Reece Samani says the UK could take the lead in bringing safe and efficacious medical cannabis products to the market by investing in R&D…
On October 22, 2020, Charlotte Caldwell got the news she had been waiting for – her son Billy, who suffers from epilepsy so severe that he was at times having hundreds of seizures a day, would finally receive the treatment he needed, prescribed by a UK doctor and supplied by a UK provider for the very first time.
Caldwell, from Co. Tyrone in Northern Ireland, had fought a four-year battle to secure the medicine for her son, going though court cases and dealing with the highest authorities in the land.
In November 2018, Caldwell had secured an initial victory that would allow her to import Billy’s medicine, so for two years had been receiving it from a provider in Canada. But with that temporary licence about to expire, she and Billy desperately needed the 2020 ruling to go through.
As she told the BBC after hearing the decision, “It means everything to Billy. This is the medicine that has kept him alive for the last four years.”
The medicine in question, experts agreed, was the most effective way for Billy to be treated, and according to Charlotte, it had reduced the frequency of his seizures drastically. Why, then, did she have to fight so hard and so long to secure an NHS-funded prescription for a product fabricated in the UK, rather than abroad?
The answer lies in the plant from which the treatment is derived: cannabis.
Medicinal cannabis is, unfortunately, still a taboo subject. In so many cases, like that of Charlotte and Billy Caldwell, it could have beneficial effects. And it could be used to treat symptoms in patients suffering from a range of conditions. But the stigma attached to the product remains very real.
Indeed, before I wrote this, I had to ask a friend if they thought it would be acceptable subject to broach, conscious of the possibility that the article would give a different perspective on my personality.
But, having thought it through, some of our most commonly prescribed medication such as aspirin, morphine and codeine are derived from plants. I do not see why this should be different.
It was in part thanks to Caldwell’s campaigning that, in November 2018, rules around prescribing medicinal cannabis were relaxed, allowing doctors to prescribe unlicenced cannabis-based treatments to patients in the UK and removing limits on which conditions the products could be prescribed for.
The then-home secretary, Sajid Javid, said at the time that the goal of the regulatory shift was “to help those who can benefit from medicinal cannabis”. However, progress has been slow and actually securing a prescription remained difficult.
Even after the 2018 ruling that relaxed the rules around cannabis-based products, NHS England maintained that they should only be prescribed where there is “clear published evidence of benefit” and when all other options have been tried. That is what forced Charlotte Caldwell into the legal action that ended in the October 2020 decision.
Billy’s is still one of very few prescriptions in the UK for full-spectrum cannabis oil, a product that contains all the chemical compounds found in the plant in its natural state, rather than the isolated, nonpsychoactive cannabidiol (CBD) found in other products.
According to a 2018 from the journal ‘Frontiers in Plant Science’, full-spectrum products are more effective than isolated CBD medicines because of what it refers to as the “entourage effect”, which is the combined impact of the hundreds of cannabidiols found in the organic form.
The cannabis plant, of course, is illegal, and possession for personal use carries a sentence of up to five years in prison. Yet that does not stop around 1.4 million people in the UK from buying street cannabis to self-medicate, according to a report from the Centre for Medicinal Cannabis (CMC).
Anecdotally, it can be effective. One in five people interviewed by the Multiple Sclerosis Society in 2014 said they had used cannabis to help with their symptoms and, according to the Society’s site, “They said it can help with muscle spasms or stiffness (spasticity) and pain.”
Upon the publication of the CMC report in January 2020, the industry body called on the government to “urgently review policy relating to medicinal cannabis access”.
And though the Caldwells’ win represents progress, I feel that we could be moving faster.
Cannabis-related products are the subject to stigma as the result of the psychotropic effects of the plant and of the decades-long law enforcement battle to crack down on its use. But compared with other legal drugs, we find that cannabis is not particularly harmful.
Alcohol is a prime example. According to figures published by Statista, there were 22 drug-related deaths due to the use of cannabis in 2018 in England and Wales. By contrast, in the same year, ONS statistics show that there were 7,551 deaths related to alcohol-specific causes registered in the UK.
Such numbers do not take into account the other side-effects cannabis may have, but they do offer food for thought. Indeed, when cannabis was upgraded from Class C to Class B in 2008, the decision was opposed by the advisory committee on the misuse of drugs.
Cannabis-based products are also far less addictive than opioids, which are often prescribed to patients suffering from chronic pain. The problem, however, is the shortage of real, detailed information available on medicinal marijuana and the complete lack of government-funded research being undertaken in the UK.
At the moment, we are in a catch-22 situation. Cannabis-based medicines are not being prescribed because there is not enough information available and their cost is relatively high. Conversely, there is no incentive to invest in producing more information or lowering production costs because they are not being prescribed.
What we need to solve this issue is investment in research and development, from the government, from the pharmaceutical industry, or a combination of the two, to provide, as NHS England put it, “clear published evidence of benefit”.
The UK could take the lead in this field, and if it did, the prospective market is substantial. These products have the potential to help numerous patients and if that potential is demonstrated in more rigorous scientific studies, sales could eventually be worth many millions, if not billions, of pounds.
As the government looks to give the economy a kick-start after the dual shocks of Covid and Brexit, it could do worse than investing in an industry that has the potential for enormous growth. For now, though, it appears stigma is still impeding progress.
Pharmacist Reece Samani is the founder of The Locum App.