Not Enough Evidence to Prescribe Medical Cannabis, Says UK Health Body

UK patients are being denied access to cannabis-based treatments because there is a “lack of evidence about the long term safety and effectiveness of medicinal cannabis,” according to an official report. 

Despite becoming legal to do so in November last year, very few cannabis medicines have been prescribed in the UK, as doctors and health bodies remain concerned over their effects. 

This reticence from the National Health Service (NHS) has led some parents of children with epilepsies to source medications from other countries, which are then seized at UK airports.  

But in its new report, the National Institute for Health and Care Excellence (NICE, an advisory health body to the NHS) stated that the research supporting cannabis as an epilepsy treatment is  “limited and of low quality,” and so it “did not warrant a practice recommendation.”

Going against guidance 

The draft guidance also considered whether to recommend cannabis medications for patients living with nausea from chemotherapy, chronic pain, and spasticity. And while the authority approved of the cannabis-based drug nabilone for nausea treatment if conventional medicines had no effect, it rejected all cannabis medications used to treat chronic pain and spasticity. 

However, one of the most comprehensive scientific reviews ever undertaken into medical cannabis concluded in 2017 that there was enough evidence to support treatment in all three areas: to reduce nausea from chemotherapy, to treat chronic pain, and to reduce spasms from multiple sclerosis.

And while that same review found the evidence for epilepsy treatment lacking, recent studies have added scientific weight to cannabis’ efficacy as an epileptic medication, and high-profile media cases of children with epilepsy have called attention to cannabis’ medical effect in certain cases. 

“At five, when his condition was at its worse, he was having intravenous steroids up to 25 times a month; that's very, very dangerous,” said Hannah Deacon, a medical cannabis campaigner and mother of Alfie Dingley, a young British boy with severe epilepsy. Speaking to Analytical Cannabis in June, Deacon described the remarkable effect medical cannabis had on her son. “So we then went to Holland in 2017, where we worked with a pediatric neurologist to use medical cannabis, and we saw [Alfie’s] seizures drop to once every 17 days. So, for us, it was like a miracle.”

Speaking to ITV News on NICE’s ruling, Deacon said that the NHS authority was “showing a complete lack of understanding of cannabis-based medicine, a complete lack of knowledge of how the cannabis plant works, and no empathy to the families… who are funding private prescriptions because the NHS doctors will not prescribe.”

But Deacon did praise a separate review from NHS England, which said children’s experiences on medicinal cannabis should be considered as evidence of how well the drug works. 

Cannabis on trial

Both the NICE and NHS England reports claim that more randomized, controlled clinical trials need to be carried out in the UK before cannabis can be regularly prescribed, but campaigners say such medical models aren’t fit to test cannabis’ effects. 

“[NICE] relies solely on the pharmaceutical model of the randomised controlled trials (RCTs), which is not an appropriate methodology for the assessment of cannabis efficacy,” said Professor Mike Barnes, chair of the Medical Cannabis Clinicians Society, in a press statement. 

Some medical professionals feel that RCTs are best suited to test single pharmaceutical ingredients, and not cannabis extracts, which can contain over 100 naturally occurring cannabinoids. This view seems to be supported by the current UK health secretary, Matt Hancock, who told MPs in July that medical cannabis will not need to be tested through RCTs in order to be licensed because “the licensing process takes into account global evidence. You don’t have to have trials in this country.”

Given the conflicting conclusions from the health secretary and the two reports from NICE and NHS England, it remains uncertain whether medical cannabis policy in the UK will change. 

The NICE draft guidance is open for public consultation until 5th September 2019.