Prof Michael Barnes: An Insight into the Medical Cannabis Scene in the UK
Prof Michael Barnes joined us from the UK to discuss the medical cannabis scene in the UK.
Prof Barnes is a Consultant Neurologist and medical cannabis expert. For over 20 years he has been at the forefront of medical cannabis in the UK and is committed to securing access to medical cannabis for all who need it.
This is an edited segment from the weekly live General Assembly meeting on February 7, 2022. The full General Assembly Meeting is available in our multimedia library.
Here’s what WCH members, staff, and coalition partners are saying about Prof Barnes’ presentation:
“Pharma is definitely trying to control the cannabis game. It must be resisted. the entourage effect is real. Isolates are a scheme to enable pharma to control this wonderful plant. -Charles Kovess
“It’s bizarre that we have a proven very dangerous injection forced on the world, but a kids parents can’t grow a few seeds to stop his seizures without spending a thousand dollars a month.” -Dr Mark Trozzi
“Thank you so much Michael, it’s so refreshing and morale-boosting to find a doctor really being guided by clinical experience. Your presentation has been so helpful. 🙏” -Meleni Aldridge
“In my opinion Hemp seed oil is amazingly great for health!” -Interest Of Justice
“Thank you very much for this interesting and revealing presentation..” -Christof Plothe
“I believe pre David Rockefeller and his UN schemes, cannabis was the second most used medicinal plant in history, in many forms including topical and oral.” -Dr Mark Trozzi
“Thank you Prof Barnes – so fresh and interesting to hear your expert opinion.” -Tess Lawrie
“Excellent talk Prof Barnes- very helpful and important to see the current perspective of this issue.” -Anne O’Reilly
[00:00:00] [00:00:32] Dr. Katarina Lindley: And next, I would like to introduce you to professor Michael Barnes. His talk, today’s going to be an insight into the medical cannabis and healing in the United Kingdom. Professor Barnes is a consultant neurologist and medical cannabis expert for over 20 years. He has been at the forefront of medical cannabis in United Kingdom, and he’s committed to securing access to medical cannabis for all who need it. [00:00:58] So thank you, professor Barnes and welcome. [00:01:02] Professor Michael Barnes: Thank you. Thank you for asking me. And, uh, as you kindly said, uh, I’m going to talk to you tonight a little bit about the medical cannabis or perhaps it’s better called the prescription cannabis, um, seen in the UK. Um, and, and then I will mention the society that is part of the World Council, the Medical Cannabis Coalition Society which is becoming international actually. [00:01:27] So, uh, I’m just going to talk for about 10 minutes or so, and, uh, just to set the scene and then I’m very happy to answer any questions that, um, that you have, and I’d love to hear any experiences of the cannabis scene, um, worldwide, because it’s accepted in many countries now, but certainly not accepted in many others. [00:01:48] So in the UK, I’m, uh, perhaps I should introduce myself, I’m a neurologist. Uh, I think you’ve covered, you’ve covered most of what I am, but I’m a neurologist involved in Cannabis for about 20 years, mainly from the background of seeing people with multiple sclerosis and learning from them, uh, that cannabis was helping there in that, in that context, mainly their pain and their muscle spasms, spasticity, um, and people were coming to my clinic and telling me they were using cannabis. [00:02:18] This is when it was very illegal and still is in a sense in the UK. And just out of, just informally, I ask those coming to the clinic, there’s about 60 people with multiple sclerosis in my clinic. And in, I live in North England, Newcastle at one time. And I was surprised actually, and perhaps naively, but I was surprised as about half of the people coming to the clinic were actually using cannabis. [00:02:40] This is the say 20 or so years ago. I then helped a company called GW pharma, uh, developed what turned out to be the first cannabis mid-cycle Sativex, which is for muscle spasm, some of you will be familiar with. Then nothing much happened in the UK for about 12 years because Sativex wasn’t approved. [00:03:01] Um, we have a body in the UK that some of you will know called NICE, which is a very strange name for a body like that. But it’s called the National Institute for Clinical Excellence and they determine whether medicines are cost effective. They look at the economics of the medicine and they decided to Sativex was not cost effective. [00:03:17] So it wasn’t introduced into our national health service. For those that don’t know the national health service in the UK accounts for about 90% of all medical intervention in the UK. And about 10% is through the private sector. So that’s a little bit different from many other countries. [00:03:36] So nothing much happened about cannabis from a legal point of view until around 2016, when things were, um, rekindled. And I was asked to do a report for a parliamentary body called the All Party Parliamentary Group on Drug Policy, which I did with my daughter actually, I must acknowledge my daughter is a psychologist and she helped me write to that report, which I think was influential, was perhaps the wrong word. [00:04:04] It was, I call it influential if I may for a moment because it’s sort of rekindled the debate on whether we should legalize cannabis, at least for medical purposes. [00:04:14] And then soon after that, there was a, what turned out to be a very well known little boy in the UK called Alfie Dingley. I suppose, from those of you from the states Alfie is the equivalent to Charlotte Figi in the States. [00:04:27] Um, and, um, his mother doesn’t mind me telling you, Alfie’s story, just briefly because it is relevant to where we got to today in the UK. Alfie has a very rare condition called PCDH19, which gives rise to severe seizures. He was having three to 400 seizures a week and not helped by any licensed anticonvulsant. [00:04:49] Um, at all, he was only helped by intravenous steroids. He was admitted to a pediatric intensive care unit, 48 times, and the previous year before his mother became desperate and, uh, took him to Holland where obviously it was cannabis for medical purposes was legal. Um, they tried him on cannabis in Holland and after a few weeks of getting the right dose, his seizures stopped. [00:05:13] And other than a brief spell where we had to some breakthrough seizures about two years ago, he has remained seizure-free ever since, which is remarkable. I mean, truly remarkable, actually from three to 400 seizures to none. And of course the result of that he’s now able to function. Uh, he goes to school, his motor control is better. [00:05:33] He can ride a bike, he can ride a horse. His quality of life is a measurably improved as of course is the quality of life if his family, because they were looking after their child and have another young daughter as well, and now are able to look after the family as a whole. So it’s made a truly remarkable difference to that family, but they were in Holland and they wanted to come home and live in the UK where the home is. [00:05:54] And so they came back without the medicine because it was illegal to import it and started, uh, turned out to be a remarkably successful media campaign, uh, that was supported by most of the media in the UK. It’s a story you couldn’t help, but be moved by. And really as a direct result of that campaign, uh, Alfie got a, uh, the first driver license in the UK, their schedule one license before the, before cannabis was made legal in summer 2018. [00:06:23] And a result of that, um, the law was changed, uh, only a few months later. So that’s a really remarkably successful media campaign that actually changed the law. And the law was changed to, was to move cannabis from schedule one of our misuse of drugs act, this is drug regulations, to schedule 2, which enabled doctors to prescribe cannabis as a medicine. [00:06:49] It was a bit limited, it was only doctors on the UCO specialist register. That means not hospital consultants, basically, and not general practitioners, not primary care physicians. That’s a bit of an issue, but I’ll come to that. Uh, but the law was changed in November 18. And then we thought, well, I thought having been part of that campaign with Alfie, I got his license for him, um, and wrote the first prescription. [00:07:12] Uh, I thought, well, that’s done. I can retire now and carry on with stopping neurology, which is my, was my plan as I’m getting very ancient. Um, uh, but that didn’t really happen. And since the law changed three years ago to over three years ago, now we’ve had to test three, three national health service prescriptions for cannabis. [00:07:35] Which is awful. And I’ll come to the reasons in a moment in the last few minutes. Um, it is available in the private sector, which is good. In many ways, people are able to access it, but it’s bad in other ways, because they have to pay out of their own pocket. And whilst cannabis as a medicine is cheap. [00:07:50] When you add in all the import costs and the doctor costs and the clinic costs and everything else, it’s not cheap. Um, and some of the families and the children need a higher dose of cannabis than adults strangely. Um, we’re paying up to 2000 pounds Sterling a month to get the prescription. Vast majority of families can no way afford that amount of money. [00:08:10] It’s come down a little bit, but families are still paying at least a thousand pounds a month. And adults are now paying about three to 500 pounds Sterling a month, which is still an awful lot of money through about 15 cannabis, private cannabis clinics in the UK. And I think that’s a shame we need to available to all free on the point of delivery, as I say, and national health services, which is what I presume, what parliament intended when the law was changed, but that hasn’t happened in our come to reasons in a moment. [00:08:40] So the situation at the moment in the UK, as I say, we have 15 clinics, we have a reasonable choice of cannabis medicines from about, it’s actually about the same number 15 producers of about a hundred products in the UK. So it was a decent choice for doctors. We have about a hundred doctors now trained. And prescribing, which is, um, for about 12,000 patients. [00:09:02] So we are, we are a little bit short of doctors, particularly from some specialties, particularly from neurology and more particularly from pediatric neurology. Um, most of the prescriptions are from pain. We have pain doctors prescribing 60% of the prescriptions are for pain cause it’s remarkably good as a painkiller. [00:09:20] Um, but 20, 25% of the prescriptions are for psychiatric conditions such as anxiety or depression, obsessive compulsive disorder, post-traumatic stress disorder. Um, and then, uh, about 15 or so percent for neurological conditions, including multiple sclerosis, um, Tourette syndrome, a variety of other things like gastrointestinal disorders, some cancer symptom treatment for cancer. And of course, what changed the law, pediatric epilepsy. [00:09:54] So that’s roughly where we are at the moment, which is obviously some progress, but given in the UK, it’s thought that there was about 1.4 million people who use cannabis every day for medical purposes, not recreational plus those who are not criminalizing themselves. [00:10:09] We recommend conservatively. There’s about 2 million potential cannabis users for medical purposes in the UK. And we’ve got 12,000. So we have 1.99, whatever it is, million to go, there’s a long, long way to go. And the main problem we’ve had is the extreme reluctance, um, by most of the medical profession, uh, to prescribe a great deal of cynicism, a great deal. [00:10:36] I think it’s largely still due to the stigma associated with cannabis. I’ll go through the reasons briefly, many adopters, and I don’t agree with any of it, but I will say what they say. Um, there was a lack of evidence, that is true. If you look at cannabis as a pharmaceutical product, and it is not a pharmaceutical product, clearly as a botanical product, doesn’t lend itself to pharmaceutical approach. [00:10:59] Um, so it double blind placebo controlled studies. That doesn’t work for cannabis. It’s a multi compound plant with 147, I think it is cannabinoids and a hundred turpines and equal number of flavonoids. It’s a very complicated plant. Doesn’t lend itself to a pharmaceutical approach. [00:11:15] Many doctors, including the government body of NICE again, they’ve said there’s not enough evidence because they’ve looked at it as a pharmaceutical product. [00:11:23] Um, if they look at the real world evidence, there is overwhelming evidence for its efficacy, particularly in pain and anxiety. And of course, epilepsy less evidence for other things. Um, so that’s where we are at the moment they say, there’s not enough evidence, the say that, their therefore not going to prescribe it until it is till that evidence is there. [00:11:46] Um, which probably means they’ll never prescribed because we’ll never have the evidence that is of a pharmaceutical basis. So what we’re doing to counteract that we are launching media campaigns, we have launched media campaigns in the UK. We’ve been a little bit we’ve, we’ve had to attack some of the doctor bodies they’ve produced some wrong, um, simply incorrect, um, guidance. [00:12:07] So we’ve corrected that particularly the British pediatric neurology association has been particularly antagonistic. So we’re doing our best with that. Um, there are some bodies to support the patients and the, those who might benefit and do that very well. It’s a very much patient driven initiative that changed the law and continues to support themselves. [00:12:29] And we formed coming back to the body that is part of the world council, the medical cannabis collision society. We formed that on the day the law changed. Um, we now have, I’m pleased to say just short of 300 members who are all clinicians. I need not to be doctors, medical doctors, pharmacists, nurses, allied health professionals, any clinician involved in the medical cannabis space. [00:12:52] And we offer teaching for doctors and it’s through that organization that, actually it’s about 200 doctors that have been taught, some of them just wanted to know about cannabis and someone had to prescribe it. And I’m all for education for those who don’t want to prescribe it so they can offer an informed opinion to that, to their patient, because we’ve got many examples, um, of uninformed opinion. [00:13:16] We offer international support Google group. So if you have a question about a particular patient, anonymously you can record that in our group and you get a reply from anywhere across the world. Actually we’d have very quick replies from States or Canada or Uruguayan Nigeria. We’re about to form an Italian branch as we have many international members as Dick’s interest in Italy at the moment also Denmark. [00:13:40] Um, so I think we’re on the verge of, I, it sounds frightfully grandiose, but perhaps renaming it, not from the UK medical cannabis commission society, but the, the world medical cannabis collision society or Europe or something simply because we’re getting, there’s very few of these societies that exist in the cannabis communities around the world. [00:13:58] And it’s nice to be able to support them through this society. And we offer teaching training webinars. And the overarching of support for the doctors, because in this country, you can’t just write a prescription for cannabis. Once you’ve decided that’s the right thing for your patient, then you have to get approval from a peer support body, which doesn’t happen to any other medicine in the UK. [00:14:21] Uh, so that’s another hurdle that cannabis prescribers have to jump and we offer that society offers that peer support to approve the cannabis prescriptions. Um, so that’s where we are. We are progressing. It’s been a rather slow and painful business. The government could do more to help us. And we’re trying to campaign with the government as well, for example, to get GPs to be primary prescribers or not, they can do follow-up prescriptions, they cannot initiate prescription. [00:14:49] So we’re, we’re lobbying government. Um, and also mainly we’re trying to lobby the medical bodies, uh, such as they are to at least not necessarily agree with us, but at least be open-minded to say that if people who come to the end of the road with their pain prescriptions or their anxiety prescriptions, or their epilepsy prescriptions, be open-minded enough to try a medicine that we know works for many, many people, not everybody, but works for many and most particularly is safe. [00:15:20] And it is remarkably safe. If it’s sensibly prescribed the chances of a serious complications, like psychosis are absolutely minimal. I’m not going to play it down to it’s totally safe, but in sensible prescription, it is remarkably safe. And if you look at the efficacy rates, just final point, um, the efficacy rates from a project in the UK called drug science, 2021 program, had a 96% response rate for the children with epilepsy. When they’ve responded not at all to licensed medication, that is truly a remarkable result. [00:15:52] Um, and if you look at the repeat people coming back to the clinic, which is a sort of surrogate marker for the fact that they’ve had a reasonable response, I suppose, to the medicine, that’s about an 80% repeat prescription rate. So for people with very resistant conditions who haven’t responded to other medications or treatments, it is remarkably successful, but I’m certainly not going to advocate that it’s a cure all for all conditions known to man, which you can see on the internet, but for the right person for the right condition prescribed correctly and sensibly, it’s a very useful medicine and it should be more widely used. [00:16:26] And I think I’ve passed my allotted time by about a minute. So I’ll stop talking and I’m very happy to answer any questions that you have. [00:16:34] Thank you. [00:16:35] Dr. Katarina Lindley: Professor Barnes, thank you so much for your presentation. Um, my colleague, Dr. Maria Hubmer-Mogg is a co-host today and she’ll ask you some questions that have been posted in our chat. [00:16:46] Thank you. [00:16:48] Dr. Maria Hubmer-Mogg: Thank you so much, Professor Barnes. Very interesting to follow your speech. Um, we have questions here. One, for example, from my lovely steering committee member Tess Lawrie. Um, she says that, um, how different is the pharmaceutical product compared to the natural product that is easily grown? [00:17:07] Professor Michael Barnes: Yeah, you can. Um, I was, I didn’t have time to develop that, but some of the companies developing isolates, that’s isolated, just THC or just CBD, which are the main components of the plant, as I’m sure many of, you know. They work. And if you take, um, nearly isolate CBD called Epidiolex developed by GW Pharma, um, they, uh, that, that medicine works for children with epilepsy about nearly half, about 43% of the children improve their seizures by at least 50%, which is a remarkable result. [00:17:40] But if you look, if you use the whole plant, the full spectrum product, you can move that you can put about double that figure of between 70 and 80% of the children will reduce their seizures by at least 50%. So I think that’s an example of a so-called entourage effect where the full plant is more efficacious than the individual components of the plant. [00:18:01] So personally, I would only ever prescribe full spectrum. A whole plant product because simply because it works better, the dose is lower and therefore the side effects are less. So, um, I understand why they’ve developed isolates because you can treat it as if it’s a pharmaceutical medicine. You can compare an isolate to a placebo and do a double blind placebo controlled pharmaceutical type study. [00:18:23] So I absolutely understand why some companies are pursuing that route, but, uh, I think it’s a bit of a shame because the full plant works better. [00:18:33] Dr. Maria Hubmer-Mogg: Thank you so much. Um, from my other student committee member, Mark Trozzi from Canada, um, he asks if people in the UK can grow cannabis or have license to grow so they can be released extreme financial burden. [00:18:48] Professor Michael Barnes: Um, no, they can’t. Um, sadly I think that’s, uh, that’s another very good debate in the UK. It’s otherwise, other than the context of a doctor prescribing it, it’s illegal. We can prescribe it for any condition. That’s good. We can prescribe it in any format except smoking. We cannot prescribe smoking. Perhaps we wouldn’t as a medicine anyway, but we can prescribe for vaping. [00:19:10] And indeed 60% of the prescriptions are for vaping with dried flower. 60%, 40% are mainly oil. The other formats like tablets are coming in. Um, so, but you can’t grow your own legally at the moment. Uh, of course there’s a case to be made for that because people then can grow a particular strain that suits their particular condition. [00:19:33] Um, and of course it would avoid the cost, cost of growing a cannabis plant is relatively cheap, but at the moment, growing your own cannabis for any purpose is illegal. And of course we haven’t yet even started a debate in the UK really about adult use as they have in Canada. That, so I don’t think that will happen in the foreseeable future. [00:19:54] Dr. Maria Hubmer-Mogg: Thank you. Um, another question, many vaccine adverse events are neurological. Do you have any experience of, or guidance for the use of cannabinoids for neurological vaccine injury? [00:20:07] Professor Michael Barnes: Neurological vaccine injuries, did you say? [00:20:09] Dr. Maria Hubmer-Mogg: Yes. [00:20:10] Professor Michael Barnes: No. Um, no, I think we shouldn’t forget that the cannabis is largely a symptom helper rather than a disease curer. [00:20:17] The one exception over time may be that it does actually help some particular types of cancer, but we don’t think we’re there yet. So for any sort of vaccine or other neurological damage, it can be remarkably helpful for quality of life improvement, uh, for pain. If that’s an issue, for muscle spasm, spasticity, if that’s an issue. For, certainly for anxiety, for sleep, for insomnia. [00:20:39] So there’s a variety of complications and problems that can follow neurological vaccine damage that may be helped by cannabis. Uh, but it doesn’t obviously affect the direct vaccine damage itself. There is a study starting in the, in the UK now actually it was, um, sort of press release last week of using cannabis for long Covid. [00:21:00] Because there was some indication, some indication very early, uh, that actually cannabis, both CBD and THC can reduce the chances of acquiring COVID and might, uh, reduce the chances of, of acquiring long COVID as a result of initial infection. They’re very earliest studies, but there’s some theoretical evidence that may be the case. [00:21:22] So they’re trying, uh, adjusting 30 patients as a trial, an early project trial to see if we can reduce the incidents or help the symptoms of long COVID. [00:21:33] Dr. Maria Hubmer-Mogg: Thank you so much. Um, then there is another question. Could you do online training for doctors elsewhere in the world? [00:21:42] Professor Michael Barnes: Uh, yes, I’ve done. Um, the society does, it happens to be me that mostly does the online training. Uh, it doesn’t have to be me. Um, uh, but yes, we I’ve done training. It doesn’t- with zoom of course, like tonight, it doesn’t really matter where people are. [00:21:59] I could be doing a cannabis training now globally. So yes, the society, um, can gladly put on some international training days, if that will be helpful to the members or to anyone else. Um, I do a training once a month, mainly to UK doctors. [00:22:15] That again,, that can be broadened globally if need be. So, yes, I’m more than happy to do that. If people identify people, who’ve got my email, I’m very happy to share it, but they can drop me a note. Um, did we share the email or can it be shared? I’m very happy to communicate with people if. [00:22:31] Dr. Maria Hubmer-Mogg: Okay with you, we will share it. [00:22:33] Professor Michael Barnes: Yeah, that’s great. That’s fine. [00:22:36] Dr. Maria Hubmer-Mogg: Okay. Another question from Australia, from Steven, I am secretary of the Australian Industrial Hemp Alliance, the peak body for hemp in Australia. We also cover medicinal cannabis. What is the UN’s current position on down-regulating the controls on medicinal cannabis. [00:22:55] And how can all of us influence the UN to proceed with this downregulation to make medicine much more freely available? [00:23:04] Professor Michael Barnes: Yeah, that’s a very good point. As you know, what, what limits many countries is the UN single convention on drugs of 1961. Um, they have downgrade is perhaps the wrong word. There’s moves to reduce that international restriction isn’t that they’ve looked at CBD and determined. It’s not narcotic. So there is some loosening of those regulations. [00:23:24] Of course, now it’s not hardly widely ignored, but it is ignored in 55 countries where cannabis has been made legal, but they’ve many countries have for medical purposes, but many countries have had to jump through sort of unnecessary, bureaucratic hoops and twisted things around, uh, to apparently get around the UN single convention. It would so much easier if the UN just scrapped the UN’s single convention in context of cannabis. [00:23:49] So I think anybody in the World Council for Health is, is very, um, being a global body is very useful at, um, uh, putting an opinion to the UN. [00:23:58] So the World Health Organization, uh, as well to, to try and that’s called it deregulate the cannabis through changes to the UN single convention. So I think that’s a, that’s a task of the, uh, some of the global players on this call could, uh, we could coordinate to try and influence things are happening, but not quick enough. [00:24:18] Dr. Maria Hubmer-Mogg: Thank you. And then there is another question from my lovely steering committee Shabnam. Um, there are clear conflicts of interest involved in healthcare. [00:24:27] What impact would be criminalization have on those who profit from the criminal justice system versus these who need the medicine? [00:24:37] Professor Michael Barnes: Um, yeah, some countries has gone down a decriminalization route, uh, which is a perfectly valid route. [00:24:43] Personally, this is very much for debate. Um, I’m not sure if that’s hugely helpful, um, because if you decriminalize you, you, people will still access the black market. Um, and there’s some very good people on the black market. I have to say, but equally, there’s the quality of the product is by no means guaranteed. [00:25:03] People will go to the black market they don’t know quite what to take or how to take it. They don’t know quite what’s in the product they’re getting, even if it’s a good product. [00:25:10] And all will happen if we decriminalize is that they won’t be criminally prosecuted for that. So it doesn’t really take us further forward in terms of getting a good quality, consistent, safe medicine. [00:25:23] So personally, and I understand the decriminalization argument, but personally, I would like to see a legalization rather than a decriminalization, and that will help I think, to take it out of the hands of the criminal market and get a good quality consistent product into the hands of those that, that badly needed. [00:25:42] You can argue that it should, it shouldn’t be medicalized and therefore with all the paraphernalia of clinics, and prescribing and those costs, um, I can see the argument that it’s certainly, it’s a plant and it should be allowed to grow that plant. Um, but I think there is a case to be made for at least having some medical input. [00:26:00] So, or at least professional input call it that I don’t think it has to be medical actually, um, that people can be prescribed safely and securely with a good quality safe product. Um, so I think there’s a downside to opening the market totally. And I’m not totally in favor of decriminalization as opposed to legalization, but that’s controversial and there I’m very happy to be controversial, but that will be my view. [00:26:27] I think we need to ensure there’s a good quality safe product is number one. I don’t think you get that necessarily by decriminalization. [00:26:37] Dr. Maria Hubmer-Mogg: Thank you so much. Um, another question from a steering committee member, Christoff Plothe from Germany, “If we isolate just a handful of active substances for pharmaceutical use, how much synergy of the other ingredients do we lose and how much do we increase potential for side effects in your opinion?” [00:26:57] Professor Michael Barnes: I think we lose quite a lot of, um, the efficacy of the plant by taking out the individual components. You can of course do that as what’s been done for Epidelix, which is CBD isolate largely and Sativex, which is THC and CBD isolate largely, um, you can do it, but as well, I think the entourage effect is undoubtedly scientifically, um, definite and you get a much better response from the whole plant. [00:27:23] So I think taking the components of the plant out, you don’t get such a good responses leaving them in. And of course, other than THC and CBD. We don’t know that much about the efficacy and what the other components do. [00:27:36] We know a little bit about CBG, maybe CBN, tiny bit about CBC, but we don’t know much about all the 140 others or so, and let alone that much about how the turpines helped direct the efficacy of the cannabis plant. [00:27:52] Um, so personally, either I’ve said before, I understand the reasons for taking out the component plants and isolating them and pushing them as a medicine because it’s easier to get them approved. They are medicalized, if you like then. I think you use the goodness of the plant and the overall efficacy of the plant and the isolates need a higher dose and they have more side effects, about twice the dose. [00:28:16] Um, I can’t say twice the side effects that’s too simplistic, but more side-effects or incidents of side effects for isolates. So I think if we’ve got a plant and it’s safer over the lower doses, let’s use the plant and let’s not try and pharmaceuticalized it. If that’s a word. [00:28:33] Dr. Maria Hubmer-Mogg: One more question. “Given the reality that millions of people will need palliation of symptoms from Jap injuries, what can be done to make it available in countries where it has been not been legalized?” [00:28:48] I mean, we heard, um, somehow an answer to that already, but maybe again? [00:28:53] Professor Michael Barnes: Yeah, well it’s politics, isn’t it? Um, it’s political view. I, I, there’s no doubt that the dominoes, if that’s the right phrase against cannabis, are falling. You know, we now have 55 countries where it’s legal in some shape or form. Um, it will come globally. [00:29:11] Uh, but equally we all know there will be some countries where it’s going to take many years because it’s got such a deeply entrenched stigma against it. Um, but it’s surprising. I mean, Thailand has now become legal and, uh, you know, they were very, um, very draconian drug laws until quite recently. So I think we might be surprised how we get it to more people worldwide, which is needed is cause very good question, but there’s no quick way of doing that. [00:29:38] I think one way is to release the countries, from the constraints of the UN single convention that is, as we said earlier, that’s one thing then I’m sadly to say it’s a lot of lobbying and pushing politics in individual countries. I think it will be helped when, I think Europe or Europe will become generally legal, fairly soon, particularly of large countries, such as Germany, uh, where it’s legal now, medically and soon will be legal from adult use. [00:30:07] Um, then I think we’ll see neighboring countries think, well, we can’t have everyone going to Germany for them. It’s, uh, we better make illegal here. So I think it will go in blocks if you see what I mean. Um, and I think it will spread through what is north and south America. [00:30:20] It will be really helpful if, if the legal restrictions in America were relieved federally, then we’d have a lot of expertise from the states, um, coming to be more accessible worldwide. [00:30:32] Uh, I’m afraid it’s, um, there’s 198 countries in the world, isn’t there? There’s 55. Yes. We’ve got another 140 countries to influence. So, um, there’s a lot of work to do, uh, but a lot of people do need access to this medicine very desperately. And for many people it will be too late when it’s legal in their particular country. [00:30:50] So all we can do is bit by bit chip away and, uh, we will get there in the end. [00:30:56] Dr. Maria Hubmer-Mogg: Yeah, absolutely. Right. So just another comment and one question and, um, so I think then we can move on to our next speaker and we have a comment from our lovely friend and lawyer from Australia. Hi, Charles. Um, hi to Australia. Um, he, he has a comment and he says, “Pharma is definitely trying to control the cannabis game. It must be resisted. The entourage effect is real, isolates are extreme to enable pharma to control this wonderful plant. So just maybe a comment on, on the whole situation? [00:31:28] Professor Michael Barnes: Yes, now sadly, you know, right, this is a threat to the pharmaceutical industry because when cannabis is introduced, you have less prescription of opioids, less prescription anti anxiety, medication, less prescription of anticonvulsant medication. [00:31:43] Um, so yes, it is a threat to the profit, the bottom line of big pharmaceutical companies. And I would, that’s, um, you’re right. Sadly, those companies will only develop isolates because the only way they can. Um, push the plants through the pharmaceutical route and you’re quite right that you lose the entourage effect and we can’t become patent the whole plant. [00:32:05] So pharmaceutical industries are not going to be interested in the whole plant. Um, so again, that’s a little bit of a negative. I know, sadly, I don’t want to sound like a conspiracy theorist, but we know there is lobbying going on from big pharma and for the big successful cannabis companies, stop others coming into the sector and preserve their profits. [00:32:24] Sadly, I hope that doesn’t happen, but I fear it will because when profits are involved, sadly industry reacts against the chipping away of their profits. I’m afraid that statement is not controversial just a statement of fact, uh, so we need to keep pushing the fact that it’s the full spectrum, the whole plant that is more beneficial than individual components. [00:32:45] And we to keep that message going. [00:32:48] Dr. Maria Hubmer-Mogg: So thank you for your comment on that. And then last question somehow, um, sums it all up. Um, it is again, “Do you think the cost could be substantially less if one has access to the plant rather than the pharmaceutical product?” [00:33:01] Professor Michael Barnes: Uh, yes, you can. Cannabis is cheap. I mean, it grows by the road side. Um, you can grow basically good quality cannabis for about 10 cents a gram. Um, generally, if we could equate it with dried flowers, people need about a gram a day, give or take. So, you know, that’s 10 cents a day, uh, 70 cents a week. Work it out for yourself. [00:33:21] That’s, comparing many medicines, that’s remarkably cheap. Now, obviously you’ve got to pay people to grow it. They need to, they need to be paid to grow it. It will need to be packaged. It needs to be extracted. It needs to be exported. I mean, there’s a lot of other people in the supply chain when it comes to the consumer. But to put a price on it in the UK now, which is artificially because there’s not many people prescribed it. [00:33:45] We’re looking at about five pounds Sterling a gram, which is actually cheaper than the street price. The average street price in the UK is about nine pounds Sterling, a gram. So even now we can provide prescription cannabis cheaper than the street cannabis. But with volume and, um, better supply chain, um, it can become even cheaper than that. [00:34:11] So it is, it’s not an expensive medicine. It is a cheaper medicine and that’s another good thing about it. And of course we shouldn’t forget the cannabis plant and the hemp plant, which is the same family, it’s remarkably good for the environment. It’s brilliant at carbon sequestration, it’s good at soil cleansing. [00:34:28] The rest of the plant is very good for its fiber. Hempcrete for the developing world for growing, um, you know, houses and, uh, we, even cars and even airplanes built of hemp. Um, so as, a, as a, as a very environmentally friendly product, we shouldn’t forget the rest of the plant is remarkably useful. [00:34:47] And, um, in going to go back, I’ll stop talking for a second, the days of Henry the Eighth in the UK, he obligated every farmer who had 50 acres of farmland to grow one eighth of one acre. It’s an old English area of hemp. So even in those days, we should go back to the days of Henry the Eighth and obligate farmers, with the least amount of land, to grow hemp for the benefit of the environment and the product of it, for the benefit of health. [00:35:14] Dr. Maria Hubmer-Mogg: Absolutely. Thank you. Thank you. Um, great presentation and for these words in the end. So I hand over back again to my lovely steering committee member Katarina Lindley. [00:35:26] Dr. Katarina Lindley: Professor Barnes, thank you for your wonderful thoughts on, uh, medical cannabis and its importance in medical treatment of many, many different diseases. [00:35:37]