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July 08, 2010

Sativex: Cannabis extract comes to the UK without a whimper?

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Its been a while since those "cannabis to be grown in the UK for medical research" stories in 2002, but it has finally come onto the UK market in the form of Sativex, a cannabinoid spray marketed by Bayer, for use by  Neurologists in the treatment of the spasticity associated with multiple sclerosis. So a friend tells me.

So far this week in the news on my drive to work I have been told that:

I nearly choked on my weetabix when ICannabiods make Sativex what it is, but the image of cannabis leaves is not going to make Middle England rest easy for the new sub lingual preparation found out that doctors could be dishing out "cannabis" (well its actually cannabinoids) to anyone (or at least people with Multiple Sclerosis) by my non medical friend. He was told so 'by another friend'. So I investigated, and yes its true. But worry not, I am not a crazed physician on a war against medication, but I'm just a little surprised by the absence of any significant media attention for this.

So a cannabis based medicine is licenced in the UK. Do you have an opinion on this? Well I certainly did before I went to medical school. But lets consider the evidence for this for a minute. If you're not a health professional why not have a quick glance through why. You may not know that you can browse abstracts of virtually all medical research of any quality on the US site PubMed, for free. This is quick, simple, and available to anybody on the internet.

The two main studies are linked below.

Randomised controlled trial of cannabis-based medicine in spasticity caused by multiple sclerosis.
Published in the European Journal of Neurology link here.


A double-blind randomized placebo-controlled parallel-group study of Sativex in subjects with symptoms of spasticity due to multiple sclerosis.
Published in Neurology Research, link here.

So. I've read them. Here are my thoughts. Essentially the first study seems to show that about 40% of the patients given the medicine had at least a 30% improvement in their spasticity, measured on an objective spasticity scale.

Seems to work. I am just a little surprised that it hasnt made it into any of the main newspapers or mainstream media from what I have seen. So if you heard it here first, you heard it here first!

Cannabiods make Sativex what it is, but the image of cannabis leaves is not going to make Middle England rest easy for the new sub lingual preparation. What about the potential for abuse? Could it become a street drug with a value to other recreational drug users? A quick scan through PubMed reveals no case reports of illicit drug use. But as compounds as common as co-codamol find their way into recreational use, it will be surprising if there is not some misuse of the drug, albeit perhaps in small amounts.

What about if you really want to know more? A good place to start is often an established charity. With a quick Internet search, the MS Trust has a well written patient information leaflet on the drug, listing the indications, and the likely responses from the medicine. I found it quite informative as a (non neurology) Healthcare professional.

For a bit of light hearted relief, lets look at the side effect profile of the drug, from the pharmaceutical company. Any of these sound familiar? They compare fairly well with what a leading UK drugs charity says about the side effects of the street drug. 

Thoughts or comments (in particular on the media reaction) to this introduction anyone?

Side effect profile of Sativex, cannabinoid extract(1 in 10 to 1 in 100people) [source patient information leaflet, direct quotations] Common side effects of Cannabis [Source: "Talk to Frank" a leading UK drug infromation website for teenagers]

Feeling depressed or confused.

Feeling over-excited or losing touch with reality.

Problems with your memory or having trouble concentrating.

Feeling sleepy or giddy.

Blurred vision.

Difficulty speaking.

Eating more or less than usual.

Changed sense of taste or a dry mouth.

Constipation or diarrhoea.

Feeling or being sick.

Mouth problems, including burning, pain or mouth ulcers

Lack of energy or feeling weak or generally unwell.

Feeling abnormal or drunk.

Loss of balance or falling over.



'Panic attack'



perhaps 'Talk to Frank' need to update thier list!

October 19, 2008

Clinical Guidlines Anybody?

Ive just been compiling a list of clinical guidelines and thought: wouldn't it be nice if they were all in the same place.

About 20+ British Societies alone.

These things are so useful for anybody writing about anything, I just dont think people are savvy enough yet to actually find these links!

Anyway if you're bored, check out some of these links...

I think Im still fit to drive

AAN: American Academy of Neurology guidelines

AACE: American association of Clinical Endocrinologists with guidelines here

BAD: British association of dermatologists with guidelines here

BOA: British Association of Orthopaedics with guidelines here

British Society of Immunology

BSR: British Society of Rheumatology, clinical guidelines here

British Toxicological Society

BTS: British Thoracic Society, clinical guidelines here

EAU: European Association of Urology guidelines here

ESC European Society of Cardiology: nice source for cardiovascular guidelines list here

Fitness to Drive: British Driving and Vehicle Licensing Agency (DVLA) downloadable PDF ‘at a glance’ guide on fitness to drive

RCOG Royal College of obstetrics and gynaecology guidelines here

The Renal Association. source for chronic kidney disease and eGFR guidelines here

It really starts to drag and although i think this sort of stuff will be useful for my other website I'm not so sure anyone will acually click on them! Never mind. I'll still use them

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