Following extensive public awareness campaigns and increased media pressure on the healthcare system, the legalisation of medical cannabis in November 2018 was hailed a monumental victory among clinicians and patients alike.
The hope was that the UK had finally caught up with other progressive countries, embracing the potential for medical cannabis to treat a diverse array of ailments. In other leading Commonwealth nations – namely Canada and Australia – it is gaining popularity in leaps and bounds with medical patients who use it as a non-toxic, non-physiologically addictive alternative to powerful pharmaceutical drugs.
Yet, the British medical establishment remains unimpressed. Accordingly, only 18 NHS prescriptions have been issued, and just 104 private prescriptions have been written due to the government’s extraordinarily restrictive criteria for patient access.
Moreover, for the tiny handful of patients who have manged to obtain NHS prescriptions (most of whom are children with potentially lethal seizure disorders), some have then had their access blocked by local clinical commissioning groups due to a lack of empirical science to validate the effectiveness of medical cannabis.
There are also logistical problems relating to access because prescriptions are often only valid for 28 days and doctors are advised to only prescribe a month’s worth at a time. In order to receive the product, a designated UK importer then needs to apply to the Home Office for a licence. Yet by the time the medical cannabis arrives in the UK, the prescriptions have often expired.
It is therefore no surprise that many people are turning to private healthcare in order to get access to medical cannabis. Nevertheless, this does not come without difficulties.
At the several UK clinics which now have a licence to prescribe medical cannabis, the charge is around £250 for an initial consultation. Then prescriptions typically cost around £2,000 (~€2,367) a month to fill. Therefore, it is not surprising that an estimated 1.4 million patients turn to the illicit cannabis market to treat medically diagnosed chronic health conditions.
This in itself is also very problematic. Besides the threat of being exposed to ‘street cannabis’ that may be contaminated with all sorts of toxic chemical residues and pathogens, patients run the risk of receiving a criminal record. So why is the UK coming up short and how much longer will patients have to suffer from this unsustainable rhetoric?
The knowledge gap
One of the major barriers to access in the UK is the lack of knowledge about cannabis amongst the medical community.
Until November 2018, cannabis had been classified as a Class A drug that had no redeeming value to society, so very little research into its medical properties existed. In turn, healthcare practitioners (HCPs) had not received any formal education around such medicinal plants. Sadly, this is still the case, even though the British government has reclassified cannabis as being a drug that does have some limited medical efficacy after all.
With such a vague knowledge base, many doctors and pharmacies alike still don’t feel adequately informed about how best to issue prescriptions. This is a travesty, especially given the fact that the UK is now the world’s largest producer of medical cannabis products, being responsible for nearly 70% of global exports in 2016.
Moreover, doctors are not insured to issue prescriptions for cannabis-based drugs which remain unlicensed in the UK. Therefore, if a patient were to have a reaction, the doctor, or the trust they work for, could be liable. Unfortunately, because of the personal risk involved, many HCPs still err on the side of caution and are reluctant to endorse medical cannabis until there is greater clarity surrounding industry guidelines.
HCPs are also being advised to only consider medical cannabis as a ‘last resort’ when in fact it may be the best treatment option available for a given condition.
Politicking drugs policy
Fortunately, long-held prohibitionist views in the UK about medical cannabis are changing.
There has even been some recent noise regarding the legalisation of cannabis use proposed by a cross-party of MPs, however, both the Conservative and Labour parties remain against the legalisation of recreational cannabis.
For now, changes are needed at the regulatory level in order for there to be a clear direction forward for progressive-minded medical professionals who want to prescribe medical cannabis.
Politicians continue to dither on implementing real reform while many patients, such as end of life cancer patients, continue to needlessly suffer. The lack of leadership regarding the regulation of the cannabis industry and fully opening its market potential has been predictably underwhelming.
Now is the time for action to triumph over political rhetoric so that we are not left behind as the rest of the world embraces medical cannabis.
Given that until 12 months ago cannabis was still recognised as a Schedule One drug under the Misuse of Drugs Regulations 2001 – it is unsurprising that widespread misconceptions have fuelled an anti-cannabis hysteria throughout society.
This has undoubtedly created a deep-seated cultural hurdle for what needs to be the widely accepted view: that medical cannabis is a legitimate and effective form of herbal medicine. Yet such misconceptions are finally beginning to erode under the pressure of real-world data attesting to cannabis’ healing powers.
For example, a recent survey by Volteface and the Centre for Medicinal Cannabis found that 76% of the UK public would be willing to be treated with medical cannabis, if prescribed to them by their doctor.
Arguably, the rising popularity of legal, non-psychoactive CBD cannabinoids in British retail stores is also helping to influence peoples’ acceptance of medical cannabis. With the market estimated to be worth almost £1bn per annum by 2025, the CBD/THC debate is now at the forefront of society and has sparked a crucial conversation.
Integration into the NHS Framework
Clearly there is still a significant gap between policy and implementation, and an urgent need for cannabis education among HCPs. However, despite a plethora of anecdotal evidence suggesting the many benefits of medical cannabis, there is still a lack of clinical research. Only when this changes will doctors become more confident in signing prescriptions.
With new guidelines issued by NICE, the hope was that medical cannabis would finally become widely available and effectively integrated into the NHS framework with clear and concise regulations. However, this did not happen and NICE only agreed to allow its use in treating patients with MS and for certain types of epilepsy.
Whilst this is a step in the right direction, the amends do not go far enough. At the end of the day, millions of British patients – especially those with chronic pain – could benefit from access to medical cannabis.
How long will they have to wait?
Now HCPs will be turning their attention to Project Twenty21, an initiative to create the largest body of evidence on medical cannabis in Europe. The hope is that this will demonstrate the efficacy of medical cannabis by documenting positive patient outcomes. With such a concrete body of evidence, policy makers will then have no choice but to make medical cannabis as widely available, and affordable, as other approved prescription medications.
Despite progress being made over the last twelve months, it’s evident that the current system isn’t working. Frankly, instead it is failing the patients who need it the most. The medical and political community alike need to recognise the vital lifeline medical cannabis can provide to patients, while also acknowledging its rightful place in Britain’s modern-day pharmacopeia.