Recently I looked at the medical cannabis clinics on behalf of the patients I support and fight for. The scheme is still very much in it’s infancy and needs our assistance to make it what it needs to be. The regulations although complex and expensive for business don’t actually offer the needed protection for patients, so it can be a pretty cowboy industry currently with the black market in many instances beating it on quality and professional service. Saying that it can be what is needed on the medical side and once adopted widely will help with the arguments for the recreational side as an alternative to alcohol which is not for all.
There are 6 different clinics I’m aware of… http://www.cannabisaccessclinics.co.uk, http://www.integroclinics.com, http://www.myaccessclinics.co.uk, http://www.medicalcannabisservices.co.uk, http://www.sapphireclinics.com, http://www.themedicalcannabisclinics.com.
The Medical Cannabis Clinic partner with prof Nutt’s project21 which collates your data to contest with NICE/NHS over the need for medical cannabis and the conditions it is working for helping the fight for cannabis freedom and also giving you discounted appointments and products for being a part of the scheme. Sapphire also have their own scheme collecting the same data for a discount on appointments and products but I guess intend to sell or use this data commercially, but I’d guess stil helps the fight a little. There may be others above who do similar to this I’m not currently aware of.
Sapphire attracted me as they offer to take the hassle out of obtaining your doctors notes which can save a few weeks of back and forth with some doctors. However in practice this is hit and miss for two reasons. One the clinics don’t charge for this service but obviously it costs them in staffing to do this so they try to keep it as simple as possible and I feel send a generic email/fax to the surgery, and often don’t follow up etc. Two the surgeries are often resistant due to confidentiality or their views on medicinal cannabis and or the patient, so they need to be reassured, pestered or threatened with action if they don’t comply, which is something the clinics don’t have the funds for as they don’t and can’t charge for this work. I find it’s best here to write a letter to your doctor specifically targeting the conditions and treatment information for your qualifying conditions. Getting it to the clinics can also be tricky but if you press them they will give you a postal address, failing that you need to scan and reduce the image size as much as you can and even batch send the scans to the clinic to avoid them being too large for email.
Due to the very tight operating costs associated with the clinics they haven’t really tuned their processes well or bought in the right systems. Now they are operating it makes it harder to tweak these processes and systems and replace systems not fit for purpose. Even the consultation required to get this right is out of their budget so they go for the simplest offering that will just do. This leads to what we used to term in the IT trade as helldesks, running helldesk software, which is hell for the operators and hell for the customer. It leads to them answering communications in strict order, rather than looking at all comms and responding to the incident as a whole. Trying to close tickets as quickly as possible vs efficiently as possible for customer and business. Inability to receive and attach some types of data to tickets etc. Thankfully most of these issues are easily resolved by getting them on the phone, which will hopefully give them a kick to fix up their systems and process as having operators tied up on calls is expensive as hell in this scenario.
This is echoed in consultation booking and payment handling where the systems are cheap or not fit for purpose and the process around them weak or illogical. Adding to that during covid many are dealing with voice conferencing for the first time in their life so it’s quite common for them to fail to join sessions, set expectations the software can’t match on all platforms. If this happens you are supposed to call a hotline number but a lot of these consults are out of hours if you can schedule for during business hours to avoid a wasted evening etc.
Once all your notes have been reviewed, agreements signed, consultation booked and consultation payment paid you will see the doctor either at surgery or via video conference, note this is the first payment for the service and this payment goes directly to the doctor and as the consultation, especially when you factor in the later board discussion before they prescribe costs more than what they charge you for consultancy fee. So at this point they need to prescribe to you just to break even else they will make a loss. The consultation is mostly about checking your doctors notes which surprised me as I felt that could have been done prior to the call. They also run though some safeguarding type questions before a brief chat about your conditions and experience with medicinal cannabis. Sadly this is a very brief chat as they are very underskilled here and only just about understand THC and CBD as a concept so the safeguarding etc takes priority and they often dismiss things they are being told I feel due to their lack of comprehension. There is little knowledge on products, administration methods, and how it helps conditions. This means you as the patient here need to be informed and assertive to get what you need for conditions and avoid things you don’t need. For example, overpriced products like CBD only preparations cheaper elsewhere, non suitable products(could be terpenes that will have a negative effect, or consumption methods that don’t work for the patient), un effective or dangerous dosage in terms of amounts and timings, bad quality products like ground full plant or terpene removed or even mould. The compassion clubs and orgs and caregivers can help here to ensure all taking this path are as knowledgeable as they can be until we can pressure the clinics to insert someone knowledgeable between the doctor and the patient who can truly understand and liaise with the doctor on their behalf. These doctors are risking a lot to prescribe too so it’s in their interest to skill up but currently they don’t have a source to do this, again some of the larger compassion and education orgs can help with this and a few are currently running courses for health and law professionals. We need more of these and more professionals to be aware and sign up.
There are some very dubious company hierarchies and commercial agreements at work here too. So as mentioned previously the consultation and service is a loss up until prescription kickback rolls in. This pushes clinics to prescribe products they get a bigger kickback on. To achieve these the clinics that are owned by large holding groups(investors) also own a dispensary and a brand. So they favour their own dispensary and brand and this factors higher than patient needs unless you are assertive and pull them on it. If that fails they then have commercial agreements with other dispensaries so they still get a little kickback again influencing prescription. This is why most seem to receive exactly the same from a clinic and the big push for cbd only products as the markup is huge! If your clinics dispensary doesn’t have what you need don’t be shy in asking them about other dispensaries/brands, you don’t have to buy what’s prescribed and can buy just what you need from the list prescribed. Below is a small table showing some of the groups, their dispensary, and their brand:
Group – Clinic – Dispensary – Brand
LYPHE – The medical cannabis clinics – Dispensary Green – NOIDECs
EMMAC – Sapphire – CBPM – Adven
IPS/Grow Pharma – Integro – Grow
It is a wonder to me that government does not want what they term as criminals in this space profiting from the sales of an illegal drug. However they don’t do a lot to ensure that big business(big pharma, and in the future alcohol and tobacco industry) act responsibly in putting patients need before profit and instead allow them to create business plan that depends purely on selling medicinal cannabis to patients when they also prescribe the products. This reminds me of the opioid epidemic in the states where doctors had been incentivised to sell opiods to those who don’t need them. With this being a new industry and a slight monopoly due to the issues with obtaining licenses etc it definitely needs more government scrutiny to keep it honest else it will end up like snakeoil cbd sellers we have seen plague the community in the early CBD adoption period. There is a danger to asking the government to regulate here again though in that they may sight this as a failure and remove the scheme totally, so we need to take this to allies in politics for advice on how to move forward.
If you need assistance with this contact your local compassion org who should be able to help, if they can’t contact Bristol Compassion Club and we will do what we can to assist them to assist you and their members.