Media Storm - Behind the scenes of Media Storm!

Episode Date: June 8, 2023

In this week’s bonus episode, Helena and Mathilda have an announcement to make… they have started a Patreon! You can access it at https://www.patreon.com/MediaStormPodcast This is a chance for us to build a community space for our Media Storm listeners, where we can discuss ideas, share bonus material and get to know you all a little better! It’s also a chance for you to contribute to the work being done at Media Storm, if and how you can. In this bonus episode, we’re also trialling some new bonus material as requested by listeners. You’ll hear an uncut interview from last week’s investigation about 'Medical cannabis and the criminalisation of chronic pain'. If you haven’t yet heard it, we encourage you to go back and listen first. This raw material features our full-length interview with Dr Steve Hajioff, who will tell you all you need to know about how cannabis regulation works in the UK, and how cannabis interacts with the body to produce medicinal effects. It should also gives you some sense of just how much interview time goes into a single one of our investigations - which typically contain five or more interviews like this, all cut together in a 20-minute adventure! Get in touch and let us know what kind of bonus material you’d like to see - whether it’s raw material like this, more episodes of our ‘This Is How You Do It’ interview series featuring media change makers, offcuts from studio discussions, Q&As with listeners, or anything else at all. You can reach us at [e-mail] or on social media @mediastormpod. The episode is created by Mathilda Mallinson (@mathildamall) and Helena Wadia (@helenawadia). The music is by Samfire (@soundofsamfire). More on Media Storm Follow us on Twitter http://twitter.com/mediastormpod or Instagram https://www.instagram.com/mediastormpod or Tiktok https://www.tiktok.com/@mediastormpod like us on Facebook https://www.facebook.com/MediaStormPod send us an email [e-mail] check out our website https://mediastormpodcast.com Media Storm is brought to you by the house of The Guilty Feminist and is part of the Acast Creator Network. Become a member at https://plus.acast.com/s/media-storm. Hosted on Acast. See acast.com/privacy for more information. Learn more about your ad choices. Visit podcastchoices.com/adchoices

Hi everyone, it's bonus week, and as you might have noticed, we're having a little play around with our bonus week content, trying to figure out what you all want. Speaking of which, we would actually love to hear from our listeners about what kind of bonus content you would like to see. Today has come from a listener suggestion, and actually I have a little bit of anxiety about it. Yes, some people have been asking if they can access some of our unedited interviews rather than the beautifully curated cuts we normally give you. Be careful what you wish for because you're getting it today. Today's bonus will include an unedited interview from last week's episode about medical

cannabis. It was the interview with the doctor, Dr Steve Hadjof, and it's for anyone who really wants to wrap their head around the nitty gritties of the UK's policy on medical cannabis. So how licensing works, what's prescription versus over the counter, and where all those CBD lifestyle products you can just pick up at whole foods tie into it all. Kind of niche. Kind of niche. So have you actually edited any of it at all? I've tried to take out bits where we've say repeated, we've done a whole section, but no, this is really about giving listeners a glimpse of what's happening behind the scenes. And that, I think, takes us onto something we're quite excited to announce. Yes, that's right. So we are setting up a Patreon account to help knit

our MediaStorm community a little tighter together. It means if you'd like to, and you're able to, support our work financially, you can subscribe to Media Storm on Patreon. We do want to hear from you about what you'd want to get from that, whether it's, for example, more of the raw material, newsletters, or even opportunities to meet and chat with Matilda and I. If you haven't already, have a little listen to our special feature that we released at the start of this season about funding independent journalism and what a free press really means. That way you can see some of the problems that you'd be helping to plug. But we also want you to know that even just listening goes a really long way.

And you are absolutely part of the MediaStorm community, whether or not you do subscribe. We really love hearing from listeners, so keep those comments and emails coming in. you can reach us on MediaStorm podcast at gmail.com. Matilda and I also keep our DMs open. We didn't actually mention how to support us on Patreon, I don't think. So if that's something you'd like to do, there is a link in the show notes. Just click on it and then you can choose your subscription option. And with that, we'll hand over to Dr. Steve Hadioff, being interviewed here by Matilda

for last week's episode, talking about how the UK's medical cannabis market works. Marijuana, pot, grass, whatever you want. want to call. It's probably the most dangerous drug. The underground cannabis business is hidden all over Britain. Just condoning another gateway drug. Look at this. Around 120 plots in it. Marijuana use inspires users to try harder drugs like cocaine or heroin. Welcome to MediaStorm, the news podcast that starts with the people who are normally asked last. I'm Matilda Mallinson and I'm Helena Wadia. This week's bonus special sitting down with Dr. Steve Hadjoff.

Hi, so I'm Steve Hadjof. I'm by training a doctor and also an epidemiologist and a health economist. Can you start just by explaining to us what we actually mean when we say medicinal cannabis? Really, it refers to any compound that's derived from this particular group of plants called cannabis plants being used to treat or to manage disease. So firstly there are hundreds of different chemicals within the cannabis plant and several of them have been shown to have activity on the body, some of which is potentially medicinal. Now the best known of these compounds, these so-called cannabinoids are CBD, cannabodial and

THC, tetrahedral cannabinol. Now they are different in the way they work. So cannabodial, CBD, it doesn't produce euphoria, it doesn't get you intoxicated, but it still has medicinal effects. The best known intoxicating substance in the cannabis plant is THC, tetrahedral cannabinole, but it also has medicinal benefits. Generally speaking, the strains of the plant that are medicinally beneficial are ones that have a range of cannabinoids, so have a similar amount of THC and CBD. And the strains that are used recreationally, tend to have much higher THC and much lower CBD.

And that makes sense because THC is the recreational compound, if you like. Does that make sense? And also, what do we mean when we talk about prescription cannabis as opposed to over-the-counter cannabinoids that are available? That's another really, really good question. So we currently have actually three different routes, if you like, for people to access cannabis-related compounds legally. There is the so-called lifestyle market.

Now, these are substances or foods or tinctures that contain CBD. They don't contain any THR or very, very tiny amount is allowed. And they are available to go and buy in a health food store or in a pharmacy. They're generally fairly low dose in terms of the CBD and they're not regulated in the same way as a medicinal compound is. So you wouldn't necessarily want to rely on those if it was for treating serious illness. So that's the first group, the sort of lifestyle CBD products. The second group are the licensed medicines. So there are two or three medicines. that are actually made from the cannabis plant that have licenses like every other medicine

and you get a prescription and you get these pills or these liquids, etc. from a pharmacy in the usual way and you take them in the usual way either as a capsule or under your tongue sort of thing. Now those are only licensed in some fairly rare conditions. There's one that's licensed in muscle stiffness for people who've got multiple sclerosis. which is obviously very, very problematic and it's a difficult disease to live with. There's another one that's licensed only in certain rare sorts of epilepsy in children. And again, there's very, very small numbers of children, thankfully, who have those very debilitating conditions and therefore can benefit from that.

But that doesn't cover the majority of people. That covers very small minority of people. There is an additional route which is unique to cannabis, and that is the cannabis-based products for medicinal use, I think is what it stands for CBPNs, is what they call them. And these are basically things derived from cannabis that don't have a licence, but they are permitted to be prescribed for an individual patient to help with their particular needs. Now it's always done for an individual patient on a named basis by a specialist because that's the law as it currently stands. And these vary from sort of powdered flour for someone to vape through to liquids to put under the tongue and a variety of other formulations. But they differ from normal medicines in that they don't have a licence and haven't gone through that usual approval process. they have another law that allows doctors to prescribe them legally and pharmacies to hold them

legally. Does that make sense? Yes, thank you. My next question is, when it comes to medical cannabis and its benefits and its safety, what does the science say? So it's really, really interesting. So there are lots and lots of bits of science around cannabis and cannabinoids. And whilst they are not without risk because nothing is without risk, they are reasonably safe and they are certainly in similar realms of safety to therapies that don't worry us to take ourselves or to prescribe. So whilst everything does have risks and there are some specific risks around THC which I might come back to, they're reasonably safe. In terms of their effectiveness, I think part of the problem is that the tests that have been done,

the so-called clinical trials that are undertaken to prove that something works, have often been done in a different way for medicinal cannabis. So it's harder for doctors to understand the outcomes. But nevertheless, there seems to be fairly good evidence. They interact with what's called the ender cannabinoid system, which is a system of substances and receptors in the body and can have an effect on things as different as mood, pain, appetite and a variety of other things. There's also evidence that cannabinoids act on the body in other ways through managing inflammation. So there is good evidence that they are safe, but there may not be the level of evidence that doctors generally want, that doctors are generally used to. So it means that doctors have to have

specific expertise in order to feel comfortable around prescribing medicinal cannabis, whereas if it were another medicine that was a licensed medicine, most doctors might well be comfortable prescribing most things. I have a couple of follow-up questions. Firstly, you said that clinical trials have been done in a different way for cannabis, and so the evidence isn't up to the level that doctors would typically expect. Can you just explain that a little bit more? In what way have they been tested differently?

So the way we have evolved to evaluate medicines over the past 40 or 50 years is through a thing called the randomised control trial. And that means we get a group of people. who have got a condition and we split them into two groups without knowing who's in which group and one group will get the medicine that we're testing and one group will get something else. Now that could be a placebo or it could be the medicine that's normally used for that condition. But nobody knows who's getting what and then we watch and see how they respond in the people in the two groups and we compare them statistically to see if

the new treatment has made a difference. Now, the reason why we do it that way is there are all sorts of psychological effects that can bias our perceptions of what's working and what's not, both as doctors and as patients as well. And by doing it this way, by keeping it blinded, if you like, we can eliminate those risks so we can be reasonably sure that the two things are different. Now, often the evidence in medicinal cannabis isn't split into two groups, isn't blinded so people know whether they're taking it or not. And so there are different sources of bias that come into those studies

that concern doctors a bit. Okay, but why? Why can't cannabis be tested in the traditional way? See, that's an interesting question because I'm, there are two scores of thought on this. Now, I'm in the camp that says it absolutely can be done in the same way. People will say, well, you can't because it makes you feel different when you're taking it, because it's psychoactive, is the term. Well, that's true for pretty much every medicine that we use in mental health.

And yet we run randomised controlled trials for those. So I don't, I don't buy that. They could say that, well, you're actually doing something physical, and so therefore you'll know. Well, again, we do sort of dummy psychotherapy, if you like, what we call attention placebos when we're testing to see if psychotherapy works. We're used to doing, I don't know how to describe it, sort of placebo activities to compare with the active activity that we're looking at. So that's already mainstream. So I kind of don't buy that it's not possible. I think the problem is partly a financial one.

Because you can't patent a natural product and natural extract, it's very difficult to see where the return for someone is, for an organisation is, because it costs a lot of money to run a clinical trial. you know, maybe, maybe five million US dollars as a starting point to run a full clinical trial. And that's very difficult for an organisation to take if they can't have a reasonable expectation that they're going to be able to grow their business from it. That said, it's very, very interesting that the National Institutes of Health Research had a fund specifically for cannabis trials. I think it was 18 million pounds and it was there and as far as I know

nobody submitted a trial that was met the standard for it to be funded by NIHR free to the sponsor. So they could have done the trials for nothing if they designed them robustly enough and I don't believe anyone actually did. So I think trials can be. be done. I think trials should be done. I don't buy that it's not possible, but I do accept that it's not easy, if that makes sense. Well, I think that's really telling that difficulties patenting cannabis may have de-incentivised proper clinical research, even when there's such strong evidence that the product could really help people. So moving on to that, you've given a few examples of ways that we think medical cannabis can help. For example, you've mentioned mental health. Can you just tell us

how, from the evidence that we do have, cannabis potentially helps certain mental health disorders. There's evidence around depression and anxiety. There's evidence in post-traumatic stress disorder that's reasonably robust. There's also some evidence. So there's a very, very serious sort of mental illness called psychosis. And it's where a person's perceptions become detached from what the rest of us see and experience. and I've seen trials run in preventing psychosis, which is really exciting. I've seen evidence in autism, particularly the anxiety symptoms that people with autism can get.

Tourette, Seed La Tourette's syndrome, I've seen some early evidence there. And that's just the mental health stuff. There's plenty in physical health as well. Would you be able to just break that down for us in scientific terms? I mean, simple scientific terms. How does cannabis actually alleviate pain in the body? Sure. And again, this is one of the areas where there's a little bit of controversy. So certainly the endocannabinoid system that I talked about earlier is involved in pain and how the body perceives pain.

And so several cannabinoids can interact with that endocanabinoid system and therefore reduce the perception of pain, but there's also a few cannabinoids that have other anti-inflammatory activities. There's a particularly powerful anti-inflammatory pathway that several cannabinoids interact with, and that's actually really exciting. And it's difficult to put your finger and say there's one of those mechanisms, because it's likely that there's two or three of them happening all the time. You know, the psychoactive element of THC may well reduce how much it bothers people, even though they're still feeling it, because it's psychoactive in that way.

And you've mentioned the difficulties in providing evidence for all of this. I want to actually build on that and hear more about reasons for caution. If there is resistance coming from many people within the medical community, what are their reasons? One is root of administration, and I've kind of touched on that before. Smoking is bad. Vaping is not much better. What we're used to prescribing for people who need our help is little white pills.

The further away a treatment is from little white pills, the less comfortable it is. So it could be just something as simple as that. I think the association with the illicit market is potentially an issue, particularly given what has happened in the past decade or so with opioids. I'm not saying that cannabinoids are in any way as noxious as opioids can be, but we've been comfortable with a set of compounds that do have what we call abuse potential and we found that we were wrong in that comfort and we've caused people harm. So I think we're a little bit more reticent about taking the risk.

And I think the final piece is very few doctors understand. the end of cannabinoid system. I think we understand inflammation and I don't think enough is made of the anti-inflammatory effect of cannabinoids in explaining how they work because that will resonate with far more doctors. So I think we've probably not done the right sort of teaching. And then finally the overwhelming majority of healthcare in this country is through the NHS and most doctors who work in private practice are really doing very similar things to what they do in the NHS. Now currently cannabis-based medicinal products are not mainstream in NHS

practice and until they are you're not going to have you know widespread familiarity with them. Does that make sense? Yes that's a very helpful breakdown. Thank you. My final question before we wrap up is how in your experience as a clinician, have you seen it change patients' lives? And what is your opinion of it as a result? So I've certainly spoken to people whose lives have been changed. You know, I've seen particularly children with nasty epilepsy. I've seen their frequency of fits drop markedly. I've seen in the US, I have a particular interest in post-traumatic stress disorder. And certainly, it is believed by the people who are using it to give them enormous benefit. And I would love to see really, really

robust trials, you know, to tell us that that's the case. Thank you for listening. Our next investigation and episode of Media Storm is on the past, present and future of strikes in the UK with special guest Mick Wheelan. That'll be out on the 15th of June, so stay tuned. Follow MediaStorm wherever you get your podcast so that you. you can get access to new episodes as soon as they drop. If you like what you hear, share this episode with someone and leave us a five-star rating and a review. It really helps more people discover the podcast

and our aim is to have as many people as possible hear these voices. Media Storm is an award-winning podcast produced by Helen Awadier and Matilda Mallinson. It came from the House of the Guilty Feminist and it's part of the ACAS creator network. The music is by Samfire.