The British Association for the Advancement of Science Meeting in Glasgow. Item 1 Cannabis
Broadcast Saturday 22/09/2001
Introduction to the British Association for the Advancement of Science meeting and interview about the medicinal use of cannabis.
Robyn Williams: Glasgow Ė well I wonder what sort of image you have of this ancient Scottish city. Itís the site this week for the British Association for the Advancement of Science meeting. Really I imagined it would be a place rather like the old fashioned image of Jimmy and head butting, the Gorbals and the slum districts; in other words, a very rough place. However, when you come here you discover that Glasgow is now one of the cultural centres of Europe. Itís also got the most fantastic university, wonderful grounds, great big looming buildings, mainly of extraordinary Victorian design though, in fact, the university goes back 550 years. It was founded in 1451. Itís also got some spectacular names to conjure with, the most famous of which is, of course, Lord Kelvin Ė he of the degree fame for measuring temperature. Absolute temperature is nought degrees Kelvin.
He took up the Chair of Natural Philosophy or Physics, a post he held for no fewer than 53 years. Another very famous person from this university is Adam Smith, one of the inventors of capitalism Ė Adam Smith had a very miserable time in Oxford in Balliol College but in fact, spent a great number of years here as a Professor of Logic and developed his ideas of course culminating in the Wealth of Nations. John Logie Baird was here as well, the inventor of television and of course there have been plenty of writers, A J Cronin, Catherine Carswell, Alistair McLean and so forth.
Well the British meeting goes on for a whole week and letís go and plunge into the middle of it, into this wonderful sun-drenched campus.
So, you might ask yourself what is the front line topic on this first day of the British Association Meeting in Glasgow and I have to tell you itís cannabis and weíll come to that with Dr William Notcutt from the James Paget Hospital near Norfolk in the southern part of Britain. Dr Notcutt have you been to Glasgow University before.
Dr Notcutt: No this is my first visit.
Robyn Williams: Itís an amazing campus isnít it, huge and elegant?
Dr Notcutt: Yes, it is lovely out here and sitting out in the sunshine is a bonus.
Robyn Williams: Well I was quite amazed by the sunshine because the weather forecast was horrendous so weíd better make it reasonably quick. Now youíve appeared on the Health Report in a program by Natasha Mitchell about some of the uses of cannabis therapeutically. Could you just sum up the ways in which youíve been giving cannabis to your patients?
Dr Notcutt: Yeah, weíve moved on since that particular report and now we are conducting studies of giving an extract of cannabis prepared to the high standards of the pharmaceutical industry, giving it to patients with chronic pain and weíre giving it to them by spraying it under the tongue as part of a clinical research program.
Robyn Williams: How many patients?
Dr Notcutt: Well weíve only studied 23 patients so far because weíre studying them in considerable depth. Itís not been done really in chronic pain before.
Robyn Williams: Because in the old days, well not too long ago, the patients used to smoke it in the traditional way with some sort of joint with who knows whatís in it and getting a vaguely defined response. It was quite impressive but of course for clinical purposes you need to know exactly, if you can, whatís going in and how long for.
Dr Notcutt: Yeah, the traditional joint is a very effective delivery system for this material but itís impossible to study it. And of course itís not an acceptable way of delivering a medicine. We donít give any other medicine by drying the leaves, rolling them up in paper and then inviting the patients to inhale the smoke.
Robyn Williams: Let alone have a good time.
Dr Notcutt: Yes, that is an issue for the recreational lobby. Our patients are not interested though in getting high. The sort of patients that Iím dealing with are very much the end of the line. Patients with chronic pain for whom life is pretty miserable, theyíre immobile, they are not able to do the things they want to do. And therefore itís not in their interests to be getting the high, getting trashed out by a large quantity of cannabis. They actually want to get on with their lives, they want to go and do things. Therefore when they are using our material, using the cannabis, they give themselves enough to relieve their symptoms but not to go over the top and finish up, for want of a better word, high or stoned or whatever it is.
Robyn Williams: No, of course on a scale of 1 to 10 how severe is the pain that they are trying to deal with and how much relief do they get?
Dr Notcutt: Our patients have a variety of pain problems. We have one or two who describe their pain as being the worse imaginable which gives some idea of how severe that is.
Robyn Williams: 10 out of 10.
Dr Notcutt: 10 out of 10 absolutely. The degree of improvement they get is variable. Some patients have seen their pain almost complete melt away, when theyíre at rest and when they do a low level of activity. Others have seen only a very modest, or even a quite limited improvement in pain but theyíve seen improvement in other things. For example many of our patients say they now sleep much better at night. If youíre trying to cope with chronic pain during the day time and youíre only getting three hours of broken sleep a night, an improvement in your sleep so that you can now sleep for several hours is a positive bonus.
Robyn Williams: Do you know what is the active ingredient responsible? Is it THC, tetrahydrocannabinol or some other such ingredient of which there are many of course?
Dr Notcutt: Yeah, there are very many active ingredients in cannabis. The two weíre looking at the moment are tetrahydrocannabinol, TAC as itís commonly known. Weíre also looking at cannabidiol, which seems to be an important constituent particularly if the cannabis the patients use is for medicinal purposes. We base this on having asked patients what kind of cannabis they find helps them most when they smoke it. We found that a lot of patients said the cannabis with a lot of cannabidiol seems to be the best. And thereís evidence that cannabidiol ameliorates some of the high effects, some of the side effects of TAC.. TAC seems to be the most psychoactive element of cannabis.
Robyn Williams: The thing that surprises me to some extent is that you should be going for cannabis when in fact there are so many analgesics. Why is cannabis so important to you?
Dr Notcutt: The quick answer to that is that all the conventional medicines, analgesics, do not get to the bottom of chronic pain. And there are many patients I see for whom morphine is absolutely useless. This always surprises people but there are a lot of pains which morphine will not treat. And I have a large number of patients who are looking at a lifetime of unremitting pain to who I can offer nothing but talk. When we discovered that the body makes itís own cannabis and that it plays an important part in damping down the nervous system, we realised that weíve discovered an agent that we can use to treat patients. It is exciting because itís something new in an area where there are very few new agents around.
Robyn Williams: Well the last report I had on this field of research was in fact from University College, London just about a year ago where theyíd given this sort of treatment to mice. Their study was published in the journal Nature. They found a clear effect in the experimental animals.
Dr Notcutt: Yes, thereís a huge body of laboratory evidence now supporting what weíre trying to do. We now know that the cannabis system is all over the nervous system and we really havenít started to explore this clinically. For 30 years it has been done in the laboratory on mice and other furry creatures. As for patients, they really havenít had a look in and thatís why the sort of work that Iíve been doing and others are starting to do, is so exciting.
Robyn Williams: Dr William Notcutt from the James Paget Hospital, thank you very much.
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