EXCLUSIVE: Interview with U.K. Cannabis Scientist Dr. Mikael Sodergren

By Oliver Bennett, Special Contributor to New Frontier Data

Dr. Mikael Sodergren leads the Medical Cannabis Research Group in the United Kingdom, is director of Sapphire Medical Clinics, and a senior clinical lecturer at Imperial College London.

In early 2021, Sapphire commissioned polling via YouGov to survey public opinion about cannabidiol (CBD) and its medical benefits. While nearly one-quarter of those polled were uncertain whether CBD was legal, 9% of Scots reported taking over-the-counter or prescription CBD products.

The takeaway for Dr. Sodergren, Sapphire’s managing director and academic lead, was that “the statistics clearly highlight the need for further education around medical cannabis, illustrated by the fact that almost a quarter of the population are still unaware that it is legal.

In an interview by New Frontier Data, he explained his introduction, interest, and engagement with CBD: “I’m an academic clinician by training with a background as a surgeon,” he said. “I operate on liver and pancreas cancer one day a week at Imperial College, and spend at least 50% of my time in research. For the last 15 years or so, I’ve been researching immunomodulatory techniques relevant to pancreatic cancer, and cancer biology more broadly,” he explained.

“I became interested in CBD some years ago because of its anti-inflammatory effects, and how it modulates the immune system to interact with some of the cytotoxins in the chemotherapies we use for pancreatic cancer. I’ve had a very long-standing clinical interest in pain, because, unfortunately, I cause a lot of pain as a surgeon. And the methods we use are deficient in many ways with side effects that can slow recovery. That led to my cannabinoid research and is how my cannabis journey started.”

Q: Cancer is a bit of a wild card in medical cannabis with many anecdotal claims. Are there specific anti-cancer factors in cannabis we should be aware of?

“Recently, I was at the International Cannabinoid Research Society Symposium in Galway, Ireland, and – for the first time – one of my PhD students presented the cytotoxic mechanism of how cannabidiol can kill pancreas cancer cells. But the most advanced research with regards to cannabinoids in cancer is in clinical trials for glioblastoma brain tumors, where there’s been some really interesting signals, although the trials haven’t been reported yet.

“But let’s be clear, nobody in my research group is saying that medical cannabis is a cure for cancer. In fact, I can confidently say it isn’t; otherwise millions of cannabis users would have shown positive effects in their cancers. However, many components of the plant do have direct anticancer properties.

“So, we’re not saying take CBD to treat cancer. What we are saying is that we should understand it better, and combine it with other recognized treatments (such as those affecting the immune system) to produce a more profound effect in combination with other therapies. Thus, if we understand that cannabidiol can induce cell death in pancreatic cancer, we can target other areas in the signaling pathway to gain a more profound clinical effect.”

Q: Within the past four or five years, about 15-20 applications have been accepted for cannabis. Will we see more?

“In terms of licensed medicines, we have Epidiolex for childhood epilepsy, Sativex for the treatment of multiple sclerosis, and Dronabinol for the treatment of chemotherapy-induced nausea. For other indications, there are no licensed medicines, although we can prescribe cannabis-based medicines as an unlicensed medicine.

“I run Sapphire Medical Clinics, the biggest private medical cannabis clinic in the U.K.. Here about 60%-70% of patients are seeking treatment for chronic pain, for which there isn’t a licensed alternative available on the NHS. We then see about 20% of patients seeking treatment for psychiatric disorders such as anxiety or PTSD, and a smaller cohort who have 10% of neurology conditions – including Parkinson’s and multiple sclerosis outside the normal criteria.

“I think we’re going to see a number of new licenses soon, and it’s just a matter of time before you have new drug candidates that have gone through the drug development pathway for pain – my guess is within the next two to four years. There are a number of other conditions where we’re seeing interesting signals in the clinic. I’m sure companies will put resources into developing market authorized medicines for those, too.

“More generally, there are a huge number of components in cannabis – including, for instance, the flavonoids. There are a lot of really interesting chemicals in cannabis that deserve further investigation.”

Q: In terms of the relationship with the NHS, we generally hear negative feedback. Is this fair?

“We’ve got a well-established system in the provision of medicines on the NHS, and the gatekeeper is NICE (the National Institute for Clinical Excellence). NICE does a cost analysis for medicines, where the cost per quality-of-life year is the key health economic metric. With manufacturers investing in new drug candidates, and then the academic medical profession evaluating them and producing the data to support their cost effectiveness, there should be new entrants to the market quite soon.”

Q: CBD is promoted heavily into the wellness market, though it’s been hampered by the novel food laws. Where do you see that market progressing? 

“Hard to say. The wellness market is only just starting to become regulated, and the FSA [Food Standards Agency] hasn’t gone through the process of giving anyone the regulatory compliance. At present there’s a clear distinction between medical and wellness models, and the medical CBD products we prescribe in the clinic have gone through GMP production and batch-to-batch variability – the checklist required for it to be deemed a cannabis-based medicinal product.

“Elsewhere, the wellness sector is unregulated, like the Wild West. Indeed, several newspapers have done tests on products and shown that the product isn’t what it’s on the label, for example. There’s a list of companies that have reached a certain stage but have not yet been approved. So as a consumer interested in wellness, it’s a stab in the dark with no guarantees. The CBD market is still growing, but a proper regulatory framework is going to be in everyone’s benefit. I’d add that it doesn’t make any sense to go down a wellness route if you’re seeking treatment for a medically diagnosed condition.”

Q: Have you a position in terms of the side effects or psychosis factor with THC?

“There is no doubt that illicit cannabis, often synthetic and with very high THC concentration – much higher than is prescribed medically – is associated with psychosis in a predisposed population. But if you look at the clinical experience, it’s a different picture. For example, the trials for Sativex contained THC and were given to an elderly population taking lots of other meds – so, prone to side effects – and they didn’t show significant psychiatric morbidity.” 

Q:  Tell us about your Medical Cannabis Registry.

“When we set up Sapphire, we understood that the majority of these medicines were going to be prescribed unlicensed and looked at other countries such as Germany and Australia. As we were all academic clinicians we had some experience with setting up data collection systems and we felt it would be a fascinating academic opportunity, because there wasn’t such a database in Europe, so we set up the UK medical cannabis registry. Now all the clinic’s patients are enrolled on it, and we’ve got over 7,000 patients on the registry, all with their consent. It’s growing all the time as see we see about 6-700 new patients per month and it’s the right thing to do. If a patient is going to be treated with unlicensed medicines, you need to record that data, including outcome measures, adverse events.

“We treat conditions for which there is some clinical evidence of efficacy already. That doesn’t have to mean randomized controlled trials or anything. But the registry helps us track the various conditions and see the most interesting signals.” 

Q: What’s next?

“We know very little about the cannabis plant in comparison to other medicines. That’s the fun part, that we’re still exploring this medicine and are discovering really interesting signals all the time. For example, we have a lab-based study looking at combinations of CBD, THC and CBG, and found that when we added a certain proportion, CBG, we didn’t need as much THC to produce the same analgesic effect. These are the kinds of things that we’re discovering all the time. The more we can learn about this plant, the better.”