“I think that we’ve opened a Pandora’s box,” Dame Sally Davies, the chief medical officer for England, told a parliamentary committee on medical cannabis earlier this month. Stressing how little is known about the health benefits of marijuana, Davies warned of its potential dangers. And she isn’t alone in her concerns.
Since legislation was introduced by home secretary Sajid Javid in November 2018, only a token few NHS doctors have prescribed cannabis to patients, despite the high demand from advocacy groups.
In this cannabis vacuum, private clinics could be the country’s first major legal dealers. Costing £200 for an appointment and between £600 and £700 a month for a prescription, these clinics, the first of which opened in Greater Manchester earlier this month, look set to supply the budding patients left wanting by the NHS.
So is the NHS withholding valuable medicine, or are the private clinics distributing dangerous drugs? “There is a belief that cannabis works for many conditions,” says Davies. “Meanwhile, what is the impact of taking it for a prolonged period of time? We know [THC, a cannabis chemical] has an impact on the brain and causes depression, schizophrenia, brain development problems in young and adolescence. If a pregnant mother was taking it, I’d be very worried.”
THC, short for tetrahydrocannabinol, is the main psychoactive compound in cannabis. When consumed, it binds to the brain’s cannabinoid receptors, associated with memory, coordination, and time perception, causing a high. The feeling is enticing enough to make cannabis the most commonly used illicit substance around the world. But research shows that prolonged consumption can have some less-than dope effects. One recent study linked high-THC cannabis varieties with psychosis and even estimated that half of first-time psychotic disorders cases in Amsterdam could be avoided if the potent drug wasn’t available.
But studies such as these are often based on recreational, ‘street’ varieties, which have been pushed to high-THC potencies by prohibition and consumer demand. Medical cannabis is instead high in CBD, the ‘miracle molecule’ that’s been hailed by many users as a cure for everything from chronic pain to cancer. Despite being a legal medicine in multiple countries, the claims associated with CBD can lead many to question its true benefits.
“There is considerable evidence of usefulness in chronic pain, epilepsy, sickness during chemotherapy, as well for anxiety, PTSD, and sleep,” says Mike Barnes, a neurologist. He is also the clinical director of the new specialist cannabis clinics and gave evidence at the recent parliamentary debate, urging the panel to take heed of CBD’s existing evidence base.
“Cannabis can be a good remedy for many conditions like fibromyalgia, appetite stimulation, Crohn’s disease, and cancer,” he says. “Sure, we need more evidence of exactly what type of cannabis, in what dose and what format serves each condition best, but there is enough evidence for their doctor to seriously consider a prescription. If that doctor will not prescribe, then they should seek a cannabis expert to assist.”
While more evidence is needed to properly convince the NHS, there is still a large stack of studies to back up Barnes’ claims. Among many revelations, research has shown how cannabis can help reducemethamphetamine addiction, remedy anxiety, suppress inflammation, treat autism spectrum disorder, and even increase sperm counts.
It also seems to help with epileptic conditions. After all, it was the plights of two boys with severe epilepsy that kick-started the UK’s cannabis conversation last summer. And after being temporarily granted the medication, the children’s seizures reportedly went down from 150 a month to zero.
Certain CBD studies have also been shown to trigger unwanted side effects, such as decreased appetite and diarrhoea. But when bombarded with examples where it does help, it’s almost no wonder that medical cannabis advocates can get frustrated with the reticence of the NHS.
“Davis said that we have to wait three or four years before that kind of high-quality data is with us. How do you explain it to a parent?” says Peter Carroll, founder of the End Our Pain, a campaign to broaden medical cannabis access to children with epilepsy. Speaking alongside Professor Barnes, Carroll confronted the parliamentary panel with a story of a mother who illegally purchased cannabis products to treat her child. “The child has improved dramatically,” he stated. “So that’s her random controlled trial. And her own local doctors in the NHS have said, ‘we see the improvement’, and then they say, ‘but we’re not going to prescribe it’.”
“I think that we have to take a broader view of the evidence here because there is a point where multiple anecdotal stories do actually build on to a pattern of evidence,” he continued. “And it seems absurd to me that we have to wait three, four or five years on these trials to be produced when there are actually real-life cases now.”
The randomised controlled trials Carroll mentions are the gold-standard for clinical drug testing. In such trials, two groups are studied, one supplied the drug, the other a placebo, with no one knowing which they’ve been given. But any resulting drug can take years to become available.
“You’ve got consider what’s happening in the context of the NHS, the culture of the NHS, the revered nature of the NHS,” says Steve Moore, who helps run the Centre for Medical Cannabis, a think tank with the aim of escalating cannabis clinical trials. “People are asking for things quickly at the moment, but I think what they need to realise is that it will work at the pace of the NHS.” Last summer, Moore directed the campaign to grant Billy Caldwell, one of the boys living with epilepsy, his cannabis oil.
While these trails get underway, those with means may opt out of the state structure and sign up to the private clinics, two more of which are planned to open in Birmingham and London later this year. Others will undoubtedly continue to source cannabis from the black market.
“I really hope we can do the trials,” said Davies as she concluded her parliament testimony. “Because without those, how can we help the patients? And that’s what we’re all here for.”