The second day of Cannabis Europa London 2023 began with a look back at the early beginnings of the cannabis business, following an engaging first day of panels centered on the sector’s future.
Raphael Mechoulam, the ‘Father of Cannabis Research,’ who passed away in March at the age of 92, was honoured before the opening session of the Barbican’s theatre by regulatory expert Esther Farkash. She described how Professor Mechoulam, who spent 60 years researching cannabis and the endocannabinoid system, started his illustrious career by connecting with officers at the local police station, who provided him 5 kg of cannabis from the evidence room to start his research. “This is why we understand THC and CBD today,” said Ms. Farkash. Following his conclusion that there must be a “built-in system in our body that reacts so strongly to these compounds,” he spent the next 30 years studying the endocannabinoid system, publishing over 700 papers for some of the finest scientific journals in the world, and formulating the rules for how patients should be treated with medical cannabis. “I would like to finish with a sentence he used to mention time and again: ‘Modulating the endocannabinoid system may have therapeutic potential to treat all forms of diseases’. Thank you all for continuing his work and vision.”
The day concluded with a lecture by Professor David Nutt, another pioneer in the cannabis sector, who provided the audience with an inside look at the ground-breaking Project Twenty21 project run by Drug Science. Prof. Nutt described the ‘truly remarkable’ results of a three-year study exploring the impact of regular cannabis usage on a number of particular diseases and on the patients’ general wellness that involved almost 3,000 participants. After three months of consistent use, patients’ baseline reported overall health indicators significantly improved, with almost 50% of those with chronic pain and another 41% of those with mental illnesses like anxiety experienced improvements.
Reports of depression-related symptoms significantly dropped, “easily as much as antidepressants,” while improvements in sleep quality were likewise “highly significant” and patients’ self-reported anxiety measurements nearly halved. “That is massive. I doubt if any trial on anxiety has had an effect size that big.” Patients who suffer from chronic pain and PTSD also noted a significant improvement, which is “very, very satisfying for patients.” Additionally, patients who were already employing opiates to treat their health related issues, noticed a marked decrease in their consumption – with the milligram morphine equivalent (MME) starting dose falling from 44 mg to 19 mg. “We didn’t direct any alterations in medication. I want to emphasise that these are patients that are choosing not to use opiates. And this is untargeted. It’s almost certain we could do better if we made the effort. I think now this is evidence enough to warrant proper systematic assessment because the evidence we’ve provided for tolerability and efficacy is unquestionably outstanding.” – Professor David Nutt.
Day two’s agenda included a panel of specialists who spoke in-depth on cannabis’ ability to treat lengthy COVID, a condition that is anticipated to impact 2 million people in the UK by January 2023. Hannah Thurgur, a senior research officer at Drug Science, began by detailing that the six-month phase-two feasibility study’s primary goal was to determine the safety of treating these patients with a CBD-dominant compound. It also sought to investigate the impact of cannabis on the patients’ quality of life, fatigue, depression, and anxiety. Albeit the sample size of 12 participants was “smaller than we would have liked,” the decrease in symptoms (even after coming off the cannabis medicines) showed promise, she said. Founder and Medical Director of the London Resilience Clinic Dr Dani Gordon said: “At least you have set the groundwork for someone else to come in and do the next phase of this study. These things are so bureaucratic, so this is a really important piece of work.” Dr. Gordon continued by saying that she had discovered that using cannabis to treat chronic fatigue as part of an integrated medicine strategy was conducive in encouraging patients to stay on track with their treatment programmes. “If we can get them a little bit more energy, then they can engage with the rest of the programme. Cannabis is a catalyst for them to engage with the next steps of their programme. Cannabis is the only thing I have found that can do this.” The discussion on the types of research undertaken on medicinal cannabis, its price, and its worth to patients and the medical community started at this session and continued throughout the day. Although it was suggested that some of the speakers discounted real-world evidence in favour of RCTs, Ms. Thurgur argued that is “real value in trying to see how more reflective representative populations of patients respond to different types of cannabis-based products, as well as being able to have this more personalised approach to that diversity”.
This issue was covered in significantly deeper depth with a trio of individual interviews concerning the evolving position of the pharmaceutical business in the European cannabis market. Robin Emerson, Managing Director of the Jorja Emerson Centre, said that the sector needs to “do a lot more hard work” to offer the clinical proof needed to advance the sector in the UK. Terry O’Regan of Brains Bioceuticals mostly concurred, noting that the sector was “restricted because no one’s doing those clinical trials”, implying that research is in early stages. “It breaks my heart when I see these failed cannabis studies, and I wonder whether it really didn’t work or they just didn’t do the due diligence in dosage. These studies are giving a negative impression of this industry, and the last thing we want is for it to be relegated to sort of homoeopathic medicine.”He argued that involving the pharmaceutical business was critical in order to obtain funding ffor this “expensive clinical research,” but in order to succeed in doing so, the sector needed to “hold ourselves to the highest standards.” Finally, Curaleaf’s Chief Medical Officer Dr Mikael Sodergren fought back, pointing out that real-world evidence was becoming more generally acknowledged in the medical community. “The MHRA, the EMA and the FDA have all released press releases stating that they are very happy to use real-world evidence to accelerate drug development. Now, real-world evidence will never replace clinical trials – that won’t happen – but it certainly has a role to make the process faster and cheaper. We have this feedback loop which is not available to pharma in traditional drug development, and that is real-world evidence. This kind of recording programme is something that can be uniquely applied to medical cannabis.”
Despite the increasing momentum of cannabis research throughout the continent, the concurrent momentum of adult-use markets threatens hinder the former’s development.
Aras Azadian, CEO of Avicanna, told a panel discussing the rising “identity crisis” in the adult-use and medicinal industries that there was “a lot to learn from Canadian mistakes. We always pushed for medical to be prioritised – we saw the opposite. The industry was so focused on getting rich from rec, which never happened, that the medical market was neglected. Because we knew rec was coming, we had medical companies that were really just recreational companies. The medical community was misled to believe there was going to be investment in trials and then no one saw that…The medical community has been completely upset by what happened.” He said that when the recreational market entered the picture, physicians were no longer engaged with this sector or eager to be educated, with many expecting that potential patients would just resort to the recreational market.
In response to Germany’s decision to’step back from rec,’ he claimed the news was “fantastic for patients.” Dr. Kojo Koram of the University of London stressed this fact, saying: “I think there is a sense among some policy makers that the issues with medical cannabis could be solved by a recreational market, allowing patients to access that medicine through those pathways. This runs the risk of undermining the legitimacy of both markets.”
Boris Moschowitz of Alephsana said in a later session focusing on the reasons to be enthusiastic about Germany’s recent changes, said that he felt Germany could still be a leading example for cannabis legislation. Unlike in nations such as Luxembourg, Spain, and Portugal, where law is ‘not executed well,’ he believes Germany has a “true will to execute what they put on paper. If we can put that energy into all of the other European countries together in one direction, I’m quite confident we’ll succeed.”