An Interview with Dr Luisa Searle
Dr Luisa Searle, a consultant psychiatrist and medical cannabis specialist, discusses her holistic approach to patient care, the science behind the endocannabinoid system, and the importance of mindful, evidence-based prescribing.
Dr. Luisa Searle, a consultant psychiatrist with a sub-specialty in substance misuse, began her journey into the world of medical cannabis about three years ago. Dissatisfied with the lack of parity between mental and physical health services, she stumbled upon an advertisement for what is now known as Lyphe Clinic. “Like many people – patients, doctors, other healthcare professionals – I was like, ‘what do you mean, medical cannabis?’” she recalls. Initially unaware of its existence beyond rare epilepsy cases, Dr. Searle investigated the CQC-registered clinic and decided to apply.
After completing training through the UK MCCS and Mike Barnes’s certification, Dr. Searle’s involvement deepened. When the clinic needed a medical director, she applied and successfully took on the role. One of her major achievements was leading the team to resolve warning notices the clinic had received. This experience ignited her passion for understanding cannabis and its potential benefits, leading her to discover the endocannabinoid system (ECS). “It was just like, ‘what do you mean we have an endocannabinoid system? What is anandamide?’ It was just absolutely fascinating,” she says.
Dr. Searle expresses bewilderment at the omission of the ECS from standard medical training. “I’m a scientist. One should not be scared of facts. They are just facts. They have no political affiliations, they have no ethics or morals, they are purely just facts. And so, you know, why has the ECS been left out of medical training, I have no idea? And I’d love the answer to that question.” She points to the historical negativity surrounding cannabis, originating from the USA during the ‘50s and ‘60s and still influencing the World Health Organization & beyond, as a possible reason for this neglect. “There is real evidence about the demonization of cannabis… just kind of like suppressing it, classing it in the same category as heroin for goodness sake.”
Regarding the MHRA’s current stance, Dr. Searle believes they are not creating barriers to cannabis, citing the increasing availability of various strains, including flower, as evidence. However, she believes they are rightly focusing on the nomenclature of medical cannabis products. “I think it’s really hard when you’re going to talk to somebody who is maybe a little more conservative and does have these rather traditional views of cannabis, that when you go to them and say, ‘Oh yes, I’ll prescribe you, say, Durban Poison .’ I think it’s really hard for them to take you seriously.” She argues that clear, professional naming conventions are crucial for broader acceptance within the medical field. She explains that “Mrs Jenkins down the road” wants to hear “brands like AstraZeneca or Pfizer or whatever. She wants some difficult to pronounce set of syllables that don’t really mean anything but scream, this is medicine!”
For Dr. Searle, understanding the terpene profile of cannabis strains is essential for effective prescribing. While research on the entourage effect is ongoing, initial studies suggest enhanced receptor activity when terpenes are present alongside THC. She also draws parallels with nature, suggesting that scents (terpenes) may signal other important properties within the plant. “For me, it’s a crucial part of it. Because otherwise, I might as well just pick one out of the hat. And that’s not really medicine to just do a bit of gambling, essentially.” She uses a rule of thumb for terpene selection: caryophyllene for pain, myrcene for insomnia and sedation, and limonene, pinene, and humulene for anxiety. She also highlighted the importance of terpinolene for patients with issues around mood, focus and motivation, and geraniol as an “all-rounder” for pain, anxiety and digestive issues.
When discussing minor cannabinoids like CBG and CBN, Dr. Searle admits that conflicting information makes it difficult to form firm conclusions. While she doesn’t see consistent results with CBD, she finds it useful for patients new to THC, as it can temper its effects.
Dr. Searle, along with colleagues Berta and Sally, founded a clinic with a holistic approach to patient care. Frustrated by the impersonal nature of some private healthcare settings, they aim to treat the whole person, not just their symptoms. “There is a complete barren wasteland of any mention of [psychology] in any of the medical cannabis clinics,” she observes. She stresses the importance of understanding treatment goals and ensuring that medical cannabis enhances quality of life. “The medical cannabis should be calming my symptoms enough so that I can contemplate and make a plan to start getting out more because, you know, as we know, social contacts are massively important for your overall well-being.”
This holistic philosophy incorporates elements of functional medicine, psychotherapeutic support, and a focus on longevity. Dr. Searle explains, “We’ll also get them to see our pain specialists, we’ll also get them to see our psychotherapist, then the three of us will have a meeting together to discuss the ongoing treatment plan…the person’s going to get their life kind of put under a microscope if you like.” This approach considers diet, exercise, social interactions, biochemistry, and physiology to create a comprehensive picture of well-being.
Regarding the potential link between cannabis and psychosis, Dr. Searle acknowledges the existing concerns and research, such as the work of Dr. Marta Di Forte. She emphasizes the importance of careful consideration and risk assessment before prescribing medical cannabis to individuals with a history of psychosis. She also expresses concern about the increasing potency of some medical cannabis strains, cautioning against the assumption that “natural” equates to “safe.” “Natural doesn’t equal safe and I think people need to really understand that.” Her focus is on informed consent, providing patients with a balanced perspective on the potential benefits and risks.
Dr. Searle also addresses the issue of cannabis use disorder (CUD), emphasizing the psychological aspect of dependence. While physiological withdrawal from cannabis is generally less severe than with substances like opiates, the psychological dependence can be equally challenging. “I want my patients to be in control of their medication, not the other way around.” She worries about colleagues who don’t take the potential for dependence seriously and stresses the importance of mindful medication use. “Mindfulness is… useful for everything that you do, including how you use medication. Use your medication mindfully. What is the purpose of it at this time?”
Finally, Dr. Searle addresses the common scenario of individuals who self-medicate with cannabis and feel they cannot function without it. She advises that cannabis, like any substance, should be part of a broader management plan, including psychotherapeutic techniques and lifestyle changes. “It shouldn’t be the only thing that you rely on to manage yourself… When you start introducing a foreign substance to regulate your body, it down-regulates your own innate ability to manage things.” She concludes that relying on a single substance is not a healthy or sustainable approach.
Here’s a summary of Dr. Luisa Searle’s views, extracted from the interview transcript:
1. Views on the Endocannabinoid System (ECS):
Dr. Searle is astonished that the ECS is largely omitted from medical training, considering it a significant oversight for a scientific field.
She views the ECS as a critical part of human physiology that should be fully understood and taught in medical education.
She believes the omission is likely linked to the historical demonization and stigmatization of cannabis, which is a barrier to scientific progress.
She believes that a dysregulation in the ECS may be the cause of emotional dysregulation and difficulty with focus and concentration.
2. Distinguishing Terpenes & Their Properties for Different Conditions:
Dr. Searle considers terpene profiles crucial when selecting cannabis strains for patients. She doesn’t just see it as a “fudge,” but a key element.
She believes terpenes are likely playing a significant role, potentially through the entourage effect or by signaling the presence of beneficial compounds within the plant.
She uses specific terpenes to address different issues:
Caryophyllene and Myrcene: Primarily for pain and as anti-inflammatories and calming agents.
Humulene: For both anxiety and insomnia due to its presence in hops, which are known for their calming properties.
Linalool: For insomnia and relaxation.
Limonene and Pinene: Can be either uplifting/energizing or calming, depending on the individual’s response.
Terpinolene: Specifically for mood, focus, and motivation issues, like in ADHD.
Ocimene: She is still exploring it, but has observed it to be a mood elevator, but doesn’t have enough experience to say this confidently.
Geraniol: Appears to be an all-rounder that can help with pain, anxiety, and digestive issues.
3. Importance of Holistic Treatment and Cannabis’s Role:
Dr. Searle is a strong advocate for holistic treatment, viewing patients as interconnected systems rather than just addressing single symptoms.
She believes that medical cannabis should be part of a broader treatment plan that includes psychotherapeutic techniques, diet and exercise, gut health, and metabolic health.
She does not believe that cannabis should be a sole solution, as a dependency could develop.
She emphasizes that the goal of medical cannabis should be to enable people to improve their quality of life and tackle underlying issues, not just manage symptoms and be housebound.
She believes that every patient should be considered an individual and that their treatment plan should be bespoke to their own needs, rather than a cookie-cutter solution.
4. Views on Potential Cannabis Use Disorder (CUD) and Prevention:
Dr. Searle distinguishes between physiological dependence (less of a concern with cannabis) and psychological dependence (the greater challenge).
Her biggest concern with CUD is the psychological dependence that patients can develop, making it hard for them to stop using cannabis.
She stresses that patients should always be in control of their medication and be able to stop it at any time without a major disruption to their well-being.
She emphasizes the need for “mindful” medication use, considering the purpose of using cannabis, and not simply using it out of habit.
She believes that the goal should be to give patients a “repertoire” of coping strategies rather than solely rely on one substance such as cannabis.
She is concerned that some of her colleagues do not take the risk of dependence seriously.
5. Views on the Link Between Cannabis and Psychosis:
Dr. Searle acknowledges the potential association between cannabis and psychotic disorders but points out that the nature of this link is not entirely understood.
She highlights three potential ways they could be linked:
Cannabis may cause psychosis directly.
Cannabis may cause the onset of symptoms earlier than they would naturally occur.
People predisposed to psychosis may naturally gravitate towards cannabis for its soothing effects.
She emphasizes the need for caution when considering cannabis for individuals with a history of psychosis and recognizes the current cautious approach of medical cannabis clinics, though she does want to help patients who have a history of psychosis in the future, by taking a bespoke and holistic approach to their treatment.
She is concerned about the increasing potency of cannabis strains, which goes against the idea of cannabis being a “natural” and safe substance.
She advocates for informed consent, giving patients both sides of the argument, ensuring that they are aware of both positive effects and the potential risks.
She believes that she is not there to be a salesperson, but to help patients make informed decisions for themselves.
She acknowledges that while some patients report significant improvement in symptoms when using cannabis, it is essential that medical professionals remain balanced and give all sides of the story.
She believes that, ultimately, patients should be treated as individuals, and that they are the best experts on their own conditions.
In summary, Dr. Searle is a nuanced and thoughtful practitioner who advocates for a scientific, patient-centered, and holistic approach to medical cannabis. She acknowledges both its potential benefits and risks and calls for more rigorous research and responsible prescribing practices.
My name’s Dr. Louisa Searle. I’m a consultant psychiatrist. I qualified back in, back in, I can’t remember, forget that, a long time ago, a long time ago, and I went through my general adult psychiatric training, but then I also had like a sub -specialty, which is substance misuse, and so that’s sort of where I began my consultant career in substance misuse. And while there and probably feeling a little bit dissatisfied, I mean, mental health does the best it can, I think, within the current climate, essentially of like non-parity with the kind of physical health, if you like. It’s kind of not given the same priority, funding, everything, essentially. And so, you know, feeling a little bit, like, dissatisfied with how things were there, I was sort of looking around, as one does sometimes, for other opportunities. And I actually came across an advert for the medical cannabis clinics, which has now been turned into Lyphe Clinic. And yeah, and they were looking for consultants, psychotherapists, to work with medical cannabis. And like many people, you know, patients, doctors, you know, other healthcare professionals alike, I was like, what do you mean, medical cannabis? I literally had no idea that it was a thing. I knew that in very special circumstances, you know, it had been approved as it were. But I think like many, I thought that that was a very protracted and difficult process potentially for patients to access it and only if you know you have some very rare type of epilepsy or something like that and so you know I had a look into it and it seemed it was a CQC registered clinic and and I thought well let me let me apply so I started off doing you know a few hours here and there for them and I got trained through them through like many doctors who get trained. We do Mike Barnes’s certification through the UK MCCS. And yeah, and I kind of just got started. And so that was about three years ago now. And while I was there, they needed a medical director because Sonny was leaving. And they asked me to take over, which I was very flattered by. And I had to apply, but I managed to get that job. And we had a big task ahead of us, which was to get that clinic out of warning notices. And so we assembled a team and we got them out of the warning notices. And yeah, and so I then progressed to other places. I’ve since left life now.
But yeah, that was how I got into it. And obviously that began my journey into finding out more about cannabis and its potential benefits and the discovery, like many medics, of this endocannabinoid system which for some reason is left out of all the physiology. I just find it insane. I’m a scientist. One should not be scared of facts. They are just facts. They have no political affiliations, they have no ethics or morals, they are purely just facts. And so, you know, why has the ECS been left out of medical training, I have no idea? And I’d love the answer to that question. But yeah, it was just like, what do you mean we have an endocannabinoid system? What is anandamide? Like, it was just, you know, it was just absolutely fascinating.
There is real evidence about the demonization of cannabis, you know, stemming from, you know, the USA, right through to the World Health Organization, just kind of like suppressing it, classing it in the same category as heroin for goodness sake. So yeah, I can only extrapolate from that and assume that it’s because of that whole demonization of recreational, you know, or drug abuse. I wouldn’t say, I won’t put recreational in the same category as drug abuse, but the drug abuse of marijuana, and just demonizing it like that. And as a consequence, everyone just being a bit, I don’t know, scared to discuss it. But I just find it crazy. It’s just physiology.
Do you get a sense the MHRA still regard cannabis in the demonisation way or are they starting to recognise the endocannabinoid system and what it can do?
No, I don’t think they demonise it, because I think if they did, we would have much more difficulty getting different strains of medical cannabis through onto the market. And I think as we’ve seen, you know, like for flower, for example, you know, it’s really expanded quite a lot in years. And so I think if the MHRA had a completely conservative view of it like that, I don’t think we would be where we are with the products that are available. But I do think they are certainly cracking down, and I agree with this 100 % actually, they are cracking down on the nomenclature of these medications. And that I think is with good reason. I think it’s really hard when you’re going to talk to somebody who is conservative and does have these rather archaic views of cannabis, that when you go to them and say, oh yes, I’ve been prescribed just something with a stupid name. I think it’s really hard for them to take you seriously. Like, and certainly if we’re trying to broaden the appeal within the medical field, you know, a lot of medical professionals are wonderful people, compassionate, empathetic people, but there are also a lot of them that are very conservative and certainly have no experience of any kind of recreational drug use. Maybe the most that they’ve done is alcohol throughout their lives. But yeah, it’s a hard sell when it’s got a silly, silly name. And I understand where those names come from, But it’s hard to sort of convince people that that’s medicine, and especially if you’ve got patients who are naive and you’re trying to extol the benefits of medical cannabis. It’s hard to tell Mrs Jenkins down the road that this is the name of her medication. She wants to hear brands like AstraZeneca or Pfizer or whatever. She wants some difficult to pronounce set of syllables that don’t really mean anything but say, scream, this is medicine!
Those people who self -medicate don’t need selling the benefits of cannabis, don’t need to be helped to understand, you know, where these names come from, you know, and that kind of thing. They are already sold, they already understand its benefits, they’re already using it, you know, and hopefully they are able to access it through legal means in a, you know, in a kind of medical way. But, you know, the average Middle England person who perhaps has never heard of it before, it makes it difficult. So, yeah, so I think the MHRA are starting to look at that and I think we are seeing some changes within prescribing in terms of how the pharmacies sort of like list their formularies we’re seeing changes now they look more like reference numbers of course for those in the know they will still recognize what that is in terms of the more populist name up, at least on the prescription, it doesn’t look like something out of pop culture, for example.
When it comes to strain selection, from the mental health perspective, there’s a lot of talk about the sativa/indica thing is a total fudge. So let’s go into more details about the cannabinoids and the terpenes. When it comes to strain selection, how much importance or how much do you look at the profile, the strain profile, to decide what to do?
Absolutely. For me, it’s absolutely crucial. I mean, I don’t know whether other, you know, medical cannabis prescribers agree, but for me, it’s a really essential part of deciding whether the terpenes, for example, are having a direct effect, I think that’s still under study. There are a couple of studies out there that have potentially, in vitro, demonstrated the entourage effect and certainly what they’ve shown is that there is enhanced receptor activity related to THC when the terpenes are present. So THC alone perhaps causes 20 % receptor activity. When you add certain terpenes, that percentage then increases. Now whether that translates to in vivo, we don’t know, but at least it’s the start of that kind of investigation. And then I think also maybe, you know, just like if we just think about nature and how it operates with things like scents, for example, so that’s what terpenes do, they’re essentially different scents. Scents often signal certain qualities perhaps in a plant, for example, so even if the scent themselves don’t have a particular function, it perhaps signals that this plant has a certain property that may be interesting to the insects that it’s attracting or maybe it’s usually it’s fake. So I think that if it’s not the entourage effect then there is going to be perhaps some, hopefully we might find that there’s some evidence that it’s signaling to other compounds that are potentially important in the plant that may be giving the effects that we are seeing in the real world, in the people. So yeah, for me, it’s a crucial part of it. Because otherwise, I might as well just pick one out of the hat. And that’s not really medicine to just do a bit of gambling, essentially.
But yeah, and so as a rough rule of thumb, I’ll tell you mine. Mine is caryophyllene for pain, Myrcene for insomnia & a sedative, Limonene, pinene & humulene are for anxiety. You probably know more?
Yeah, so definitely caryophyllene and myrcene for me, definitely linking with pain, anti -inflammatory, the more calming types. I would probably put humulene, I think right for anxiety but also humulene for insomnia simply because humulene is from hops and hops we know are generally quite calming, quite sedative. I’d also put linalool in the kind of insomnia, relaxing kind of range as well. But yeah, certainly limonene and the pinenes, I think it depends on the patient. They can either be uplifting and energising or they can be very, very calming or a combination. I think it just depends on how you respond when you go to a forest or if you smell lots of lemon. That’s right. Do you feel uplifted or do you feel calm and I think it has those. And then I think there are some other little interesting ones like terpinolene, I think it really is one that I look for when people have issues with mood and focus and lack of motivation.
I look for that terpene, whether that’s, you know, 100 % accurate, but just, you know, from what I’ve seen in my patients, ADHD, mood disorders, terpinolene is the one that I will look for.
What else? I’m trying to think. There’s ocimene that I’m seeing a lot, you know, that’s a rare, I don’t see it so much, actually, yeah, we don’t see it so much. And I think ocimene, where I have seen it, in a couple of flowers where ocimene is quite dominant, it tends to be a kind of mood uplifting one. But I think I’ve not seen it enough to be able to confidently say that yes, generally if I give somebody one with high in ocimene that it will be good for their mood. and any others? Ah, geraniol, which is one particular strain where it’s very, very high and I just find that it’s a real all -rounder, actually. If you’ve got pain, anxiety, if you’ve got digestive issues, geraniol seems to be the one, like…
Where do you stand on the minor cannabinoids, like the CBG, CBNs?
Yeah, I find there’s a lot of conflicting information, and that’s where I get really stuck. So I haven’t really formulated any firm ideas, I would say. So I wouldn’t like to comment on that, because I think the jury’s still out for me. Yeah, I haven’t seen anything that’s super convincing just yet, like in terms of consistency. And even with CBD, I just don’t see consistency of results with it really. But it is something that I definitely like to have on board when somebody is naive to THC specifically, just because I just think it just tempers the effects of THC a little bit, makes it a little bit more gentle on the system. And certainly I think as well, like, it’s something that I think you can utilise if you’re, you know, if you’re, if you’re, I think sometimes some of the strains can give like too much to be too energising. Like, if, and I think if you don’t, if you’re not very aware, and you don’t kind of like harness that energy into some, and I think it has to be a physical activity, really, I think you’ve got to get that body movement going, then it can be a little bit much for people and it can feel quite unsettling. And so I think CBD in those circumstances again can just help to temper things and just calm things down when the THC is beating you up a little bit.
So with my good friend Berta, she helps runs a charity called Ethbida, which is about education of cannabis, and my good friend Sally, who’s a pain consultant, we just got fed up with, because basically all three of us have come from the NHS. So we’ve come from this like socialist healthcare system and then we’ve entered into this quagmire that is private healthcare and it’s been gross actually. One extreme to the other. And we kind of just, we just got fed up of seeing not only patients as numbers on a spreadsheet for some CFO to play with, but also the people that work in these companies as numbers in spreadsheets for CFOs to play around with. And it just has left a very distasteful taste in our mouths. And then also there is, I think one of the things that I worry about especially is a lack of psychology, and I’m talking from a psychotherapeutic angle, there is a complete barren wasteland of any mention of that in any of the medical cannabis clinics. And as far as I’m concerned, I am always sort of saying to my patients right what are your goals for treatment and what is it that the medical cannabis is going to enable you to do because it shouldn’t just be sitting around in your house you know yes your anxiety might be calmed down etc but it should be enhancing your quality of life like so if I’m sure yeah yes exactly if I’m very anxious for example and I struggle maybe to interact with family members or I struggle to get outside. The medical cannabis should be calming my symptoms enough so that I can contemplate and make a plan to start getting out more because, you know, as we know, social contacts are massively important for your overall well -being, the length of your life as well, you know, and quality of life is an important thing. So, I never want my patients to just be, you know, sitting at home and not tackling, you know, the issues, you know, that they kind of come in with. And so, you know, the psychotherapeutic element is just missing, you know, from all of it. And then also just generally just like looking at the patient as a whole. Again, there’s no point in me managing all of your anxiety and then your metabolic health is completely, you know, shot to pieces because that’s also going to shorten your life and reduce your quality of life. So I very much, you know, I’m about looking at the whole picture, the whole person. So yes, there may be the anxiety here, but is there a root cause for the anxiety? Is your gut health completely out of whack and that is feeding back into your brain and causing inflammation in the body that might be leading to anxiety. That’s just like one example. Is your metabolic health all out of whack so that your glucose homeostasis is just causing toxicity all over the body and affecting your glucose blood -brain barrier so it’s becoming less and less affected and so toxins and plaques are building up in your brain? Like, the person Medicine is an interconnected, you know, sense of the different systems. So that’s sort of where we’re coming from. So where we are moving into with the clinic that we’re trying to open is trying to think about people holistically. And I guess it’s elements of longevity, so thinking about improving and maintaining people’s health well into their old age so that you can be healthy and happy in your retirement. like why work your whole life to death and then you retire and then you’ve got to just deal with a whole bunch health issues. No, you should be enjoying your well -earned retirement. So it brings in elements of functional medicine. So functional medicine is really about a deep dive into what’s causing your chronic illness and it’s bringing in the kind of psychotherapeutic elements. So it’s managing your cognitive health, managing your social interactions, building resilience and managing trauma, that kind of thing, and sort of bringing all of that together. Now where medical cannabis fits in to that I think is going to be a very patient -to -patient dependent thing. Unfortunately at the moment we don’t have a test for whether your endocannabinoid system is out of whack but I’m hoping that we might start to see that, you know, as time goes on. but I’m sure there are probably clues. Things like emotional dysregulation, for example, might be a clue that your endocannabinoid system is out of whack. Not being able to focus and concentrate, again, these might be clues. So where the medical canvas comes in I think is very much going to be patient -dependent and that’s really what we are trying to do in the clinic is sort of like, take each patient as an individual. The idea is that they might come with something like chronic depression, say for example, but we’ll also get them to see our pain specialists, we’ll also get them to see our psychotherapist, then the three of us will have a meeting together to discuss the ongoing treatment plan and it will bring in, so you know, the person’s going to get their life kind of put under a microscope if you like, and we will be asking about your diet, your exercise, what are your social interactions, and where we can sort of like help you to devise a plan to increase activity in those areas if there is a deficit, as well as the kind of, you know, standard things like looking at your biochemistry, looking at your physiology, that kind of thing, the kind of things that are based in in sort of biology, if you like, but they all sort of like come together and and I think that it kind of gives an overall picture of your well -being and I think your well -being is what’s important.
Yes, psychosis, you know, what we know at the moment is that there’s potentially an association with, you know, cannabis and different types of psychotic disorders. So, you know, when we think of psychotic disorders, people might not necessarily know what they are, but essentially it encompasses a whole range of symptoms and from, you know, hallucinations, which think people kind of will understand, you know, they can be visual, you can hear voices, but they can also be tactile. You can get hallucinations where you feel like somebody’s touching you or that parts of your body don’t belong to you. There are elements where your thoughts feel alien to you or that you feel like people can read your mind and, you know, scary things like feeling like thoughts are being put, you know, alien and being put into your brain that don’t belong to you. So it’s a whole range of symptoms, but sometimes somebody might get diagnosed with something like schizophrenia, which encompasses various elements of some of those symptoms that I mentioned. But there can be psychosis, for example, in bipolar disorder as well. There can be psychosis in very severe forms of depression. So it’s not just the kind of schizophrenia that people commonly think about. And what we don’t know is does cannabis directly cause psychosis? Does it make you manifest these symptoms earlier than you otherwise would develop them? So there are sort of peaks of certain types of disorders that come out at certain ages. You know, there is the kind of adolescent kind of time, you know, around 17, 18, 19, that kind of early 20s. But then there’s another peak, you know, around your early 30s as well. So, you know, if you were to develop it in your early 30s anyway, because that was just the nature of your brain, does cannabis make you develop it in your early 20s instead? We don’t know. Or the third one, and probably not the final, I can’t think of them all, but potentially, does cannabis, do people who develop these types of illnesses, like naturally gravitate towards cannabis because of, you know, potentially its soothing effects. And that’s a big question mark for something that potentially has such a life -changing impact and changes the trajectory, potentially, of your life quite significantly, you know, not just in terms of, you know, employment opportunities, but also in terms of interpersonal relationships, you know, maybe your desire to start a family, you know, it has huge, huge implications and I think we would be remiss and negligent and not like consider it, which is partly why, you know, people who have any kind of psychosis in their background tend to be rejected from these medical cannabis clinics. And I kind of understand, you know, why that is because there is this big question mark that people like Dr Marta Di Forte are trying to, you know, establish for us and quite rightly so because it’s a very serious illness and it shortens people’s lifespans and reduces their quality of life. So I think there has to be, you know, some very careful thought about whether you’re going to prescribe somebody medical cannabis and obviously you try to account for these potential risk factors to reduce the potential risk to a patient. But I am concerned about these stronger and stronger and stronger strains of medical cannabis that are coming out. I mean, people do like to talk about cannabis being a natural substance. And I would say, yes, maybe in the 70s. It was definitely a natural substance back then, but that’s like 50 odd years ago and, you know, with what we’ve done with the plant, I would say, is quite far removed from the natural cannabis that you find, you know, maybe growing in the Himalayas these days. So I don’t think we can just say, oh, it’s safe because it’s a plant and because it’s natural. You know, as we well know, there are lots of mushrooms out there that are natural, not been tampered with, but they will take you from alive to unalive in 60 seconds, you know, if you eat the wrong ones. So natural doesn’t equal safe and I think people need to really understand that, which is why I think it’s a right step for people to be coming into the medical field so that I can give you both sides and it’s down I think for what what I’m all about and what what the Kailo Wellness Center which is what we’re opening with my colleagues are all about is about informed consent so if you come to me and and you ask me about a certain thing I am NOT a salesperson I am here to give you the balance. So that is the positive. And there are many, many, many positives to cannabis. I wouldn’t be prescribing it if I didn’t think there were enough positives to potentially outweigh the negatives. But there are negatives and patients need to be aware of that so that they can weigh up those risks for themselves and make an informed decision so that you’re always going into things with your eyes open.
You mentioned the addiction as well in CUD, Cannabis Use Disorders, and as someone whose career is in addictions, what’s your summary of it?
Absolutely. So I think with cannabis you have to worry less about the physiological dependence. So, not to make a comparison in terms of safety, but just in terms of the physiology. If somebody is, you know, sadly addicted to the opiates, then they will have a physiological withdrawal that is really quite horrendous to deal with. There is also a psychological dependence and addiction that they will also have to deal with, but they kind of have to deal with both. So when somebody’s trying to detox from opiate -type substances, they have kind of like this horrendous physiological withdrawal that they have to deal with. Now with cannabis, that is much, much less. It’s not to say that people don’t experience withdrawal with cannabis because they absolutely do but it is nowhere near as intense and challenging to deal with versus something like the opiates.
Now where the challenge comes in I would say is the psychological dependence. So with the opiates and with the cannabis I would say that they are on a par with each other, because people who have become psychologically dependent on any substance, that is the real challenge. And that’s where they become, it becomes really, really difficult for them to kind of break those ties. So when patients, when I’m talking to patients about medical cannabis and I am becoming concerned about their potentially escalations in their use, et cetera, how they’re using it, what purpose they’re using it for, I’m always at the forefront of my mind is is I want my patients to be in control of their medication not the other way around and that can be really really difficult to determine and also for the patients to understand and determine. Essentially as a patient on a medical cannabis prescription you need to be able to feel confident that at any moment should you decide that medical cannabis is no longer for you, for whatever reason, you can put it down and walk away from it. Like, it shouldn’t be this massive challenge of, like, compulsion and anxiety and worry that, you know, without this particular substance, your life and mental health and everything is just going to fall apart and you are not going to be able to cope. That is, that’s the concern for me. and it’s a horrible place to be for people to see them struggling not with you know the physiology in some ways is potentially easier to deal with because I can give you other medications to try to help you like manage the physiological issues and especially with cannabis because they are much less intense than other types of substances that you might become physically addicted to it’s generally much easier to give you other medications that might help you with with that withdraw but the psychological dependence, it’s tough and I hate to see people feel like they just can’t manage and they can’t cope and I think we see it, you know, with patients like, you know, kind of like losing it when they cannot get their prescription, you know, for whatever reason there’s a delay or that particular strain is not in stock and they just fall to pieces and you know their personalities change and you know they become very very distressed and it’s horrendous to see it and and I don’t mean distressed in terms of all their symptoms are not going to be managed that’s a very much a real part of it but I mean just in terms of the fear and the anxiety that it generates that the feelings that they can’t cope etc. It’s horrible to see that.
And I think the other thing that worries me as well is that, you know, obviously coming from a substance misuse background, I have also been somewhat concerned about my colleagues who don’t seem to take it seriously either. The potential for dependence, physiological or psychological, you know, it’s almost like in their mind it’s a completely safe compound with no potential psychological hazards. And I’ve just been really quite shocked and worried that it’s not even a consideration. It’s not that I’m there hammering all my patients with you’re addicted, you know, it’s not that, but at least it’s there in the back of my mind and I’m thinking about it and if anything, you know, could have pricked my radar, I’m quite comfortable having those, because it is a difficult conversation to have with people when you do suspect this, but at least I know how to have those difficult, and I’m not shy of having those difficult conversations. And, you know, even if the patient doesn’t want anything, you know, to want to do anything with it and they move to another, you know, clinician that’s perhaps not going to challenge them in this way, at least I have had that conversation with them and I have sort of like given that duty of care to at least make them aware that I have these concerns. So that hopefully, you know, maybe not all of them but maybe some of them will start to think about it and start to be mindful. So I think mindfulness is not just about meditation and, you know, and being in the moment. Mindfulness is, I think, useful for everything that you do, including how you use medication. You know, use your medication mindfully. What is the purpose of it at this time? Am I using it because genuinely I’ve got pain or, or my anxiety is just stifling my ability to just be a human being. Or am I using it because I’m a bit bored and I’m not sure what to do with myself? Or I’m not comfortable just being with myself. You’ve got to be able to be with yourself with nothing to do and not feel completely like it’s some sort of ordeal. So, those are the kinds of things that I like people to think about and their medication might be.
I want to, and this isn’t a question that I previously wrote down, but there’s a lot of, I go to a lot of cannabis underground as you know, you know, we, I know a lot of people who say they, and I know this sounds melodramatic, they say they couldn’t live without cannabis, you know, it’s, it is. And to them, it’s, it’s almost like a gift, that cannabis allows them to focus, and again, I’m not a psychiatrist, I’m not a doctor, I’m not in a position to make diagnosis of any sort, but I would say there’s a prevalence of ADHD and anxiety that people have self medicated. They found that cannabis, they describe it as racing grain. So that racing grain, I can’t focus, I can’t do anything in the day unless I have cannabis and it calms my mind and then I can focus.
Yeah. And if you were to look at the amount that they were taking, you would probably say that’s probably over the threshold and the fact that you take it every day and you say you can’t do without it would sort of be the definition of addicted. Yes. What, I mean, what’s your, and this is just an opening, this would be, because fans equate.
Yeah, no, so, you know, for that kind of person, what I would say is, okay, fine, yes, you have this plant pharmaceutical, as it were, that you utilize to help you, and you say it’s for, you know, your ADHD, et cetera, but how are you kind of, what else are you doing? like cannabis, you know, any kind of foreign substance to the body, you know, unless you have, you know, some life -threatening deficit like a type 1 diabetes where if you don’t get insulin, it’s game end for you. It should be part of a repertoire of management and it doesn’t have to be more pharmaceuticals, like cannabis could be your only pharmaceutical but, and I think this is where, the holistic element comes in. It shouldn’t be the only thing that you rely on to manage yourself, as it were. Like, there should be a repertoire of things. You know, there are psychotherapeutic techniques that you can utilise so that maybe it doesn’t remove your need for medical cannabis, this, that it might reduce your need. Like, so, you know, like I said, you’ve got this endocannabinoid system that is also part of your nervous system, that is also part of, like, many other systems in the body. When you start introducing a foreign substance to regulate, you know, your body, it down -regulates your own innate ability to, like, manage things. So when you do that and then you suddenly take away that substance, what does your body do. It goes, it’s all out of whack and it’s all haywiner and it can’t necessarily manage on its own. So I think it’s important to have, you know, lots of, lots of arrows, you know, in your quiver as it were, to manage it, and if you’re saying, I can’t manage without this one thing, that’s not a good place to be. Yeah, no strategy in life should rely solely on one thing. What would happen if there was… You know, we had mad cow’s disease a few years ago. I’m sure the availability of beef went right down. What happens if there’s some disease suddenly afflicts the cannabis plant and it obliterates stock and you’re only coping you don’t know it’s a very extreme like scenario but what if that was to happen and cannabis is your only coping mechanism for whatever it is that you’re going through like so i think people need to think about that. You should never just be reliant on on a single person financially like it just you should never just have one solution to a problem I think it should be to have a repertoire and you should pick and choose like depending on you know what you need to do so for ADHD for example if you’ve got a really important piece of work to do and it’s really important that you focus yes maybe cannabis is suitable in that’s in that particular circumstance but if there’s something lesser going on? Is mindfulness not useful at that time? Is thinking about whether you’re hydrated and your diet appropriate at that time? Is your level of activity and exercise appropriate at that? There are different circumstances in life and I think cannabis should be, again, applied mindfully and you should be really thinking about whether it is actually necessary in this point. Have I even tried to manage without it? You know, even to just give myself that psychological feedback of, yeah, but she’ll give it an attempt in a different way so that it doesn’t become this singular solution.
Now, that’s made a really good point. Again, slight, a very slight digression. I was speaking to one self-med patient, she said she’s diagnosed with autism and she’s self -diagnosed by ADHD, and she said, yeah, cannabis just helps me in the morning to focus, racing brain. I said, so what sort of strains help you? And she says, “strawberry flavoured”. And I know some doctors who would just roll their eyes at that, but it sort of makes sense in the cannabis world that, you know, for her, strawberry flavours are the ones that she says help her. You’re like, well, who am I to argue with that?
You know, we touched on terpenes before and it may be that the terpenes that make up the strawberry flavour are either having an effect in that way, or like I said, they’re signaling to something else in the plant that is having the desired effect. So I’m not averse to that. Yeah, I’m not averse to that, and I certainly, you know, I would certainly, I like to work collaboratively with patients. So if a patient has been self -medicating and they are aware, like, and it’s not always possible in the UK, especially in the black market, to know what types of strains you’ve been getting. But if they’ve been somewhere, like California, let’s say, and they’ve been to a reputable dispensary and they know that they’ve gotten certain strains and that those strains have worked wonders for them, I will absolutely take that on board and try to, if we don’t have it available in the UK, at least look at that strain, see what parent genetics it comes from.
Have we got any of those potentially? Those are the parents. Have we got anything with a similar terpene profile? I do my best to try because, you know, why shouldn’t I take into account the patient’s own experience? Of course, they are the experts themselves. So I think it would be remiss of me to not at least listen to that and hear that.
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Interview with Dr Luisa Searle – Part 1
Interview with Dr Luisa Searle – Part 2
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