Managing medication side effects: Why more patients are exploring medical cannabis

Getting a medical cannabis prescription in the UK

As mentioned above, patients can now receive a medical cannabis prescription for a wide range of conditions. The vast majority of these prescriptions are granted by private clinics like Releaf medical cannabis clinic, while prescriptions through the NHS remain extremely limited. 

Several conditions must be met before cannabis-based medicines can be prescribed. These are namely:

• Only doctors who are registered on the General Medical Council’s (GMC’s) Specialist Register can write initial prescriptions for medical cannabis. 
• Patients can only be prescribed medical cannabis when they have been prescribed at least two conventional medications that:
• Did not achieve the desired treatment outcomes;
• Were associated with risks or side effects that outweighed their clinical benefits.

Despite these conditions, the number of medical cannabis patients in the UK has been steadily on the rise - and interest is only increasing. Unfortunately, much of this interest stems from the potential risk of side effects associated with many conventional medications, many of which are routinely prescribed for a significant number of conditions. 

So, let’s take a look at some of these medications, their risks, and potential side effects.

Opioid side effects

Opioids are a class of drugs that are derived from or mimic the effects of substances found in the opium poppy. They include both pharmaceutical medications, such as oxycodone, codeine, and morphine, and illegal drugs like heroin. Their pain-relieving properties have made opioid medications a common option when treating conditions associated with pain. 

It is estimated that between 50% and 80% of patients in clinical trials experience at least one side effect from opioid therapy. The incidence in everyday use may be even higher. Common side effects of opioids can include:

• Drowsiness
• Constipation
• Nausea and vomiting
• Pruritis (itch)
• Myoclonus (involuntary twitch)
• Sedation
• Respiratory depression
• Delirium

Despite the risk of these side effects, 2021 data shows that over one million people in England were prescribed opioids for more than three months. In recent years, significant efforts have been made to reduce this number and provide patients with alternative pain management options. 

Non-steroidal anti-inflammatory drugs (NSAIDs) side effects

NSAIDs are a class of medications that are routinely used to treat pain, inflammation, and fever. They work by blocking cyclooxygenase (COX-1 and COX-2) enzymes. In turn, this blocks the production of prostaglandins - hormone-like chemicals that are associated with pain and inflammation. Examples of NSAIDs range from over-the-counter medications such as ibuprofen and aspirin to prescription medicines like celecoxib, diclofenac, and etodolac. 

While NSAIDs can be effective in managing pain and inflammation in a wide range of conditions, they can also be associated with significant side effects, particularly over the long term. According to data, NSAIDs may be responsible for 30% of hospital admissions for adverse drug reactions in England. Some side effects of NSAIDs can include:

• Bloating
• Stomach pain
• Nausea and vomiting
• Constipation
• Diarrhoea
• Dizziness
• Stomach ulcers - which can cause internal bleeding and anaemia
• Headaches
• Allergic reactions

NSAIDs can also interact with other medications, increasing the risk of side effects.

Selective serotonin reuptake inhibitors (SSRIs) side effects

SSRIs are the most widely prescribed antidepressant. They work by increasing the amount of serotonin - a neurotransmitter that regulates several functions, including mood and sleep. As such, they can be effective in managing mental health conditions including depression, anxiety disorders, and post-traumatic stress disorder (PTSD). Common SSRIs include fluoxetine (Prozac), citalopram, and sertraline. 

In recent years, the prescription of SSRIs has been on the rise. Data shows that 45 million SSRIs were prescribed in the UK in 2021/2022, up 35.2% compared to 2015/2016. SSRIs are associated with a number of undesirable side effects, some of which may make them intolerable for some patients. Some SSRI side effects include:

• Headaches
• Dizziness
• Drowsiness
• Nausea
• Diarrhoea
• Sexual dysfunction

Serotonin-norepinephrine reuptake inhibitors (SNRIs) side effects

SNRIs are another class of antidepressant medication that are commonly used to treat depression and a range of other conditions, including anxiety disorders and chronic pain. They work by increasing levels of serotonin and norepinephrine in the brain. Similarly to SSRIs, this can help regulate mood, sleep, and memory. 

SNRIs can be an effective solution to symptoms of depression, anxiety, and chronic pain in both the short and long term; however, long-term use can be associated with several side effects, including:

• Nausea and vomiting
• Diarrhoea
• Dizziness
• Drowsiness
• Cardiac symptoms (including palpitations, tachycardia, and hypertension)
• Excessive sweating
• Insomnia
• Sexual dysfunction

Other common medications and side effects

Corticosteroids - This class of anti-inflammatory medicines - also known as steroids - can be prescribed to treat a range of conditions, including asthma, eczema, arthritis, inflammatory bowel disease (IBD), lupus, and multiple sclerosis. While they are not generally associated with serious side effects when used for short periods, long-term use can be linked to mood changes, increased appetite, and sleep problems. 

Benzodiazepines - A class of depressant drugs, benzodiazepines are commonly prescribed to treat anxiety disorders, insomnia, seizures, and muscle spasms. They work by slowing down the functions of both the body and the brain. Common side effects of benzodiazepines include drowsiness, confusion, slurred speech, memory problems, and nausea. 

Nonbenzodiazepines - Sometimes known colloquially as “Z-drugs”, this class of psychoactive medicine is often used in the treatment of insomnia and other sleep conditions. Z-drugs work by slowing activity in the brain which can help to improve sleep; however, they are also associated with several risks and side effects, including drowsiness, psychiatric symptoms, and an increased risk of accidents.

Medical cannabis as an alternative therapy

With so many pharmaceutical options available, it can be easy to wonder “Why do patients use alternative medicine?”. However, as we have explored in this article, many patients remain inadequately served by conventional medicines, often due to the significant side effects associated with these medications. As a result, alternative therapies such as medical cannabis are becoming increasingly popular. 

Releaf patient, Chaos, experienced significant side effects from conventional treatments, which included two strong painkillers (including tramadol) and an anticonvulsant: 

“In all honesty, I was avoiding taking it, as it was just swapping the nerve pain for terrible stomach pain,” Chaos recalls of the tramadol she was prescribed to manage her pain.

So how has medical cannabis changed Chaos’s treatment? “The most obvious difference is the lack of heavy side effects and how much more manageable my pain (and anxiety) has become. I'm a lot more relaxed now, and I find it much easier to take on the day.”

Medical cannabis can be considered for patients with a wide range of conditions when at least two conventional treatments have been unable to deliver adequate relief or have been associated with intolerable side effects. Our specialist doctors will work with you to identify the optimum dosage regime for the best outcomes. Patients with Relaf+ can book a follow-up appointment to discuss their treatment at any time.

It can be easy to despair when conventional treatments don’t work as you need them to, but there are other options available. To learn more about medical cannabis therapy, complete our eligibility assessment today.