An interview with Dr. Julie Moltke, Editor in Chief at Dosage
Could you give our readers a little background on your professional life? When did you start to become interested in exploring cannabis and cannabis derivatives as a treatment for patients?
I became interested in cannabis years ago when I first realized how limited our conventional treatment options are. I was driven to explore alternative treatment options and the science and evidence behind them. I have worked a lot with meditation and mindfulness as a treatment for various mental health problems as well as herbal medicine. When I realized the power of the cannabis plant to help people with so many different medical conditions there was no turning back. I have since then worked with cannabis education, prescribing, public speaking, and research.
As someone who is au fait with the medical cannabis landscapes in both the UK and Scandinavia, what have these countries done well that could be replicated by other European countries?
I think that what Denmark has done well compared to the UK is to let GPs prescribe. Initially, the Danish pilot scheme was initiated from the political side, whereas the legalization in the UK was more so fuelled by campaigns from patients and their families. Therefor cannabis is more available to all patients in Denmark, compared to the UK, but there are still big hurdles. In Denmark, we do not have many products to choose between and this is causing patients to get back to the black market. We have a handful of licensed producers who are ready with Danish cannabis but sadly the final approval from the medicines agencies is still lacking.
Conversely, what’s not gone so well and can be taken as ‘lessons learned’, for countries rolling out their medical cannabis programmes?
I think we can learn that the education of medical professionals should be a top priority. You cannot expect doctors to start prescribing something that they know nothing about, which in their perception is an illegal drug and where they have no prescription guidelines. It is like giving a bunch of school teachers the keys to a moon racket – they probably will never leave the earth or reach the moon.
In progressing further roll-out of cannabis-based treatment, which do you think is more important – educating current clinicians or educating wider society (albeit that both are extremely important)? Which do you think would lead to policy change occurring at a faster pace?
I think that they go hand in hand. But we already have a huge interest in society for alternative and herbal treatments and I think educating doctors and nurses will make the policy change happen faster as we need to see actual results from the clinical world and not just from people using illegal medicinal cannabis from the black market. Both one will support the other, so both sides are equally important in my view.
How interconnected would you say the medical and health & wellness markets are in both the UK and Denmark? In your opinion, is there a greater need to bring these closer together, or create clearer divisions between the two, and why?
This differs a lot between the two countries. In the UK, the wellness and the medical market is hugely interconnected. I recently conducted a survey for UK CBD-users and it turns out that more than two-thirds use CBD for conditions you can also get prescription medicine for like chronic pain and anxiety. In Denmark, the wellness market is not as developed as in the UK. There are several reasons for this, with the biggest being that CBD cannot be sold as an over-the-counter supplement for ingestion. We do however see that people sell it as a “skin-oil” which is then ingested by clients.
You’ve written a lot about CBD in the past and the impact it can have on sleep and anxiety (as well as a wealth of other symptoms and illnesses). How would your advice differ to someone looking to remedy sleep issues – regarding dosages, delivery mechanisms, and products to use – versus somebody who’s keen to treat their anxiety with CBD?
The mechanism of action for why CBD can help reduce anxiety and help with insomnia is likely to be similar. It seems to be working on serotonin receptors in the brain and reducing feelings of stress and anxiety. The difference between the two is that I would recommend taking CBD 1-2 hours before going to bed, in a dose of 25-50 mg. It can be taken as an oil, capsules, or a water-soluble CBD drink. If you suffer from general anxiety, I recommend using CBD several times per day and some people might even benefit from vaping because of the quick onset.
As a clinician, what’s your view on cannabis treatment being prescribed to patients for illnesses where there is a lot of observational efficacy, but a lack of clinical trials to draw from? Is this something you’re in support of, and why (and in what circumstances, if nuanced)?
I think that the most important question when you prescribe something is always safety. If you know that a medicine is safe, then I think it makes sense to rely on observational efficacy until we have clinical trials and evidence to support it. I generally think that evidence-based medicine is great and helps us secure the overall efficacy and safety of a drug. But we must remember that at the end of the day, people are hugely different in the way they react to certain drugs and the placebo effect (the effect contributed our belief in the efficacy of the substance) plays a huge role. I foresee that the future of medicine will be personalized and differ for every patient, based on genetic and psychosocial factors as well as on the wishes of the patient.
You can hear more from Dr. Julie Moltke at the GCI Europe Virtual Summit.
Check out other interviews on the GCI Content Hub by clicking here.