In a Dispensary Green first, we recently held a virtual Q + A event giving patients the chance to find out more about the workings of Dispensary Green, and also about the wider medical cannabis ecosystem.
The session was chaired by Jeremy Roth, a medical cannabis patient, and Chris Ashton, our Superintendent Pharmacist, Richard Neilson, Director of Pharmacy Operations, and – all the way from Canada – Madeline Carter, Programme Manager at Northern Green joined to answer your questions.
We’ve broken the Q + A into several parts (because there were quite a lot of questions asked!) and tried to break them up into related sections to make it easier for you to read.
Could you talk me through some of the some of the different providers that are involved in the supply chain from growth to the to when it gets to the patient? So how many? How many steps does that have? Who does it go through?
If we go end to end, you’ve got the providers that grow the product – they won’t necessarily be the ones that then pack it and release it into the market. You could have, for instance, Northern Green growing it, and then it could be going to somebody else to then pack it and quality release it.
It’s then shipped across the globe from various different countries to the UK. So there’s a logistics provider there. It would land in the UK with a licenced importer, of which there are only a few eligible to work with cannabis. And from there, it’s sent to the pharmacy on a prescription by prescription basis. Then from pharmacy to the patients on a prescription basis. So you’ve got lots of logistics in each of those chains, which is strained I suppose from COVID.
At the start of that process, you then have two sets of permits involved. We have the UK permits – which we have to get through the MHRA and through the home office – so that’s two different applications. And then I understand that in Canada for example, they have to go to their health board or Health Canada to get their set of export permits to ship to the UK.
The permit process alone can take – worst case scenario – I’ve seen it take as long as six months to get new permits. You know, some countries are quicker than others and, and even ourselves – we’ve seen the MHRA and home office take anything from a week to three months to approve permits on our side as well.
From what you’ve said there, there are a lot of potential stress points as things go along. Obviously it doesn’t take away from your responsibility, but there are couriers that are involved, there’s air logistics which has obviously been under a lot of pressure recently.
We should make it clear that Dispensary Green is a pharmacy, and they don’t do the importing. They don’t do the permit processes. We just know a lot about how they happen, because we try to support those looking to import into the UK. That being said, it shouldn’t be seen as an excuse.
The importers need to do better, the producers need to do better and to be honest, the agencies that issue the permits need to do better. What we can’t lose sight of is the fact that we have patients that desperately need this medication and the whole supply chain needs to step up and become more efficient and more reliable.
Madeline, how does medical cannabis differ between growers?
In Canada, we are allowed to do various growth methods. Through the summer months we have producers that have large outdoor grows, which is typically done in soil. They grow larger plants and higher volumes. We also have quite a few greenhouses, which are very similar to outdoors. And then we have a lot of indoor producers.
We are an indoor producer. There are various different grow methods and irrigation styles that are used throughout the industry and there’s no regulations on which type of grow method has to be used. So you see, some producers do aeroponics, hydroponics, all different types. For us specifically, we are hydroponic indoor grow. We have different irrigation types such as flood and drain, we have drip systems, and different ways of actually growing and pruning the plants. So in that you see variability in the output of flower produced just because of all of the different growth styles that are available and no restrictions to what each producer can do.
Madeline, I’ve heard that your flower isn’t irradiated, Why are some irradiated and others not?
Irradiation is a process used to decrease the microbial contents in the flowers if they are outside of what the specified range is. But at Northern Green we do not radiate. We’re able to do this because we are an indoor facility, we are able to have a lot more control over our environment and our processing rooms versus other facilities. Greenhouses can have a little bit more influence from the natural environment where you have high humidity during the summer months etc which can impact the microbials in the plant.
It’s a living organism so there is inherently some microbial growth in there. However, Northern Green Canada, maintaining our GMP status, we are not licensed to do any irradiation on our flowers. So we grow and have all of our processes in place so that we do not have to irradiate our products.
I would say at this point, I think Northern Green is the only GMP approved grower that doesn’t irradiate because it is grown in such a clean environment. I certainly feel very lucky to have Northern Green working with us because it shows the quality of the product that they don’t have to irradiate it to get the microbes down.
Is the irradiation process to meet those standards? Or is it just this is some that choose to.
Radiation is necessary sometimes to get product within the standards so producers have no choice but to comply with those standards. As I understand it most other producers use gamma irradiation. I think there are one or two out there that use electron beam.
I think there’s some suggestion that the gamma radiation can reduce the quality of the cannabis, I suppose it’s quite subjective, but certainly the feedback I’ve had is non irradiated, indoor grown is sort of the golden nugget of cannabis that’s out there in the industry.
What is the control procedure for cannabis flower? We all know that there have been, what seems like so many recalls. If we start with Richard.
There will seem to be a lot of recalls, especially when it affects you or when it affects a group. But if you look at it in terms of everything we offer, there’s actually been very few recalls. And when we look into other markets – for example Canada – recalls are something that happen on quite a regular basis.
Is it a bad thing? I think it is when it affects the patients, but it’s done for a reason. When there’s a recall there is something that someone (normally the MHRA in the UK) is concerned about, and when the MHRA have got concerns, then me, as a healthcare professional, also shares those concerns.
And that’s why an item of stock is sometimes quarantined until any investigations are done. I think that going forward, that will be less and less and I think that in the future there will still be product recalls but you’ll be able to see more alternative products available so that people can quickly prescribe products that they can use instead.
I think that that’s something that we can look forward to even though there have been some recalls – we need to remember it’s because we have such strict standards in the UK. And I’m very supportive of those standards.
There’s been a real lack of a laboratory that is suitably licenced and with the suitable machinery here in the UK to test products. I received word from the MHRA that there is actually now one approved in the UK and they’re going through what’s called the ‘technology transfer process’. This means additional testing of the product once it lands in the country. So Northern Green would test it before they ship it here. We could then test it in addition when it arrives. If there were quality complaints from patients then we can send retained batches or sample batches from patients off to be tested immediately and get a sense for you know, how big of an issue there is? Or exactly what the problem is.
So that’s a really big step for the UK quality management system that has been missing since medical cannabis was legalised.
Madeline, do you experience recalls in the Canadian market at all?
Yes, we do from time to time – and that’s because there is variation in the different producers, and the different growth styles that are out there.
We do have producers that grow outdoor cannabis, which inherently has its own issues. We also have growers that use greenhouses, and then we have indoor facilities such as ourselves. So we do see them from time to time with various issues, but it is something as the industry grows, and as people learn more, we’ll see a reduction in that.
That’s the end of Part 3. Keep an eye out for part three in the coming days – and remember you can watch the full webinar on our Youtube page.