Cannabis clinic: 'It's a highly profitable service'

Stephen Dickson, owner and superintendent pharmacist at the Dickson Chemist group of pharmacies in Scotland talks to Saša Janković about setting up a UK cannabis clinic.

Service type: ukcannabisclinic.com

Name and location of pharmacy: Dickson Chemist group, Scotland

Name of superintendent pharmacist: Stephen Dickson

When did you start offering this service?

We started our research at the end of 2017, and got it going in 2019, just before the pandemic hit.

Why did you start offering this service?

Back in 2017 we realised there was an unmet need around cannabinoids, as there were so many unknowns and misinformation, not to mention poor quality products. Nobody knew if it was safe to take them with other medicines, at what doses, what conditions they were useful for, how to take them and for how often, so we spent a year with other clinicians and pharma manufacturers and doctors looking at how best to safely provide cannabinoids to patients.

In our own pharmacies we were finding people turning up with bottles of things bought on markets stalls and high street health food stores, but our own analysis showed many of these products don't meet the standards for foods or often weren’t what they said they were, as they are not manufactured by reputable agencies and the regulations around these products are not being enforced.

It took us almost a year to gather an evidence base of what you could and couldn't do with cannabinoids, and we then teamed up with Rokshaw Labs in England to manufacture a pharmacy-only dispensing product for our own needs. Canidol is one of small number of products that made it through the regulatory process onto the Government approved list of products that can be sold, and we have now made it available on the open market to patients and healthcare professionals via ukcannabisclinic.com

What, if any, training did you or other team members have to undergo?

We spent a few years on our own research and have since created a training program for pharmacists – through our UK Cannabis Clinic – with guidance on the supply, education and information relating to the supply of medical cannabis products.

In a nutshell, what does the service involve?

Any prescriber in the country can write a prescription for our Canidol product, and we have our own IPs who run clinics remotely and, recently, in our Partick shop as a physical location. We won’t treat children but can refer patients on to others who can, although for children the consultation needs to be done face to face, not remotely.

Patients have an initial consultation, with follow-up every three months, and an annual review of treatment to see if it’s doing what it should. The protocols we follow ensure that we know our patients who are interested in using cannabinoids are doing it safely, and if they are using other products then pharmacists can at least access reference material to advise on what they are taking.

How have patients responded to the service?

We have had a great number of patients coming all over the place – and from some unexpected quarters.

I had a call from a consultant vet from The University of Glasgow's School of Veterinary Medicine, asking for something for dogs in their pain clinic. We started a 6-8-month consultation period to learn about how dogs, felines and horses metabolise these chemicals and came up with a guide and training guide for vet practices up and down the country. Instead of an oil product we made an oral mucosal paste as animals will just spit out an oil based formula. For animals it’s a food products not a medicine, so vets can write vet prescriptions for them making it vastly cheaper for patients than to try use something off the shelf, and of course people can being their vet prescription to the pharmacy.

In humans using cannabinoids people say their pain feels better or their depression is improving, for example, but when a vet says this is working well for a dog – who doesn’t know it’s being treated – and the owner says the dog is happy again, that’s been an incredible learning curve for us.

How much do you charge for the service?

Consultations are £40 remotely, or start at £100 for in-person, depending on what other tests the person wants done. Our Canidol product is £20-£100 per month depending on the mg dose.

Roughly how much a month do you make from offering the service?

It is a highly profitable service as patients pay for consultations as well as the product. As we manufacture the product we can make sure it is a lot less expensive than buying something in the high street, but also we have a margin.

Would you recommend offering this service to other contractors?

We now have thousands of patients on cannabinoids in our own group who are doing really well. It has shown me that all the work we had done on cannabinoids that took a year of our lives was worth it, and we now have a robust training program for human and animal treatment with a reference guide which tells HCPs what to do.

A couple of hours’ training leads to a harm reduction exercise because you are controlling doses or cannabinoids which are medicines – with a side effect profile, interactions with other medicines, and measurable clinical effects – so you have to treat them as such.

When all else has failed and a patient is determined they want to try cannabinoids then at the very least we can make sure they try them in a safe way with someone to monitor if they are working. We started with patient need and ended up with products that are being sold across the nations.