Dr Sunil Arora talks to BusinessCann about his journey from cannabis sceptic to cannabis prescriber
ONE of the issues Dr Sunil Arora currently faces is weaning his patients off their illicit supplies which some consume in cannabis cakes or chocolate sauces.
However, it’s one he feels he is winning – as he now also finds himself treating a new type of patient.
He said: “My patients, now, fall basically into two categories on the one hand we have patients who have never, ever considered it before, but are starting to consider it as a medication, and, actually as a natural medication because they feel it comes from a plant.
“Then you have the patients that have been taking it for years – and I mean years. They are very well educated and they’re educating me. When I first learnt how they were accessing and taking cannabis I was initially quite shocked.
Chocolate Cannabis Sauce
“One of my patients was telling me about the edibles and cakes they use; one was in a chocolate sauce – it sounded delicious.
“But the people who do take it illicitly say that it depends on what they can get, and how it can be very variable in quality, and they want to know how much they’re taking.
“With the cannabis medicines at our disposal we can produce consistent doses and effects time after time, and that now sees them willing to go down the medical cannabis route.”
The main change is from a home-grown or street sourced flower to a prescribed oil.
He continued: “This provides the certainty they want. Because it’s reproducible, they know if they take it two hours before bed, they’ll have a good night’s sleep and they’ll sleep for eight hours.”
‘The Medicine You Give Me Doesn’t Work’
A practising doctor for the last 20 years, Dr Arora started as an anaesthetist and developed a compassionate interest in treating patients with chronic pain.
And, he found that talking to patients who had gone through the traditional prescription drugs the only one that could help them was cannabis.
“I would reach the end of the line of all the medications that are possible to use. So I just started to think there’s got to be something else and that’s when I started to talk to patients.
“I stopped asking them, ‘are you taking any illicit drugs?’ As everyone used to say, ‘no’, and then I started specifically asking about cannabis and then. ‘Yeah’, they would say. ‘I take that and it’s the only thing that works. What you give me doesn’t’.”
He decided to learn more about cannabis, attending conferences and visiting North America to see how its systems were working.
“The doctors I spoke to told me that it really worked. So then my mindset sort of changed from treating it as a drug to a possible medication.”
First Patient Prescription
Following the law change in the UK in November 2018, he felt compelled to galvanise his medical peers to take responsibility and deliver cannabis medicines to those in need.
Through one of the UK’s growing band of private clinics – My Access Clinics – Dr Arora became one of the first UK doctors to prescribe a cannabis medicine; in this case to an elderly lady suffering chronic pain.
“She’d tried everything else. She’d had loads of procedures. She’d been to neurosurgeons, orthopaedic surgeons, was having multiple injections. She was on multiple medications. And despite that, she was still in pain, and not sleeping.
“Well, we’ve corrected all of that with her. So we’ve been quite successful. She’s not pain free, but her sleep’s improved a lot and she’s now able to do a lot more. She’s awake and able to function and able to live her life, rather than being asleep all of the time.”
The lady in question now uses an oil with a one to one ratio of CBD to THC to help her sleep in the evening and during the day it’s an oil with a twenty five to one ratio of CBD to THC, he explained.
UK Prescribing Through Private Sector
While the UK prescribing regime through the NHS has not lived up to billing – with less than a handful of prescriptions – Dr Arora has some sympathy.
“I think it is difficult for the NHS. You know, they’ve got a certain budget and they want to be able to use medicines that work for the vast majority of people.
“And, in order to make that happen, the evidence has to be there for them to be able to say, look, NICE (The National Institute for Health and Care Excellence) says yes.”
BusinessCann recently reported that no trials have been launched since the the law change and the evidence-gathering is now being driven by the medical cannabis community as in initiatives such as Project 2021.
It aims to enrol up to 20, 000 patients by the end of 2021, recruiting those with chronic pain, epilepsy, multiple sclerosis, post-traumatic stress disorder, Tourette’s syndrome, anxiety disorder, or substance-use disorder.
Educating Fellow Doctors
He plays a key role in raising awareness of the benefits of cannabis medicine amongst the prescribing community.
“I am continually looking to educating doctors about cannabis as a medicine, whether it be webinar or a meetings. I like to be questioned and will open myself up to criticism from other doctors who want to know why I am doing it.?
“I hadn’t felt comfortable with doing this until beginning of this year. As I wanted to feel comfortable that what I was doing was was safe and justified.
“I had to really convince myself in the first instance before I could try and convince other people. But, I now believe that in certain conditions, including chronic pain for example, cannabis can help patients.”
Open Cannabis has a structured learning programming for doctors which provides an opportunity to discover more about cannabis as a medicine, it also aims to help patients understand what options are available for them.
From Dr Arora’s experience last year’s research which shows some 1.4m UK people use street or homegrown cannabis to help with their health issues is pretty accurate.
Younger Generations Support Medical Cannabis
With cannabis still in deep freeze in the minds of many older doctors Dr Arora signs sees signs of a thaw among the up and coming generations.
“When I speak to doctors of my age or above, they just dismiss it, but the younger doctors, when you actually speak to them, they’re more accepting of it.
“So it may be a generational thing, where we’ve been brought up to consider it a drugs, whereas the younger generation, coming through, perceive it more as a potential medicine.
“A patient should be open with their doctor. Although I know a lot of patients get shot down with doctors comparing cannabis to the opiate crisis.
“But there are differences. For instance, you can just stop medical cannabis straight away straight and you don’t get any particular withdrawal, whereas that’s not the case with opiates.
“With any medication if you’ve got the wrong prescriber or you’ve got someone who doesn’t know what they’re doing, then things can go wrong.
“Whereas if you get somebody who knows what they’re doing, who knows how to titrate the correct doses and combinations, then it it can be managed in the patients’ interest.
“One doctor put it like this to me; ‘if you have 18 pints, you’re gonna get liver disease and you’re going to die, but If you have one, you might feel nice for a little while, and then just stop there. Let’s just go for that the benefit’.
“That may be a crude way of putting it but I like the analogy – it makes sense.”