Health, Welfare and sport, this provides sufficient time to arrange a more structural solution. The Transvaal Pharmacy confirmed that they were given permission to continue to supply prescriptions to UK residents until the 1st of July.

According to the UK press, the cannabis oils Bedica® and Bedrolite®, ´have revolutionized the treatment of drug resistant epilepsy and has led to children who formerly suffered hundreds of seizures daily to go long periods of time seizure free’.

Read also:

Netherlands to supply medical cannabis until july despite Brexit ban

Mother fears son could die as Brexit stops medical cannabis supply

See also:

Availability
Bedrocan currently produces medicinal cannabis for patients (under the care of a physician), pharmaceutical companies and researchers from around the world. Availability of Bedrocan products per country is listed here

“Mother fears son could die as Brexit stops medical cannabis supply”

Hannah Deacon, mother of nine-year-old epilepsy patient Alfie Dingley, sounded the alarm in the British press on 6 January. She says Alfie’s life is at risk after being told that Brexit stops medicinal cannabis supply for English patients.

Alfie suffers from a severe form of epilepsy, with 150 seizures a day being no exception. The condition is considered “life threatening” and Alfie does not respond to available regular medication. A few years ago it appeared that cannabis oil, according to pharmaceutical quality requirements and on the basis of standardized medicinal cannabis produced by the Transvaal Pharmacy in The Hague, was the solution.

Brexit threatens Alfie
Alfie Dingley

Permission

After petitioning, in which Deacon received support from more than 40 families with children who have the same condition, British doctors were given permission in 2017 to prescribe the Dutch oil and the children had access to their “life-saving” medicine. Initially by travelling to the Netherlands and picking up the medicines themselves, later with the help of a courier service.

No alternative

There was great shock when the parents received a letter from the British Ministry of Health on December 17, in which it became clear that – in line with Brexit – they will have to look for an alternative medicine as of January 1, 2021. But according to Deacon, there is currently no alternative and her son’s life – and that of the other children – is in danger. “I am facing the fact that my son might go into refractory epiletic seizures again which can kill people”, she told the British press. “If Alfie is forced to take another product, his life is in danger.”

Empty-handed

Hannah Deacon’s alarm bell has also been heard in the Netherlands. The AD, one of the largest daily newspapers, asked pharmacist Paul Lebbink of the Transvaal Pharmacy for an initial response. Lebbink and colleagues are not allowed to honor doctors’ prescriptions from the United Kingdom due to Brexit and are currently left empty-handed. “We have developed a relationship with these patients and now have to abandon them.”
Lebbink indicates that the Transvaal Pharmacy will do everything possible to make sure that English patients can obtain their medicine in the future. At the same time, the Dutch Ministry of Health, Welfare and Sport has announced that the Dutch government wants to prevent as many problems as possible as a result of Brexit, “certainly for vulnerable people” and also if it concerns residents of the United Kingdom. “The Netherlands has indicated which steps the United Kingdom can take to solve the problem in practical terms and is in discussion with the British government about this. For this group it is important that a solution is found as soon as possible”, the AD quotes.

Update January 12

On December 9, 2020, Sage Journals published Ending the pain of children with severe epilepsy? An audit of the impact of medical cannabis in 10 patients, in which RR Zafar, AK Schlag and DJ Nutt report a case of series of 10 individuals using CBMP’s in the UK to treat their conditions. This retrospective study suggests that a combination of CBD and THC based products are effective in reducing seizure frequency in a range of epileptic conditions.
See link below.

On january 6, the Dutch Member of Parliament Carla Dik-Faber (ChristenUnie) has sent questions to the Minister for Medical Care on the consequences of Brexit for the supply of Dutch medicines to the United Kingdom. These questions explicitly refer to the situation of the more than 40 British children who are dependent on cannabis oil from the Netherlands. She also questions the solution provided by the UK Department of Health, namely alternatives to cannabis-based medicines that are accessible to British patients, but which are not a solution for Alfie Dingley and the other children. Almost at the same time, the Dutch ministry answered press questions, in which it was again indicated that in close consultation with the English government, a solution is being sought for the supply of products based on medicinal cannabis in both the short and long term.

On Saturday, January 8, The Times also posts an interview with Hannah Deacon. She outlines the seriousness of the condition Alfie suffers from and elaborates on the proposal by the English authorities (DHSC) to use similar alternatives to Dutch cannabis oil available in England, with different cannabinoid profiles. According to Deacon, this is ‘evidence of the DHSC’s “gross misunderstanding of botanical products.”

“Each product is made with a different plant, with different cannabinoid profiles. So it’s not like swapping a generic paracetamol for another one. You can’t just switch and hope for the best.”

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