Dr Sunny Nayee Answers Patient Questions – Part 1

Last week, Lyphe hosted their first live Q&A session with their Medical Director and Pain Consultant, Dr Sunny Nayee. The exclusive event gave many patients the chance to ask anything they wanted to know, and gave us the chance to give some great insights into how medical cannabis works.

For those who weren’t able to attend the event, you can read all of the questions we got to and what Dr Sunny had to say below now:

What advice would you give to someone with regards to the stigma around both the illicit use of medical cannabis in their work and social setting?

“That’s a tricky question that I get a lot from patients during consultations. I think there is still a stigma associated in workplaces and social settings, partly due to the smell when a patient’s vaporising cannabis and, also, perhaps due to a lack of understanding as well. In terms of specific advice that I give people, I think it’s worth noting that this is a legal route to accessing medical cannabis. It’s OK to share your prescription, and I’m happy to do that with employers. I’ve had patients go through to occupational health and inform them, because it’s quite a novel medication.

Quite often, occupational health gets in touch with the clinic and they check in with us, and we’re happy to share medical records, of course with the patient’s consent, and help anyone who’s having particular problems or issues.

We try to educate and share the knowledge, and I think the best advice I can give would be to try and be as open and honest about using this medication as you can. If you’re on morphine or something similar, or you’re having other health-related issues, you’d share that with your employer so I’d encourage you to do the same in this instance.

If that then means that occupational health has to go through certain checks, we’re more than happy to support patients with that.”

What is the cost of treatment, and what is the difference between the CBD and THC cannabis you prescribe?

“I’m pleased to say that the cost’s been coming down.

I remember when medical cannabis first started out in the UK, probably just over a year ago properly, and it was really expensive. There was only one brand that was available for medical use, and that was from a Dutch range – the Dutch being the European pioneers for medical cannabis based patients. We were paying in excess of thousands of pounds a month for that.

In terms of treatment costs, if you’re in the UK and the price is a concern then Project 21 is a great route. This caps prescription costs to one hundred and fifty pounds per product per month. That’s thirty grams of flower or thirty minutes of oil. We do appreciate that there are other ongoing costs, such as consultations, and it can sometimes be expensive for patients.

It can be tricky if patients, for example, are disabled and don’t necessarily have a high income – but I do think that it’s reassuring that the general trend is prices coming down. I’m hoping that will continue going forward.” 

Can evidence be shown for muscle spasticity that takes into consideration patients with special needs accessing medical cannabis?

“There are some areas that allow the use for medical cannabis in this instance, one of these are based on a set of conditions – such as multiple sclerosis, and the specific spasticity that comes with this.

If patients do suffer with spasticity, I would encourage perhaps speaking to their neurologist, if they have one, to see whether they’re eligible for any state funded medical cannabis to treat this.

As far as I’m aware, a patient that has multiple sclerosis has set criteria that takes into account how the NHS can strategically treat this with balanced cannabis bullets in terms of the CBD and THC ratio, and that’s given in terms of spray type formulas, put right to the back of the mouth.

So I would say, with regards to spasticity, do speak to your GP or  neurologist. There is a new drug on the market that particularly targets neck and back spasms called Mayo Pradhan. This is something that’s free and completely non-addictive, so, whilst cannabis has a role in treating this, this is also a good starting treatment. There are also a whole range of other treatment options that you could consider, too.”

Would you recommend medical cannabis as an option for someone with particular pain around a wound and scar tissue other than pregabalin, which is causing many gastrointestinal side effects?

“This isn’t a caveat or specific advice for any particular patient but, in terms of this as a condition, I’m seeing a lot of my NHS pain clinic patients with post-surgical scar pains after operations that are using medical cannabis. If you’ve got an injury like that, I would recommend asking your GP to refer you to a pain clinic as there are lots of techniques out there.

What I always tell my patients, whether they’re seeing me in my medical cannabis cape or through the NHS, is to start to think of pain as a pyramid. You’re going to start off with all the simple treatments first, and then you move up the ladder to some more invasive treatments to try and keep the risks as minimal as possible.

There may be other treatments out there, such as pulsed electrical neuromodulation treatments, but if you’ve tried and failed all of these more conventional treatments then, of course, you can have a chat with one of the doctors at TMCC and we can look at what the best route would be for you.”

Do you think patients will ever be able to grow their own medical supplies? 

“There are various petitions going through parliament at the moment with regards to this, but it’s currently still illegal. Depending on the local police force, I think the ways this is dealt with vary.

Medical cannabis is very, very new in the UK – especially compared to other countries, and I think the only way that laws will change is by patients signing petitions and engaging politicians so that there can be an open, friendly debate about the pros and cons of using cannabis medicinally.

I don’t know of any impending changes with regards to this, but I know that there are various people lobbying for laws to be changed.”

To see what else was asked in this session and what else Dr Sunny had to say, read the second part of our blog on the event next week.