This is an extraordinary time in the history of medicine.
Medical products made from the cannabis plant are now legal.
For the first time, doctors can legally prescribe medicinal cannabis in the UK.
I'm Javid Abdelmoneim, and I'm an A&E doctor.
OK, so that's your blood pressure now...
I've been watching the developments in medical cannabis,
and I've heard it being called a miracle cure
for all sorts of conditions.
And I'd love to know whether I could use it to treat patients.
But it's all produced from the plant that I know of
as a potentially damaging recreational drug.
And as prescribing cannabis is still highly controversial,
I'm going to investigate what the latest research can tell us
about whether it will help or harm patients...
..why cannabis has remarkable effects in conditions like epilepsy...
How many seizures has he had since that time?
None. Nothing at all? Nothing at all.
..and yet new studies link recreational cannabis more strongly
than ever to alarming mental health problems...
24% of the new cases of psychosis could be attributed
to use of skunk alone.
..and what we can learn from countries like Israel,
where they've been using cannabis as a medicine for over 20 years.
We haven't seen any troublesome effects in our elderly population.
You're so British!
And I'll take part in a ground-breaking trial...
MACHINE BEEPING Inhale...
..into the effects of the chemicals in cannabis on our mental state...
It's just making me laugh about everything!
Oh, my God!
..to find out what the latest research reveals
about how it affects our bodies and our brains.
That's paranoia.
I was paranoid about everything!
Medicinal cannabis has been legal in the UK
since the 1st of November 2018.
I want to meet someone who's actually being prescribed it.
I'm on my way to meet a young patient whose life has been transformed by medical cannabis.
In fact, he's even been instrumental in having the law changed in the UK.
Hello, hello.
Hi! Hi, Hannah?
Yes. Hello, how are you? Lovely to meet you...
I've come to see seven-year-old Alfie Dingley and his family.
Alfie, you're climbing.
How are you doing? I'm Javid. Hello!
How you doing, Alfie?
I'm a friend!
Can I be your friend? Friends!
Alfie was born with a life-threatening form of epilepsy.
His mum Hannah wants to show me the severity of his condition.
The last thing I thought about was taking a video of him
having a seizure, but this is just a small seizure...
..when he was a bit younger.
Oh.
Oh, gosh, yes.
He's making a moaning sound.
You can see the arm going...
ALFIE MOANS
By the age of five, Alfie was in hospital every week
with hundreds of violent seizures.
He would have back-to-back seizures and would stop breathing.
It's a very, very severe, aggressive seizure and I'd have to literally
hold him to the bed while they put a cannula into him
while he was screaming, while I was crying...
Let's walk up to that...
Hannah started looking online for anything
that could help Alfie's condition.
She came across epilepsy patients in America who had success
using an oil containing chemicals extracted from the cannabis plant.
I spoke to our neurologist and he actually said to me and, these were his words,
"If you talk to me about that again, I will refer you to social services." Really?! Yes.
This was 2017 and medicinal cannabis wasn't legal in the UK.
Hannah and the family took a drastic measure.
They moved to Holland so Alfie could be treated
with the oral cannabis oil.
And the first five weeks we used it, and it did nothing.
I remember just having a complete meltdown, and sitting in my car,
and crying my eyes out and I just thought, "This has got to work!
"This has got to work because if it doesn't... I can't bury my child.
"I just can't do it." And I was really, really upset.
But it was a changing point because then he started to get better,
and his seizures stopped.
And it was just absolutely amazing.
Incredible. And I'm just like, "Oh, my God!"
Yeah, it was incredible.
# Happy birthday, dear Alfie... #
Yay!
The cannabis had worked, but the family couldn't afford
to stay in Holland any longer.
So, Hannah started campaigning.
In June 2018, she had a breakthrough.
Using cannabis for medicinal purposes - the Home Secretary
announces a review which could see more patients allowed
to use the drug.
It comes as the mother of six-year-old Alfie Dingley is granted a licence...
Alfie was given the first licence of its kind in the UK
for medicinal cannabis.
It was wonderful to be part of that and for Alfie to have the first licence
after everything we went through.
Obviously, I'll show you what we're using but we know...
Alfie now gets his oil prescribed on the NHS.
One bottle contains CBD, and the other, THC - the active chemicals
from the cannabis plant.
So, that's a 2% THC, so he has three milligrammes a day of that.
So, it's tiny, like, two drops.
Tiny amount and then he has a big dose of the CBD, which is that.
In addition?
In addition - he has that three times a day.
Oh, crikey! It really smells of cannabis, doesn't it?
SCOFFING: Ugh!
Sorry, I wasn't expecting that!
Can they make it strawberry flavour or something for him?
Yes, he's only seen him two or three times. And how did you...?
Today, Alfie's coming to King's College Hospital
in London for a checkup.
Tell you what, you have that paper, Alfie.
And I'll have this one. Do another one?
Dr David McCormick is a consultant paediatric neurologist.
So, last time when I saw you,
those seizures had stopped...
I want to do a number five, please.
Yes, I can do you a number five.
A five is a hard number to do.
It looks like that.
So, that was August last year. He'd gone four weeks without seizures.
So, how many seizures has he had since that time? None.
Nothing at all?
Nothing at all.
Can you do number six, please? I can do a number six.
That's a six.
Well done! Since you are so nice... Thank you!
I know what's coming next.
Seven?
THEY LAUGH
So, I think the other thing I notice as a real difference
with Alfie is how he is socially.
So, when you were here last time, he didn't really make eye contact
with me, he was quite irritable.
Whereas the first thing he did was come up and talk to me, and want to show me things from his bag,
and we're having this interaction.
Can you do a p? You've done a p, Alfie. It's perfect.
CLAPPING Clever boy, hooray!
Hooray!
THEY LAUGH
Come on...
Come on. You're all right.
This is not going to hurt, Alfs.
David believes Alfie's improvement is down to the effects
of the CBD and THC.
He thinks these naturally-occurring chemicals in cannabis,
known as cannabinoids, are acting on the abnormal electric currents
in his brain that are causing his seizures.
Exactly how they do this is unclear.
We know in general for epilepsy, medications bind with receptors
and affect how it makes electrical currents in the brain
and causes the seizures.
We really don't know how the cannabinoids as a whole work
but we don't fully know the mechanism for some
of the other agents we prescribe either.
Can you put your feet together for me?
Feet together. Good boy, look forward...
Although it's legal for specialist doctors like David
to prescribe medicinal cannabis, there's still a lot of caution.
Well done, you. Yeah, high five!
This is because the drugs Alfie's taking are unlicensed.
They haven't been through full clinical trials,
and so the dosage and safety are unclear.
We're finding we're getting multiple inquiries on a daily basis
about these products.
And we need to find that balance between rolling it out quickly
enough to not deny people with severe conditions something
that could help but having enough evidence to know
that it's going to work, and enough evidence to know
that it's going to be safe for those patients.
The latest advice to NHS doctors is to hold off prescribing medicinal
cannabis products to any additional epilepsy patients,
because there currently isn't sufficient evidence
to support their use.
I've never experienced a situation like this as a medic before.
It's exciting for Alfie or patients like Alife.
He has a very complex type of epilepsy which, for him, seemed to be magically turned around
with a cannabis product.
But the difficulty is it's not well researched,
doctors aren't familiar with it,
it's completely new, and yet it's in the minds of the public,
and it's in the minds of, say, epilepsy patients and they may well
come to doctors and say, "I actually want to try that."
And if they say, "I'm going to stop all my epilepsy medicines,
"I'm going to go and buy some of this,"
that's potentially really dangerous.
So, it's a moment that's actually still risky.
Cannabis has had an unusual route into the medical world.
And it's becoming big business.
I want to find out how these medicinal products
are being produced from cannabis.
So, I've come to Odense in Denmark to meet some of the scientists
driving this new industry.
Apparently, there is a huge cannabis farm around here that's only
just opened, and they're expanding production because they're expecting
a really big rise in the demand for medical cannabis in Europe.
"Spectrum Cannabis".
This farm is the first European venture for a Canadian company
that also make legal recreational cannabis.
Spectrum is their medical arm and produce herbal flowers, oils
and capsules to be prescribed to patients.
OK, so here we need to put something for your hair.
Thank you.
Dr Pierre Debs is the European managing director.
We're going to have to put something for your facial hair. Right.
All very exciting. We are growing a pharmaceutical product,
so we want to make sure we're as sterile as possible going in. Yeah.
Welcome to Mars.
All right, let's go. Let's do it.
So, let's go into the mother room.
JAVID LAUGHS
Wow!
These are cannabis plants.
Gosh, and you can smell them!
They do have a characteristic smell.
But to be clear, this is the plant that people get stoned with?
This is the plant that people would use for recreational purposes, yes.
That's the word I was looking for. Yes.
LAUGHING: "For recreational purposes". Absolutely.
The difference between these plants and those grown for illegal
recreational use is that they have to be produced
in controlled conditions so you know exactly what active chemicals are in them.
Why now? So, why are you expanding now?
Quite frankly in Europe the regulations are opening up
one country after the next.
We plan on being everywhere in the European Union.
Yeah. In March 2017, the law came in Germany.
And the same then happened in Poland, in the Czech Republic,
in Denmark, and in the UK now.
Clearly, we will be supplying the UK from here as well.
Let's hope by the end of the year.
It's estimated that the global medicinal cannabis market
will be worth $19 billion by 2027.
Did you work in here before it was growing cannabis?
Yes, I was. What was it growing before?
Erm...
Orchids? Really? Yes. Oh, gosh.
Oh, it's VERY different. Yeah. Yeah.
And does your family...?
Did they ever think that you'd be growing cannabis? Oh, no. No?
Me neither.
BOTH LAUGH
Spectrum grow 18 different varieties of cannabis plants here.
Each one has a different amounts of the cannabinoids THC and CBD.
Pierre, what's the difference though between THC and CBD?
The basic difference is that the CBD is not going to get you that...
..what everybody knows as "being high". Right, and THC does?
THC is responsible for that, the classic effect of being high, yes.
THC acts on cannabinoid receptors throughout the brain
and central nervous system.
By altering signalling between cells in the brain,
it has a psychoactive effect, and makes us intoxicated.
CBD also affects brain activity in conditions like epilepsy.
But how it works is much less well known.
And it doesn't make you intoxicated.
Plants can be bred to produce higher concentrations of THC or CBD.
Patients need different amounts just like patients need different
medications, and that mix ultimately determines if it's good for someone
with pain, or it's good for someone who doesn't sleep well,
or it's good for someone who has depression...
Well, how do they know that though?
Through trial and error.
A lot of this is generated by the patients.
Because of the rules and regulations we can't really say what you can use it for. Right.
That has to be...
That's a conversation that goes on between the doctor and the patient.
The active chemicals will be extracted from these cannabis
flowers and turned into medicinal products
to be prescribed to patients.
But so far they haven't completed the rigorous large-scale testing
that other medicines go through.
I'm really surprised, actually, that those products are getting
to the market, because when a doctor prescribes a drug,
it's been trialled across an entire population.
And in that way, the medic can hopefully understand
that predictably, "For this one individual in front of me,
"it will have X effect."
It could have interactions with other drugs or medicines,
it could have side effects...
Pierre himself said for these products
that it's just trial and error.
So as a doctor, that leaves me really uncomfortable.
I'm just sort of in the dark with how to prescribe these.
Clearly patients are passionate about the effects
of medicinal cannabis, and that can't be dismissed.
But I've been taught to use evidence-based medicine.
So, I'm going to do my own research
into the conditions it's been claimed to treat.
Alzheimer's, arthritis, asthma, chronic pain, Crohn's disease,
epilepsy, glaucoma and multiple sclerosis - so, a long list there.
You wonder what the actual weight of the evidence is.
I've come across a clip of a man using cannabis to treat symptoms
of his Parkinson's disease.
I mean, this man has clearly got a really bad tremor.
The subtitles say that he is inhaling about 30 mg cannabis.
Oh, look, and after six minutes, he's practically sitting still.
That is such a relief.
That's quite impressive.
Another condition which has received a lot of attention
for cannabis cures is cancer.
No chemo, I only do cannabis, and the tumours are gone.
What more do you need?
These stories are compelling but where's the scientific evidence
that it's an effective treatment for these different conditions?
I found the UK government's report from June 2018 summarising
what studies have been done into the effectiveness
of medicinal cannabis.
So, "no or insufficient evidence
"to support or refute the conclusion that cannabis
"or cannabinoids are effective treatment for cancers
"and motor system symptoms in Parkinson's disease."
The report does confirm that prescribed medicinal cannabis products work for some conditions.
Chronic pain in adults, nausea and vomiting after chemotherapy,
and symptoms of multiple sclerosis.
But there isn't enough evidence for most of the conditions
that it's been hyped to treat.
I mean, just because there's no or insufficient evidence or limited
evidence doesn't mean that they won't work or don't work.
It just potentially means that they haven't been studied yet.
Clinical evidence around medicinal cannabis is lacking.
But patient and industry pressure is growing.
If we're going to increase usage, I want to know if it's safe.
And most of the knowledge of the potentially harmful effects
of cannabis comes from looking at illegal recreational use of the drug
and what it does to the brain.
I've come to King's College London...
..where they're studying cannabis available on the black market,
and how different types affect mental health.
Dr Marta Di Forti is a psychiatrist and research scientist.
Marta, this is really quite surprising!
HE SNIFFS Why do you have this?
So, these are samples that I haven't bought from drug dealer
but have been given to us by the collaboration of the Met Police.
So, these that look like soap bars - they're called "soap bars"
as their street names - but they're actually what we also define as "resin".
You know, you can see a sort of quite solid resin.
And down here we move into the "skunk" domain.
The smell is radically different. Can I open it?
Yes, if you're brave enough to smell this.
This, as you can see... Oh, yeah! ..it is actually skunk.
The name is of course suggestive of the intensity of the smell.
And our result indicated that if you did use skunk on a daily basis,
your chances to present with a psychotic disorder
was five times greater than if you never had used cannabis.
Right. And what was quite striking is that when we look at those
who had been using resin, their risk profile was no different
to the one that used cannabis at all.
So, to never-users.
Marta's research is the first to show that daily skunk use causes
a staggering fivefold increase in the risk of psychosis.
And she thinks she's found the reason why.
It's not only the smell that separates these two.
The key element is the difference in the concentration of THC,
which in this one is around 4%
and here is, on average, 14%.
And actually this specific sample goes up to 23% of THC. Oh, wow.
It's the very high concentration of the psychoactive THC chemical
that's causing the increased risk in mental health problems
among skunk users...
..which makes her next finding even more concerning.
The skunk, the buds, they represent pretty much 99% of the available sample
when we look at what the Metropolitan Police has been seizing.
In 2005, we actually had 60% of the available market was resin.
But now it's really a totally different market.
And 24% of the new cases of psychosis in our catchment area
could be attributed to the use of skunk alone.
If the percentage of THC in this wasn't as high,
you expect that those numbers would drop.
Yes, exactly.
And the other side of the coin is that because pretty much
everything out there now is this, I'm concerned - would the number go up?
Cannabis only affects the mental health of a minority of users.
But this potential of certain types
of cannabis to cause serious harm is worrying.
I think having met Marta, I'm quite sort of...
..shocked, really, or surprised.
And of course it isn't just that it's cannabis per se
that's the issue here.
It's the concentration of THC
from Marta's point of view really quite specifically.
The concentration of that chemical is the issue.
Scientists think the solution to the risks of cannabis could lie
in better understanding the effects of its different chemicals
on the brain.
They're carrying out a pioneering trial looking at how
to make recreational cannabis safer.
And I'm taking part to help me better understand the effects
its chemicals could have on patients.
I'm about to sign up to a research study where I'm going to be taking
different concentrations of the two main active ingredients in cannabis.
Now, I admit, I've done this before.
I've taken cannabis before. I was 18, I was backpacking,
and I had good experiences,
but I also had really negative experiences.
And so I'm a bit nervous today.
The trial is being run by psychopharmacologist Dr Amir Englund
from King's College London.
Amir, how are you doing? Nice to meet you. Nice to meet you, too.
Welcome to the King's research facility. Thanks for having me.
I'm one of his 45 volunteers.
Amir, what am I signing up for?
What we think is an important and exciting cannabis study.
What we're interested in is to find out more about the relationship
of the two main components of cannabis.
So, the first one is THC.
And then we have CBD.
Now CBD together with THC seems to offset some of these negative effects
that we've seen on memory, paranoia and anxiety.
The team want to see if adding more CBD to recreational cannabis
could make it safer.
On four separate visits,
I'll be given different combinations of CBD and THC to inhale.
Get a temperature reading as well.
To remove bias, none of us will know which I get each week
until the end of the trial. Thank you.
Amir and the team will be measuring the effects on my mental state.
The aims of their study could be considered controversial.
So, what will you actually do with the results?
Our policy stances towards cannabis across the world is changing.
So, a lot of places are going towards a more liberalised way
of dealing with cannabis and it's for consumers to have a bit
more understanding of what risks they're exposing themselves to.
How much cannabis will I be getting today?
We don't know exactly what ratio you will get but we know exactly
how much THC you will get because that's the same
for all four visits.
That's ten milligrammes of THC.
A study from a couple of years ago in Spain, they found out
that the average amount was about seven milligrammes.
Gosh. So, you're actually getting slightly more
than the average Spanish joint.
OK. So, this will be strong.
Crikey.
The scientists have a special Home Office licence
to import the cannabis from the Netherlands.
While it's prepared in the vaporiser, I start to contemplate
what I've actually signed up for.
So, that's a lot of cannabis in one go.
But actually more nerve-racking for me is - and I remember it so clearly,
I mean, it's 21 years ago now when I tried it -
I-I got really bad thoughts, very paranoid thoughts,
sometimes even hearing sounds and voices.
And I don't want to have that feeling again.
That's why I stopped.
Right, Javid. Your cannabis is ready.
OK. Here you go. It's a lot. Yeah.
Are you ready? Mm-hmm.
Here we go.
MACHINE BEEPS Inhale...
..and hold.
MACHINE PIPS Three, two, one, and exhale.
Yeah, you can taste it. Good job. Mm-hmm.
Another one...
You feeling any light-headedness? Yeah. Yeah? OK.
And inhale again.
That's good, very good.
One, and exhale.
Good? I feel like smiling a lot! You can smile.
Inhale.
Great job! Have a seat. Thank you. Relax for a minute.
That's around the time where we would expect some of the effects
of the drugs to start manifesting.
Oh, my God.
What an odd feeling.
Yeah? Yeah.
Is it strong, is it mild?
What would you call it?
It's just making me laugh about everything!
Would you say this is a pleasant or unpleasant experience so far?
It's pleasant but because of that memory of...
..what it could turn into, I have...
I can feel some anxiety as well.
OK.
Now, the team are going to put me through a series of tests.
All right, I'm trying.
They're looking at the effect the different balance of chemicals
in cannabis has on my mood and memory.
LAUGHING: I actually don't know what I'm doing!
You're doing the best you can.
What is that?!
We think it's particularly the effect of THC
that influences how people do on memory performance,
and conversely CBD might interfere with THC's effects.
They're also testing my ability to judge emotions on people's faces.
When people misjudge facial expressions,
it can make them paranoid and anxious.
Previous studies have found that one's ability to correctly judge
emotional expression gets worse when people get THC.
Throughout all these tests, Amir and the team are looking for signs
that the cannabis is impacting my state of mind.
Cannabis can make us a bit extra wary around people
and their intentions, which can lead to some paranoia potentially
and some anxiety.
How is this test?
I'm beginning to think this is a trick on my patience.
Is this going to carry on going till I stop or what?
He has been a bit suspicious when it comes to one of the laptop tasks
being excessively long, deliberately so,
to mess with his thoughts or trick him in some ways.
I'm stopping, I'm stopping, I'm stopping! No, no, no...
You're tricking me. No, no, no...
Oh, really? Yeah. I literally thought this is some sort of...
No. .."let's see how long the idiot goes". No, not at all.
Are you sure?! Yes, I'm sure.
Why is it not stopping?!
Shit!
Ooh...
Nice work. See, I told you!
Oh, my God.
Two hours later, I'm beginning to sober up.
Do I feel high? Mm. Anxious? No.
And Amir wants to know more
about the paranoia I experienced, a symptom of psychosis.
Could you kind of still understand what was going on?
Everything had the potential to have an ulterior motive. Right.
I kept thinking, "Things are going derailed here,
"things are going derailed," and then panicking, and then trying to look calm.
My head just kept sort of going off on one.
Maybe at one point I thought I was quite clever cos I noted
that you were all in a conspiracy against me!
During the cognitive testings, I thought,
"Aha! I've got to the bottom of this."
That's paranoia. I was paranoid about everything!
Yes.
I'll be coming back each week over the next month, and each time,
I'll inhale a different balance of chemicals to find out
what effect this has on my brain.
I don't know.
Was that all THC?
Or was that the highest CBD content one and I've got three more worse
anxiety-paranoid sessions to come?
So, I'm actually quite nervous.
I want to know why cannabis has this negative impact on our mental state.
LIFT: Third floor.
Doors opening.
So, I've come to meet Amir's colleague -
Professor of Psychiatry Philip McGuire.
He's been studying the brains of people under the influence.
So, these are brain scans showing the activity in the brain in a group
of healthy people who've been given THC.
And we found more activity in this particular region
of the brain called the striatum.
The more paranoid people became, the greater the activity in this particular brain region.
So, they might be becoming suspicious about what was going on
in the scanner, what the purpose of the scan was,
whether we were really researchers or actually working
for some sinister organisation or something like that.
I mean, that's EXACTLY what I felt during that trial day.
So, I can definitely identify with that.
So, the striatum is particularly interesting in relation to paranoia
because that's one of the brain areas that's most critically
involved in disorders like schizophrenia.
Next, Philip gave the volunteers the other chemical in cannabis - CBD.
And what we found was that THC and CBD seem to have opposite effects
on the activity in that striatal region.
The remarkable discovery is that CBD could have beneficial effects
in brain areas associated with psychosis.
This made Philip wonder if CBD could be used
as a treatment for schizophrenia.
There haven't been any new treatment developments since the 1950s.
So, there's a desperate need for new kinds of interventions
for patients with psychosis.
So what we're now looking at is running clinical trials of CBD
in large groups of patients to see if it has these kind
of beneficial effects.
In Philip's trials so far more than half of the schizophrenia patients
treated with CBD have shown an improvement
in symptoms of psychosis.
CBD is being touted as the exciting cannabis cure
in contrast to the risks of THC.
And there's been an explosion in the popularity of over-the-counter
CBD products bought on the high street and online
to treat conditions from anxiety to sleeplessness.
But a word of caution.
These products contain very low levels of CBD compared
to what's prescribed in medicinal versions.
And there's no evidence that these non-prescription products
are effective to treat any conditions.
Over the next few weeks, I go back for three more trial days
with Dr Amir Englund and the team.
And each time, I'm given a different balance of CBD and THC.
This time, it's a lot more mellow.
So, I'm just very...
..relaxed and happy to just lie here.
So, potentially a different type of cannabis, this. I think so.
You think so? Mm-hmm.
On the third visit, I start to have quite a lot of fun.
These are really good.
It's so good!
I can taste the salt.
I can feel the crumble.
That's just a really good cookie!
And then I can really remember it's like a slow-motion piercing memory
of seeing the chocolate...
You know? It's just pretty weird.
Seeing the chocolate being eaten by my teeth.
Inhale.
But in the fourth and final week,
some of the negatives of week one start to creep back in.
I've got loads of thoughts.
I feel cold, I feel sleepy, I've got phantom pains...
It's the weirdest sensation!
Just feel really, really, like, not with it.
Throughout the month,
the team have been testing my memory,
ability to recognise facial expressions
and my mental state for symptoms of psychosis.
In a few weeks' time, I'll find out what effects the different chemicals
in cannabis have had on my brain.
I don't know - there's an element of feeling that you're not in control
that I don't like.
There's an element of, "That's not of my...
"Th-That's not because I...", you know?
STAMMERING: That I don't have control to...
Oh, crap! It's actually stronger than I thought, then.
In the UK, the scientific research has mostly focused on the benefits
of CBD and the potential harm of THC.
I've come to Tel Aviv in Israel, where they're certain
that psychoactive THC has medical benefits...
..and have been treating patients with it for the last two decades.
They've been routinely prescribing cannabis for years
but not just the harmless CBD part.
They've been giving the entire cannabis experience.
And that really interests me.
I'm fascinated to find out why they've decided
to go down that route.
Tikun Olam is Israel's largest medical cannabis company.
They treat nearly half of the 40,000 patients being prescribed it.
I'm joining Esther Barashi for her consultation
with head nurse Mario.
Hi, Mario.
Esther has been using cannabis to treat pain
following a back operation.
Yes, most of my pain in my neck.
Does the cannabis help you for the pain?
Very much. Any side effect after the treatment with the cannabis?
I have a little bit dizzy for a...
..few seconds. Oh.
Esther's here today to learn how to vape cannabis.
Very nice. That's quite a large pinch. 0.2 grammes.
And then, you can start to inhale it.
OK.
A little bit.
Mario, I can already see two things here that are making me
very interested in this.
It says across this "dangerous drug" and there's a whopping THC amount.
It's include 18% of THC.
It's a high rate of THC.
I struggle to work out what I'm feeling right now...
MARIO LAUGHS ..because in a sense it's a bit,
like, I don't want to say bonkers but it's bonkers
that you're prescribing cannabis.
This is straight up...
Yeah. ..a skunk bud.
Look, when the patient have pain, the inhaling affect him immediately,
in five minutes.
So, it is precisely this percentage combination of THC-CBD
that you have found is best for your pain?
Yeah, and I know how much to take, you know, how to smoke it better...
Shalom.
Pain is the most common condition to be treated here with high THC,
flowers, oils and capsules.
THEY SPEAK HEBREW
Other conditions are nausea, and low appetite following cancer treatment.
I have to admit, a lot of my inner sceptic has bubbled up.
And that thought itself is new to me because I thought I was quite open
to all of this.
There's an enormous variety of what's available on the shelf
there which is really surprising, and then some stuff there
with really high THC - in quantities that I just immediately think of
as illicit, illegal.
I want to find out the science of why psychoactive THC
could have medical benefits.
And I think I've come to the right place.
I've been told that the reason Israel's been using medical cannabis
for such a long time is this man - Raphael Mechoulam.
He's been studying THC for over 50 years and it's for that reason
that he's also known as the "Godfather of Cannabis".
To track Professor Mechoulam down,
I'm travelling to the Hebrew University outside Jerusalem.
Ah, Professor, hello...
He's now 88, and still involved in research as a medicinal chemist.
Raphael, what was your interest in cannabis?
Why did you start researching it?
I was surprised to find out that cannabis,
the chemistry of cannabis, was not well known.
So, we went ahead,
I got the cannabis from the police.
So I went over, got five kilos of hashish... That's a lot.
..but then we worked on that cannabis for several years.
In 1964, while trying to understand the active agents in cannabis,
Mechoulam discovered THC and CBD.
How did you know that THC was the psychoactive
or the high-causing compound?
Well, we tested it on ourselves.
Right! I don't smoke cannabis, never have, but we decided to test it.
Four of us took THC - pure THC - in a cake that my wife made.
And those of us that took the THC...
..we saw activity.
The main focus of Mechoulam's research was how cannabis affects
the body and whether it could have a medical application.
In 1992, he made a breakthrough.
He discovered endocannabinoids - chemicals we produce in the body
that act on the same receptors as cannabis.
We identified two compounds that our brain and our body...
..they make, and they are more or less equivalent
to the THC in their action.
We called one of them anandamide based on "Ananda" which in Sanskrit
is "supreme joy".
Ha!
Anandamide is a natural painkiller in the body.
It acts on receptors in areas regulating pain and mood.
It might even create a natural high.
Anandamide acts in a similar way to THC...
..but the body produces it in very low levels.
If there is pain, anandamide will be formed in the area of the pain.
So, actually, THC mimics
the action of compounds that we make.
This discovery that we naturally produce cannabinoids in the body
increased our understanding of why cannabis affects us.
And it helped lead to the medical cannabis revolution in Israel
and around the world.
But what still isn't clear to me is whether THC is actually safe.
I've heard that scientists here have just carried out a study
into its safety and effectiveness
by looking at their largest group of medical cannabis patients.
The elderly.
So I'm visiting the NiaMedic geriatric clinic in Tel Aviv.
Inbal Sikorin is the head nurse.
Hello, how are you?
Her patient Naamah has been suffering chronic pain
following cancer treatment.
The pains were...
..impossible. And now, no medication at all.
That's incredible. Nothing.
Nothing, only cannabis.
And, Inbal, it's a THC-containing flower that she smokes?
Yeah. Mm-hmm. Yeah. Usually, it's around 23% of THC.
Do you know though that it's safe for the patients that you give it to?
Yeah, we're very careful with mental problem like schizophrenia,
or manic depression, and we don't use cannabis for them.
Does it affect you in any way that you could say you were high, for example?
I'm high in a good way.
I can tell you one thing.
It's like a second birthday for me.
Wow. Yeah.
I want to know if the results of the research support Naamah's experience
and if THC really can be effective and safe.
SPEAKING HEBREW
Professor Victor Novack is a doctor and research scientist
from the Soroka University Medical Center.
He studied 3,000 elderly patients.
We know that medical cannabis has psychoactivity,
and we were afraid that our patients would be basically stoned, right?
And they will sit doing nothing.
But that's not what we found in our study.
What we see also in elderly that there is a reduction of 40%
in incidence of falls just because they're taking less opiates
and less benzodiazepines.
So, they're more sort of stable.
Victor found that pain levels fell by half
in elderly patients using medical cannabis.
This meant that 20% were able to stop using the potentially
more dangerous opioid medication...
..which has side effects ranging from nausea to slowed breathing.
But I want to know if using a psychoactive drug
is really any safer.
Thinking on the link of THC with psychosis,
have you found any evidence for safety or lack of safety there?
On average, we start with a high dosage of CBD and low dose of THC.
And so we are very cautious when we start THC
in our elderly population.
So, all in all, I would say that we haven't seen
any troublesome effects of THC.
So, right now, we're giving them opioids to treat their pain
with a plethora of side effects.
You have patients who stop breathing with opioids, right?
So, if instead of this you will have medical cannabis
which treats your symptoms with the same effectiveness but half
or even less than half side effects, it will be just terrific.
You're so British.
It's strange to smoke in front of people that aren't allowed to smoke!
Victor's study is only observational.
Not the sort of clinical trial
that I would expect a new medicine to go through.
But it's still valuable.
And I ask myself, "Why didn't I do it before?"
My experience in Israel has certainly been eye-opening.
There seems to be a really open and relaxed attitude
to medical cannabis here.
I met patients for whom it really worked,
and the evidence for that is growing...
I'm just not convinced it's strong enough as yet.
Many people in the UK see success stories in countries like Israel
and argue that our system needs to change...
..because controversy around THC has led some patients here
to break the law.
Carly Barton is a former university lecturer living in Brighton.
For the last three years,
she's been treating her chronic pain with black-market cannabis.
But this could be about to change...
..because Carly has just become the first British patient
to be written a prescription for cannabis flowers
containing high levels of THC.
So, this is my prescription.
He's written here that it is to be administered by vaporiser.
And it's around the same THC content as this is.
And I have been prescribed up to a gramme each daily.
Yeah, so this is, I guess, the little bit of history that's been made.
Carly has suffered chronic pain since she had a stroke
in her early 20s.
I had burning pain in all of my joints.
And sometimes it felt like there was, like, hot pokers
just instead of bones that they were just...
It was burning from the inside.
It's horrific and it's just relentless.
I was completely off my face on opiates for the whole time.
It took away so much of my personality.
Completely ruined my life.
Carly credits cannabis with transforming her quality of life
when other treatments weren't working.
But until her legal medication arrives,
she's still using the black market.
At the moment, I am at risk of arrest.
They could come, they could search my house.
They could kick the door in in the middle of the night.
That stress and anxiety of that is...
It's definitely there.
The new prescription should remove these fears.
But Carly has now been waiting seven weeks for her legal cannabis.
As the first UK patient, there isn't a system in place
to supply it, and there's a huge financial implication.
So, this cannabis-based medicine comes out at about six euros a gramme.
But on top of that, the pharmacy fees, the import costs,
everything all totted up - just solely for this prescription
for three months' medicine - is going to cost me £2,500.
I have got £2,500 saved.
That is my savings. That's all I've got.
That's everything... It's everything I've got.
And I am putting all of that into this prescription.
A month later, the day comes.
Carly, there's someone here to see you. OK.
Her legal cannabis arrives.
The press have gathered for this historic moment.
Sign there, please...
This is a bit of history happening.
It's a bit surreal, really.
I think it's quite surreal that this has actually happened. Like...
I don't know. It feels like it's been such, like, a long fight
that it's quite emotional and... This is actually here.
This is a landmark case in the UK.
This will be the first time I have consumed cannabis legally...
..which is an interesting experience.
But Carly's worries aren't over yet.
I can only afford one month's supply, so once that ends,
then it'll be back to the black market.
And, you know, I'd like that to be reported if that becomes the case,
because I think it's worth highlighting that the system
that's in place at the minute isn't necessarily working.
Carly wants her cannabis on the NHS
and for people like her to have easier access.
Her story highlights the problems facing patients and doctors
in the UK at the moment.
It's really significant.
Let me... Let me say that -
that, essentially, Carly's been prescribed - legally -
recreational cannabis.
These are the flower buds with high THC.
Now, if the NHS is asked to prescribe that for her,
they'd have to say to themselves,
"Are there better alternatives or less harmful ones?"
And she's been through a process where she's demonstrated
that there aren't, so that's OK for her.
But I think it's a tricky one here, because it is known
that what Carly's being prescribed is associated with psychosis.
Now, if the whole population then turned around and said,
"Now, we want this prescribed on the NHS, too,"
the evidence isn't there for the population.
In August 2019,
NHS doctors were advised not to prescribe medicinal cannabis
to treat pain until there is more evidence.
Carly is now growing her own supply illegally.
To find out more about the possible risks of cannabis to patients,
I've been taking part in a ground-breaking trial
at King's College London...
..studying the effects of THC and CBD on the brain.
So they're going to tell me what blend I was given each time,
how well I did in the tasks and what effect that had on my mental state.
And I'm actually really interested to find out -
because each time I went, it was a completely different experience.
It's been three weeks since my last visit,
and Dr Amir Englund has been busy analysing the data.
He wants to know if it's possible to make recreational cannabis safer.
It's really exciting, because it's the first look
that we've had on your results.
And just to remind you that, on every single visit,
you get the exact same amount of THC.
But we didn't know how much CBD was on each week. We didn't.
Shall we have a look? Yes, OK. All right.
So, this is the first experiment you did. So, week one.
I'm beginning to think this is a trick on my patience.
Is this going to carry on going until I stop or what?
My God!
I'm stopping, I'm stopping, I'm stopping... HE LAUGHS
It was just this pervading, horrible paranoia.
So that was actually THC alone. Oh, really? OK. No CBD at all.
And that's actually the cannabis that's the most similar
to what's out on the streets. Really?
Yeah. That's definitely frightening.
But the next visit felt quite different.
Basically, there was lots of paranoia last time.
And this time, there isn't.
It's really quite pleasant.
I look much more mellow that time, don't I? Yeah. Just really calm.
You had no paranoia that day at all.
And that's when you had the most CBD.
You're joking! Mm!
This time, I received three times as much CBD as THC -
the most CBD of any visit.
..happy to just lie here.
So what about week three?
This is really good.
HE CHUCKLES
It's just a really good cookie!
I was seeing the chocolate being eaten by my teeth.
Oh, no!
Interestingly, again, there was no paranoia at all.
No. You had the second-most CBD on that day.
On this visit, I had twice as much CBD as THC.
Finally, it's week four.
All right. Let me try and focus. Right, break time!
I literally can't get it. HE LAUGHS
Sh...
Wow! What a funny feeling! I've got no idea what this means!
Oh, my goodness! So, this is when you had as much CBD as THC.
And in terms of versus week two and three,
this was less than both? Yeah.
You were the second-most paranoid, actually.
Really? Yep.
This means that on weeks one and four, I had the least CBD
and the most psychosis-like symptoms.
When it came to the other tests,
Amir found that CBD did not affect my memory.
But what about my ability to judge facial expressions?
Your performance overall is the worst when you've had THC.
And then, as soon as we add CBD to it, it goes up.
By a long way. Yeah, and we do see that people who suffer
from psychotic illnesses are also quite poor on emotional recognition.
CBD clearly had a positive effect on my mental health...
..but I want to know which balance of CBD and THC
Amir thinks is best overall.
For you, I would say it's the two to one - so, week three.
So, to be clear, then, that's the week where there was
twice as much CBD as THC.
Yeah. It's partly because it's the one that has the least
negative impact on your mental health and wellbeing,
but it's also one that you enjoy quite a lot. And that's important
because if a less harmful cannabis is not enjoyable,
then people won't use it - and they'll go back to street cannabis
and still be exposed to that kind of harm.
That makes perfect sense.
Amir's study suggests that it is possible
to make recreational cannabis safer.
And, for me, it's highlighted the potential risks of high THC
in medicinal cannabis...
..but that we could make it safer by including CBD.
This sort of research is vital if we're to decide whether cannabis
will help or harm our patients.
I feel it's a really crucial moment for cannabis.
I've seen instances where it really works for some specific cases,
and that should be explored.
What needs to happen urgently is that, essentially,
like any other medicine, the trials need to be delivered.
We need evidence to show that cannabis can be used in this form
for that disease, to that effect.
And you need to know that it's safe and effective
and will not cause harm.
And once that's all done - I mean, if the evidence is all there -
well, then the potential for cannabis really is exciting.