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Cannabis in the UK is a medicine for the rich but a crime for the poor

Cannabis in the UK is currently a medicine for the rich and a crime for the poor – can the UK continue like this?

Even today judges are sentencing people for growing their own medicine. I believe the industry has to push for decriminalisation to ensure medical cannabis benefits all.

The judiciary seemed to have missed the memo highlighting that cannabis is now legal for medical use. The juxtaposition of legal medicine and illicit crime from the same plant really does come down to money and an EU GMP certificate. Policing by consent in this country is the bedrock of our system and is being eroded by the current cannabis legislation which sees massive disparities in wealth, crime and punishment based on opportunity and ethnicity.  

Now, don’t get me wrong – cannabis farms with modern slaves and electricity theft are the bane of modern society and need to be stamped out. That’s why we need proper regulation with an equitable balance, and it needs to be enacted now. The future will see reparation payments for the lives blighted by the current legislation and highly likely an official apology in time. Why is the UK not looking at the global change happening now?

Well, at the same time medical cannabis became legal in the UK, the Canadians implemented the Cannabis Act. Canada legalised adult-use following two decades of successful and extensive medical access where no one died.

What can the UK learn from Canada? First, the starting point for Canada’s legislation was delivering harm reduction and quality of life outcomes. The previous two decades of medical access were not set up to focus on scientific research or ensuring cannabis was an option of last resort but an option of choice. If someone with a medical condition wanted to choose cannabis they could, if they felt better and gained benefit from using medical cannabis that was good enough for the Canadians. Patients could even get a prescription to grow their own medicine empowering them to take back control of their own health.

This is in stark contrast to the UK approach where only GMC consultants can prescribe Cannabis medication. The consultation at a private clinic can only happen after all other effective treatment options have been considered and exhausted. Each script is a specified product with no leeway for patients to choose options that may be more suitable for them as other countries allow in the dispensary system. 

The private clinics since 2018 have seen around 10,000 cannabis patients, way behind other countries such as Australia with close to 100,000 patients, Germany with over 120,000 and Canada with over 350,000 patients pre-adult use. The UK has come so far but at the same time achieved so little. There are, by most estimates, around 1.75 million people using illicit cannabis for medical purposes. These people have not felt compelled to move to legal medical cannabis even though they risk legal action against them if caught, for them cannabis is a crime.

Why have more people not sought out legal cannabis?

Maybe the initial consult and the monthly script costs are too high. This seems on the surface the reason why medical cannabis has not expanded as quickly. However, the medication costs in some cases are comparable to illicit cannabis so it is not the whole story. Part of the picture seems to be that many people still don’t know medical cannabis is legally available, if they do, it is seen as too difficult to access. 

I happen to think one of the key factors is clinician responses. My own personal experience shows the issues.  I asked my GP about using Cannabis for my lower back pain.  They told me it was only available for epileptic children, but they offered me opioid painkillers instead. I reluctantly started co-codamol but saw no benefit and knew further escalation could lead to dark addictions.

The GP had given me incorrect information and shown no understanding of Cannabis as a medication. This is why AccessKaneh was formed to help people understand cannabis and navigate the regulatory system. But even now in appointments with doctors when I mention Cannabis there is definitely a feeling of disapproval in the air. I am reasonably healthy so visits to my GP are rare.

However, if future treatment decisions are affected by my choice to use medical cannabis that makes me uneasy and for many is an untenable option. That’s why they continue in the shadows of others. Their use of cannabis means they are healthy and don’t have the medical records required to get a script. There is a multitude of reasons that a more relaxed approach will remove. Personally, I hope we move to a system where nurse practitioners or trained GPs can prescribe, like Australia and Canada. I can then find a GP that understands cannabis and looks at holistic medicine as an opportunity, not a snake oil.

On the positive side, I recently went to the Royal Society of Medicine for an event aptly named as “Pain and cannabis medicines: Everything you want to know (but were afraid to ask)” it felt like cannabis is actually starting to make an impact in the medical world amongst the more enlightened doctors so things are starting to move. 

That said, listening to Paul Chrisp from NICE – National Institute for Health Care Excellence, the gatekeepers and advisors on what the NHS should fund and whose current guidelines are blocking cannabis prescribing in the health service, I was so frustrated. Mr Chrisp’s view was there is just not the evidence to the standard NICE will accept to change their opinion. He did however say they would look at real-world evidence and quality of life data but the gold standard was always going to be Randomised Controlled Trials (RCT’s).

This methodology once again disadvantages cannabis. The current research and licensing system is for single active ingredient drugs where pharma companies can recoup their RCT investment for specific conditions. Cannabis will never be able to fund such research at scale because strains and cultivars are easily reproducible and cannot be patented to get the return on Investment.

One answer is to empower citizen science and open-source research using the data from the many countries endorsing access. This approach can accumulate country-wide data into collaborative research following the model that has been shown so effective in COVID research. Maybe this model can convince NICE to make cannabis accessible to all.

Paul Chrisp’s comments made me think once again why we are not looking at the historic record of safe use. For thousands of years people have used cannabis as a medication before we sanitised medicine to symptom control and lost our holistic approach. It is only in the last hundred years since the real industrialisation of societies started that cannabis fell out of favour. The century of prohibition led patients to the shadows and vilified their medicinal cannabis use. 

Strange to stand on their shoulders, listening to General Medical Council registered (GMC) consultant after consultant presenting slides and case studies on how effective the medication is. The descriptions of patients where pharma meds had not been effective but cannabis or a derivative have been, make compelling real-world evidence. 

The endocannabinoid system (ECS) is the critical reason why cannabis is so effective in so many conditions. But we find out during the conference that the ECS and its operation are still not taught in medical schools because the GMC still does not deem it important enough. This is perhaps because cannabis takes us into this area of holistic caring which has always presented problems for the medical establishment and its pharma orthodoxy. The mantra “prevention is better than cure” means to me the ECS should be top of the training curriculum of all future clinicians. 

Back to the question, how does the UK stop cannabis being a medicine for the rich and a crime for the poor? This has to be based on exactly the same criteria Canada used to evaluate its steps forward. Harm reduction and real-world quality of life outcomes. These guiding principles should directly affect the way the UK approaches cannabis. We can learn from around the world where health systems are subsidising the price or cost of consultations for medical cannabis, so it is a medicine for those that choose it. It’s time the NHS looked at the holistic opportunity that the ECS and medical cannabis present. 

Currently, EU GMP cannabis sits in concrete and steel edifices that take away the plant’s power to regenerate our planet’s atmosphere. For me, the most important issue on the horizon is why medical cannabis is not regulated as a herbal medicine, where I believe it should really sit. If cannabis was restored as a herbal medicine the industry could actually be a leader in climate change action and environmental impacts while delivering real social change to benefit the world’s poorest and helping the majority.

The introduction of dispensaries as advocated by the Cannabis Trades Association in our 10 point plan on cannabis would reinvigorate the high street leading to a renaissance of many high streets and providing local jobs.   

Cannabis will be part of the future – the question is who will it benefit?

As the great physicist Carl Sagan said:

“The illegality of Cannabis is outrageous, an impediment to full utilization of a drug which helps produce serenity and insight, sensitivity and fellowship so desperately needed in this increasingly mad and dangerous world”

Written under his pseudonym Mr. X to avoid the heavy social stigma associated with cannabis in 1969.

What has changed? Enlightened countries are re-evaluating and unleashing the healing power of cannabis, will the UK?

Tim Henley
Medical cannabis patient advocate
Access Kaneh

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