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In this very first interview, we have the privilige to read what Dr Orzala Pazhman has to say about medical cannabis. Dr Pazhman works as a physician for a private pain clinic in Stockholm called Aurea Care. There, she treats patients with chronic pain, tremor or spasticity with cannabis-based medicines.
Can you tell us about your experience in treating patients with chronic pain using medical cannabis? In your experience, what types of chronic pain are most effectively treated with medical cannabis?
As a medical doctor working with pain patients and medical cannabis, my experience has shown that patients with neuropathic pain tend to respond the best to medical cannabis treatment. However, I have seen good results in patients with all types of chronic pain, epilepsy, and multiple sclerosis as well.
What are your thoughts on the use of medical cannabis for other conditions beyond chronic pain, such as epilepsy or multiple sclerosis?
I believe that medical cannabis can be a viable treatment option for various conditions beyond chronic pain, such as epilepsy and multiple sclerosis. In fact, there are already two approved cannabis medications in Sweden, Sativex and Epidiolex, for MS and some forms of epilepsy in children.
Online you can find many, many individual anecdotes of chronically ill patients whose lives have been completely transformed after they started using medical cannabis. Do you have any similar experiences with patients whose lives have been dramatically changed by cannabis-based medicines?
Yes, I have seen many patients whose lives have been transformed dramatically by cannabis-based medicines. Patients with severe pain who were almost bedridden were able to return to work after many years and live better lives. There are many such stories that I have had the privilege to be a part of.
You work with medical cannabis in Sweden. Can you give us a short rundown of the current status and regulations for the use of medical cannabis in Sweden?
In Sweden, there are currently two approved cannabis medications, Sativex and Epidiolex, with indications for MS and Lennox-Gastauts syndrome (LGS) or Dravets syndrome (DS). Dronabinol and Cannabinol can also be prescribed off-label as magistral prescriptions, or so called unlicensed medical cannabis preparations, provided patients have had a sufficient trial of licensed products and are otherwise appropriate candidates.
Looking ahead to the future, how do you see the use of medical cannabis in Sweden evolving over the next decade? Do you think there will be any changes to current laws or regulations surrounding medical cannabis use?
Looking ahead, I believe that the use of medical cannabis in Sweden will continue to grow as more high-quality studies are conducted and more clinics and doctors become comfortable with prescribing medical cannabis to patients who need it. However, changes to current laws and regulations surrounding medical cannabis use may be slow due to the stigma associated with cannabis in Sweden.
What are your thoughts on the debate between using isolate vs full spectrum cannabinoid-based medicines? In your experience, have you found one to be more effective than the other?
Most high-quality studies on medical cannabis are based on isolated cannabinoids, which provide valuable information on the safety and drug interactions of these medicines. However, there is still a lot we don’t know about the components of full-spectrum cannabinoid-based medicines. Not all of the compounds in these medicines are safe for every condition, and further research is needed to fully understand the benefits and risks associated with them. Despite the fact that there is still much to learn about cannabinoids, I generally recommend isolated cannabinoids due to the greater amount of information available on their safety and interactions.
What do you believe are the biggest misconceptions about cannabis, particularly in Sweden? How do you address these misconceptions with your patients?
In Sweden, the biggest misconception about medical cannabis is that the positive pain-relieving effect is due to patients getting a “high.” This is a false assumption. The aim is to provide good pain relief without causing side effects such as dizziness and lightheadedness. Most patients aim to achieve sobriety, which has been challenging for them due to their long-term use of prescribed opioids and its known cognitive side effects.
Did you learn about the Endocannabinoid System (ECS) in medical school? How did you get into the controversial area of medical cannabis?
Neither I nor any of my colleagues can recall learning about the Endocannabinoid System (ECS) in medical school, but I got into the controversial area of medical cannabis because I wanted to learn more about this new medicine and help patients who were not getting good pain relief from other treatments.
How important do you think it is for doctors to have a thorough understanding of the ECS when treating patients with medical cannabis?
I believe it is essential for doctors to have a thorough understanding of the ECS when treating patients with medical cannabis because it is an elaborate system with many functions that can impact a patient’s health and disease. Given that the endocannabinoid system is a complex system with numerous functions, it is crucial knowledge for all medical doctors. Unfortunately, most doctors in Sweden currently lack the necessary knowledge regarding the ECS.
How much knowledge do you think Swedish doctors in general have about medical cannabis? What steps do you think can be taken to improve education and awareness around the use of medical cannabis in the medical community?
In general, most Swedish doctors lack basic knowledge about medical cannabis, and this is mainly due to the stigma still associated with cannabis in Sweden. More education and awareness around the use of medical cannabis in the medical community can be achieved by conducting high-quality studies and providing training to medical professionals.
My textbook in human physiology back from university contained zero information about the endocannabinoid system. I checked the content of the newest version of the same textbook online and it still hasn’t changed. As a physician working with medical cannabis, how essential do you believe it is for doctors to understand the endocannabinoid system in order to have a complete picture of human physiology and what impacts health and disease?
I believe it is very important for doctors to understand the endocannabinoid system in order to have a complete picture of human physiology and what impacts health and disease. The ECS plays an important role in regulating various bodily functions, and a better understanding of it can help doctors provide more effective treatment options to patients.
Thank you so much Dr Pazhman for telling us about the current state of medical cannabis in Sweden!
Stefan Broselid, Ph.D.
Molecular Pharmacology
Editor-In-Chief, Aurea Care Medical Science Journal