07 Sep NEW BEGINNINGS – BY DR DAVID BAILEY
Dr David Bailey has been a GP on Jersey since 1996, he has interests in substance misuse and vulnerable adults. For fun he swims in the sea and takes photographs. He co-founded Susida Medical with his friends and colleagues 12 months ago.
Until the SMMG conference 2 years ago, I like most GP’s assumed cannabis was another illicit drug, used recreationally and less likely to cause harm compared to alcohol and other illicit drugs but occasionally leading to interactions with the criminal justice system for patients using it.
However, my opinion changed after a lecture on medical cannabis, what it is, and how it can help patients with a diverse range of medical conditions that we all see in our surgeries. This lecture was just before lunch, my usual mind wandering about sandwich fillings was completely dismissed by the content of the talk. I’d never considered its benefits and dismissed patients using it for help with “medical conditions” as being self justification.
Medical cannabis became the topic of conversation with my colleagues over the following weeks, as Jersey had legalised medical cannabis for GPs to prescribe a few months previously. We considered how we could set up and offer a service to potential patients. This was a welcome distraction to Covid!
For me medical cannabis is a perfect fit into primary care. All the conditions we can prescribe for are managed in Primary care. We all have patients with anxiety, depression, chronic pain, insomnia (and more) that we struggle at times to help with either BNF medication, referral to secondary care or other treatment modalities. Medical cannabis provided a real alternative for treatment of these conditions. Primary care is used to dealing holistically with patients needs, considering multiple drug prescribing and complexity of different co-existing medical problems.
We decided to set up an independent clinic (not part of a larger one or allied to a specific pharmacy) and started initially by registering with the Financial Services commission on Jersey. This proved the easy bit.
Getting a bank to give us an account was a challenge. None of the local banks were setting up accounts during covid for small businesses and especially if you mentioned the “C” word.
During this set up period, designing a website and social media was accompanied by self-education. There is a lot of online resources for this as well as books on the subject. It does take time to research what was not on my Medical School curriculum. Don’t expect large scale, double blind, but do have an open mind too what is there and what patients say, learned experience is a valid resource with medical cannabis.
We have also been very fortunate to have had support from other sources. At the SMMGP conference we met a Lead Scientific Liaison with a manufacturer of a well known oil brand. They have provided a lot of support, encouragement, ongoing education, and case
discussions from both before we started and since with mentoring on cases / specific problems and never pushed a “sales pitch”.
We also paid for a personal education session that supplemented our own research.
We drew from all information available to us and developed treatment protocols for conditions, consent forms, information sheets for patients, a formulary and clinical record templates. The protocols are essential for a consistent approach and to provide a barrier to people looking for cannabis vs patients looking for help.
Although an investment in time the process was stimulating, looking at different oils / flowers that are available was initially daunting but with careful planning it proved straight forward to prescribe. Basic principles of prescribing, common sense (go low / start slow) is no different to “conventional” prescribing.
Support has also come indirectly from other sources. A local Facebook group has an active local group with 1300 followers, this provides support to people already using or considering medical cannabis. They have explained the clinic process to prospective patients and ongoing support.
Another unexpected help came from the local Vape shop.This has also proved to be a valuable source of advice for patients who wish to vape medical cannabis. They advise on what to use and how to use it, useful for a non-smoker / non vaping GP!
As we launched 2 other local clinics set up within the same week. This provided all the social media and public interest we needed. Our personal philosophy of a small clinic, providing the best support and care we can, had all the initial “advertising” it needed.
The initial patient emails proved interesting. We disappointed some enquiries who did not meet treatment thresholds. The first patient falsely claimed to be a lawyer who would sue us if we did not “treat” them!
The first clinics were straightforward, a good assessment document and patient leaflet with detailed consent are essential and form the basis of a patient discussion. Concerns with other drug interactions, for example, are no different from regular prescribing. Taking a medical history and subsequent checks against inclusion criteria are no different to normal practice.
Once we had the first rush of “drug seekers” we began seeing genuine patients. These included someone at end of life with complex health needs who benefitted from the analgesic / sedative effects of medical cannabis oil. The benefit this patient received when the usual medication had failed was a lesson to us of the potential benefit of medical cannabis.
Subsequent “new patient” and “review” clinics quickly build confidence in prescribing, as you see it is successful. We have had patients who have not responded the “start low (dose)
/ go slow (with increases)” mantra, but these are the minority. Most patients have done well, reducing opiates / gabapentinoids / benzodiazepines.
Some have reduced or stopped smoking or drinking alcohol and some have reported a general well-being from improved sleep or mood when prescribed for other chronic problems.
We have had the usual patient unrealistic expectations expected in a private clinic. These usually revolve around issues outside our control such as supply issues of prescribed medication. These are understandable considering the costs involved to patients monthly.
We have had some negative interactions with other Health care professionals, sometimes the “nasty surprise” variety. These are disappointing and could have been aired in appropriate forums.
Overall, the experience of becoming a medical cannabis prescriber has been positive. I strongly believe that primary care has a place in prescribing. As one of my partners pointed out, “If you can do it David, it can’t be that difficult!
Dr David Bailey – Jersey based GP and founder of Susida Medical