In the United Kingdom on the NHS medicinal Cannabis is now legal, and now the drug is accessible to patients across England, Wales and Scotland following a significant law reform.
Products that can now be prescribed contain cannabis, cannabis resin or cannabinol, but patients will only be prescribed the medication if their doctors believe they could benefit from it.
The government made the major change to legislation after facing pressure from campaigners, and high-profile cases included Charlotte Caldwell, whose son Billy suffers from severe epilepsy, politicians heard how she went to Canada to buy the cannabis oil which she says controls Billy’s seizures.
But after arriving back at Heathrow Airport, her supply was impounded, sparking anger.
Her son then fell ill before the government was obliged to step in after doctors made clear it was a “medical emergency,” and after the supply was returned, home secretary Sajid Javid began a policy review into the advantages of sanctioning medicinal cannabis.
The primary review by chief medical officer Dame Sally Davies verified that there was enough proof to imply it could be of curative use, and the Advisory Council on the Misuse of Drugs (ACMD), which carried out the second part of the review, further reinforced that doctors should be able to prescribe infused products so long as safety standards are satisfied.
The findings ended in a landmark law change that now sees medicinal cannabis become legal in Britain, but for Charlotte Caldwell, what began as a journey which was about the needs of her little boy actually transformed into something a lot bigger.
Medicinal cannabis gave her back her rights as a mother, but the most important thing medicinal cannabis has done is give Billy back his right to life.
But even though medical cannabis was made legal, there appears to be hazy guidelines and bumbledom that are leaving patients hanging.
In November last year, home secretary Sajid Javid introduced legislation which made it possible for people to legitimately obtain cannabis for medical reasons. At the time, campaigners welcomed it as a benchmark achievement.
The Conservative government had typically taken a hardline position on rescheduling drugs, and scientists and researchers embraced the move, and people throughout the United Kingdom, who had been self-medicating with cannabis for years, expected the legislation to ultimately make their lives easier.
Three months later campaigners said that only a few have actually received a medicinal cannabis prescription since November 2018, and that the few who did succeed in getting a prescription have not actually been able to obtain medical cannabis, owing to difficulties with persuading specialists that cannabis is the best choice, getting licenses for cannabis-based products, and even transporting them once they’re in the United Kingdom.
The difficulty isn’t necessarily the law, but the interim recommendations, devised by the Royal College of Physicians and the British Paediatric Neurology Association, were written with far less time than specialists are normally given.
The law makes no stipulations on the kinds of products that can be prescribed, except that they can’t be smoked, but experts are used to having large quantities of information from randomised controlled experiments when they’re formulating new guidelines.
The central difficulty with formulating those guidelines was that cannabis had been until recently identified as a Class A drug with no medicinal use, which made it hard to carry out experiments on its properties, and the range of psychoactive components within cannabis and derivatives products can further make scientific study complex, as some of the component parts of one cannabis product may behave differently in another dosage, or even if produced in a different way.
The principal problem here is two-fold, that specialists don’t value or trust foreign data, and that the old ways of studying medicines won’t necessarily work for cannabis, and there’s been a tremendous disinclination from doctors and pharmacies to jeopardise their licences by facilitating access, and the vast preponderance of people, except for those individual children who are still being forced to rely on the black market to source their medication.
Cannabis is currently treated as a Class B drug under the Misuse of Drugs Scheduling Act of 2001, but before the bill was amended in November, there was a series of high-profile cases of children who required medical cannabis products to survive such as Alfie Dingley and Billy Caldwell who were granted waivers by Sajid Javid.
These individuals still have access to specific products, but for everyone else who was hoping to use medical cannabis products, the path is still somewhat challenging, and in a recent report on the status of cannabis in Europe found that doctors in the United Kingdom didn’t know how to prescribe cannabis because they believed that they weren’t informed enough.
Currently, medical cannabis products aren’t licensed for distribution or prescription, and each prescription appears to happen because of one patient speaking to a specialist about medication that has previously worked for them and then attempting to access it through legitimate means.
In practice, these prescriptions won’t be accessible on the NHS, and these products are referred to as unlicenced specials, so there’s been confusion and hurdles with getting to grips with that regime, and doctors, for good reason, won’t prescribe specials except if there’s a particularly valid reason for them doing so.
The decision to prescribe medicinal cannabis is a clinical decision for specialist hospital doctors, made with patients and their families, to determine the most suitable medication or course of treatment for a particular patient, but an image circulating on Twitter, from the Royal Derby Hospital, said that pain consultants and associated staff will not be endorsing or prescribing medical cannabis for chronic pain patients, and that they follow national guidance from the National Institute for Health and Care Excellence (NICE) and NHS England to maintain good clinical practice and effective prescribing.
One patient, Jorja Emerson, who was two years old got a prescription on the NHS, but no pharmacies stocked it or were prepared to shoulder the responsibility themselves for importing it. Another, Carly Barton, is still waiting to actually receive her products. She went through a private pain specialist, and the medication itself will cost her approximately £2,500, even though the actual product itself is far less costly.
The prescription has to be written to a very specific level of detail, and then because it’s Schedule 2, it has to be written on pink paper, and the pharmacy that was going to import it required a special license, and then you have to get the package size, either 25 or 30 units exactly right, and then the delivery drivers, and the companies that are involved in delivering it, like shipping companies, need special licenses too.
Many of the products also have expiry dates, and even though the approved prescription dosage under these guidelines is roughly enough for a month, the current prescription and delivery process takes around eight to ten weeks, according to various estimations.
This is not expected to change until more people get prescriptions, and wholesale importers and pharmacies begin importing products in bulk which might bring down the costs and smooth the process over. It’s easier to prescribe in the private sector because money doesn’t come into it, for instance, some NHS trusts might not have wanted to open the floodgates to funding medical cannabis, there are fewer restrictions, but it’s a dilemma because effectively a lot of the population won’t be able to access it because of its cost.
Views are divided into potential solutions, and there are no facts available about who has been able to get a prescription on the NHS, and so far, campaigners are estimating three or four people as far as they’re aware, but the NHS has set up a monitoring unit, which will issue its first results in March 2019.
NICE will publish new guidelines towards the end of 2019, which should help doctors make more informed choices around cannabis prescription. In the hope that individual doctors will prescribe, and see that once they’ve done it, and it’s worked, and they realise it’s a beneficial medicine, then it will pick up. For instance, in Germany, it took two or three years for the medical profession to catch up.
As it stands, the current position around the prescription of medical cannabis could become a self-perpetuating cycle. Not enough scientific data could lead to restrictive guidelines, which leads to fewer prescriptions for people who need them, which means limited proof of their benefit, and so on.
But patients have been self-medicating for years, frequently seeking various products and soliciting help from online forums or communities, although that data isn’t formalised through studies.
The interest in medical cannabis prescriptions isn’t happening in a vacuum. The disparity between what users and specialist know will need significant endeavours to bridge, and for patients in the United Kingdom who are still fighting to access medical cannabis, it simply might not be enough.