Medical Cannabis Shouldn’t Always Be Considered a Last Resort, Says Review
On November 1, 2018, after a sustained period of patient pressure and high-profile media campaigning, the UK government legalized the prescription and use of cannabis for medicinal purposes.
Nevertheless, over 18 months later, medical cannabis access still remains incredibly difficult for most ordinary patients.
Published in the Journal of Psychopharmacology earlier this month, “Medical Cannabis in the UK: From principle to practice” is a review article exploring these barriers to entry and the current disparity between medical cannabis demand and supply in the UK
Written by some of the country’s top drug science and policy researchers, the review puts forward a number of ‘next steps’ for the country to consider pursuing in order to better support prospective medical cannabis patients in the UK.
“The current situation regarding medical cannabis in the UK is a travesty of justice, policy and humanity,” David Nutt, a professor of neuropsychopharmacology at Imperial College London and co-author of the report, told Analytical Cannabis.
“Our paper should give the medical profession and the Department of Health support in moving this exciting new treatment regime forward.”
Barriers to medical cannabis prescription
Previous to November 2018, cannabis was considered a Schedule 1 drug. This designation severely restricted the extent to which the drug could be researched, resulting in a paucity of information on the potential health benefits and risks of medical cannabis.
This lack of scientific knowledge on the topic feeds into a general lack of knowledge among medical professionals, who may then lack the confidence to prescribe cannabis medicines despite several cannabis-based medicinal products (CBMPs) being included in various UK prescription guidelines. To this end, bodies such as The Academy of Medical Cannabis and Drug Science have developed educational programs for medical professionals and students, geared towards improving the understanding of medical cannabis research, and the wider action of the endocannabinoid system.
Also born from this paucity of scientific research are doctors’ fears that prescribing medical cannabis could result in adverse mental health effects and the development of cannabis dependence. To this, the authors of the review point to research on cannabis and psychosis, which suggests that these adverse effects are mainly the result of using street cannabis with high levels of intoxicating tetrahydrocannabinol (THC) and would not be a concern with CBMPs. Large-scale data collected by Health Canada also shows very few, if any, cases of psychosis associated with the medicinal use of cannabis.
Doctors can also feel limited by somewhat restrictive prescription guidelines. Current guidelines from the National Institute for Heath and Care Excellence (NICE) recommend the use of three licensed CBMPs in treating spasticity in adults with multiple sclerosis, chemotherapy-induced nausea and vomiting, and treatment resistant epilepsy, i.e. Lennox-Gastaut syndrome and Dravet syndrome. However, doctors may be influenced by guidelines produced by the Royal College of Physicians and the British Paediatric Neurology Association, which recommend medical cannabis only as a last resort after conventional treatments have not been effective.
The review authors also identify high private prescription costs, limited imports (which is being reformed following a March 2020 rule change allowing for bulk imports and storage), and ethical issues as additional factors that are contributing towards poor patient access to medicinal cannabis in the UK.
Recommendations for future progress
As well as identifying the current barriers to prescribing, the review authors offer several recommendations for best practice, and highlight next steps that can be taken to ensure future progress.
In terms of best practice, the authors say it is essential that the UK monitors patient outcomes and adverse effects for those patients that do receive treatment, as is already being done by Health Canada. In a space where there are few clinical trials, collecting real-world data can help to develop the available evidence base for doctors, scientists, and politicians to work with.
Other future steps could include a review of whether it is appropriate to consider cannabis as a ‘last-resort’ medicine, and a further review of its benefit-safety balance versus other commonly used drugs. Having a better handle on the effectiveness and safety profile of different CBMPs could easily aid medical practitioners in their decision making.
Coordinating a collaborative network between patients, prescribers, clinics, and scientists could also help to monitor health outcomes while ensuring that medical cannabis is used with appropriate care and foresight.
Finally, public communication on medical cannabis needs to be improved, the authors say. If a communication vacuum occurs, or if misconceptions are unchallenged, this could open the door to industry lobby groups who might look to spread their own messages.
