The liberalisation of attitudes towards cannabis across the globe during the past decade have allowed us to begin understanding the vast array of medical conditions it can help with.
While few people would associate cannabis specifically with women’s health, it has been shown to be effective in helping treat the symptoms of PMS, PMDD and Endometriosis, and increasing amounts of women are turning to cannabis as an alternative to conventional treatments.
Ahead of Cannabis Europa London 2022, taking place on between June 28 -29, BusinessCann spoke to author of ‘The CBD Bible’ and founding member of the Medical Cannabis Clinicians Society Dr. Dani Gordon to explore medical benefits of cannabis on women’s health.
Could you give us an overview of your career, the work you do and the various businesses and organisations you’re involved in?
Sure, my name is Dr. Dani Gordon. I’m a conventionally trained medical doctor. I finished my residency in Canada about 15 years ago.
I then went into the field of integrative medicine which is when you combine natural evidence based approaches, things like mindfulness based stress reduction and botanical medicines, with conventional drug therapy, and I practised in that manner for a decade in Canada.
I added cannabis officially to my practice in 2015 and I’ve been prescribing cannabinoids alongside the other integrative medicine therapies ever since. I’ve treated 1000s of patients with medical cannabis.
I am actually a GP as well as a cannabinoid medicine specialist and an integrative medicine specialist. And because of that, it’s allowed me like many doctors in Canada to prescribe cannabis and gain experience across a wide range of specialty areas. So I’ve prescribed for patients with neurological disorders, lots of neuropsychiatric conditions, women’s health, all of the different things that cannabis can help with.
I moved back to the UK where my family is based and also British. In 2018 I met Professor Barnes and was one of the founding members of the Medical Cannabis Clinician Society of which I’m the Vice Chair.
I also work with a number of nonprofit groups and government policy groups, including the Conservative Drug Policy Reform Committee, Drug Science on their medical cannabis committee, and with Project 21.
I’m the founder of Resilience Medicine Clinics, which is my integrative and collaborative medicine clinic here in the UK, and we treat patients across the country virtually focusing on complex chronic disease and other psychiatric conditions, and I also see a lot of women’s health.
Why did you decide to get into Cannabis?
For many years before I officially started prescribing cannabis in Canada, my patients were using cannabis themselves and because I do integrative medicine, they were telling me about what they were doing.
I found it incredibly intriguing because I had patients who, on their own using grey market cannabis, were able to wean themselves down on some of their opioid painkillers. This is for really severe chronic pain, people who had rods in their spines, people who had advanced bone metastatic pain from cancer.
I was actually very anti-cannabis because in medical school we’re all taught that cannabis just causes psychosis and it has no medicinal value.
My patients started to convince me and then I had a terrible accident with my hand. And I had rods and screws and I was told that I was at high risk for developing complex regional pain syndrome. I had loss of nerve pain and I started using cannabis myself topically on my wrist and that made such a huge difference to me that I decided finally I have to start adding this to my practice. I’ve found that since I added cannabinoids to my practice that my patients’ lives dramatically changed.
Cannabis is not a cure all but it’s certainly had such dramatic improvement in their quality of life in so many different areas ranging from their ability to connect socially, their ability to do meaningful work, their mental wellbeing, decrease their pain, reduce problematic polypharmacy, which is where we use too many medications at one time with lots of side effects.
I became such an advocate for including this as a tool in our practice because it works. And it works for so many complex symptom clusters that we see as GPs.
Many people might not immediately associate cannabis with women’s health, could you walk us through some of the conditions that impact women specifically that cannabis has been shown to help with?
It’s a great question. I think I’ll start by saying even the conditions that affect both men and women, because women have hormonal cycles with our menstrual cycle and then we go through of course perimenopause and menopause, we have slightly different needs even when it comes to chronic pain management.
So even when the condition is the same the treatment may be slightly different for women. For example, one of the things I was finding in my practice treating 1000s of my patients for many years, was that patients on cannabinoid therapy sometimes needed different things at different points in their cycle.
If we’re treating someone with a mood disorder, the mood actually does fluctuate in some people more than others as we go through the different phases of the menstrual cycle. So that affects things like cannabinoids, and we have cannabinoid receptors in our womb throughout the female reproductive system.
Now, we’re not yet seeing this reflected in the research because we’re very behind in the research with cannabinoids. That’s a whole talk in itself. There’s many reasons for that. One of the reasons is because these are whole plant medicines, so they have hundreds of bioactive chemical compounds, plant compounds, and you can’t put them in this narrow, randomised, placebo controlled model that we do with drugs.
That is being solved by real world evidence collection like Drug Science is doing in the UK, for example, but that’s one of the reasons why. We’ve always had this kind of lagging behind studying the effects on women specifically, in many different specialties of medicine, it’s a real problem. That’s just part of the inequity legacy of medicine, but it is changing slowly.
So because we don’t have that body of research, we really have to rely on things like clinical experience, expert opinion and well collected real world data for now to really guide us in those areas.
That’s the first point, the second is women’s health problems that only affect women or people with a uterus. Those can include something called Endometriosis, which is a very painful chronic condition where the womb lining grows outside of the womb where it shouldn’t and it bleeds in cycles every month and causes a lot of pain and disability.
This is one of the most highly disabling chronic conditions. It’s a chronic pain condition so you can treat it with cannabis. It has the added trickiness that many of these women of course are of childbearing age.
With cannabinoids in pregnancy, there’s a lack of evidence so we have to consider all those factors and the fact that we don’t yet know what the effects of THC is on the endometrial lining.
However, we do know that Endometriosis patients find cannabis very effective from the real world evidence of data sets that we have. So far in my practice I have found the same thing. But we just have to consider for example, if you’re trying to get pregnant or pregnant, or if they’re breastfeeding, we don’t use it. There’s just a few more considerations.
Then we have things like PMDD (premenstrual dysphoric disorder), a mood disorder that gets worse the week before the period. This is definitely another area where cannabinoids can be helpful, and what we usually do is combine these cannabinoid therapies with conventional therapies in both cases.
So one of the nice things about cannabinoid therapy is, with a few exceptions, you can combine it with most other medications. And it leads to better efficacy of the treatment as a whole, less side effects, and better patient adherence.
PMDD, Endometriosis, you also have milder things like PMS, and stress and burnout, which really affect many, many women, a lot of women use over the counter CBD products to help with those milder symptoms themselves.
There’s not a lot of evidence as far as RCTs (randomised control trials) on these hemp based products for those milder issues, because they’re over the counter because they’re a supplement or not a medication, it’s a little harder to collect the data.
Then we have things like periods, period pain which again both CBD and THC seem to be good for, usually combined with anti inflammatory medications.
These can be prescribed under a chronic pain condition, because it’s really what we’re talking about here. We’re talking about what is actually helping, so it’s not treating the underlying disorder, per se, it’s treating the pain associated with the disorder.
It’s not a cure for women’s health problems, but it’s effective treatment for quality of life in patients who are not actively trying to conceive, pregnant or breastfeeding.
How does cannabis compare to some of the most common treatments for these conditions currently on the market in terms of things like side effects, price and accessibility?
I’ll tackle the side effects question first because it is a very important one. When we look at a medication we want to see two things. How effective is it? And then how many adverse or side effects do we see with it?
With cannabinoids in general, these are very well tolerated medications, especially when they’re properly prescribed. Properly prescribing usually means starting with high CBD, low THC products, especially when someone is naive or new to THC.
And then sometimes, if they’re having trouble with nighttime symptoms that are really disruptive to their sleep or pain at nighttime, then adding a high THC long-acting product in a very low dose, what I would consider almost a microdose is the way that we like to start.
So when we prescribe like this, it’s very different for someone using recreational very high THC cannabis on their own. And when we prescribe in this very low risk, lower THC, ‘start low go slow’ method, people tolerate cannabinoids extremely well.
In fact I have discovered in my practice, and again the Drug Science data is showing the same thing, is patients rarely have side effects that prevent them from continuing their medical cannabis. And even more broadly, they rarely have moderate side effects at all.
Most of my patients have no side effects from their medical cannabis. Occasionally what we see when patients take more THC, for example for extreme chronic pain, they might get red eyes, they might feel a bit groggy or fuzzy if they take too much. That’s when we back off and we change again.
The nice thing about cannabinoids, in addition to being well tolerated is they’re not lethal, you can’t overdose like opioids, or even some of the older antidepressant medications. So they’re actually very low toxicity, they don’t have any acute organ toxicities. So actually, when they’re properly used, they’re extremely safe medications.
And this is a general statement, but when you choose your patients correctly, and you screen them for the few contraindications that are present, like history of psychosis for prescribing THC products for example, then they’re they’re just they’re very useful and safe medicines.
Now side effects that we have with some of the other medications, that is the issue that drives patients to choose cannabis medicines because they’ve already tried those things.
For example, in the UK, at least a third of patients with depression do not respond really at all to the conventional antidepressants we currently have available. That’s another reason why the therapeutic psychedelics are so interesting, because this is another therapy that works in what is called treatment resistant depression or TRD. And cannabinoids can also help there, although there’s not a lot of published evidence yet.
Also a lot of people cannot tolerate the side effects of antidepressants, especially speaking of women’s health, lack of libido, inability to orgasm, and sexual dysfunction caused by those medications, it’s a really big problem.
It’s not either cannabis, or conventional medications, I think we have to come away from that idea. Sometimes we’re using them together with opioids.
(With opioids) there’s the obvious effects of the much higher risk for addiction for side effects related to severe constipation to gut motility. A lot of my patients who were on high dose opioids for chronic pain, developed a mood disorder and when we wean them off of the opioids and onto the cannabinoids, their mood improved into the normal ranges again.
We recently spoke to your colleague Professor Mike Barnes, and he told us that patients play a key role in driving the development of the cannabis industry, would you agree?
I absolutely think this has been a patient-led grassroots movement and it’s great in a way that is really empowering for patients. But there also is a downside to that because patients have had to be pushing this forward the whole time.
A lot of these people are quite vulnerable. They’re not well, and to put the burden of the access to medical cannabis on our patients, I think is a terrible misfortune.
So I think it’s very positive that it’s happening due to this amazing swell of patient demand because now it’s moved the whole industry forward.
But I think now, at least on the medical side, when we’re prescribing things to patients, they want us to be the experts. So it doesn’t mean we were going to dictate paternalistically towards them what to do, that era is over and my patients don’t want that either.
They want me to partner with them. But they want me to know what I’m talking about. And they want me to know more than they do about their cannabis. Oftentimes, when I see patients, they’ve seen another doctor, even someone who’s prescribing cannabis, and the doctor knew less than they did about their medical cannabis.
And that is problematic when you have someone who has a complex case, for example. And you may need to tweak their cannabis to make it work better, reduce side effects, that sort of thing. The patients might be out of their depth too. So they’re looking to you for that level of expertise.
So yes, I totally agree with Professor Barnes patients have led the way and thank goodness they have, but now it’s time for the medical community and I think the legislators to step up and support more research and support access for patients to medical cannabis support, education and training, which of course we do at the MCS.
On the consumer side, I think it’s a little bit different because it’s all about what people can buy on their own and what people can do as part of their self care. And that’s where we’re going to see consumers still playing a huge role, and I think that’s really appropriate.