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How Accessible Is Medical Cannabis In The UK?

When the British government approved medical cannabis on November 1st 2018, many people naturally assumed that they would soon be able to receive their medical marijuana from the NHS. Yet according to a study that appeared last month in the Journal of Psychopharmacology, only 12 prescriptions for unlicensed cannabis-based products have so far been given out by the NHS[i]. So what gives?

To get your head around the numerous barriers separating the British public from medical cannabis, it’s necessary to look at the circumstances that led to the change in law. After stubbornly refusing to acknowledge the plant’s curative properties for decades, the government finally changed its stance in order to allow two young boys named Billy Caldwell and Alfie Dingley to receive life-changing cannabis-based medications for their severe epilepsy. Following this move, licenses were granted to three marijuana-containing products, all of which can be prescribed by specialist doctors but only for specific conditions.

These include Epidyolex, which can be prescribed to treat seizures in people suffering from certain forms of epilepsy; Nabilone, which is used to reduce nausea and vomiting in cancer patients undergoing chemotherapy; and Sativex, for the treatment of spasticity in people with multiple sclerosis.

All other cannabis products remain unlicensed, including those that might be used in other countries to treat conditions such as chronic pain or anxiety. This has led to quite a bit of confusion, with some clinicians saying they now spend 80 percent of their clinic time explaining to patients that unlicensed cannabis products are not freely available on the NHS[ii].

Yet that’s not to say that these medicines are off-limits, as the rescheduling of cannabis products to Schedule 2 means that specialist doctors are actually allowed to prescribe them. The fact that they clearly aren’t doing so is the result of their own reluctance, which in turn is influenced by a number of factors.

First of all, clinical guidelines advise doctors to avoid prescribing unlicensed cannabis products wherever possible. The National Institute for Health and Care Excellence (NICE), for example, published a report in August 2019 which concluded that cannabis should not be used to treat chronic pain, due to a lack of proper scientific research on the subject[iii]. Similarly, both the Royal College of Physicians[iv] and the British Paediatric Neurology Association[v] have said that marijuana-based products should only ever be prescribed as a last resort, where patients have failed to respond to all conventional therapies.

Of course, clinicians are free to make up their own minds and prescribe cannabis where they think it is appropriate, but a lack of knowledge means that many remain hesitant to do so. This isn’t that surprising when you consider that 44% of medical schools in the UK provide no preclinical training on cannabis, cannabinoids or the endocannabinoid system.

Then, as always, there’s the question of money, with each prescription for an unlicensed cannabis product costing the NHS an average of £2,789.21[vi]. Undoubtedly, this influences clinicians’ thinking when handing out scripts (or not, as the case tends to be), meaning many patients are forced to fork out up to £40,000 a year for private prescriptions.

Yet as everyone knows, it’s much cheaper and easier to simply grow your own weed, or buy it from a street dealer. According to the Centre for Medical Cannabis, some 1.4 million Brits currently rely on illegal cannabis for medical purposes[vii]. Furthermore, half of all UK growers are thought to cultivate the plant for medical reasons – despite the fact that doing so can land a person in jail for up to 14 years.

One person who hopes to change all that is Carly Barton, who was left bed-ridden and in constant pain by an autoimmune disease – until she began treating herself with cannabis. This enabled her to end her dependence on opioid painkillers and live an active and happy life, although she has had to fight for her right to grow her own supply.

Speaking before an All-Party Parliamentary Group (APPG) on Drug Policy Reform last year, she explained how she was once busted for growing cannabis, and that her arresting officer broke down in tears at having to confiscate her medications. Determined to bring about change, she set up an initiative called Carly’s Amnesty, which aims to enable people with certain health conditions to legally grow their own medical cannabis.

“There are currently 48 conditions that cannabis can be prescribed for, including anxiety and depression,” Barton told Seedsman. “What we’re aiming for is a slight amendment to the law, so that anyone with one of these conditions who can’t afford a private prescription is not prosecuted for cultivating their own cannabis.”

“There are a lot of lawyers working pro-bono on the case, and we’re working directly with parliament and the prosecution office to come up with a solution.”

Numerous politicians and other influential figures have come out in support of the scheme, including the director of the Police Foundation, Dr Rick Muir, who has described Carly’s Amnesty as “a positive proposal [that] should be adopted nation-wide.”[viii]

Barton says that if those in Parliament can “re-educate themselves and un-blinker themselves from the truth about cannabis, then projects like mine could help us take half a step forward, at least by stopping people from being criminalised.”

[i] Schlag AK, Baldwin DS, Barnes M, Bazire S, Coathup R, Curran HV, McShane R, Phillips LD, Singh I, Nutt DJ. Medical cannabis in the UK: From principle to practice. Journal of Psychopharmacology. 2020 Jun 10:0269881120926677. – https://pubmed.ncbi.nlm.nih.gov/32522058/

[ii] The UK Medicinal Cannabis Report: The Needs of a Nation – https://www.cdprg.co.uk/the-uk-review-of-medicinal-cannabis-part-a

[iii] National Institute for Heath and Care Excellence (NICE) (2019). Cannabis-based medicinal products. NICE guidelines NG144. – https://www.nice.org.uk/guidance/ng144

[iv] Royal College of Physicians (2018) Recommendations on cannabis-based products for medicinal use. – https://www.rcplondon. ac.uk/projects/outputs/recommendations-cannabis-based-productsmedicinal-use

[v] British Paediatric Neurology Association (2018) Guidance on the use of cannabis-based products for medicinal use in children and young people with epilepsy. – https://bpna.org.uk/userfiles/BPNA_ CBPM_Guidance_Oct2018.pdf

[vi] https://www.parliament.uk/business/publications/written-questions-answers-statements/written-question/Commons/2020-01-22/6669/

[vii] Couch D (2020) Left behind: The scale of illegal cannabis use for medicinal intent in the UK. – https://www.thecmcuk.org/ left-behind-the-scale-of-illegal-cannabis-use-for-medicinal-intent-inthe-uk

[viii] https://www.theguardian.com/society/2019/apr/25/i-shouldnt-have-to-look-over-my-shoulder-carly-bartons-fight-for-medicinal-cannabis

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Ben Taub