DESPITE coming under increasing pressure to unblock the medical cannabis prescribing impasse the UK Government this week continued to distance itself from the issue.
Three years ago Health Secretary Sajid Javid changed the law – but just three prescriptions for unlicensed cannabis medicines for children with treatment-resistant epilepsy have been approved by the NHS.
To mark the November 1 anniversary many MPs signed an End Our Pain petition demanding action – and on Wednesday MPs held a debate entitled ‘Medical cannabis under prescription for children with epilepsy’.
On Thursday, in the House of Commons, a further debate was held on the ‘use of medical cannabis for the alleviation of health conditions’.
Clinical Not A Political Issue
In both debates MP’s spoke passionately on behalf of constituents on the need to improve access to medical cannabis using observational trial data, garnered from lived experiences.
Wednesday’s debate was opened by Alberto Costa, Conservative MP for South Leicestershire, and in a powerful address he called for the NHS to cover the costs – at over £1,000 a month – for families currently using privately-prescribed, unlicensed medicines.
However, health minister Maria Caulfield in Wednesday’s Westminster Hall debate illustrated the Government’s stonewalling attitude – these were repeated on Thursday, too.
Ms Caulfield, the Conservative MP for Lewes and Minister for Patient Safety and Primary Care in the Department of Health and Social Care, said ‘prescribing now rests in the hands of the clinicians’.
“I fully appreciate the strength of feeling on this and the impact it is having on many lives…which is why the government changed the law to allow unlicensed medical cannabis products to be prescribed by doctors.
“The government is supportive, but this is a clinical issue not a political one.
“Doctors are not prepared to prescribe as these products are unlicensed and there is a lack of significant research, not just on their efficacy, but also on the adverse effects…the clinicians take responsibility for any impacts.
“No-one is saying these are not safe, there is just not enough of an evidence base to get a licence,” she said.
Concerns Around THC
She went on to say that for the MHRA (Medicines and Healthcare products Regulatory Agency) to approve unlicensed cannabis medicines – which are often prescribed in the form of flowers with varying THC and CBD balances – it needs clinical trial evidence.
She said the MHRA, as an independent body, does this for every medicine, adding that no country in the world, ‘including the US Food and Drug Administration and the European Medicines Agency had licensed these types of medicines for children’.
When pressed by one MP on the abundance of real-world evidence to show cannabis works, she said: “There are concerns particularly around the THC element that there could be some effect on developing brains and heart conditions.”
She then continued: “I want to reassure members I absolutely understand the issue, the Government has changed the law to allow its use but unless we give clinicians that confidence that these drugs first work – and there is a consensus in the room that there is a feeling of that – and a safety profile they feel confident with, they not going to prescribe them.
“We can debate this forever in this chamber but it’s the clinicians that have to be convinced and the way to do that is to get this product licensed, and the way to do that is to get good quality research; research the MHRA can look at and feel confident in licensing and taking that drug forward.
“The Government’s view is that there is funding for that research. My commitment to members is that I will work with colleagues to see if we can speed up that work.
Should Not Be An Issue
“We will try to use every lever to get that through, and the licensing process through so doctors feel confident in prescribing this medicine which makes such a difference to young people’s lives.”
Speaking in Thursday’s debate proposer Ronnie Cowan, Scottish National Party MP for Inverclyde, said: “Politicians and clinicians have turned a blind eye to this issue, however ensuring that medicines are given to sick people should not even be an issue.”
He said while further research is needed to show the efficacy of these medicines people are living with this ‘day-in and day-out’ and this evidence also needs to be taken into account.
He highlighted the main issues were the lack of training for doctors and the NICE (The National Institute for Health and Care Excellence) guidelines which treat cannabis as a pharmaceutical medicine.
Crispin Blunt, Conservative MP for Reigate, and Co-Chair of the All-Party Parliamentary Group for Drug Policy Reform, highlighted the financial and health benefits a reduction in reliance on opioids would bring.
Private Members Bill Imminent
He continued: “We must do our duty and ensure that sick people do not have to look to the criminal markets to treat their own conditions. People don’t want to see sick people prosecuted, it goes against public opinion.”
Jeff Smith, Labour MP for Withington, south Manchester, said it was ‘unusual to have debates on medical cannabis on successive days’.
He elaborated how treatment-resistant epilepsy takes over families’ lives, but also highlighted the positive transformation on families’ lives such as in the case of Hannah Deacon and her son Alfie.
He highlighted how medical cannabis can help across a range of conditions including; multiple sclerosis, pain, anxiety and nausea.
On the issue of Randomised Controlled Trials he said that over 70 medicines have been licensed in such circumstances and that cannabis, with its 100-plus compounds is a ‘unique plant and, as such, ministers need to be flexible and creative in looking at new ways of breaking the log-jam’.
“We need a new concerted attempt with some with new thinking…rather than seeing people paying a fortune to illegal drug dealers or leaving people condemned to a life of pain,” he said.
In response Ms Caulfield once more said it was ‘inappropriate for the Government to force clinicians’ and with ‘safety being as important as efficacy, clinicians will remain reticent until there is more evidence’.
However, she went on to say the government is committed to finding a way forward when ‘the evidence is there’.
@A date for a second reading of a Private Members Bill brought forward by Mr Smith – The Medical Cannabis (Access) Bill – will be heard on December 10th.
