Medicine, man

Specialist doctors are now legally allowed to prescribe cannabis-based medicine. But campaigners worry they won't

1st November 2018

From today, specialist doctors in the UK are able to prescribe medicinal cannabis products to patients with specific medical conditions.

Technically, any form of cannabis can be prescribed, and to any patient who a specialist thinks might benefit from its use. In practice though, it’s likely that only oils or resin-based products will be prescribed, and only for specific conditions like epilepsy and multiple sclerosis.

Home Secretary Sajid Javid announced the move in July, following a number of high profile cases involving children who needed medicinal cannabis to treat severe and treatment-resistant forms of epilepsy.

Until now, the government has been notably more conservative on the issue of cannabis reform than many other countries, including the US and Canada, where cannabis was fully legalised last month. Some have been astounded at the speed at which this shift in policy has occurred in Britain, and campaigning by the families of Alfie Dingley and Billy Caldwell, as well as the continued efforts of groups like Clear, End Our Pain and others, are undoubtedly the main factor in the decision.

That aside, there’s an economic benefit for the government to acknowledge the medicinal benefits of cannabis anyway, as Britain is now the largest producer of medical cannabis products in the world, according to the UN.

Due to decades of prohibition, research and testing on cannabis is relatively limited compared with most pharmaceutical drugs, though it has been shown in some cases to effectively treat chemotherapy sickness, vastly decrease the frequency and severity of seizures in some types of epilepsy, ease chronic pain and treat muscle spasticity caused by multiple sclerosis.

It’s estimated that as many as one million people in the UK currently use cannabis medicinally, despite the vast majority of those not having safe, legal access. The problem with this is two-fold: patients who are forced to buy street cannabis have no control over the quality or makeup of the drug they’re receiving, and in order to attain it they must enter into the criminal black market, effectively criminalising themselves in order to get the medicine they need.

Britain is the biggest producer of medical cannabis products

The majority of Brits of all ages are pretty open to the idea of using cannabis as medicine if prescribed by their doctor, with more than three quarters of people saying they’d use it, according to polling carried out by Populus on behalf of think-tank Volteface and the Centre for Medicinal Cannabis.

Though the government has been keen to stress that this move toward allowing medicinal cannabis will not lead to legalisation for recreational use, a clear majority of 59% support ending cannabis prohibition, according to the polling. Perhaps unsurprisingly, support is strongest among younger generations, with 68% of 18-24 year-olds backing legalisation, but a not-insignificant 49% of people aged 65 and over also agreed.

Specialist doctors will be able to prescribe cannabis products to any patient they think could benefit from it, which could potentially include those suffering from a wide range of conditions, though some have expressed concerns that due to the lack of guidance and education around medical cannabis, many specialists will be reluctant to prescribe it.

Most [consultants] won’t want to prescribe

NHS England has not yet released any guidelines around medicinal cannabis, and though the National Institute for Health and Care Excellence (NICE) is working on a detailed guide, it’s unlikely specialists will see it for at least 12 months.

Professor Mike Barnes, a neurologist and medicinal cannabis expert who was the clinician who managed to secure an emergency license for Alfie Dingley in July, explains he’s concerned this lack of information could prove to be an obstacle for patients in need.

“Regrettably, most [consultants] won’t want to prescribe. This is largely out of understandable ignorance of the product, which they have never been taught about. We need an urgent teaching programme,” he tells The Overtake.

Seeking to address this, Barnes has set up such a programme, The Academy of Medical Cannabis, and is also launching a Medical Cannabis Clinicians society, aiming to bring together interested doctors for training and support.

It will change slowly but, in the meantime, many patients will suffer

For patients who find themselves unable to get their specialist to prescribe cannabis, Barnes says there is the option to look for another specialist, but this may well prove difficult.

“[They] can go to another specialist. Thus, we really do need an accessible database of doctors prepared to help. It will not be easy, as so few doctors will cooperate.

“In Germany, only 2% of doctors will prescribe, and in Australia only 1%. It will change slowly but, in the meantime, many patients will suffer.”

As well as “understandable ignorance”, there seems to be a number of consultants who are set against the move to allow the prescription of medicinal cannabis.

A letter to the Times signed by 166 specialist pain doctors expressed deep concerns that “medical cannabis will fuel an addiction crisis” and warned, “We have suffered an opioid crisis and foresee history about to repeat itself.”

More research is needed but not at the expense of stopping people accessing this medicine now

These claims have been criticised by campaigners and patients, with Barnes describing the key claim that medicinal cannabis will fuel an addiction crisis as “total nonsense”.

“They have ignored significant evidence that cannabis can help pain of many types. That was the conclusion of a number of review articles that summarise the literature and even the view of the Chief Medical Officer in the UK.

“They also ignore the very real evidence from many tens of thousands in the UK who currently use cannabis illegally for their pain. They dismiss all evidence that is not part of a double-blind placebo-controlled trial. Very narrow minded.”

He continues: “More research is needed but not at the expense of stopping people accessing this medicine now. Their attitude seems to be one of letting those people remain criminals until their narrow view of medicine is satisfied. Poor and very disappointing.

“9% of cannabis users incidentally develop a dependency. However, that is mainly in the high THC street cannabis. Generally, the medical cannabis is of a lower THC, and even that is counteracted by CBD. This addiction risk is very low. It will not fuel an addiction crisis.”

The idea that every member of the Faculty of Pain Medicine who signed that letter to the Times is taking bribes, is ridiculous

In a blog post, Peter Reynolds of Clear UK describes the letter as “an astonishing display of evidence-free ignorance from a profession that needs to challenge its own prejudice”.

However Reynolds also criticises those cannabis advocates who would portray concerned doctors as somehow colluding with, or being bought off by, pharmaceutical companies — a fairly common trope among some who are pro-medicinal cannabis — and echoed Professor Barnes’ point about a lack of education.

“There may well be some doctors who are corrupt and there are still, despite much improvement, serious questions over the relationship between pharma companies and doctors, but the idea that every member of the Faculty of Pain Medicine who signed that letter to the Times is taking bribes, is ridiculous.”

“The real reason is ignorance, and that’s not an attack on doctors. It’s a reason. They have been subject to the same relentless torrent of reefer madness propaganda from government and media as the rest of society. They have been prevented even from learning about the endocannabinoid system by the authoritarian policy of prohibition, and any doctor in the UK who has any experience of cannabis as medicine will have been in breach of professional ethics, as well as the law.”

Despite criticism from campaigners, if the views of these 166 specialists are shared at large among their profession, the likelihood is that patients who could benefit from medicinal cannabis — those suffering from chemotherapy sickness, severe epilepsy, MS and a number of other conditions — will struggle to access it safely.

A handful of the one million estimated users will be fortunate enough to have a specialist who understands their needs, but it seems likely that a much larger group will have to choose between illegally acquiring a potentially sub-standard version of the medicine that helps them enjoy a better quality of life, or not accessing it at all.

1st November 2018