UK Medicinal Cannabis – A Painful Journey For Millions

THE typical patient at Sapphire Medical Clinics is a 65-year-old lady using cannabis medicine for chronic pain.

This chimes with Germany – Europe’s largest medicinal cannabis market – where an estimated three-quarters of its 60,000-or-so patients are prescribed for pain.

Medicinal cannabis capsules. Picture by Kate Hliznitsova, Unsplash

A recent UK Government review into the country’s poorly-functioning medical cannabis programme reported its effectiveness for pain.

But, patients are still being denied access through National Health Service (NHS) due to a fundamental flaw in this review.

This comes as the latest figures show that less than 10 patients are currently receiving medicinal cannabis through the NHS. 

Just One Of 20 Chosen Trials Useful 

Out of 20 Randomized Controlled Trials (RCT) the Government review considered only one had used a drug with the ratio of THC to CBD favoured by clinicians, familiar with cannabis medication for pain relief.

It was undertaken by NICE (The National Institute for Health and Care Excellence) and it told BusinessCann that this decision is unlikely to be reviewed for a further five years.

Sapphire Managing Director & Academic Lead Dr Mikael Sodergren is also a cancer surgeon at Imperial College Healthcare NHS Trust and lecturer and researcher at the affiliated Imperial College.

NICE Fails To Understand Cannabis Medicine

Sapphire Managing Director & Academic Lead, Dr Mikael Sodergren.

He told BusinessCann: “I think they (NICE) got it wrong for cannabis and pain because they chose to look at some randomised trials for some cannabis-based medicine we do not use for pain.

“NICE defined cannabis based medicines as one medicine. That is the underlying problem, whereas we know the cannabis medicines we use for kids with epilepsy which is a purified CBD, with no THC, is completely different to what we use for middle-aged people with chronic pain problems, where we usually have a higher ratio of THC to CBD.

“They are completely different medicines. And what NICE did is that they considered cannabis medicine as one thing, and thought to themselves ‘we’re going to take the highest level of evidence that has been published for pain’.”

Of the trials assessed by NICE the most commonly used drug was Sativex, made by UK firm GW Pharmaceuticals. It contains equal quantities of CBD and THC and is predominately prescribed for spasticity with Multiple Sclerosis.

Mr Sodergren added: “If we’d been able to contribute and identify a certain-type of cannabis-based medicine then we wouldn’t have got the randomised trials they chose.

“We would have got another bunch of studies that weren’t RCTs, they were case studies or cohorts of something else that may have given a different answer.”

A spokesperson for NICE said it had initially considered evidence from almost 20,000 RCTs before whittling it down to 20.

Going on to say ‘it recognises the need for patients to have access to cannabis-based medicines where they are shown to be effective’ and that further research is needed to ‘build the evidence base for their use’. 

Review Finds Pain Medicine Too Expensive

The NICE review into the poorly-functioning UK medicinal cannabis programme was initiated by Health Secretary Matt Hancock, following a barrage of criticism over the lack of prescriptions.

Entitled the ‘Cannabis-Based Medicinal Products Review’ it considers their use for people with intractable nausea and vomiting as a result of chemotherapy, chronic pain, spasticity, and severe treatment-resistant epilepsy.

Whilst giving the go-ahead for the use of Epidiolex for children with two types of epilepsy it refused to give the go-ahead for the use of cannabis for pain relief.

On chronic pain it said ‘the number of people who might benefit is large and the cost potentially high (but) the products were not an effective use of NHS resources’.

It concluded that while there is evidence Sativex is effective for pain it could not prescribe it due to its cost. 

NICE generally funds treatments that cost less than £20,000 a year, but balks at those costing over £30,000.

Less Than 10 Patients On NHS

Medicinal cannabis was made available through the NHS in November 2018, and 18 months on, 32 prescriptions for cannabis medicine were written in February this year – the last month for which data is available.

These new figures obtained by BusinessCann show that seven of these were for Sativex, and the rest for unlicensed medicines.

Prof Mike Barnes, Chairman of the UK Medical Cannabis Clinics is aware of two patients, including young Alfie Dingley, currently receiving unlicensed medicines though the NHS.

To put this into perspective, within two years of permitting medical cannabis in Germany at least 30,000 patients had secured access.

Real-World Data Not RCTs

Campaigners for better access to cannabis medicines in the UK say the NHS should focus less on RCTs and more on real-world data from patient experiences, such as Project 21.

We understand, and accept, the need for evidence. But evidence comes in more than one form.

Peter Carroll, Director of End Our Pain

Both Sapphire and The Medical Cannabis Clinics are assimilating data from the patients they treat.

Peter Carroll, Director of End Our Pain, a medical cannabis advocacy group, said: “We understand, and accept, the need for evidence.  But evidence comes in more than one form.  

“We have seen multiple examples of patients, particularly in the area of pain and paediatric epilepsy,  who have proved beyond all reasonable doubt that medical cannabis works for them, being consistently denied access to it on the NHS.  

“It seems perverse that in such situations, clinicians are prepared to continue to prescribe conventional drugs that are known to have serious side effects.”  

Private Sector Steps Up

Dr Sodergren and colleagues at Sapphire anticipated the 2018 introduction of legislation permitting the use of cannabis based products for medicinal use would not proceed smoothly.

A lack of familiarity with cannabis medicine among the UK medical profession was the main reason for Sapphire’s scepticism. 

This led to the creation of Sapphire Medical Clinics and with over 200 patients on its books it is currently writing more scripts than the NHS.

The UK is expected to have around 20 private cannabis clinics by the end of the year.

The British Pain Society estimates over two-fifths of the UK population – around 28 million adults – are living with pain that has lasted for three months or longer.

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