Medical cannabis

I offer no apology for returning to a subject that I have visited many times before. Medical cannabis. 

It is a hugely important subject, but also a tricky one, often clouded with confusion – not least concerning what ‘medical cannabis’ even means. The cannabis plant has many active components. THC and CBD are most well-known, but there are over 100 of the so called ‘cannabinoids’ present, and 100s of cannabis varieties, or ‘strains’, with widely varying levels of these active drugs. There are then an array of different cannabis based medicines that can be made from the plant, from single component pharmaceutical extracts, to whole plant preparations including herbal cannabis, cannabis tinctures, oils and concentrates, skin balms, edibles and beverages. From this bewildering array of products are a very few used formally as licensed medicines or food supplements, and a great many more used informally to self-medicate – their users facing potentially serious legal threat of prosecution for doing so.

Over 30 US states now have access to some form of cannabis derived medicines. A rapidly growing number of European countries – around a dozen to date, including recently Germany and Denmark – allow various forms of medical cannabis, as does Australia, New Zealand, Israel, Uruguay, Chile, Colombia and Jamaica These country’s authorities have concluded that cannabis derived medicines, in many cases including standardised herbal cannabis products, have therapeutic value and tolerably low risks. Despite the fact that cannabis does not fit neatly into the regulatory frameworks that have evolved to deal with single molecule pharmaceuticals, these governments have found ways to make them available, via doctors, to people who need them. In many cases this has involved bespoke legislation. It is tricky, but far from impossible, and now millions of people around the world are benefitting, and our knowledge of cannabis as a medicine is growing. But not, it would seem, in the UK.   

There are now many legally available CBD (cannabidiol) oil products, extracted from the cannabis plant  and sold on most high streets as well as online from a rapidly growing list of vendors. CBD is not psychoactive so therefore not captured by the Misuse of Drugs Act or Psychoactive Substances Act, and is instead sold as food supplement – unable to make medical claims. While it is important to protect consumers from ‘snake oil’, the problem with CBD oil is that while it does appear to have great medical potential, patients currently struggle to get good information on how to use it, and the products themselves are of highly variable quality due to a lack of regulation, making it difficult for doctors to recommend or prescribe – let alone do meaningful research. The truth is, beyond anecdotal evidence, we don’t know nearly enough about CBD oil, and the tragedy is that the Home Office do not appear to be actively pursuing answers either. 

The U.K. Government is clearly confused on this issue. On one hand in 2010 it licensed Sativex as a prescribed medicine. Sativex is a whole plant extract of cannabis (in alcohol – as a tincture) which is manufactured in the UK by GW pharmaceutical, and available as a mouth spray. It contains both THC and CBD, and has been demonstrated to alleviate neuropathic pain, spasticity and other symptoms of multiple sclerosis, the only conditions the MRHA has licensed it to be used for. So Sativex is being licensed as a medicine and is a whole plant tincture – to all intents and purposes it is medical cannabis.

It is a bizarre and untenable situation when the Home Office repeatedly claims medical cannabis has no therapeutic value, but at the same time licenses the largest Government approved medical cannabis industry in the world  I would expect the Home Office to be able to express a clearer and more articulate position on this issue. It’s not as if they aren’t close to the producers. British Sugar grows  cannabis under licence from the Home Office which they sell to GW pharmaceuticals to make its new CBD based medicine, Epidiolex, which is expected to be licensed by the US FDA imminently. British Sugar’s Managing Director is Paul Kenward and he just happens to be married to the Home Office Minister with responsibility for drugs Victoria Atkins. Since this fact was widely publicised she has recused herself from addressing issues related to cannabis – an extraordinary position for the drug minister to be in. And this cosy relationship doesn’t end there. The Prime Minister’s husband, Philip May, is a Relationship Manager at Capital Group, who through Mentor Capital, are the single largest shareholder in GW Pharmaceuticals, with a holding worth hundreds of millions. 

We should be asking, is the UK government prioritising the interests of ‘big pharma’ monopoly profits over the health and wellbeing of UK citizens? There are for example, standardised herbal cannabis products, licensed as medicines for prescription in the Netherlands and various other EU countries. But UK doctors are unable to see their prescriptions, for these medicines, honoured in the UK. Absurdly, however, a Netherlands citizen can bring their prescribed herbal cannabis to the UK and use it freely, but a UK citizen cannot travel to the Netherlands, pick up a prescription there and bring it back.

Access to medicines is a fundamental element of the right to health – this is being denied to UK citizens. At least for the majority for whom Sativex is not the right cannabis product. Openness and transparency are required. The products exist and the procedural hurdles can easily be navigated as other countries have demonstrated. The time has come for the U.K. government to nail its colours to the mast and explain its current stance and future strategy. Not only should prescriptions for existing licensed medicines be honoured for importation the Government should open up the potentially hugely beneficial research and production opportunities for medical cannabis in the UK currently monopolised by a single company with close links to the cabinet. At Westminster the advent of an All Party Parliamentary Group for medical cannabis under prescription can hopefully act as a catalyst to bring together cross-party and cross house support to the cause. The very many men, woman and children that could benefit from medical cannabis should not be denied any longer.

 

Ronnie Cowan MP

Vice-chair of APPG on drug policy reform

 

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