CBPM

CBPMs encompass a broad range of products that are formulated using various components of the cannabis plant. The primary active compounds in these products are cannabinoids, the most well-known of which are tetrahydrocannabinol (THC) and cannabidiol (CBD). THC is the psychoactive compound responsible for the ‘high’ commonly associated with recreational cannabis use. At the same time, CBD does not produce these psychoactive effects and is often highlighted for its potential therapeutic properties.

The cannabis plant boasts over a hundred different cannabinoids, each with its unique effects and potential medical applications. This diversity allows for creation of a wide variety of CBPMs tailored to target specific medical conditions and symptoms. These products are available in several forms, including oils, capsules, sprays, and, more recently, more sophisticated pharmaceutical preparations.

The medicinal use of cannabis is not a novel concept; it has a history spanning thousands of years across various cultures. However, its use declined in the 20th century due to regulatory restrictions, concerns over abuse, and the development of synthetic pharmaceuticals. The resurgence of interest in CBPMs in the modern era can be attributed to a growing body of scientific research that has begun to uncover the potential therapeutic benefits of cannabinoids in treating a range of conditions.

CBPMs have been investigated for their potential to treat various medical conditions. Some of the key areas of research include:

• Pain Management: CBPMs have been explored as an alternative treatment for chronic pain, particularly where conventional pain management strategies have been insufficient. This includes conditions like neuropathic pain and pain associated with multiple sclerosis.
• Neurological Conditions: Evidence suggesting the effectiveness of CBPMs in managing certain neurological disorders, such as epilepsy. In some cases, CBPMs have been found to reduce the frequency and severity of seizures.
• Mental Health Disorders: While the research is still in its early stages, some studies suggest that CBPMs might have a role in treating mental health conditions like anxiety and depression. However, this area requires much more rigorous research.
• Cancer-Related Symptoms: CBPMs are also being studied for their potential to alleviate symptoms associated with cancer and chemotherapy, such as nausea, vomiting, and loss of appetite.

The legal status of CBPMs in the UK is a subject of considerable nuance and complexity. It is governed by laws and regulations designed to manage their use, possession, distribution, and production. This framework seeks to balance the potential medical benefits of CBPMs against the risks associated with their misuse and abuse.

Historically, the use of cannabis for medicinal purposes has been restricted in the UK. However, recent years have seen a shift in attitude and policy, reflecting growing evidence of the therapeutic benefits of cannabis-based products in certain medical conditions.

Regulation of Prescription CBPMs

• Controlled Substances: CBPMs are regulated under the Misuse of Drugs Act (1971), which categorises drugs based on their potential for abuse and medical utility. Cannabis was reclassified in November 2018, allowing for its medicinal use under strict conditions.
• Scheduling System: Cannabis is classified under Schedule 2, allowing for its prescription by medical professionals for specific conditions.
• Prescription Regulations: Strict guidelines exist for doctors and pharmacists who prescribe and dispense CBPMs, ensuring their responsible and safe use.

Licencing and Oversight

• Medicines and Healthcare Products Regulatory Agency (MHRA): This agency oversees the licencing, supply, and marketing of medicines in the UK, including CBPMs.
• National Health Service (NHS) Involvement: The NHS plays a crucial role in determining the accessibility of CBPMs, guided by the National Institute for Health and Care Excellence (NICE) recommendations.

Illicit Cannabis Laws and Penalties

• Prohibition and Criminalisation: The non-medicinal use of cannabis remains illegal, with possession, sale, and production subject to criminal penalties under the Misuse of Drugs Act.
• Penalties: Penalties for illicit cannabis use range from fines to imprisonment, depending on the severity of the offence.

Accessibility and Prescription Criteria

• Eligibility: CBPMs are typically prescribed only when other treatments have failed and in cases where there is evidence of benefit. Conditions like severe epilepsy, chemotherapy-induced nausea, and multiple sclerosis are among those for which CBPMs can be considered.
• Specialist Prescriptions: Only specialist doctors on the General Medical Council’s Specialist Register can prescribe CBPMs.

Public and Medical Perception

• Shifting Attitudes: There has been a gradual shift in public and medical attitudes towards CBPMs, influenced by emerging research and high-profile cases demonstrating their effectiveness in certain conditions.
• Continued Debate: Despite legal changes, there remains a debate within the medical community regarding the efficacy and safety of CBPMs, reflecting the need for ongoing research and evidence gathering.

Import and Export Regulations

• Regulated Import: CBPMs are tightly regulated, requiring appropriate licenses and adherence to specific quality and safety standards.
• Export Controls: Similarly, the export of CBPMs is subject to strict regulatory controls to prevent diversion and misuse.

Future Directions and Challenges

• Research and Development: The need for further research into the efficacy, safety, and long-term effects of CBPMs is widely acknowledged.
• Policy Evolution: Legal and policy frameworks continue to evolve, reflecting changes in scientific understanding, societal attitudes, and international trends.

In the United Kingdom, Cannabis-Based Products for Medicinal Use (CBPMs) refer to a diverse range of medicinal products derived from the cannabis plant. These products are utilised for their therapeutic properties, primarily targeting various medical conditions and symptoms. The classification of CBPMs is largely based on the composition and concentration of their active compounds, primarily cannabinoids.

Key Components of CBPMs:

Cannabinoids are the crucial active ingredients in CBPMs. The most prominent cannabinoids include:

Tetrahydrocannabinol (THC): Known for its psychoactive effects, THC is the compound associated with the ‘high’ of cannabis. In medicinal contexts, THC is valued for its pain-relieving properties and its ability to alleviate nausea and stimulate appetite.

Cannabidiol (CBD): Unlike THC, CBD does not have psychoactive effects. It is noted for its potential in reducing inflammation, anxiety, and seizures, and is being studied for its broader therapeutic applications.

Classification of CBPMs

CBPMs can be classified into several categories based on their cannabinoid content:

High THC Products: These products contain a significant concentration of THC and are typically used for their potent analgesic and antiemetic properties. They are often prescribed for conditions like chronic pain, muscle spasticity, and severe nausea.

High CBD Products: These products are rich in CBD and low in THC. They are primarily used for conditions such as epilepsy, anxiety disorders, and inflammatory diseases.

Balanced THC/CBD Products: These contain roughly equal amounts of THC and CBD, offering a balance of the effects of both cannabinoids. They are often used in conditions where both pain relief and anti-inflammatory properties are desired.

Cannabis-Based Products for Medicinal Use (CBPMs) are diverse, with several common types, including:

• CBD Oil: Extracted from the cannabis plant, focusing on high cannabidiol (CBD) content with minimal tetrahydrocannabinol (THC).
• Medical Cannabis: Contains both CBD and THC, prescribed for specific conditions under specialist guidance.
• Nabiximols (Sativex): A mouth spray with balanced THC and CBD, often used for multiple sclerosis spasticity.
• Dronabinol (Marinol): A synthetic THC used primarily to treat nausea and vomiting caused by chemotherapy.

Physical Effects

CBPMs interact with the body’s endocannabinoid system, leading to various physical effects. These can include pain relief, particularly in chronic pain and neuropathic pain conditions. They are also known to reduce muscle spasticity in conditions like multiple sclerosis and to alleviate nausea and vomiting, especially in chemotherapy patients. However, they can also cause side effects such as dizziness, dry mouth, gastrointestinal discomfort, and in some cases, can affect coordination and reaction times.

Psychological Effects

Psychologically, CBPMs can have a calming effect, which may be beneficial in anxiety disorders. Some formulations, particularly those with a higher THC content, can also temporarily enhance mood and create a sense of relaxation. However, there are concerns about their potential to exacerbate or trigger mental health issues in some individuals, especially with high THC products. These can include increased anxiety, paranoia, or in rare cases, psychosis, particularly if the user has a predisposition to these conditions.

Short-term:

Initially, CBPMs can induce immediate effects like pain relief, muscle relaxation, and anxiety reduction. Users might experience altered sensory perception, particularly with THC-dominant products. These effects can be beneficial for therapeutic purposes but require careful dosing and monitoring.

Long-term:

Long-term use of CBPMs, especially those high in THC, may pose risks. Physically, there could be impacts on lung health (if smoked) and potential changes in brain chemistry. Psychologically, prolonged use might lead to dependency and, in some cases, cognitive impairments or the worsening of pre-existing mental health conditions. However, when used responsibly and under medical supervision, the long-term benefits of chronic conditions can be significant, offering sustained relief from symptoms where other treatments have failed.

CBPMs have garnered significant attention in the UK for their potential to treat various medical conditions. These include:

• Chronic Pain: Particularly effective in neuropathic pain and conditions like multiple sclerosis.
• Epilepsy: Certain CBPMs have been shown to reduce the frequency and severity of seizures.
• Cancer-Related Symptoms: Used to alleviate chemotherapy-induced nausea and to stimulate appetite.
• Mental Health Disorders: Potential benefits in treating symptoms of anxiety and PTSD.
• Neurodegenerative Disorders: Investigated for their effects in conditions like Parkinson’s and Alzheimer’s disease.

Oral Consumption

Oral intake is a common method for administering CBPMs. This includes capsules, oils, and edibles. When consumed orally, these products are absorbed through the gastrointestinal tract into the bloodstream. This process, known as first-pass metabolism, involves the liver, where a significant portion of the drug can be metabolised before reaching systemic circulation. As a result, oral consumption often requires higher doses than other methods.

• Capsules and Oils: These forms are preferred for their convenience and the ability to provide precise dosing. They are particularly useful for chronic conditions requiring consistent dosing over time. However, the onset of effects can be slow, sometimes taking up to two hours, and the duration of effects can vary significantly among individuals.
• Edibles: Incorporating CBPMs into food products is a discreet method of medication. Like capsules and oils, the onset of effects is slow, and dosing can be less precise due to the variability in how different individuals digest and absorb the compounds.

Sublingual Administration

Sublingual administration involves placing drops of tinctures or sprays under the tongue. This method allows the active compounds to be absorbed directly into the bloodstream through the mucous membranes, bypassing the liver. This results in a quicker onset of effects, usually within 15 to 30 minutes, and a more consistent absorption rate. Sublingual administration is particularly beneficial for patients requiring a rapid onset of action or those with difficulty swallowing capsules.

Inhalation

Inhalation of CBPMs, primarily through vaporisation, is another popular method. This involves heating the product to a temperature that releases the active compounds in a vapour, inhaled into the lungs and absorbed directly into the bloodstream. This method provides a rapid onset of effects, often within minutes, making it suitable for conditions that require immediate relief, such as acute pain or anxiety. However, the effects can be short-lived, requiring more frequent dosing.

Topical Application

The topical application involves applying CBPMs to the skin through creams, ointments, or lotions. This method is primarily used for localised pain relief or skin conditions. The cannabinoids interact with receptors in the skin, providing relief without significant systemic absorption, which minimises the risk of psychoactive effects or other side effects.

Suppository

Suppositories, both rectal and vaginal, are used when oral administration is not possible or not preferred. This method is particularly effective for certain types of pain or when gastrointestinal absorption is impaired. Suppositories provide a rapid onset of effects and bypass the liver, reducing first-pass metabolism.

Transdermal Patches

Transdermal patches are applied to the skin and release CBPMs slowly over an extended period. This method is ideal for chronic conditions that require a consistent level of medication in the bloodstream. Patches allow for continuous, slow absorption of cannabinoids, providing prolonged therapeutic effects and reducing the need for frequent dosing.

Intranasal Administration

Nasal sprays are a relatively new method for administering CBPMs. They offer a rapid onset of effects, similar to inhalation, as the drug is absorbed quickly through the mucous membranes in the nasal passages. This method is useful for patients who cannot use oral or inhaled medication.

Other Methods

Innovations in CBPM delivery continue to emerge, including methods like nebulisation, where a liquid form of the medication is converted into a fine mist to be inhaled, and buccal administration, where the drug is placed between the gum and cheek for absorption.

Dosing Considerations

Determining the appropriate dose of CBPMs is complex and varies based on the administration method. Factors such as the patient’s age, weight, metabolism, and the severity of symptoms play a crucial role in dosing decisions. Healthcare professionals must start with a low dose and adjust gradually based on the patient’s response.

Safety and Side Effects

While CBPMs are generally considered safe, they can cause side effects, particularly at higher doses. These include dizziness, dry mouth, changes in appetite, and, in some cases, psychological effects like anxiety or paranoia, especially with products high in THC. The method of administration can influence the likelihood and intensity of these side effects.

Patient Education and Compliance

Educating patients on the various methods of administration, proper dosing, and potential side effects is crucial. Patient compliance can be influenced by their understanding of using these products effectively and safely.

The abuse of Cannabis-Based Products for Medicinal Use (CBPMs) in the UK is a complex issue, given the therapeutic benefits these products offer for certain medical conditions. However, when misused, CBPMs can lead to significant health and social consequences. Understanding the intricacies of CBPM abuse, its signs, symptoms, and consequences is essential for healthcare professionals, patients, and the public.

Signs of CBPM Abuse

Recognising abuse of CBPMs involves identifying behavioural and physical changes indicative of misuse. Here are some signs:

• Increased Tolerance: There is a need to consume larger amounts of CBPMs to achieve the same effects.
• Withdrawal Symptoms: Experiencing physical and psychological symptoms when not using CBPMs.
• Social Withdrawal: Neglecting social and occupational responsibilities in favour of CBPM use.
• Risky Use: Using CBPMs in situations where it is hazardous, such as while driving.

Psychological Symptoms

The misuse of CBPMs, particularly those high in THC, can lead to various psychological symptoms:

• Mood Swings: Rapid and unexplained changes in mood.
• Anxiety and Paranoia: Increased feelings of unease, anxiety, and paranoid thoughts.
• Impaired Cognitive Function: Difficulty in concentrating, remembering, or making decisions.
• Psychosis: In rare cases, particularly in individuals with a predisposition, high THC levels can lead to psychotic symptoms.

Physical Dependence and Withdrawal

Physical dependence on CBPMs is characterised by the body’s adaptation to the drug, leading to withdrawal symptoms upon cessation. These can include:

• Sleep Disturbances: Insomnia or disturbed sleep patterns.
• Appetite Changes: Increase or decrease in appetite.
• Physical Discomfort: Headaches, nausea, and general malaise.
• Mood Changes: Irritability, restlessness, or depressive symptoms.

Consequences of Chronic Use

Long-term misuse of CBPMs can have several adverse consequences:

• Cognitive Impairment: Prolonged use can impact cognitive functions, particularly in adolescents with still-developing brains.
• Respiratory Issues: If smoked, chronic use can lead to respiratory problems similar to those caused by smoking tobacco.
• Mental Health Deterioration: Exacerbation of pre-existing mental health conditions, such as schizophrenia or bipolar disorder.
• Relationship and Social Issues: Strained relationships and social isolation due to prioritising CBPM use over social interactions and responsibilities.

Overdose Symptoms and Management

While a fatal overdose on CBPMs is unlikely, excessive use can lead to distressing symptoms:

• Intense Anxiety and Paranoia: Severe psychological distress.
• Hallucinations: Experiencing visual or auditory hallucinations.
• Physical Discomfort: Nausea, vomiting, and dizziness.
• Management: In case of an overdose, it is crucial to provide a safe environment, reassurance, and medical support if symptoms are severe.

Addiction Risk

Addiction to CBPMs is characterised by compulsive use despite adverse consequences. It can be influenced by genetics, the product’s potency, and the use frequency.

Addressing CBPM Abuse

Addressing CBPM abuse involves a multi-faceted approach:

• Education and Awareness: Providing accurate information about the risks and safe usage of CBPMs.
• Support Services: Offering counselling and support groups for individuals struggling with abuse.
• Monitoring and Regulation: Ensuring proper regulation and monitoring of CBPM prescriptions and usage.
• Research: Continuing research into the long-term effects of CBPMs to inform clinical practises and policies.

Social and Economic Impact

CBPM abuse can also have broader social and economic impacts, including increased healthcare costs, loss of productivity, and strain on social and legal systems.

The abuse of CBPMs poses significant risks, necessitating a comprehensive understanding and approach to mitigate these dangers. Balancing the medicinal benefits of CBPMs with the potential for abuse is critical. This involves not only clinical and regulatory measures but also societal efforts to educate and support those at risk of or struggling with CBPM abuse.

Navigating the use of CBPMs in the UK requires comprehensive harm reduction strategies. These guidelines serve to mitigate potential risks and promote safe and responsible use. Understanding the specific properties of CBPMs, their therapeutic potential, and risks associated with misuse is critical. Patients and healthcare providers must work collaboratively to ensure that the benefits of CBPMs are maximised while minimising any potential harm. Educating patients about the safe use of these products is a cornerstone of this approach. Regular monitoring, clear communication, and adherence to legal guidelines are essential elements. The dynamic nature of CBPM research necessitates ongoing adaptation of these guidelines. Ensuring the safety and well-being of patients using CBPMs is paramount.

Dosage and Frequency Guidelines

For medical use, adherence to prescribed dosages and frequency is crucial. Deviating from prescribed regimens can lead to adverse effects or dependency. Healthcare providers must ensure patients understand their dosing schedule. Regularly reviewing dosages in response to patient feedback and clinical outcomes is important.

Patients should be educated on the importance of consistency in dosing. Self-monitoring by patients, and reporting any concerns is encouraged. Adjustments to dosages should only be made under medical supervision. Understanding the pharmacokinetics of different CBPM formulations is important for effective dosing. Patient-specific factors such as age, weight, and overall health must be considered when determining dosages.

Safe Use Practises

Avoiding the mixing of CBPMs with other substances is critical. Patients should be informed about the risks of using CBPMs alongside alcohol or other medications. Safer routes of administration, such as oral or sublingual, should be encouraged. The purity and source of CBPMs should be known to assess potential risks. Clean and safe equipment use is essential, especially for methods like vaporisation.

Patients should be advised against sharing any equipment to prevent contamination. Safe storage of CBPMs to prevent accidental ingestion, especially by children, is vital. Understanding the delayed effects of some CBPMs, particularly edibles, is important to prevent overconsumption. Patients should be educated on recognising and responding to adverse reactions. Regular cheque-ins with healthcare providers can help ensure ongoing safe use.

Resources for Help and Support

Accessibility to addiction treatment centres for those struggling with misuse is crucial. Community support groups can provide valuable support and shared experiences for patients. Online forums offer a platform for individuals to share experiences and seek advice. Healthcare providers should provide information on these resources. Patient education resources should be readily available and easily understandable.

The stigma around seeking help for misuse or dependency should be addressed. Support should extend beyond just medical treatment to include mental and emotional health. Encouraging open discussions about challenges faced in using CBPMs can foster a supportive environment. Follow-up and ongoing support are key to ensuring long-term success in managing conditions with CBPMs. Professional counselling services should be made available for those needing more intensive support.

Safer Consumption Tips

Starting with a lower dose and gradually increasing it helps gauge the body’s reaction. Patients should be reminded of the importance of hydration and adequate nutrition. Allowing time for the body to rest and recover between uses is crucial. Understanding individual reactions to CBPMs can help tailor safer consumption practices.

Patients should be made aware of the signs of overuse or misuse. Educating patients on the different forms and strengths of CBPMs aids in safer consumption. Avoiding using CBPMs in potentially dangerous situations, like driving, is important. Safe use also involves being mindful of the mental and emotional effects of CBPMs. Regular medical check-ups can help monitor the impact of CBPM use. Creating a personal use diary can help patients track their usage and effects.

Harm reduction and safe use of CBPMs are multidimensional and require continuous effort and education. These guidelines are not static and should evolve with ongoing research and patient experiences. Collaboration between patients, healthcare providers, and support networks is key to harm reduction.

The goal is to maximise therapeutic benefits while safeguarding against potential risks. Empowering patients with knowledge and resources is fundamental to achieving this balance. Regular reassessment of these guidelines ensures they remain relevant and effective. Ultimately, the focus is on improving the quality of life for those using CBPMs for medicinal purposes.

As we conclude our exploration of Cannabis-Based Products for Medicinal Use (CBPMs) in the UK, it’s evident that this area represents a significant intersection between modern medicine, legal frameworks, and societal perspectives. The journey of CBPMs from a stigmatised, illegal substance to a medically acknowledged treatment option reflects the evolving understanding of cannabis and its potential therapeutic benefits.

The therapeutic potential of CBPMs, particularly in treating conditions such as severe epilepsy, chronic pain, and chemotherapy-induced nausea, marks a milestone in medical science. The ability of these products to provide relief where traditional medications have failed offers hope to many patients. However, the prescription of CBPMs is not a one-size-fits-all solution. It requires careful consideration of individual patient cases by specialist doctors, constant monitoring, and a willingness to adapt treatment plans as necessary. The medical community’s role in educating patients, managing expectations, and mitigating potential risks cannot be overstated.

The legal status of CBPMs in the UK, governed by a robust framework, aims to balance the accessibility of these medications for genuine medical needs against the risks of misuse and recreational use. The reclassification of cannabis for medicinal use underlines a shift towards a more evidence-based approach to drug policy. Nonetheless, the legal landscape is complex and requires patients, healthcare providers, and the public to be well-informed about the regulations governing the prescription, use, and possession of CBPMs.

Despite the progress, the path of CBPMs is not without challenges. The debate over their efficacy, safety, and long-term effects continues in the medical community and beyond. Issues surrounding the potential for misuse, addiction, and psychological effects, particularly related to THC-containing products, remain areas of concern. Addressing these challenges requires ongoing research, patient education, and a cautious yet open-minded approach to treatment.

The social and cultural dimensions of CBPMs cannot be ignored. The stigma associated with cannabis use, albeit diminishing, still influences perceptions and can impact patient experiences. Advocacy for patient access to CBPMs, balanced with responsible use messaging, plays a crucial role in shaping public opinion and policy.

Harm reduction and safe use guidelines are vital in ensuring that the benefits of CBPMs are realised while minimising risks. These guidelines encompass dosage and frequency adherence, safe administration practices, and awareness of potential side effects. Patients need to be empowered with knowledge and resources to make informed decisions about their treatment.

Healthcare providers have a pivotal role in navigating the complexities of CBPMs. They are not just prescribers but also educators, guides, and support systems for their patients. Their responsibility extends beyond the prescription pad to ongoing management, monitoring, and adjusting treatment as needed.

Looking ahead, the landscape of CBPMs in the UK is likely to continue evolving. Advances in research may provide clearer insights into the efficacy and safety of these products. Legal and policy frameworks may adapt to new evidence and changing societal attitudes. The potential expansion of conditions for which CBPMs are prescribed could open new therapeutic avenues.

At the heart of the CBPM narrative is the patient. Ensuring that patient welfare, autonomy, and access to effective treatment remain central to the discussion is essential. Balancing this with the responsibility to prevent misuse and protect public health is the ongoing challenge for policymakers, healthcare providers, and society.

The journey of CBPMs in the UK reflects a significant shift in medical, legal, and social approaches to cannabis. While promising as a treatment option for certain medical conditions, CBPMs demand a nuanced, well-informed, and patient-centric approach. The ongoing dialogue among healthcare professionals, researchers, policymakers, and patients will undoubtedly shape the future of CBPMs. This dialogue must remain open, evidence-based, and responsive to new information and societal needs.

In conclusion, CBPMs represent a medical innovation and a catalyst for broader discussions about drug policies, healthcare delivery, and patient empowerment. Navigating this landscape requires a collaborative, informed, and dynamic approach to ensure that the potential benefits of CBPMs are harnessed responsibly and effectively.

Royal College of Psychiatrists: Position Statement on Cannabis-Based Products for Medicinal Use [PS05_19]: https://www.rcpsych.ac.uk/docs/default-source/improving-care/better-mh-policy/position-statements/ps05_19.pdf?sfvrsn=2db968d3_2

Isle of Man Government: Cannabis-Based Products for Medicinal Use (CBPMs): https://www.gov.im/categories/health-and-wellbeing/cannabis-based-products-for-medicinal-use-cbpms/

UK Government: Advisory Council on the Misuse of Drugs – Report on Cannabis-Based Products for Medicinal Use (27 November 2020): https://assets.publishing.service.gov.uk/media/5fc0de5b8fa8f559ded502cb/OFFICIAL__Published_version_-_ACMD_CBPMs_report_27_November_2020_FINAL.pdf

States of Guernsey: Cannabis-Based Products for Medicinal Use – FAQs: https://www.gov.gg/cannabisfaqs

PCCA Patients UK: Personalised Medicines – Cannabis-Based Products for Medicinal Use: https://patients.pccarx.co.uk/personalised-medicines/cannabis-based-products-for-medicinal-use-cbpm/

Dr. Wayne Kampers: Cannabis-Based Products for Medicinal Use: https://www.drwaynekampers.co.uk/cannabis-based-products-for-medicinal-use-cpbm

Specialist Pharmacy Service: Cannabis-Based Products for Medicinal Use – Considerations for Clinical Practice: https://www.sps.nhs.uk/wp-content/uploads/2020/01/Cannabis-QA-considerations-final-v.3.pd

Fieldfisher Insights: 10 Things You Need to Know About Medicinal Cannabis in the UK: https://www.fieldfisher.com/en/insights/10-things-you-need-to-know-about-medicinal-cannabis-in-the-uk

NHS England: Long Read – Cannabis-Based Products for Medicinal Use (CBPMs): https://www.england.nhs.uk/long-read/cannabis-based-products-for-medicinal-use-cbpms/

Isle of Man Government: Health and Wellbeing – Cannabis-Based Products for Medicinal Use: https://www.gov.im/categories/health-and-wellbeing/cannabis-based-products-for-medicinal-use-cbpms/