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It’s time the government woke up and took medicinal cannabis seriously

Sebastien Kurzel
September 20, 2022

Medicinal cannabis shows huge potential for treating challenging health conditions, writes Sebastien Kurzel, but it's still held back by an archaic regulatory system that lacks common sense.

The medicinal cannabis market in the UK is still in its early infancy. It became legal on a permanent basis in 2018 following the widely publicised cases of Alfie Dingley and Billy Caldwell. The law began allowing unlicensed cannabis products to be prescribed to patients by November that year, which was hoped to make medicinal cannabis more accessible.

At the same time, medicinal cannabis has attracted the attention of some of the world's leading entrepreneurs and investors, including the likes of Octopus Ventures, telecoms entrepreneur Bassim Haidar, and American singer-producer will.i.am. Yet, the scale of this investment and changes to the law have not ramped up accessibility as much as needed, much to the frustration and disappointment of families across the UK.

There are currently three main cannabis based medicinal products (CBMPs) which can be prescribed in the UK. These medications are available to patients with a few select illnesses: adults and children with rare, severe types of epilepsy, adults with nausea associated with chemotherapy, and people with muscle stiffness and spasms caused by multiple sclerosis. And, yet, despite 'conclusive or substantial evidence' for its efficacy in the treatment of chronic pain in adults, it is not approved for this purpose under any circumstance.

CBMPs remain unlicensed, which significantly restricts the ability for doctors to prescribe them. Only doctors on the General Medical Council (GMC) special register are permitted to do this, and it is often the very last resort. Only 95,850 doctors are on this register as of May 2019, out of 300,040 doctors overall – making up just 31.9%. Even those who can prescribe medicinal cannabis are very reluctant to do so.

This has led to cases such as 3-year-old Charlie Hughes. His epilepsy only responds to full extract cannabis oil, which is unlicensed. He has been refused this treatment by two different NHS trusts, forcing his family to pay for it privately despite the drug meeting the European Medicine Agency's guidelines. Something must be done to address these shortcomings.

The first change which is hugely overdue is to give specialists the confidence to prescribe CBMPs. In line with other unlicensed treatments, the guidance encourages clinicians to consider each case on an individual basis, though it does not advocate the use of CBMPs and is worded in a very conservative way. In an NHS report, it was found that doctors are following guidance very rigidly, rarely considering CBMPs and often refusing to consider them at all. One of the key reasons cited by doctors was the lack of knowledge and training related to CBMPs compared to other drugs.

To combat this, it is essential that doctors are involved in discussions around medicinal cannabis, its usages and efficacy, and cases where it has been effective in the past. The Medical Cannabis (Access) Bill 2021-22 is providing some hope, attempting to allow all GPs to prescribe CBMPs, offer training to doctors, and encourage new studies into the medications. It is currently awaiting its second reading and looks unlikely to pass any time soon. Speed is essential here – as each day goes by, more families are missing out on the benefits of CBMPs and suffering as a result.

Research into medicinal cannabis is chronically lacking in the UK. There have been efforts to encourage research from the National Institute for Health Research (NIHR) which put out a call for clinical trials seeking funding in 2018. In the year that the invitation was open, they received only one proposal which was eventually rejected. Reasons cited for the lack of interest include the unusual approach to asking for proposals as well as the timing of the call, which was during the transition of cannabis from a schedule 1 to schedule 2 drug, impacting the ease of research.

The lack of research has been a key reason for the reluctance of clinicians to recommend it, with the 'vast majority' of doctors concerned about the lack of randomised control trial data demonstrating efficacy and safety. This is especially pertinent with drugs containing a high percentage of THC, with the impacts on mental health being of high concern. Further research would help calm those worries and provide doctors with the bank of information needed to prescribe CBMPs confidently, making them a higher priority among treatment options.

In terms of importing medication, there are significant barriers in place. Despite the UK being the world's biggest exporter of medicinal cannabis, importation is painfully slow due to the colossal amount of red tape and the lack of demand, kept low thanks to the reluctance to prescribe. Some patients' medication is so slow to arrive that their special permits (typically only lasting for 30 days) have expired by the time they receive it. Some simple tweaks to the regulations could make imports much smoother and have almost immediate positive impacts for patients. Changes made in March 2020 have already got us halfway there – it's now about maximising the possibilities and the outcomes for patients.

Medicinal cannabis has endless potential to help those with the most debilitating illnesses in the UK. The government and its regulatory bodies are holding back the industry to a point where patients are suffering and unable to access the medication they need – all while allowing licensed drugs with much more severe side-effects to be prescribed by GPs across the country. By simply being more receptive to the idea of CBMPs and allowing them to be researched, imported, and prescribed with ease, patients could have their lives transformed, and this must be prioritised immediately.

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Sebastien Kurzel is a Masters student at LSE, and previously studied geology. He is interested in the interface between energy sources, geopolitics, and UK national security.
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