Dr Anup Mathew: The impact for my patients has been game-changing

Dr Anup Mathew is a psychiatric consultant for Mamedica. 

I’ve been in psychiatry for over 10 years now, and was starting to get very frustrated with the lack of choices and treatments available to my patients. There are very few new medications being made available, while some that were working quite well have been discontinued. The majority of medications that we do prescribe are off-licence; I’m using low-dose antipsychotics or antidepressants to treat anxiety or emotional dysregulation, and both treatments come with their own potential risk profile and side effects.

We had a lot of patients that were struggling with basic things like anxiety, low mood, depression and ADHD, who were essentially having to suck it up and deal with these off-licence medications giving them side effects, which they then need further medication to counteract. Furthermore, many of these patients are not in the right frame of mind to engage in talking therapies without first receiving treatment that reduces their symptoms. I started reading about medical cannabis being used in the UK around the time it was receiving news coverage as an epilepsy treatment. I got involved in a training course and it all took off from there.

The impact for my patients has been game-changing. That’s the only word for it. 

Their mood, their hope, their view of the future – everything changed. Their side effect profiles changed because they were able to reduce their prescriptions for traditional medications – and in some cases come off those medications completely.

Patients became less anxious, better able to function, were able to go back to work, start new relationships and engage with their families again. Even though I don’t manage pain, some of my patients with chronic pain were able to reduce their dependence on opioids, along with the side effects that accompany those medications. It has been absolutely game-changing on every level.

The vast majority of my patients – and of patients in the country – use medical cannabis in the form of a flower. It’s only legal to use if you vape it by heating it up in a vaporiser device – it’s not legal to smoke it. Taken this way, the cannabis acts quickly – usually in 10-15 minutes – which is very useful for people who are using it for anxiety or panic attacks, for example, which need to be treated immediately. The alternative is to take it in oil form, which involves placing drops sublingually (under the tongue). In this instance, the cannabis takes effect in 2-3 hours, which can be useful for people who have trouble falling and staying asleep, for example. Likewise, there are two different strains which serve different purposes, broadly speaking; one is more alerting, the other more sedating.

One of the main benefits of medical cannabis is that you always know exactly what type you are getting, you know you are being prescribed the right type for your personal needs and you know it is a pure, high quality product. When you are given a prescription, you know exactly what percentage of THC you are getting compared to CBD. None of this information has been available to patients who have had no option but to buy street cannabis in the past, while the illegality of buying on the street is greatly anxiety-provoking and counterproductive to the conditions it’s being used to treat. Medical cannabis is couriered to your front door, your GP is on board, you’ve got all the legal paperwork and everything is demystified, so there’s no stress or anxiety whatsoever.

I’ve had patients from every walk of life, from every career. We’ve had doctors, dentists, pharmacists, firemen, policemen, BBC executives – everyone. Some of those patients were on sick leave because their symptoms were so severe, and the fact that they’ve since managed to go back to work has been one of the most rewarding parts of my job. Our patients provide a lot of feedback, and the vast majority tell us they’ve never slept so well, their anxiety has reduced to the point they can now go out with their families, attend their children’s sports days and all these sorts of things. Hearing those things has made this the most rewarding role I’ve ever had.

I always advise patients to inform their employer that they are being prescribed medical cannabis, so that their employers can support them at work. Most patients have done so, and their employer will then contact me, usually with a list of questions about whether the treatment will impact the patient doing certain tasks and how long the treatment will last. I’ve found my patients’ employers to be extremely supportive, and they come back with feedback saying they’ve seen a marked improvement in their employees. When they see the results of the treatment, they get on board and just want to provide support – and they reach out to me via the clinic to obtain more information on how they can be more supportive. That’s been really reassuring to see.

The biggest barrier to more doctors prescribing medical cannabis is not knowing how to prescribe it. 

No one knows how to prescribe this unless you’ve had the training and seen a prescription for medical cannabis. It’s not like writing a standard name for an antidepressant that’s available anywhere – you need to know what is actually available in the country at any given moment, you need to know the specific name of the flower you’re prescribing – or, if you’re prescribing an oil, the percentages of THC and CBD it contains – and how you’d like the patient to use it. How much are they allowed to use per day? So the prescription requires specialist knowledge and has to be quite detailed.

A lack of education and awareness is the biggest obstacle to medical cannabis being more widely prescribed, and I think this is where cannabis clinics and academics need to come together. We need to be targeting the Royal College of Psychiatrists, the Royal College of Pain Medicine and the Royal College of General Practitioners, and we need to attend their conferences, for example, to demonstrate the benefits of medical cannabis and how easy it is to prescribe.

The benefits to the NHS, from a financial point of view, could be absolutely astronomical. GPs are being exhausted by patients for whom no other medication is working, and they don’t know what else they can offer. I’m frequently seeing patients that are on maximum doses of antidepressants, because they keep going back to their GP and saying “my symptoms aren’t getting any better”, and all the GP can do is increase the dose or try a different medication. But I feel the attitude towards medical cannabis is shifting among GP practices, because they’re starting to see that some of these patients have tried medical cannabis, are responding to the treatment and have stopped returning to their GPs as a result.

Especially because of COVID, there is an immense backlog at pain clinics and with outpatients. All these clinics are tremendously backed up – many of them with waiting lists longer than a year. I think, gradually, doctors are waking up to the idea that medical cannabis may be a way of reducing these kinds of issues dramatically.