Written for Business of Cannabis by Releaf.
General Practitioners (GPs) are on the frontline of healthcare in the UK, and represent the primary touchpoint for patients hoping to get treatment.
Yet, unlike in places like Germany, GPs are unable to make an initial prescription for medical cannabis for patients in the UK.
The initial prescription for cannabis-based medicinal products (CBPMs) must come from a GMC-registered specialist, with most prescriptions being issued by private medical cannabis clinics like Releaf.
However, they are able to issue repeat prescriptions once a specialist has granted an initial prescription, alongside conducting follow-up appointments and to ensure the treatment’s efficacy and providing repeat prescriptions.
At Releaf, patients are assured of a supportive experience from both specialists and GPs. To illustrate this, Dr. Harrison Offiong, a GP at Releaf, shares insights on working in the medical cannabis field and what patients can expect during follow-up appointments. Read his insights below.
Q&A with Dr Harrison Offiong
So, Dr Offiong, when did you first decide to become a GP?
“Growing up, I always had a fascination with the human body, and how things work. My dad noticed this and said ‘I think you should become a doctor’ when I was around 8 or so, and of course, him being a Nigerian father – I wasn’t going to argue! I’m joking of course, my father nurtured my curiosity, and I’m glad I chose this path.
I qualified as a doctor in 2006, then in 2009 I moved to the UK and did a master’s degree in Public Health, followed by successful stints working in A&E, and General medicine, until I started my GP training in the West-midlands, and I finally felt it was the right fit for me.
Although it did take me a while to settle on a speciality post qualification, in hindsight this gave me valuable insights into different areas of medicine, and varied experiences overall.”
And, what led you to the medical cannabis field?
“While working as a GP during the pandemic, I started to look into medical cannabis. This started innocently and organically; I came across a blog post about cannabis’ therapeutic potential in 2020, and ever since I’ve been determined to find out more.
I kept on asking questions as to how I could work in this field as a GP. Pretty early on I became a member of the Medical Cannabis Clinicians Society, and later I joined Releaf, where I now oversee existing medical cannabis patient’s treatment plans, hold appointments, sit on multidisciplinary review teams, and issue repeat prescriptions under shared care.”
Q: Why are GPs allowed to issue repeat prescriptions for medical cannabis patients?
“In the UK, there are over 95,000 doctors listed on the General Medical Council’s Specialist Register that can issue patients with an initial prescription for cannabis based medicinal products if they believe they may be a suitable or appropriate option for them.
However, in reality, only 0.25% of these are believed to have ever issued a prescription for cannabis-based medicines, and so, appointments with these specialists can be hard to come by.
There are a number of reasons as to why GPs can issue repeat prescriptions for medical cannabis patients, and the most evident is to take the burden off these specialists. By allowing GPs to monitor these care plans too, we can reduce patient waiting lists times, as well as reduce the probability of disruptions during treatment, and ensure each patient receives effective treatment monitoring and safeguarding.
Now there are over 70,000 GPs actively practising in the UK, I’m hoping the number of those working for medical cannabis clinics like Releaf increases, and we can help to get more patients the right treatment for them. But ultimately, I hope that in time, these legislations may be altered so that GPs like me can practice with more freedom, and have the same opportunities specialists do in terms of helping as many patients as possible.”
Q: What can patients expect when they see a Releaf doctor?
“When patients come to Releaf, they can expect to interact with healthcare professionals who are genuinely committed to helping them manage their health, and underlying medical concerns.
As a doctor, I feel it’s important to build a therapeutic relationship with patients and develop a good rapport. I also think because these patients have often been let down by the options they’ve previously tried before arriving at Releaf, it’s even more important we get it right.
We want patients to be able to be honest and open with us, and feel comfortable discussing any aspect of their health or medication, to make sure they’re getting as much benefit as they possibly can from their medical cannabis treatment, and can continue to do so.”
Q: How frequently should medical cannabis patients see their doctor?
“Four weeks after their initial prescription for medical cannabis or cannabis based medicinal products is issued by Releaf, all patients should expect to have a follow-up appointment.
For more complex conditions or cases, this is likely to be with the specialist they had their initial consultation with, but for others they may get the chance to meet with me, or one of the other wonderful doctors in our team.
Once their treatment is stabilised and working effectively, medical cannabis patients at Releaf should expect to see a clinician every quarter, or once every three months.”
Q: What happens during these follow-up appointments?
“During follow-up appointments, we ultimately discuss how the patient is doing and assess how effective their overall treatment with medical cannabis has been. Thankfully, most of the time, these results can be seen quickly.
In these check-in appointments, we speak about the symptoms the patient was previously experiencing the most trouble with, and how they’re doing now. We’ll also ask how they’re getting along with medication titration, and see if any adjustments to dosing quantities or routines should be made, or if they’ve encountered any side effects that need addressing.
It’s important to have these regular appointments to not only track any developments or progress, or make any kind of adjustments, but also to help build a genuine, trusting relationship between the patient and practitioner, so that we can address any additional health concerns that may arise.”
Q: What happens if a patient is experiencing side effects from their medical cannabis treatment?
“There are a few side effects that are mentioned more frequently than others in follow-up appointments with medical cannabis patients, especially those new to cannabis. However, thankfully, the majority of these are minor, such as feeling tired, and can be easily treated by making adjustments to their medication concentration, dosing quantities, or dosing routines, which just have to be signed off and approved by a specialist after the appointment.
Other common side effects include experiencing a dry mouth, red eyes or an increased appetite. These side effects can usually be tackled relatively easily by staying hydrated, using over the counter lubricating eye gels, and by meal planning to avoid overeating, or stocking up on healthy snacks to curb hunger pangs.
But, if for some reason a patient experiences side effects or adverse reactions that are serious, and that cannot be rectified by altering their cannabis-based treatment plan or implementing external measures such as the aforementioned, we’d take a different approach. In these cases, we’d re-evaluate their symptoms and treatment goals and signpost them to an alternative treatment approach, or to where they could get a second opinion.”
Q: Why is it important for medical cannabis clinics to have a varied clinical team?
“I think it’s really important that medical cannabis clinics have a varied team of healthcare professionals. From specialists, to generalists, to nurses, and pharmacists – everybody plays an essential role in patient care, and we all offer different expertise, experiences, and insights.
Our daily multidisciplinary team reviews are really enlightening and provide a great platform for open-minded discussion and collective approaches to healthcare, and Releaf’s patient support team help provide patients with coordinated care, and enhanced communication.
When all these cogs are turning and working smoothly, patients can receive the best possible treatment, support, and overall care. And ultimately, that’s why they’ve come to Releaf in the first place.”
