“The conventional medicines we have for dealing with pain are not that good… So I really wanted to have a good look at cannabis-based medicines, which I think may in some ways be better and safer for people with long-term pain.”
Dr Anthony Ordman is one of the UK’s most experienced specialists in the treatment of pain. Honorary Consultant in Pain Medicine to the Royal Society of Musicians and Past President of the Pain Medicine Section of the Royal Society of Medicine, Dr Ordman has recently joined Integro Medical Clinics as Senior Clinical Advisor and Hon. Clinical Director.
We sat down with him to find out more about his background, understand why he’s backing cannabis as a pain treatment, and to get his thoughts on what the future looks like for cannabis-based medicines in the UK.
Hi Anthony, could you tell our readers a little more about your medical background?
“In the late 1990s, I set up one of London’s biggest pain clinics at the Royal Free Hospital. Pain is a very difficult problem. It’s not like a chest infection – “here’s an antibiotic”, or a worn-out joint – “have a hip replacement”. Long-term pain is really much more ingrained into the person’s body, and indeed mind – it’s much more difficult to improve, and that’s why multidisciplinary teams are often needed to help.
“You need doctors to diagnose and prescribe medications and so on, you need psychologists because long-term pain causes anxiety and depression, and you need physiotherapists who understand how the body works when it’s in pain, and how to restore normality. I brought all of these specialists together, at the Royal Free, which was unusual in those days. It was quite an innovative clinic and it had a big influence.
“I became involved with the Pain Section of The Royal Society of Medicine, and eventually the section’s president, so I could further influence ideas on pain. I also have my own private pain medical practices based at the Wellington Hospital and The Royal Free Hospital.”
You’ve recently joined Integro, a medical cannabis clinic. What made you join Integro, and why now?
“I left the NHS about three years ago and was very pleased when Integro asked if I would lead the new clinic, which would be using cannabis-based medicines. I realised we should all have a good look at cannabis-based medicines, because the conventional medicines we have for dealing with pain are not that good. They don’t always work for long-term pain and they all have side effects which can make people’s lives worse, not better. I really wanted to have a good look at cannabis-based medicines which I think may, in some way be better and safer for people with long-term pain.
“There are a few cannabis medicine clinics now, but Integro really has the patient at its heart. Before I joined Integro, we all agreed that what we wanted to offer was good, patient-centred medicine. I believe that if you first listen to the patient and everything they want to tell you, you can understand the patient and their pain better. Then you can try and provide what they need, rather than some standard prescription. I’ve made sure that we have plenty of time to listen to the patient and discuss their case, and we are extremely fortunate that our managers share this view. We don’t say “you have to have this medicine, it from this pharmacy. We may not always agree with every patient’s initial thoughts, but we really try to work in partnership with each and every one.
“I always believe you listen to the patient and everything they want to tell you, so you can understand the patient and their pain better. Then you can try and provide what they need, what their body needs rather than some off the shelf prescription. That’s what I’ve brought into Integro, that we’re all very patient-centred. Plenty of time to listen to the patient and discuss the patient. We don’t just say “you have to have this medicine, you have to get it from this pharmacy…” We really try to find what the patient wants and not necessarily give them what they want but at least listen.
“And they can go off with their prescription, or go to our pharmacy. We really rely on the fact that our patients are very pleased with the way we have interacted with them, and they seem to appreciate the difference between our clinic from other clinics. We brought the very best of the NHS pain clinic into Integro.”
You are one of the UK’s leading pain specialists, how does cannabis help treat chronic pain?
“There are very complex pain processing centres in the nervous system, both in the spinal cord which transmits pain messages up to the brain, and in the brain itself. These processing centres use molecules that are very like cannabis to do the signalling between nerves. In long-term pain states, these centres can get very unbalanced; overactive or underactive, so that all the pain messages just flood uncontrolled through to the brain.
“Cannabis molecules such as CBD and THC are very similar to the natural signalling substances (endocannabinoids) in the nervous system, and we can use them to rebalance the nervous system so it’s not over-excitable and over-transmitting pain messages. We aim to re-balance the body’s endocannabinoid system.
“I’ll give you an example. If you’re standing at a bus stop on a cold February evening, when it’s dark, wet and miserable, and somebody kicks you in the shin, it hurts like anything. If you’re about to score the winning goal at Wembley and somebody’s boot contacts your shin, you don’t notice the pain because the processing system in the nervous system prioritises the goal, and blocks the pain messages from going up to the brain. But in long-term pain, the processing systems in the nervous system tend to get stuck open, and can even amplify the pain. If we can calm these systems, using substances from the cannabis plant, we can rebalance these systems in a way that’s probably better than using the conventional medications we have. Pain causes anxiety and low mood. Cannabis medicines can help those as well, which can also help the pain.”
If someone believes cannabis could help them treat their condition, what should they do?
“They can contact us through our website or by phone. Enquirers will meet somebody who will explain about Integro, and be offered a chat with our specialist nurse who is very experienced in cannabis medicines. Then if they want to proceed, prospective patients will meet with myself or a doctor colleague. We’ll have a more in-depth interview to see if we can help with cannabis medicine, and which ones we recommend. Then, before we make any final decision, we discuss your case in our multidisciplinary team meeting, to ensure we make the best decision for each person.”
How did you personally get into cannabis as a way to treat people?
“As a doctor, you go to seminars and conferences to keep up to date. Over the years, there were always talks and lectures from medical scientists about the body’s own endocannabinoid system, which produces natural endocannabinoids, much like cannabis compounds, which the body makes itself. The endocannabinoid system regulates the way the body works, not only with pain and mood, but also immunity and all sorts of things. The scientists kept saying ‘one day we’ll use this system to help people with pain’ but nothing much happened because of cannabis legislation. Now the regulations have been changed, making it possible to prescribe cannabis medicines provided you’re a specialist. so now, we finally have the opportunity to go ahead and do what we’ve been waiting to do for so long.”
Do you think the public should have greater access to cannabis?
“Yes, but in a very careful way. Any medicine can do more harm than good if we’re not careful. So yes, eventually cannabis medicine should be available for use in the NHS, for example. But first, we need the research, and we need people who have the time to find out about cannabis medicines. At the moment the NHS is under such pressure in terms of time, as well as finances, so I don’t think there’s the spare capacity there just now. So we really need to help the NHS by finding out more about how these medicines can work best, and how best to use them.”
Finally, where do you see the future heading for cannabis in the UK and the rest of the world?
“I think over the next three to five years we’ll be finding out much more. We’ll be even more comfortable that we’re not doing any serious harm, which is a very important thing to show. The use of cannabis as medicine will only increase, but we need to take any romantic notions about cannabis meds out of the equation. These are medicines that we are learning more about, as we go along. So, to quote a couple of phrases you often hear about cannabis medicines, were going to “start low and go slow” because “this is a marathon, not a sprint”!
Integro Medical Clinics aims to provide patient-centric high-quality medical care that is effective, appropriate, timely and within a safe environment. For more information visit https://www.integroclinics.com/ or call 0203 440 5146.