DRUG MAKER WILL SOON HOLD PATENT ON THC, CBD AS CANCER CURES

MEDICAL CANNABIS

DRUG MAKER WILL SOON HOLD PATENT ON THC, CBD AS CANCER CURES

GW PHARMACEUTICALS, A DRUG COMPANY THAT SPECIALIZES IN CANNABIS-BASED PHARMACEUTICALS, HAS RECEIVED EARLY APPROVAL ON A PATENT COVERING THE USE OF MARIJUANA CHEMICALS FOR TREATING BRAIN CANCER.

GW Pharmaceuticals announced Wednesday that it has been issued a Notice of Allowance from the U.S. Patent Office for a patent application involving the use of THCand CBD, the two main chemicals in marijuana, for treating gliomas.

Once a patent application is deemed a genuine invention, the Patent Office sends a Notice of Allowance that outlines the fees involved with final approval.Specifically, the company provides this description of the patent:

“The subject patent specifically covers a method for treating glioma in a human using a combination of cannabidiol (CBD) and tetrahydrocannabinol (THC) wherein the cannabinoids are in a ratio of from 1:1 to 1:20 (THC:CBD) with the intent to reduce cell viability, inhibit cell growth or reduce tumor volume.”

Filed in 2009, GW’s patent application lists Otsuka Pharmaceutical as a collaborator and initially claimed the invention of the “use of a combination of cannabinoids in the manufacture of a medicament for use in the treatment of cancer.”

Five Year Wait For U.K. Cannabis Prescriptions?

PATIENTS may be forced to wait five more years to routinely secure cannabis medication through the U.K.’s health service.

This damming assessment by Prof Mike Barnes, one of the country’s leading medical cannabis experts, follows the publication of a long-awaited report. Since the introduction of legislation to allow for medical cannabis last November less than a handful of patients have been able to secure cannabis prescriptions through the National Health Service (NHS).

Last November the Government also asked its expert panel – The National Institute for Health and Care Excellence (NICE) – to evaluate the clinical use and cost-effectiveness Cannabis Based Medicinal Products (CBMP).

Cannabis Chances on the NHS – ‘Basically Zero’

Its interim findings, published earlier this month, cannot ‘recommend CBMPs for routine use’ – and called for fast-tracked clinical trials to establish an evidence base.

Speaking to CBD Testers Prof Barnes, a neurologist who was been working in the cannabis arena for over almost two decades, says the guidance means the chance of securing an NHS prescription has shrunk from minuscule to ‘basically zero’.

“This a backward step from NICE. It will stop NHS prescriptions for the foreseeable future, because no-one is going to go against the NICE guidelines, although they are not mandatory. We need more research, but we shouldn’t be hung up on Randomized Control Trials as they won’t work for cannabis medicines. 

“It’s not one product, it’s a whole family of medicines and the nature, and personalization of cannabis, does not lend itself to placebo-controlled trials. We should not wait to start prescribing until we have those results. We should start prescribing as we go along.

“We can produce good evidence and we should be considering retrospective studies from Canada, Australia and elsewhere; that should not take long, but it depends on whether our medical bodies would take any notice of them.

British Doctors’ Arrogance

“There is a certain arrogance amongst British doctors and the British medical hierarchy that only British evidence counts and they can dismiss evidence  from other jurisdictions, which is sad. These jurisdictions are way ahead of us in terms of experience in prescribing, and the potential side-effects. We need to take into account the findings from elsewhere as evidence.

“To carry out the research in two to three years would would be an effort. Our clinicians have been brainwashed into thinking the only evidence that matters is Randomised Control Trials and they will take a lot longer than two to three years, these could take up to five years.”

Prof Barnes believes things could change quickly if there is a change of Government, saying: “The Government cannot tell the doctors to prescribe, but they could make the system for prescribing easier.”

But he went on to say the main issue, now, is to ‘change the hearts and minds of U.K doctors’.  Prof Barnes is heavily involved in this having helped establish the Academy of Medical Cannabis and The Medicinal Cannabis Clinicians’ Society.

‘Negative’ Prescribing Guidelines

He continued: “The main issue is the doctors and the doctors bodies, such as the Royal College of Physicians, the British Paediatric Neurology Association and NICE all of which have produced fairly negative guidelines. Other jurisdictions Australia, for example, have produced fairly sensible guidelines on epilepsy, for example, and this system is working well, but we are ignoring the evidence and guidelines from other countries.”

The draft NICE guidance, which is open for further consultation until early September, considers the use of CBMPs for people with intractable nausea and vomiting as a result of chemotherapy, chronic pain, spasticity, and severe treatment-resistant epilepsy.

On epilepsy it says ‘there was a lack of clear evidence that these treatments provide any benefits’.

It recommends nabilone – synthetic THC – as an option for adults with chemotherapy-induced nausea and vomiting, but does not recommend Sativex for treating spasticity in people with multiple sclerosis, saying ‘it’s not cost-effective at its current list price’.

Findings Are ‘Absolutely Ridiculous’

Both Prof Barnes and Hannah Deacon, whose son Alfie Dingley is one of only possibly only two patients to receive a CBMP through the NHS, had requested to sit on the NICE panel. Ms Deacon was told that she could, but only if she sacrificed any media opportunities to talk about cannabis. 

Prof Barnes said the panel was ‘stacked with people against cannabis’, saying the result was a ‘forgone conclusion’. When asked for her thoughts on NICE’s findings Ms Deacon told Hemp And CBD Magazine: “I think this it is absolutely ridiculous! Are we saying that every country in the world with medical cannabis legislation is wrong? Are we that arrogant?

“I think we are pharmaceuticalising cannabis, and that is wrong. It does not lend itself to a Randomised Controlled Trial process, because of the nature of the plant.”

Boom Time for Black Market

Prof Barnes reflected ruefully on the journey following the U.K. Government’s swift change of heart, after medical cannabis which came storming into the mainstream media, last summer, through cases like those of Alfie Dingley.

“I really did not expect to find us in the position we are in now. I thought back in November we had cracked it. We had changed the law and it would just be a matter of slowly and surely, as doctors gained more confidence, but it looks like its going to take a lot longer than anticipated.

“It’s really sad, the black market will be thriving as we have got so much publicity about the benefits of cannabis and what it can do, more people will want to try it and as they can’t get it off the NHS or privately, because it’s too expensive for most, then they will get it from the illicit market. I think the criminals are rubbing their hands in joy at the publicity they are getting for their product. It’s crazy.”

Paul Chrisp, director of the Centre for Guidelines at NICE, said it recognised that some people will be ‘disappointed’ with its findings, saying there was lack of ‘robust evidence base for these mostly unlicensed products’.

Canada Now Has Psilocybin Dispensaries

Dana Larsen is anything but discreet about his business—and that’s exactly the point. “I’m definitely not the first person to sell mushrooms online,” he says. “But I might be the first to put my name, face, and reputation on the line for it.”

Larsen’s worked in the cannabis industry for 30 years, but from the beginning, he says, “it’s always been a broader push than just cannabis.” To that end, he’s founded the online Medicinal Mushroom Dispensary that ships microdoses of psilocybin to patients across Canada. While the business isn’t technically legal, the authorities are so far indifferent. And if things did come to a head, all the better, with Larsen willing and ready to challenge the law and set a precedent in court. 

A fixture in Vancouver’s cannabis scene, Larsen’s accustomed to navigating legal gray areas. A cannabis dispensary owner and longtime legalization activist, he’s co-founder of the Vancouver Seed Bank, an online dispensary for cannabis, peyote, and coca seeds, and former editor of Cannabis Culture, a magazine founded by Canada’s “Prince of Pot” Marc Emery.

Larsen’s activism pushed him to run for federal office in 2000 and provincial office in 2001 as a founding member of the Marijuana Party of Canada and the BC Marijuana Party, respectively. He’s since become a member of the New Democratic Party, one of Canada’s three major political parties, urging its leadership to support alternative approaches to drug policy such as safe injection sites for opioids.

Yet he’s something of a strange politician, because the other side of Larsen’s activism has involved breaking the law in order to change it. As a dispensary owner, he’s contributed to the collective effort of the underground cannabis community to normalize and eventually legalize cannabis. Years of activism on behalf of that community has involved breaking the law to sell cannabis in dispensaries, publicly emphasizing its medicinal value, and challenging the federal ban on its use and possession in court—and the same could happen for psilocybin.

Throughout that time, cannabis existed in a gray area, in which police only actively pursued dispensary owners when ordered to do so by higher-ups. Just as the police have looked the other way for years while cannabis dispensaries opened up in major cities like Toronto and Vancouver, Larsen is now hoping that law enforcement will take that same approach to psilocybin. He’s not the only one. At least one other psilocybin dispensary in Canada, called Blue Goba, is doing the same thing.

When DoubleBlind spoke to Larsen, he had only been operating the dispensary for two weeks and claimed to have served 100 patients in just that short time. At this time, all of Larsen’s patients are Canadian and his online service does not ship to the United States—though he notes that Americans have certainly made requests.

Patients who sign up for the service are more akin to club members than to customers. For a one-time membership fee of $10 CAD, they receive personally tailored microdoses of psilocybin with a recommended dose and rate-of-use based on the individual patient’s needs and experience with psychedelics. In addition to consulting with Larsen about dosage, patients must provide proof of a diagnosis that would warrant psilocybin treatment. This can come in the form of prescription bottles, insurance forms, or a recommendation from a doctor or naturopath to prove they’ve been diagnosed with an illness, such as PTSD, depression, cancer-related anxiety, or any other ailments that psilocybin has shown promise for.

Membership takes about 24 hours to process. After that, patients are sent $4 to $7 capsules, which contain 25mg, 50mg or 100mg of dried Golden Teacher strain mushrooms mixed with Spirulina—an algae-based dietary supplement added mostly as a filler for the capsules. At their highest dose, Larsen’s capsules are a tenth of what is considered a threshold recreational dose of one to three grams (depending on the mushrooms’ strain, how they’re grown, how they’re consumed, and a number of other factors that have yet to be formally tested for non-synthetic psilocybin, like the kind Larsen sells).

In the coming months, Larsen intends to open a safe consumption space, where patients who require higher doses can be treated in a therapeutic setting. Still in the planning stages, that physical location is all part of a grand scheme to change public perception and ultimately the laws around psychedelic mushrooms.

Larsen’s approach to psilocybin follows the model cannabis has set in Canada—one which attempts to prove the medical value of a plant before challenging its legal status in court. He’s even taken to calling psilocybin microdoses “the CBD of entheogens,” since microdosing, he says, is strictly therapeutic and its effects are relatively nonintoxicating. In talking about, and using, mushrooms in this way, the idea is to force both medical and legal authorities to see mushrooms in a new light, separate from stereotypes about recreational use.

“I think we’re seeing a similar shift [to cannabis] in public perception around psychedelics,” Larsen says—and the recent push from activists, researchers, and politicians, alike, for further study of psychedelics is proof of that.

Before Canada had even legalized cannabis for adult use in the fall of 2017, psychedelic advocates—with the support of Liberal MP Nathaniel Erskine-Smith—were already petitioning the government to support further research into these entheogens. By April of 2018, the ruling Liberal Party amended its platform with the aim of decriminalizing the possession of all drugs, using Portugal as a model.

Though mushrooms are currently illegal in Canada under the Controlled Drugs and Substances Act (CDSA), exceptions can be made under a provision known as Section 56. Currently, a team of seven therapists, known as TheraPsil, is trying to obtain that exemption.

Those who apply for that exemption are often bogged down in a lengthy approval process from Canada’s Department of Health, which could eventually, nonetheless, deny their application. Yet even if they’re approved, TheraPsil’s lead therapist, Bruce Tobin, tells DoubleBlind that their services will be restricted to patients who have exhausted all other treatment options for symptoms of serious psychological distress such as PTSD and end-of-life anxiety. “Psilocybin will not be more generally available until it has successfully completed Phase 3 clinical trials, which are just now starting [in Canada],” he says. “That will likely take several years.” The only alternative is to challenge the government in court, which Tobin has said he’s willing to do as a last resort.

Larsen, on the other hand, whose online service is not exempt under Section 56, argues that defying the law and pushing for a court battle is the only real option for legalization. “I think it’s time to start using the same tactics that we used to get the law changed on cannabis,” he says. “From my perspective, it was primarily civil disobedience and court cases that really advanced legalization.”

“It’s time to start using the same tactics that we used to get the law changed on cannabis,” Larsen says. “From my perspective, it was primarily civil disobedience and court cases that really advanced legalization.”

In essence, the idea is that an unjust law has to be broken in order to prove its injustice, especially when many of the experts on psychedelics are either limited in their research or pushed entirely underground.

“Ultimately, if you want to change the law, that requires some good politicians willing to vote to change the law,” Larsen says. “But I saw most of our success come from opening [cannabis] dispensaries in violation of the law and forcing the government’s hand toward decisions in court battles.”

It’s certainly true that in Canada medical cannabis laws were practically litigated into existence, beginning with the R. v. Parker case in 2000, in which an epilepsy patient challenged the federal ban on cannabis possession based on the plant’s medicinal value. In 2016, criminal defense attorney John Conroy was part of the last landmark court battle to date (one of nine cases), known as the Allard Medical Marijuana Case, which challenged a ban on growing medicinal marijuana as a violation of the Charter of Rights and Freedoms (Canada’s Bill of Rights).

In that case, Justice Michael Phelan ruled that a denial of access to medicine violates a citizen’s Section 7 Charter rights to “life, liberty, and security of the person.” Justice Phelan’s ruling found that the ban was imposed arbitrarily under the CDSA because, according to Conroy, “the purpose of the CDSA is to protect people’s health, so when a doctor comes along and approves you for a particular drug [on the banned list] that becomes inconsistent with the purposes of the Act.”

Conroy told DoubleBlind that if Larsen’s business and others like it are operating with the recommendation or involvement of medical professionals, an eventual court case regarding psilocybin could follow the same path as cannabis.

“If they busted Larsen, he would bring forward that evidence to show that he was only supplying it to people who were medically approved and he’d probably bring a constitutional challenge that busting patients would violate their Section 7 Charter rights,” Conroy says. “It would be Allard revisited, but specific to psilocybin.”

But that doesn’t mean that Larsen is providing his services just to get caught. In fact, he insists that his goal is not to get anyone—including himself—arrested (even though shipping psilocybin pills on a national scale certainly carries the potential for legal issues, which could result in a court case that challenges prohibition). Ironically, the only thing standing in the way of another major court case is that the police don’t seem to care enough about Larsen’s business to bring him to court, so any challenge would have to come directly from a patient who believes they could win a case with the support of a medically licensed doctor.

“I must confess, I haven’t had a psilocybin case for an awfully long time,” Conroy says.

He suspects that the police consider it a lower priority because Vancouver is currently fighting a deadly opioid crisis. Larsen, who’s grown comfortable with challenging hazy or unjust legal territory, agrees. He says that if he turned in a list of his customers to the police, they wouldn’t even care. “I don’t think the RCMP [Royal Canadian Mounted Police] are going to harass my customers for buying non-psychoactive doses to treat their migraines,” he says.

In fact, when DoubleBlind reached out to Canadian authorities, they replied with what amounted to professional shrugs. The RCMP, Canada’s federal police force equivalent to the FBI, referred us to the local Vancouver Police, despite the nationwide nature of Larsen’s business. The Vancouver Police gave us a boilerplate assurance that they know what’s happening and promised they were looking into it. “We are currently assessing the business to determine if any criminal offenses have been committed,” VPD Media Relations Officer Sgt. Jason Robillard said. “I am not aware of any enforcement action taken at this point.”

Miro Tomoski is a Canadian journalist reporting on politics and drug policy. His highway journalism covers American presidential campaigns as well as legalization efforts across the U.S. and Canada. Follow him on the road and on Instagram.

An Update on Plant Photobiology and Implications for Cannabis Production

This review presents recent developments in plant photobiology and lighting systems for horticultural crops, as well as potential applications for cannabis (Cannabis sativa and C. indica) plant production. The legal and commercial production of the cannabis plant is a relatively new, rapidly growing, and highly profitable industry in Europe and North America. However, more knowledge transfer from plant studies and horticultural communities to commercial cannabis plant growers is needed. Plant photosynthesis and photomorphogenesis are influenced by light wavelength, intensity, and photoperiod via plant photoreceptors that sense light and control plant growth. Further, light properties play a critical role in plant vegetative growth and reproductive (flowering) developmental stages, as well as in biomass, secondary metabolite synthesis, and accumulation. Advantages and disadvantages of widespread greenhouse lighting systems that use high pressure sodium lamps or light emitting diode (LED) lighting are known. Some artificial plant lighting practices will require improvements for cannabis production. By manipulating LED light spectra and stimulating specific plant photoreceptors, it may be possible to minimize operation costs while maximizing cannabis biomass and cannabinoid yield, including tetrahydrocannabinol (or Δ9-tetrahydrocannabinol) and cannabidiol for medicinal and recreational purposes. The basics of plant photobiology (photosynthesis and photomorphogenesis) and electrical lighting systems are discussed, with an emphasis on how the light spectrum and lighting strategies could influence cannabis production and secondary compound accumulation.

Introduction

The legal status of cannabis production is shifting, causing a rapidly expanding market in both North America and Europe. Canada has become the second country in the world to legalize the use of both medicinal and recreational cannabis (Dyer, 2018). Such full legalization allows industry and researchers to work together to explore the uncharted science of this once-forbidden plant. Although cannabis (Cannabis sativa ssp.) has been harvested for food (seeds), fiber (stems), and medicine (buds) throughout most of human history (Mercuri et al., 2002Clarke and Merlin, 2013), its listing as an illegal drug to date has left little published scientific literature.

Commercial cannabis production typically occurs indoors and requires environmental controls such as humidity and lighting for both vegetative growth and budding (flowering) developmental stages (Hillig, 2005). During the vegetative growth stage, high light intensity is needed to maximize cannabis growth and proper photoperiodicity control is necessary to initiate budding (Arnold, 2013). Growing cannabis plants solely with indoor lighting allows a continuous and uniform cannabinoid yield for high-quality products, but it requires high-energy inputs. As such, indoor cannabis production has been classified as one of the most energy-intensive industries in the US (Warren, 2015). In this regard, the selection of electrical lighting systems and light spectra are of utmost importance, as they determine operation costs and consequent product pricing.

In the general horticultural industry, growers use different light spectra and intensities to influence plant morphology, secondary metabolism, and flowering (Lefsrud et al., 2008Kohyama et al., 2014Wang et al., 2016). However, commercial growers in the cannabis industry are still referring to unreliable information, given the lack of peer-reviewed reports on cannabis production. Exceptionally, it has been reported that reducing the photoperiod to approximately 12 h is a common practice in the cannabis production industry to initiate flowering (Chandra et al., 2017). For other commonly grown flowering plants in the horticultural industry, flowering is initiated via night interruption (Yamada et al., 2008Blanchard and Runkle, 2010Park et al., 2016). Both methods initiate flowering; however, reducing photoperiod potentially leads to plant yield reduction.

With decades of research committed to understanding the impact of narrow light spectra on plant growth, the basis of wavelength effect on photosynthesis and photomorphogenesis for greenhouse crops has been well investigated (Massa et al., 2008Bugbee, 2016Bantis et al., 2018). Until now, our knowledge of cannabis production has stemmed from experiments performed when growing cannabis was illegal (Vanhove et al., 2011). Current findings in plant photobiology and lighting control will provide the information needed by horticultural scientists to establish optimal cannabis production protocols and to maximize cannabinoid yields. To this end, this review focuses on recent developments and our current understanding of photosynthesis and photomorphogenesis in greenhouse crops, with the latest reports on cannabis production in order to adequately inform the industry on the importance of lighting control for cannabis growth and cannabinoid production. A brief overview of the cannabis profile is provided, and three main topics are explored: (1) light, photosynthesis, and photosynthetically active radiation (PAR); (2) photomorphogenesis, plant photoreceptors, and secondary plant metabolites; and (3) electrical lighting systems.

Cannabis Profile

The cannabis plant is the one of the oldest plant sources for food, medicinal, or ritual use (Kriese et al., 2004Chandra et al., 2017). Today, cannabis is often referred to as marijuana, a term used to describe a female cannabis plant that produces flower buds, as opposed to hemp, which is grown for several industrial applications. Throughout this review, use of the term “cannabis” will refer to the female cannabis (C. sativa) plant with high psychoactive properties. Cannabis plants synthesize and accumulate 60–85 different psychoactive cannabinoids in their budding structures, and these are directly associated with cannabis consumption (El-Alfy et al., 2010). The most abundantly produced cannabinoids in cannabis plants are tetrahydrocannabinol [THC; or Δ9-tetrahydrocannabinol (Δ9−THC), cannabidiol (CBD), and the primary product of THC-degradation, cannabinol (Benson et al., 1999)]. The most psychoactive cannabinoid is THC, and its pharmacology has been well studied (El-Alfy et al., 2010). Over the last few years, CBD has drawn significant attention since its reported therapeutic potential as a treatment for intractable pediatric epilepsy (Friedman and Devinsky, 2015).

The Cannabis genus is commonly conceived as only constituting a single species. However, C. sativa L. may be divided into three sub-species: C. sativa ssp. sativaC. sativa ssp. indica, and C. sativa ssp. ruderalis. The first two species, often referred to as “Sativa” and “Indica”, are the main cannabis plant species of recreational and medicinal interest (McPartland, 2017). They have distinct yet opposing THC and CBD ratios; C. sativa ssp. indicatypically possesses a high THC to CBD ratio (Fischedick et al., 2010), whereas the reverse is known for C. sativassp. sativa. In today’s marketplace, however, these distinctions are almost meaningless as new strains have been created from crossbreeding. C. ruderalis is the least known subspecies, and it is not commercially produced because of low plant yields (Fischedick et al., 2010).

Light, Photosynthesis, and Photosynthetically Active Radiation (PAR)

Light is one of the most important environmental parameters that impacts plant growth and development. It exerts a vast range of effects on photosynthetic activity and photomorphogenic responses throughout the plant’s life (Pocock, 2015Naznin et al., 2016Ouzounis et al., 2016). Close to half of the sun’s total radiation emission reaching the Earth’s surface is visible light, ranging from 400 to 740 nm wavelengths (Both et al., 2015). Visible light is flanked by shorter wavelengths and invisible ultra-violet (UV) electromagnetic radiation (10–400 nm) and by infrared radiation (IR; 700–1 mm); this roughly constitutes the remaining half of the solar radiation incident on the Earth’s surface (Cooper and Hausman, 2004). These three wavelength regions of the electromagnetic spectrum are the most significant with respect to biological systems (Mishra, 2004). Visible light includes violet (~400–450 nm), blue (~450–520 nm), green (~520–560 nm), yellow (~560–600 nm), orange (~600–625 nm), red (~625–700 nm), and far-red (FR; > 700 nm). The most important part of the light spectrum for plants, PAR (400–700 nm), falls within the visible light range (McCree, 1972a,bvan Iersel, 2017).

The Basis of Photosynthesis

Photosynthesis plays a critical role in plant growth, as there is a close correlation between plant productivity and their photosynthetic rates in a given environment (Zelitch, 1975). Photosynthesis defines the complex set of reactions by which plant and phototrophic cells harvest, transfer, and store light energy as chemical potential in the carbon bonds of carbohydrates (Cooper and Hausman, 2004). Photosynthesis occurs within the chloroplast, a chlorophyll-bearing plastid organelle dedicated to energy production (Cooper and Hausman, 2004Mishra, 2004). Chloroplasts are mostly found in the cytoplasm of palisade and spongy mesophyll cells located between the bounding epidermal layers of leaves (Mishra, 2004). The energy-generating, photooxidation-reduction reactions of photosynthesis occur within the third, internal thylakoid membrane system of the chloroplast; it forms networks of flattened thylakoid disks, often stacked in grana (Cooper and Hausman, 2004). Embedded in the thylakoid membrane are five-membrane protein complexes that serve in electron transport and the concomitant synthesis of the energy carrier molecules NADPH and ATP, fueling carbohydrate synthesis. Prominent among these are the two main photosynthetic light reaction centers, membrane protein photosystem I and II complexes (PSI and PSII), named after the order of their discovery yet counterintuitive to their evolution in nature (Cooper and Hausman, 2004).

The aforementioned photosystems contain arrays of associated chlorophyll and carotenoid antenna pigments, molecules involved in harvesting light energy for photosynthesis, organized in such a way as to maximize light energy capture and transfer. Plant pigments have specific wavelength absorbance patterns known as the absorbance spectrum (Figure 1). Chlorophylls a and b (Chl a and b) absorb wavelengths of light strongly in the red and blue regions, with less absorbance occurring in the green wavelengths. In acetone, Chl a exhibits peak absorbance at 430 and 663 nm, while Chl b peaks at 453 and 642 nm. The pigments β-carotene and lutein in acetone absorb strongly in the blue region of light with a maximum peak occurring at 454 and 448 nm, respectively (Hopkins and Hüner, 1995Taiz and Zeiger, 2002). These pigments have local absorbance peaks, while β-carotene has a second absorbance peak at 477 nm, and lutein has two local absorbance peaks at 422 and 474 nm. However, it is important to note that peak absorbance can shift up to 38 nm and is dependent on the specific environment surrounding the chloroplasts (Heber and Shuvalov, 2005).

Photosynthetically Active Radiation (PAR) and Standard Units for Plant Lighting

Understanding the spectral quality of photosynthesis is critical when selecting a lighting system with proper light quality and quantity for any indoor plant cultivation. Our current understanding of the spectral quality of photosynthesis is mainly based on McCree’s findings in the 1970s (McCree, 1972a). The action spectrum of plant leaves was described as the span of wavelengths from approximately 400–700 nm, over which plants absorb and effectively use radiant light energy for photosynthesis (McCree, 1972a). This brought some definition to what is now commonly known as PAR (measured in μmol m−2 s−1), the measure of that relates the intensity and rate of radiant light energy per surface area emitted by a light source from within the action spectrum of plants. To achieve this, the photosynthetic spectral quantum yield or the CO2 consumed by plant leaves per mole of photons absorbed was determined for 22 crop plant species by correlating the monochromatic light irradiance intensity (W m−2) required to obtain a certain rate of photosynthesis in leaf fragments to their absorption spectrum, measured in an integrating sphere with a spectrophotometer. The assay covered the wavelength range from 350 to 750 nm, in 25 nm waveband increments, and photosynthesis was measured based on the CO2 uptake rate, measured with an infrared gas analyzer based on CO2 differentials under dark light versus the tested wavelength band of light. Two major, distinct peaks at 440 and 620 nm were observed, followed by a secondary peak at 670 nm. To this end, McCree’s experiments first described a plant’s PAR curve, a term that defines a plant’s light action spectrum and the wavelengths used most efficiently for glucose biosynthesis and the storage of free chemical energy (McCree, 1972bYoung, 1991).

McCree (1972b) determined that quantifying PAR in quantum or photon flux units based on moles of photons would yield results that more closely correlated to the actual photosynthetic rate, since photosynthesis is a quantum photochemical process, with one carbon fixed and one molecule of oxygen evolved per roughly 10 photons (quanta) of light absorbed. Both units of measurement, radiant flux density (W m−2) and photon flux density (μmol m−2 s−1), are typically used to report plant lighting systems (McCree, 1972aInada, 1976Both et al., 2015); however, plant yields are overestimated for blue light over red light when using radiant flux density, and this overestimation is smaller when light energy is measured in photon flux density (McCree, 1972bInada, 1976). Therefore, PAR is defined from 400 to 700 nm in quantum units of photosynthetic photon flux density (PPFD, μmol m−2 s−1) (McCree, 1972bInada, 1976van Iersel, 2017). PPFD is broadly considered as the available estimate of potential photosynthetic flux, since the two are positively correlated. PAR is determined by integrating PPFD values within the limits of the plant action spectrum for photosynthesis (McCree, 19711972b). Based on McCree’s findings on plant action spectrum, the PAR spectrum is used to integrate photon flux values, and PPFD gives an instantaneous estimate of potential photosynthetic activity with regard to measured light source emissions (Sager and Giger, 1980Sager et al., 1982).

Although McCree (1972a,b) proved that the use of PPFD is necessary when quantifying photosynthetic productivity over four decades ago, other photometric units of light such as lumens, lux, or foot-candles are still employed. These photometric units are based on the eye’s response to brightness, where human eyes are more sensitive to green light than red or blue light. Moreover, light below 400 nm and above 700 nm induces photosynthetic activity, which was not previously considered in PAR (McCree, 1972aInada, 1976). This led to the use of yield photon flux. Yield photon flux weighs photosynthetic activity from 360 to 760 nm based on McCree’s quantum yield curve, under the assumption that the curve remains true with different light conditions (Sager et al., 1988Barnes et al., 1993). Importantly, all spectral quality studies were conducted under low light intensity (< 150 μmol m−2 s−1). Whether the curve keeps its infamous form under higher light intensities or can be applied to other plants remains to be determined (Lefsrud et al., 2008). In the case of cannabis plants, most studies have been conducted under light intensities ranging from 300 to 2000 μmol m−2 s−1; this is higher than what is typically used for greenhouse crops and all spectral quality studies (McCree, 1972aInada, 1976Chandra et al., 2008Chandra et al., 2015). In this scenario, the spectral quality of photosynthesis for cannabis plants is required to optimize growth.

Light Compensation and Saturation Points

Increased PPFD increases with plant growth and photosynthetic rate, and this linear increase occurs between the light compensation point and the light saturation point. The light compensation point is the point at which the photosynthetic activity of the plant equals its respiration activity, and the resulting CO2 release from respiration is equivalent to that used during photosynthesis. The light compensation point is used as a base to select an appropriate light intensity. If light intensity is below the light compensation point, there is a net loss of sugars (Noodén and Schneider, 2004). For broad spectrum light, Erwin and Gesick (2017) reported that light compensation points were 25, 13, and 73 μmol m−2 s−1 for chard, kale, and spinach, respectively.

The light saturation point is the light intensity at which the photosynthetic rate reaches its maximum, where more light has no or a negative effect on photosynthesis. Understanding the light saturation point in plants provides lighting engineers with an opportunity to provide optimal light intensities that will maximize plant growth. Light saturation points have been investigated for many greenhouse crops, including kale, spinach, and Swiss chard (Boese and Huner, 1990Yamori et al., 2005Dahal et al., 2012Ruhil et al., 2015). A study using 470 and 655 nm LEDs reported that the light saturation points for kale and chard ranged between 884 and 978 μmol m−2 s−1 and at 1238 μmol m−2 s−1 for spinach (Erwin and Gesick, 2017). The light saturation point for cannabis has not yet been determined, but its net photosynthetic rates at different temperatures (25–40°C) and intensities (up to 2,000 μmol m−2 s−1) were reported (Chandra et al., 2008Chandra et al., 2015). In these studies, no decline in photosynthesis rate was observed at the highest intensity used; however, net photosynthetic rates at 30°C decreased by ~20% from 1,500 to 2,000 μmol m−2 s−1 (Chandra et al., 2008Chandra et al., 2015).

For any given wavelength and plant, an increase in photosynthetic rate results in increased yields until reaching the light saturation point. Therefore, additional lighting results in a similar linear increase in biomass yield that is counteracted by increased operating light-related energy costs (Terashima et al., 2009). With high-intensity LED lights, a favorable and constant light intensity above the light compensation point and below the light saturation point is required but this is species-, environment-, and grower needs-dependent (Mathieu et al., 2002van Ieperen and Trouwborst, 2007).

Photomorphogenesis, Plant Photoreceptors, and Secondary Plant Metabolites

Light wavelength and intensity are used to quantify light in plant lighting experiments, and it is now widely accepted that both influence photosynthesis and photomorphogenesis (Olle and Viršile, 2013Singh et al., 2015). With the McCree curve and lighting technology improvements, photomorphogenic responses with whole plant measurements have been investigated under various wavelengths and intensities of narrow spectrum light for greenhouse crops (Hoenecke et al., 1992Kim et al., 2004aLi and Kubota, 2009Stutte et al., 2009Martineau et al., 2012). In contrast to photosynthesis that is associated with growth from direct light energy, photomorphogenesis is defined as the effect of light on plant development. Several plant responses such as germination and flowering result from the mere presence of light and are not influenced greatly by its intensity (Hall et al., 2014Kołodziejek and Patykowski, 2015). Therefore, the outcome of a plant’s response under any light spectrum results from the interactive effects between photosynthesis and photomorphogenesis. These two responses are difficult to separate from each other for long-term whole plant growth. Note that plants grown with sunlight, whether in an outdoor environment or in a greenhouse with supplemental electrical lighting, still receive the broad spectrum of light and have corresponding photomorphogenic responses. Sunlight and electrical lighting systems are further discussed in Section Traditional Light Sources.

Photomorphogenic Responses and Photoreceptors

Photomorphogenesis is the light-mediated development of plants regulated by five different photoreceptors (Figure 2Folta and Carvalho, 2015Pocock, 2015). They mediate and modulate dozens of structural plant developments such as height, leaf size, and flowering. These changes to plant architecture affect long-term plant development and subsequent photosynthetic surfaces.

The aforementioned photosystems contain arrays of associated chlorophyll and carotenoid antenna pigments, molecules involved in harvesting light energy for photosynthesis, organized in such a way as to maximize light energy capture and transfer. Plant pigments have specific wavelength absorbance patterns known as the absorbance spectrum (Figure 1). Chlorophylls a and b (Chl a and b) absorb wavelengths of light strongly in the red and blue regions, with less absorbance occurring in the green wavelengths. In acetone, Chl a exhibits peak absorbance at 430 and 663 nm, while Chl b peaks at 453 and 642 nm. The pigments β-carotene and lutein in acetone absorb strongly in the blue region of light with a maximum peak occurring at 454 and 448 nm, respectively (Hopkins and Hüner, 1995Taiz and Zeiger, 2002). These pigments have local absorbance peaks, while β-carotene has a second absorbance peak at 477 nm, and lutein has two local absorbance peaks at 422 and 474 nm. However, it is important to note that peak absorbance can shift up to 38 nm and is dependent on the specific environment surrounding the chloroplasts (Heber and Shuvalov, 2005).


Red (~625–700 nm) and Far-Red (> 700 nm) Light

Red light impacts photomorphogenesis, leaf nutrient content, and stem growth. It is essential for chlorophyll synthesis and for straightening the epicotyl or hypocotyl hook of dicot seedlings (McNellis and Deng, 1995Goins et al., 1997Poudel et al., 2008Johkan et al., 2012). These processes are under the influence of phytochrome control. Phytochrome is sensitive to red (~650–670 nm) light and far-red (FR) light (~705–740 nm), and to a lesser extent, blue light (~400–500 nm). For any one phytochrome, there exists a photoequilibrium of two interconvertible forms, red and FR absorbing forms (also known as Pr and Pfr, respectively). Pfr is the active form of phytochrome and it elicits physiological responses (Shinomura et al., 2000). Pr, the other form of phytochrome, is the inactive form that switches to Pfr upon absorbing ~650–670 nm light (Nagatani, 2010Folta and Carvalho, 2015). In long day plants, various experiments suggest that flowering is promoted mostly when red light (or light creating a high Pfr/Pr ratio) is delivered during the early part of the photoperiod and when FR light (or light creating a lower Pfr/Pr ratio) is delivered toward the end of the photoperiod (Lane et al., 1965Evans, 1976Kadman-Zahavi and Ephrat, 1976Thomas and Vince-Prue, 1996). However, certain cannabis genotypes such as “G-170” are insensitive to changes in the R:FR ratio, and no effect on flowering has been observed (Magagnini et al., 2018). The authors concluded that a low R:FR ratio during a long photoperiod (18 h light, 6 h dark/vegetative stage) is beneficial to the development of mature cuttings, contradicting popular belief in the cannabis industry.

The effect of red light on plant physiology has been investigated (Poudel et al., 2008Vu et al., 2014). Poudel et al. (2008) reported that red light induced an increase in rooting percentage and root numbers in grape (Vitis vinifera) plants. Wu and Lin (2012) showed that king protea (Protea cynaroides L.) plantlets grown in red light produce a higher number of roots and new leaves. Vu et al. (2014) reported that “Lapito” tomato plants grown solely under red LED light produce a higher total root surface area, length, and number of root tips in comparison with other light treatments. Lower leaf nitrogen content was found in rice (Oryza sativa L.) and spinach (Spinacia oleracea L., cv. Megaton) grown under red light treatment (Matsuda et al., 2004Ohashi et al., 2005Matsuda et al., 2007). In addition, photosynthetic rate reductions observed for plants grown under red light are reportedly due to stomata being controlled more by blue light than by red light (Sharkey and Raschke, 1981Zeiger, 1984Bukhov et al., 1996).

Red light further regulates flowering quality, quantity, and flowering duration (Bula et al., 1991Tennessen et al., 1994). According to Guo et al. (1998) and Thomas and Vince-Prue (1996), inhibition of flowering with red light is effected by red light receptors including phytochromes (Kelly and Lagarias, 1985). The number of visible flower buds in marigold plants was approximately five times higher when grown with fluorescent light supplemented with red LEDs, as well as under fluorescent light, when compared to monochromatic blue or red light. No flower buds formed in salvia plants when grown under monochromic blue or red light or when fluorescent light supplemented with FR light was used for marigold (Tagetes minuta) plants.

Plants grown under canopy shade conditions or in the proximity of other plants show a range of responses to changes in R:FR ratios of ambient light. This response, known as shade avoidance or the near neighbor detection response, is characterized by an acceleration of flowering time (i.e., becoming visible within the expanded floral bud) and rapid elongation of stems and leaves (Halliday et al., 1994Smith, 1994). Kasperbauer (1988)determined that FR light reflected from neighboring seedlings increased the R:FR ratio plants received, inducing a density-dependent increase in stem length, chloroplast content, chlorophyll a/b ratio, and CO2 fixation rate, along with decreased leaf thickness. In recent years, the effect of FR light (or a low R:FR ratio) has been intensively investigated in different plant species and development stages (Li and Kubota, 2009Finlayson et al., 2010Mickens et al., 2018Park and Runkle, 2018). Supplemental FR treatments increased dry mass for many greenhouse crops during vegetative development (Hogewoning et al., 2012Lee et al., 2016Mickens et al., 2018Park and Runkle, 2018), but conflicting results on leaf area were reported. Hogewoning et al. (2012) reported no significant difference in leaf area for tomato (L. esculentum “Mecano”) and cucumber (Cucumis sativus“Venice”), whereas an increase in leaf area was observed for lettuce, petunia (Petunia × hybrida), geranium (Pelargonium × hortorum), and coleus (Solenostemon scutellariodes) (Lee et al., 2016Mickens et al., 2018Park and Runkle, 2018). Such differences in leaf area responses among species are still unknown and need to be addressed. For an extensive examination of FR light, the reader is referred to a recent review (Demotes-Mainard et al., 2016).

Blue (~450–520 nm) and UV (< 400 nm) Light

Blue and UV-A light triggers cryptochrome (320500 nm) and phototropin (phot1 and pho2; 320–500 nm) function (Jones, 2018). These two photoreceptors regulate various physiological and developmental processes including chloroplast relocation, germination, elongation, and stomatal opening, which impacts water transpiration and CO2 exchange (Cosgrove, 1981Schwartz and Zeiger, 1984). Blue light mediates chlorophyll and chloroplast development, enzyme synthesis, and plant density, and regulates responses to biotic environmental stresses (Goins et al., 1997Schuerger et al., 1997). Walters and Horton (1995) reported that blue light deficiency can impact the light saturation rate of photosynthesis and can change the Chl a/b ratio in Arabidopsis thaliana. Blue light causes thickness of the epidermis and palisade mesophyll cells in Betula pendula (Sæbø et al., 1995). Lee et al. (2014) concluded that shorter blue wavelengths (<445 nm) promote stem growth, plant height, and anthocyanin synthesis in green perilla (Perilla frutescens var. japonica Hara cv. Soim) plants. Cannabis plants grown under blue light with a short photoperiod (12 h light:12 h dark/flowering stage) improved cannabinoid content (Magagnini et al., 2018). This same study suggested that there is a synergy between UV-A and blue wavelengths that induces cannabigerol accumulation in cannabis flowers.

Blue light activates Zeitlupe (ZTL) family function, a group of proteins that plays a role in circadian clock regulation, wherein their light-dependent function allows modulation of internal timing signals (Kim et al., 2007). Accordingly, optimal lighting regimes for cannabis growth and production should take advantage of this temporal regulation initiated by the circadian clock and light-sensitive ZTL protein function.

Wavelengths of light that are shorter than the PAR spectrum [e.g., violet light and UV (<400 nm) radiation] have limited photosynthesis; however, discrete photomorphogenic effects are observed when UV-B (290320 nm) sensing systems are triggered (Frohnmeyer and Staiger, 2003Folta and Carvalho, 2015). UV-B radiation is perceived via the UV-B photoreceptor UV resistance locus 8 (UVR8). Although UV-B represents a threat to plant integrity in large quantities, smaller quantities of UV-B have important benefits such as promoting pest resistance, increasing flavonoid accumulation, improving photosynthetic efficiency, and serving as an indicator of direct sunlight and sunflecks (Ballaré et al., 2012Wargent and Jordan, 2013Zoratti et al., 2014Moriconi et al., 2018). Further to this, some UV-B responses can also be modulated by a UVR8-independent signal and UV-A radiation, since plants’ responses to UV-B light are regulated by both UVR8-dependent and -independent pathways (Morales et al., 2013Li et al., 2015Jenkins, 2017). UV-B light reportedly elicits THC accumulation in both leaves and buds (Pate, 1983Lydon et al., 1987Potter and Duncombe, 2012).

Green (~520–560 nm) Light

Green light is often considered unavailable for plant growth since plant photosynthetic pigments have limited absorbance for these wavelengths. However, there is evidence that green light is available for active plant growth, yet this phenomenon is wavelength- and intensity-dependent (Kim et al., 2004aKim et al., 2005Johkan et al., 2012). Green light influences plant morphology, including leaf growth, stomatal conductance, and early stem elongation (Folta, 2004Kim et al., 2004a,b). Kim et al. (2004) first examined the effect of green light on plant growth and photomorphogenesis, later concluding that it impacted plant growth at low light intensity (~150 μmol·m−2·sec−1) (Kim et al., 2005). A low percentage (≤ 24%) of green light enhanced plant growth, whereas plant growth was inhibited under a higher percentage of green light (Kim et al., 2004a2005Folta and Maruhnich, 2007Lee et al., 2011Liu et al., 2017). Lee et al. (2011) reported that lady’s slipper orchid grown under a combined LED lighting regime (8:1:1 ratio; 660 nm, 525 nm, and 450 nm) had at least 60% greater shoot dry mass when compared to blue or red LED emissions alone, or to a combination of red and blue lights at the same light intensity. Furthermore, green light exhibits better leaf tissue penetration ability (Brodersen and Vogelmann, 2010), resulting in better plant canopy penetration than either red or blue light (Klein, 1992). The issue with green light is that it exerts an antagonistic effect on other blue light-induced responses, including stomatal closure (Frechilla et al., 2000) or anthocyanin accumulation (Zhang and Folta, 2012). In cannabis plants, THC levels are negatively affected by the presence of green light (Mahlberg and Hemphill, 1983Magagnini et al., 2018).

Secondary Plant Metabolites

Secondary plant metabolites such as carotenoids, flavonoids, and anthocyanins accumulate in plant cells and leaves as light-screening compounds to limit damage caused by high light intensity and UV radiation (Takahashi and Badger, 2011Darko et al., 2014).

Carotenoids

Carotenoids are photosynthetic accessory pigments that have absorbance spectra in the 400–550 nm region (Frank and Cogdell, 1996). Carotenoids prevent photo-oxidative damage caused by the photosynthetic light harvesting apparatus and other cell components by thermally dissipating the excess energy of the single excited chlorophyll (1Chl*) and possibly a triplet excited chlorophyll (3Chl*) within light reaction centers, as well as scavenging any evolved singlet-oxygen (1O2) (Müller et al., 2001Mozzo et al., 2008).

Terpenes

Although present in much smaller quantities than cannabinoids, most terpenes in cannabis plants (e.g., monoterpenes and sesquiterpenes) are located in the glandular trichomes and are functionally diverse (Malingre et al., 1975Turner et al., 1980). Terpenes are volatile aromatics that impact or contribute to the taste and smell of plants (Goff and Klee, 2006), defend against biotic stresses (Martin et al., 2003), and are plant hormones that regulate growth (Milborrow, 2001Sakakibara, 2005Hedden and Thomas, 2012). In addition, some terpenes help plants manage light and drought stress (Buchanan et al., 2000). Studies have demonstrated a relationship between terpene biosynthesis and light (Loveys and Wareing, 1971Gleizes et al., 1980Yamaura et al., 1991). Schnarrenberger and Mohr (1970) and Tanaka et al. (1989) both observed that carotenoid and monoterpene biosynthesis is regulated by the red light photoreceptor, phytochrome.

Cannabinoids

Cannabinoids are synthesized in secretory cells inside glandular trichomes, which are highly concentrated in unfertilized female flowers before senescence (Potter, 20042009). Shoyama et al. (2008) found that cell death was induced when cannabis leaves secrete cannabinoids from glandular trichomes into leaf tissue. Lydon et al. (1987) reported increased THC concentrations when cannabis plants were grown with supplemental UV-B radiation, suggesting that cannabinoids may play some role in UV protection. Limited published research exists on the role of cannabinoids in cannabis plants.

Flavonoids

Flavonoids are sensitive to light quality, and flavonoid concentrations in plants are higher when grown under UV, blue, and FR light treatment (Fu et al., 2016Pedroso et al., 2017Liu et al., 2018). The two-ring, 15-carbon, general structure of flavonoids makes this group structurally and functionally diverse. Flavonoids comprise many classes (flavonols, flavones, flavanones, anthocyanins, and isoflavonoids) that are defined by various accessory groups attached to the central 15-carbon skeleton (Iwashina, 2000). This allows for their important roles as pollinator and feeding attractants, oviposition stimulants, and feeding deterrents, as well as in plant disease resistance and managing light stress (Hamamura et al., 1962Ingham, 1972Arakawa et al., 1985Noh and Spalding, 1998Nishida, 2005Goff and Klee, 2006). Optimal lighting systems for cannabis growth and production must include an optimal light spectrum for flavonoid production. UV, blue, and FR are beneficial wavelengths that should be given greater consideration.

Electrical Lighting Systems

Electrical lighting systems usually serve as supplemental lighting for photoperiod control, to increase light intensity in a greenhouse, or as sole lighting for indoor plant production. Electrical lighting systems available for plant growth include incandescent bulbs, fluorescent bulbs, high pressure sodium (HPS) lamps, and LEDs. All of these light sources have been used throughout the history of cannabis production (Potter, 2009). For instance, fluorescent bulbs and HPS lamps are mainly used for young cuttings and during the flowering stage, respectively. For the vegetative growth stage, a wide variety of lighting types have been reported; these include metal halide bulbs, HPS lamps, LEDs, or a combination of different lighting types (Sweet, 2016Chandra et al., 2017).

Traditional Light Sources

Sunlight and traditional light source spectra are shown in Figure 3. Incandescent light bulbs are composed of an airtight glass bulb and a tungsten filament that emanates electromagnetic radiation in the visible spectrum upon being heated (Kitsinelis, 2016). Visible light is emitted as the filament reaches ~2,800 K, with intensity increasing from 400 to 700 nm (Gupta and Agarwal, 2017). Most energy is emitted as FR light and only 60% of light energy is within the PAR spectrum. Its luminous efficiency never exceeds 20 lumens per watt (lm/W), and the energy conversion efficiency ranges from 1 to 5% (Gupta and Agarwal, 2017). The low luminous efficiency of incandescent light compared to other lighting systems has led to the phasing out of incandescent light bulbs, and they have limited applications for cannabis cultivation.


Acknowledgments

The authors thank McGill University for funding this work and all colleagues in the Biomass Production Laboratory for their continuous support.


Derbyshire doctor who smoked cannabis and ordered his staff to tell patients he was dead has suspension extended again

A doctor who admitted smoking cannabis – and ordered his staff to tell his patients he had died – has had his suspension extended AGAIN. Thursday 13 June 2019

Dr Anatta Nergui, an adult psychiatrist for Derbyshire Healthcare NHS Foundation Trust, has been suspended from the medical register for a further nine months.

This is in relation to him running an online psychiatry service but failing to refer patients to professionals, putting them at “significant risk of harm”.

Dr Nergui has found himself under close scrutiny by industry watchdogs seven times in the past eight years – through both fitness-to-practise panels,  medical practitioners tribunals and several reviews.

These were linked to two incidents – admitting smoking cannabis and also the website.

His first appearance at a fitness-to-practise panel was in 2011, when the now Derby-based doctor was working as a locum consultant psychiatrist at Wishaw General Hospital in Glasgow.

In that hearing, it had been proved that in 2009 he grew cannabis at his home, smoked this cannabis and asked his staff to tell his patients that he had ‘died in peace’.

He also said that he no longer smoked cannabis.

At the time, Dr Nergui had been known as Dr Shehzad Ahmad Javed.

But on June 9, 2009, he phoned his secretary and said: “Tell everyone that Shehzad Javed died in peace. It’s not a suicide of the body, but a death of the mind.”

Staff at Wishaw General Hospital called the police due to being concerned about Dr Nergui’s safety.

He then admitted that he had smoked some home-grown cannabis the previous night and that he had used cannabis in the past.

Dr Nergui also admitted that he drank a bottle of vodka every one to two weeks.

During an evaluation, Dr Nergui stated that Dr Shehzad Javed had died and for the remainder of the interview he referred to Dr Javed in the third person.

He referred to himself as ‘Nergui – the nameless one’.

At the time, it had been decided that Dr Nergui could continue to work but with a range of conditions to ensure that he did not repeat his ‘misconduct’.

The doctor officially changed his name to Anatta Nergui by Deed Poll on August 3, 2009.

In 2013, Dr Nergui started a psychiatry role at Derbyshire Healthcare NHS Foundation Trust.

A tribunal that year had ruled that Dr Nergui was not guilty of misconduct. However, this was taken to High Court for appeal, which quashed the decision.

A subsequent tribunal in 2014 ruled misconduct.

Now Dr Nergui, an adult psychiatrist for the same trust, has been suspended from the medical register for a further nine months.

This will take his suspension to more than five years – since he was handed a three-year suspension in 2014 by the Medical Practitioners Tribunal Service.

The 2014 tribunal had found that Dr Nergui’s fitness to practice medicine was ‘impaired’.

Further tribunals in 2017 and 2018 found that he was still not fit to return to medicine without intense supervision and strict conditions – with each extending his suspension by nine months.

Now another tribunal hearing this month has found that Dr Nergui is still impaired – with a further nine-month suspension.

Christina Moller, tribunal chairman, wrote in a report: “The tribunal found that Dr Nergui had not demonstrated sufficient, if any, insight into the seriousness of his misconduct and consequent risks to the public.

“Dr Nergui has not discharged the persuasive burden on him to show that he is no longer impaired by reason of misconduct.

“The tribunal is not satisfied that there is a low risk of repetition.

“The tribunal found that Dr Nergui’s response to his regulator’s concerns was inadequate.

“It considered that a finding of current impairment is necessary to promote and maintain public confidence in the medical profession and to uphold professional standards, as well as to protect the public.

“The tribunal could not be satisfied that he fully appreciated the gravity and seriousness of his misconduct.

“Dr Nergui did not appear to accept that his actions amounted to misconduct.”

In 2012, Dr Nergui had owned and maintained a website called www.neurofeedback-scotland.com through which users could ask for advice from an online psychiatrist.

However, the report says that Dr Nergui’s response to one patient which was deemed to be of ‘a philosophical style which risked interpretation’.

Meanwhile, the report says that in 20 out of 22 cases between February and April 2012, Dr Nergui had failed to recommend that the user see a doctor or psychiatrist.

The report continues to say that in 30 cases Dr Nergui failed to recommend that the user attend a course of counselling or psychotherapy and in seven out of a possible 12 cases, he failed to request further information from the user with a view to determining a diagnosis.

A High Court hearing found that this amounted to misconduct.

It was agreed by the 2014 tribunal that while there was no evidence of any direct harm to patients having occurred as a result of Dr Nergui’s actions, there was also not any evidence that patients were not harmed.

A report on Dr Nergui’s misconduct found says that he ‘had created a situation which exposed vulnerable patients to significant risk of harm’.

It added that “Dr Nergui’s misconduct had damaged the public interest, in that his work purported to offer the services of a psychiatrist without appropriate safeguards to patients”.

Dr Nergui, who did not speak at this month’s hearing or send representation, emailed the General Medical Council, which brought the case, to say: “‘I confirm I have never stopped providing online advice.”

A spokesperson for Derbyshire Healthcare NHS Foundation Trust said: “We are extremely proud of the skills, commitment and caring attitude demonstrated by the overwhelming majority of our workforce.

“When concerns are raised about the performance of an individual employed by the trust, we will thoroughly investigate those concerns working in partnership with the relevant professional organisation or body.

“We cannot provide information on the circumstances of individual employees.”

Eddie Bisknell , Local Democracy Reporting Service


Aberdeen man admonished after admitting to growing cannabis

An Aberdeen man who admitted growing cannabis to help him cope with migraines has escaped further punishment.

Stephen Amato, 48, previously pled guilty to producing the class B drug between July 19 and 22 2018 and sentence was deferred for a year for him to be of good behaviour.

And now Amato, of Provost Rust Drive, has been admonished over the offence, meaning although the conviction remains on his record, he will not face further punishment.

During the last hearing, Aberdeen Sheriff Court was told the total weight of the drugs found was 235.5g with a potential street value of £1,500.

Defence agent Mike Monro previously said: “He accepts that he is a regular cannabis user. The taking of cannabis is to alleviate migraine headaches.

“It’s for his own use. There’s no suggestion at all that this is anything commercial.”

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We’re committed to providing the most updated studies as well as highlighting on many studies of the past along with our own interpretation of them. Keep in mind that in the emerging cannabinoid medicine industries which include research, it’s easy to find different interpretations of the same studies. Clinical trials are the concentration as they’re much more concrete in gaining knowledge on how humans respond to cannabinoid medicine. Due to laws that have prohibited Cannabis, this area of research is extremely limited in nature.

https://globalcannabinoidrc.com/f/cannabis-research-1964-2016-over-650-peer-reviewed-studiespapers?fbclid=IwAR3wnJces-kUlhkqD_sc0wFdeurb4hJnOn1eme2AVjBxM-ebOpUSYqcrjX0