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Peter Reynolds

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Archive for the ‘Science’ Category

CLEAR Advises Department of Health and MHRA on Definition of Cannabis-Derived Medicinal Products.

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Last week, CLEAR was invited to participate in a teleconference with representatives of the Department of Health and Social Care (DHSC) and the Medicines and Healthcare products Regulatory Agency (MHRA).  This followed our written submissions made over the last few weeks.

The teleconference included two representatives from each party. The DHSC was represented by the Medicines Pharmacy and Industry section. The MHRA was represented by the Licensing Division.

CLEAR has now submitted a summary of all the advice offered which is reproduced below.

1. The definition of cannabis-derived medicinal products (CDMP) is for products that will be re-scheduled in the Misuse of Drugs Regulations out of schedule 1 and ostensibly into schedule 2.  These products will be available for prescription by doctors.

2. With the exception of Sativex, a whole plant cannabis extract with a THC:CBD ratio of 1:1, there are no cannabis-derived medicinal products available in the UK which have been licensed by the granting of a marketing authorisation (MA) or a Traditional Herbal Registration (THR). THR licensing is for minor ailments only that do not require the supervision of a doctor. MA licensing would be required for any CDMP aiming to treat most of the conditions for which cannabis is currently being used illicitly unless such CDMPs are prescribed as an unlicensed medicine.

3. In every other jurisdiction in the world where CDMPs are legally available, governments have recognised that licensing regimes designed to regulate single molecule pharmaceutical medicines synthesised in a lab are not suitable for regulating CDMPs. All such governments have either established entirely new cannabis regulators or created a specialist division within the existing medicines regulator.  If there is a genuine intent to enable legal access to CDMPs by the estimated one million people currently using illicit cannabis as medicine, this is the only practical route forwards. The cost and length of time involved in obtaining an MA makes them prohibitive for a plant-based medicine. Given the experience of using cannabis as medicine over many millennia, its non-toxic nature and very low risk profile, the rigorous approach of an MA is unnecessary.

Recommendation 1. A CDMP regulator should be established encompassing genuine expertise in the use of cannabis as medicine. The Cannabis Trades Association UK (CTA) is already in the process of developing the Cannabis Products Directive (CPD) in co-operation with the MHRA and FSA.

4. There is no justification or evidence that can support cannabis being in such a restrictive schedule as schedule 2 alongside opioids and cocaine.  The potential for causing social harm, which is the criterion used to determine the correct schedule, is several orders of magnitude greater with all existing schedule 2 drugs. They are all demonstrated to produce far higher levels of problematic dependence and long-term health harms than cannabis.

Recommendation 2. CDMPs should be re-scheduled into schedule 4 alongside Sativex.

5. The primary objective of the definition should be to ensure that the products are safe. Cannabis is non-toxic with no practical lethal dose and any harmful health or social effects are only likely with sustained and abusive use. In normal, moderate and especially medical use the potential for any harm is extremely low, certainly no higher than with common over-the-counter medicines. The main safety considerations are therefore the risk of contamination during cultivation and in subsequent processes such as extraction and refinement of oils, arising from the use of pesticides, herbicides, nutrients and solvents.

6. The definition should be wide enough to encompass all cannabis products that are produced to specified quality standards. It should not be so narrow as to prohibit high THC and/or low CBD products that may well be appropriate in individual circumstances. Prescribing guidelines should be issued to enable doctors to make appropriate clinical judgements on appropriate THC:CBD ratios for different conditions. These guidelines must be compiled by experts in the use of cannabis as medicine, not by the ‘non-experts’ who have been appointed to the expert panel on cannabis-derived medicine.  FOI Requests have revealed that none of the members of the panel have any knowledge, experience or expertise in the use of cannabis as medicine.

7. The definition should be wide enough to provide for a future in which doctors can vary THC:CBD ratios and terpene content in accordance with evidence for therapeutic effect. For example, in paediatric epilepsy, CBD has been shown to be the most important compound but some children require a small percentage of THC for it to become effective.  Doctors should be free to vary dosage in the same way as they do with many licensed medicines in accordance with the way the patient responds.

8. Regulators/authorities will properly require some independent assessment of the safety of products as defined above. The only such assessments currently available are Good Manufacturing Practice (GMP) and certification by the Cannabis Trades Association UK (CTA). By definition, these certifications are only available for products that are legally available and CTA only operates within the UK where only exempt, low-THC products (known as CBD products) are legally available. GMP certification is available on some cannabis products legally available outside the UK.

9. Cannabis consists of around 500 molecules including approx. 110 cannabinoids, 120 terpenes and 20 flavonoids which provide the important therapeutic effects, most effectively, when working together in what is known as ‘the entourage effect’. The most significant cannabinoids are believed to be THC and CBD. THC has long been demonised as the principal psychoactive component but it has very important therapeutic effects, notably as an analgesic, an anti-spasmodic and an appetite stimulant. CBD works as an analgesic, anti-inflammatory, anxiolytic and anti-psychotic.  It is beyond doubt that they work best together as they enhance each other’s positive effects and ameliorate any side effects. It is vital that cannabis for medical use contains a balance of both.  In some conditions, THC is more important than CBD and in others the reverse will be the case. We recommend that for medical use the ratio of THC:CBD should ideally not be less than 10:1.  This will protect against any negative effects of THC which a very small proportion of patients may be vulnerable to. In most instances, for medical use, the ideal THC:CBD ratio will be 1:1. Doctors should however be free to prescribe outside these parameters including high THC and high CBD products, subject to prescribing guidelines.

Recommendation 3. The definition of CDMPs should be primarily concerned with safety in the production process. CDMPs should have either a. GMP certification b. CTA certification c. an existing MA d. an existing THR. The composition and cannabinoid ratios of CDMPs should be a matter for determination by doctors in accordance with prescribing guidelines.

Recommendation 4. Prescribing guidelines for CDMPs should be developed by experts in the use of cannabis as medicine, not by the ‘non-experts’ who have been appointed to the expert panel on cannabis-derived medicine. 

10. Cannabis has traditionally been smoked and millions of people have gained great benefit from it over many centuries. The principal benefits of smoking, which are extremely important, without any of the negative effects, can now be achieved through vaporising. The benefits are rapid onset of therapeutic effect and accurate self-titration of dose.  When ingested, either through the GI system or absorbed through the mucus membranes, onset is much slower, the effect is prolonged and accurate titration is very difficult to achieve. Vaporisers are already in widespread use and a variety of different types are available.  The Storz and Bickel ‘Volcano’ has a CE mark and is a licensed medical device in Canada and Israel. The Teva Pharma ‘Syqe’  has completed three clinical trials with positive outcomes for safety and efficacy.

11. Vaporised, pharmaceutical-quality, standardised herbal cannabis with consistent cannabinoid and terpene levels is the gold standard in the use of cannabis as medicine.  Presently the only way to achieve this in Europe is with GMP-certified cannabis produced by Bedrocan BV, the Netherlands government officially contracted producer.  Some Canadian producers are also GMP certified.

Recommendation 5. Vaporisers should be made available on loan, for subsidised purchase or free-of-charge in accordance with existing provision for those in receipt of benefits.

12. The DHSC should prevail on GW Pharmaceuticals to reconsider its pricing strategy on Sativex which is presently under a ‘do not prescribe’ edict from NICE on the grounds that it is not cost-effective. The price of Sativex is extraordinarily high and products which, for all practical considerations of safety and efficacy, are identical are available over-the-counter for one-tenth of the price in US cannabis dispensaries. There is no justification for the price of Sativex except for the recovery of the cost of clinical trials which GW Pharma was required to engage in in order to obtain a marketing authorisation.  GW Pharmaceuticals should also be encouraged to make herbal cannabis products available as an alternative to Bedrocan, something it should be able to achieve within a few months with little difficulty.

13. Cannabis extracts and oils will be required for some patients, particularly children, and those that cannot or do not wish to use inhalation via a vaporiser.  Prescribing guidelines must recognise that the pharmacology of cannabis is totally different when ingested through the GI system or absorbed through the mucus membranes.  Absorption of oil through suppositories has also been found to a valuable method of ingestion.

14. While CLEAR fully supports decriminalisation of domestic cultivation of cannabis for personal use, homegrown cannabis should never be considered part of a therapeutic programme under the supervision of medical professionals.  The potential for contamination and poor quality is far too high.

Recommendation 6. In the short term, aside from low-THC exempt products known as CBD products, the only CDMPs readily available are from GW Pharmaceuticals, Bedrocan BV or Canadian producers, notably Tilray. Standardised herbal cannabis for vaporising or oils for other methods of ingestion should be available from these producers immediately.

15. Originally Nick Hurd MP, the Home Office minister, wrote in The Times, 29th June 2018, that cannabis would be rescheduled and could be prescribed by GPs whenever a benefit could be identified. Without any explanation that now appears to have morphed into ‘specialist’ or ‘senior’ clinicians and only in cases of ‘exceptional clinical need’.  As well as a broken promise which is causing widespread consternation, this is irrational, as are suggestions that cannabis should be regarded as a medicine of last resort.  The safety profile of cannabis is such that any rational, evidence-based policy would suggest cannabis as a medicine well before many analgesics, anxiolytics and anti-depressants which are widely, readily and regularly prescribed by doctors without any concern.

16. A workable definition of CDMPs together with well-informed prescribing guidelines that enable prescription by GPs for any condition where a benefit is identified is essential. Unless this is satisfactorily achieved, the one million people in the UK currently using cannabis as medicine will continue to do outside the law, outside any form of medicines regulation and without any medical supervision.  The likelihood is that this cohort of patients will continue to expand rapidly as knowledge of the therapeutic benefits of cannabis and its use in other countries becomes more widespread. The implications of failing to establish a proper regime are very significant for health, patient-doctor relationships, the criminal market in cannabis, the police and the criminal justice system. This is a nettle that must be grasped.

Recommendation 7. CDMPs should be available in accordance with the Home Office’s initial commitment, that is on prescription by GPs for any condition where a benefit can be identified

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The Definition Of A Cannabis-Derived Medicinal Product Must Include Standardised Herbal Cannabis Or Sajid Javid’s Reform Will Fail.

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Bedrocan, the Netherlands government’s official producer, grows cannabis in which the cannabinoid and terpene content is standardised and consistent. It does this by very careful cultivation techniques which include clonal propagation, continuous analysis and gamma irradiation to eliminate contamination with potentially harmful microbes. Its production facility is Good Manufacturing Practice (GMP) certified.

With the exception of Sativex, which NICE has declared as not cost effective, the Bedrocan range offers the only medicinal cannabis products which could be readily available in the UK.  They are also available as oils extracted directly from the raw herbal flowers.

It’s very simple, unless Bedrocan products come within the definition of a ‘cannabis-derived medicinal product’, the very welcome reform announced today by Sajid Javid will fail and most people will have no option but to continue sourcing their medicine from the illegal market.

There is no doubt that the gold standard in safety, efficacy and self-titration is vaporised herbal cannabis of Bedrocan-standard quality.  Cannabis that is ingested as oil, either sub-lingually or through the gastrointestinal system, has a substantially different pharmacology and is very difficult to titrate accurately or to deliver its beneficial effects promptly.

Bedrocan provides an immediate solution.  GW Pharmaceuticals could also easily turn to providing a similar range of products.  One hopes that it could also be prevailed upon to reconsider its pricing of Sativex. It is essential however that new, domestic production facilities are established quickly.  Up to now the Home Office has rejected all efforts to set up such facilities, even applications from extremely reputable international businesses that already have licences elsewhere.  This policy must be immediately revised.

Dame Sally Davies advised that “only cannabis or derivatives produced for medical use can be assumed to have the correct concentrations and ratios”. The ACMD agreed with this, stating that “raw cannabis (including cannabis-based preparations) of unknown composition should not be given the status of medication.”  Bedrocan products fully comply with these requirements and it is essential that they are re-scheduled and made available on prescription.

Written by Peter Reynolds

July 26, 2018 at 5:57 pm

An ‘Expert Panel’ On Medicinal Cannabis Without A Single Expert On It?

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Dr Michael McBride, Chair of the Cannabis-based Medicines Expert Panel

To be fair, the members of the expert panel are hardly a surprise.  It’s the medical establishment writ large.  The chairman, Dr John McBride, was, according to Charlotte Caldwell, “instrumental” in stopping Billy’s medicine being prescribed, despite the original prescription coming from a consultant neurologist specialising in paediatric epilepsy.

A government which has denied any medicinal value in cannabis for nearly 50 years needs ‘cover’ for its long overdue U-turn.  Surely though, there needs to be at least one member of the panel who has some expertise in the subject? It’s doubtful that any of the members have ever seen a vaporiser or could tell the difference between weed, hash and a concentrate. They’d probably just call them all ‘skunk’.

Professor Dame Sally Davies, Chief Medical Officer

The intention is probably to turn ‘medicinal cannabis’ into a pill or a bottle of medicine, a nice square peg that these bureaucrats can slot into their square hole. Such servants of the status quo are incapable of considering that modern medicine might have anything to learn from traditional, plant-based medicine that has been used successfully for millennia, instead of barely a century of the simplistic, reductionist theory that they represent.  Of course it shouldn’t be a matter of either/or, we should use the best of both theories because both have much to offer to the health of the nation.

It’s instructive that Professor Dame Sally Davies managed to find “overwhelming” evidence of the medicinal value of cannabis in about 24 hours flat. The evidence has been wilfuly ignored by every government and the self-serving individuals who have held the role of Home Secretary since 1971.

It’s astonishing though that in her review, delivered at lightning speed, she’s come up with this pejorative term “grown cannabis” yet seems enthusiastic about synthetic cannabinoids on which there is precious little clinical research and strong evidence of severe, even life-threatening side effects, totally different from the natural product.

Dame Sally writes: “Cannabis has many active chemicals and only cannabis or derivatives produced for medical use can be assumed to have the correct concentrations and ratios. Using other forms, such as grown or street cannabis, as medicine for therapeutic benefit is potentially dangerous.”

Where else does cannabis come from if it isn’t ‘grown’?  It has to be synthesised in a lab. Why on earth would Dame Sally want to go down that route when no other jurisdiction enabling legal access to medicinal cannabis has done so? Bedrocan products are grown specifically for medical use and standardisation of “correct concentrations and ratios” is exactly what the company is focused on.

This is a clash between two different approaches to medicine which, as I say should be regarded as complementary, not contradictory but we cannot possibly move forward if the only ‘experts’ have no expertise!

To be fair, this is all unfolding at breakneck speed.  Imagine Theresa May hovering in the wings, the hard line prohibitionist eager for any opportunity to kick this back into touch. As it stands, the expert panel will fail, it’s bound to.  We have to give Dame Sally a chance to adjust to the new reality.  With the assistance of Professor Mike Barnes, CLEAR will be keeping a close watch on progress and we will keep Dame Sally apprised.  We have already written to her twice this week setting out our concerns and we will do so on a regular basis.

 

 

 

 

Written by Peter Reynolds

July 5, 2018 at 7:06 pm

The Facts About CBD In The UK. April 2018.

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This article is an update to ‘The Facts About CBD In The UK. December 2016.

The past three years have seen a true phenomenon develop around the cannabis law reform movement which has quickly crossed into mainstream society, commerce and general awareness.  It’s the explosion of the CBD market, a trade that has grown from zero to £50 million per annum in the UK in this very short period.

There has been a great deal of nonsense published about the market, the products and their legality both under drugs laws, food and medicines regulation. The facts that are set out in this article are established from close involvement with the developing market on a daily basis as well as consultation with a number of lawyers of all types and levels of experience as well as direct contact with the Home Office, the Medicines and Healthcare products Regulatory Agency (MHRA), the Food Standards Agency (FSA) and other authorities.

The market has been driven initially because of growing interest in the medical benefits of cannabis and the recognition that, within certain constraints, products derived from low-THC cannabis, legally grown under licence as industrial hemp, are a legal alternative.  An important factor has been that CBD is most often consumed by placing a few drops of oil under the tongue. This has avoided the stigma of smoking a joint and is more in line with the way people perceive a medicine or health food.

The CBD market has also exposed the contradictions, inconsistencies and errors in the Misuse of Drugs legislation and particularly in the confused and inconsistent way in which the Home Office attempts to administer it. For instance, currently there are CBD products produced legally in other EU countries and the USA which can legally be sold in the UK but which the Home Office will not permit UK companies to produce.

Ironically, the most significant development has been that responsible CBD suppliers have moved away from claiming the sort of medical benefits that are, in fact, the reason for the market’s existence.  Although everyone knows this is why people are buying CBD, if you’re in the business of supplying the products you can’t say a thing, not even indirectly, about the medical benefits it offers.

18 months ago, all the leading and responsible suppliers of CBD products in the UK joined together to create their own trade association.  The Cannabis Trades Association UK (CTA UK) now represents 80% by turnover of all the CBD suppliers in the UK. It is governed by its members who have established a set of standards on products, labelling and marketing which all abide by.  These standards are designed to protect and inform consumers and to ensure that all CTA UK members are compliant with the law.

The formation of CTA UK was prompted by the MHRA issuing warnings to some suppliers about making medical claims for their products. To remain within the law, CBD products must be sold as food supplements and the most that can be said about them is that they help to improve and maintain health and wellbeing.  Before any product can be marketed with medicinal claims it must have a marketing authorisation from the MHRA. Food supplements must also comply with certain laws and regulations administered by the FSA.

CTA UK is now engaged in a continuous dialogue with both the MHRA and FSA.  Regular meetings are held to consider new suppliers and products entering the market to ensure they comply with the law, regulations and CTA UK standards.

When supplied by a CTA UK member, consumers can be certain that the product they are buying is 100% legal and is accurately labelled and described.  CBD is not a ’controlled drug’.  It does not appear in any of the classifications or schedules to the Misuse of Drugs Act 1971.

There is widespread misunderstanding about the 0.2% THC limit in industrial hemp.  This is the limit in the growing plant and is not relevant to CBD products.  Clearly what may be under 0.2% in the growing plant would be far higher in an extract which is, by definition, concentrated. The Misuse of Drugs Regulations 2001 make it clear that any product derived from low-THC cannabis grown legally under licence as industrial hemp is “exempt” provided it contains “not more than one milligram” of THC or CBN. This is the limit that matters. See The Misuse of Drugs Regulations 2001 ‘Interpretation’ 2-(1) (a)(b)(c)

Contrary to suggestions that the market is “in chaos”, “half-legal”, “a bit of a mess” and other spurious claims, in fact, it is a model of self-regulation where the industry itself has put aside its competitive instincts to co-operate for the benefit of consumers and in its own long term self-interest.

No suppliers will be admitted to membership of CTAUK unless they cease making medicinal claims, stop selling illegal products (for instance with high levels of THC, described as ‘indica’ or intended for pets or veterinary purposes).  Indeed, any suppliers that continue such conduct are likely to be subject to enforcement action by the MHRA and Trading Standards.

There are further changes or clarifications in the law relating to some CBD products which have emerged in the last few weeks.  These arise out of regulations from the FSA.  Isolates or pure CBD are now no longer permitted as they have been classified as ‘novel foods’.  This could mean a prison sentence of up to two years for anyone selling them.

It’s a myth, although regularly reported in the press, that there has been any change in the law or that CBD has been made legal or classified as a medicine. CBD products can already be prescribed by doctors without any restriction, just as any other food supplement. When the inevitable cannabis law reform takes place it will still be unlawful to make medicinal claims about any CBD or cannabis product without a marketing authorisation from the MHRA.

Within the next few months, the first CBD medicine will receive a marketing authorisation from the MHRA. Epidiolex, a whole plant extract, refined to deliver 98% CBD, is GW Pharmaceuticals’ second cannabis-derived prescription medicine which is intended for severe forms of paediatric epilepsy. It is not derived from industrial hemp but from high CBD strains of cannabis grown specifically for the purpose. It should be noted that this is to be administered in massive doses of up to 20 mg per day per kg of body weight,  CBD as a food supplement for adults has a maximum recommended dose of 200mg per day.

The CBD food supplement market will continue to grow.  Other medicines may be authorised in the near future, most likely under the MHRA’s Traditional Herbal Registration scheme, which will permit them to be described as medicines for minor ailments not requiring the supervision of a doctor.

Clearly, it remains urgent that our government gets to grips with the reality of the need and benefits of cannabis for medical use in the wider sense. However, even as we begin to make progress the CBD market in its present form will continue to fulfil an important need for many years to come.

 

 

 

 

“The Settled View Of Ministers Is That The Medicinal Campaign Is Just An Excuse To Take Cannabis”.

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These are the words of Sir Oliver Letwin, my MP, during a meeting with him just a few days ago.

To some this may be an astonishing revelation, to others it will be depressing confirmation that this bigoted and out-of-date view still persists.  Anyone with even a modicum of knowledge will agree that it is deeply ignorant and in defiance of a vast quantity of scientific evidence.

This is the end point of my two and half years of discussion with Sir Oliver.  He’s not currently a cabinet minster but through his 20 year parliamentary career he’s always been at the top of the Conservative Party: Shadow Home Secretary, Shadow Chancellor and then in government in 2010 elevated to the status of right hand man to David Cameron.  As Minister for Government Policy and then Chancellor of The Duchy of Lancaster, he was been described as ‘the intellectual powerhouse of the Tory Party’ and as ‘number three in the government after Cameron and Osborne’.

So what goes through Oliver’s mind is a pretty good indication of how the Tory Party establishment thinks.  I’m absolutely certain that what he has told me is exactly the present mindset of ministers from Theresa May down.

Back in 2015 Oliver wrote to George Freeman MP on my behalf, then the minister with responsibility for medicines.  He’s also written to Jeremy Hunt, the Health Secretary and Amber Rudd, the Home Secretary.  None of this correspondence has resulted in anything but the usual, anodyne words that are nothing but a brush off.  I did think I was getting somewhere though when he told me he would establish with the Department of Health what its position was on the scientific evidence. Back came the answer that all the evidence had been considered, expert advice had been taken and the conclusion was that the risks of  legalising for medicinal use would outweigh the benefits.

Now this didn’t make sense to me. I wanted to know what evidence and what experts.  After half a dozen requests for this information and no response I submitted a Freedom of Information Request to the Department of Health.  Eventually it was returned stating quite clearly that it had neither requested, received nor considered any evidence on medicinal cannabis. Coincidentally, just a few days later, Paul Flynn MP asked almost exactly the same question in Parliament and received the same answer. So I wrote to Oliver and said that either he had been misled or he was misleading me, which was it? It was at this point that he stopped replying to my emails.

After several months of repeated requests and no response I went direct to his parliamentary secretary and booked a surgery appointment to see him as a constituent.  I was quite prepared to confront him face to face.  I was amused to receive an email from Oliver the very same day in which he said that would reluctantly agree to see me on the subject “one last time”.  So at the meeting his explanation was that it had all been a huge misunderstanding, he didn’t mean to suggest that any evidence had been examined, it was simply “the settled view of ministers is that the medicinal campaign is just an excuse to take cannabis”.

Such is the state of our so-called democracy and so-called evidence-based policy.

Written by Peter Reynolds

October 18, 2017 at 4:26 pm

The Daily Telegraph Misrepresents ‘Skunk’ Cannabis Mental Health Cases With Figure of 82,000. True Figure is 1,600.

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Martina Lees

Two almost identical articles were published in The Daily Telegraph on 11th and 12th August 2017

Does smoking skunk trigger psychosis? And if so… why aren’t we doing more about it?

The secrets of skunk

In both articles, journalist Martina Lees wrote that:

“…hospital admissions with a primary or secondary diagnosis of drug-related mental and behavioural disorders have more than doubled over the past decade, to almost 82,000 a year. Most are believed to be cannabis-related.”

This is a combination of wildly misleading manipulation of data and brazen falsehood.

Hospital Episode Statistics are maintained in great detail by the NHS using a system of coding called ICD10 – a medical classification list by the World Health Organization (WHO). containing codes for diseases, signs and symptoms, abnormal findings, complaints, social circumstances, and external causes of injury or diseases.

The specific code for ‘mental and behavioural disorders due to use of cannabinoids’ is F12.  For the past 11 years, ‘finished admission episodes’ (FAE) for F12 have averaged 973, so the claim that most of the 82,000 are cannabis-related is simply false. (Unless of course, Ms Lees is going to claim she made a mistake.)

So where does the extraordinary figure of 82,000 come from (the exact figure is 81,904)?

Firstly, it is for all illicit drugs or ‘drug misuse’ including the following ICD10 codes:

F11 Mental and behavioural disorders due to use of opioids
F12 Mental and behavioural disorders due to use of cannabinoids
F13 Mental and behavioural disorders due to use of sedatives or hypnotics
F14 Mental and behavioural disorders due to use of cocaine
F15 Mental and behavioural disorders due to use of other stimulants, including caffeine
F16 Mental and behavioural disorders due to use of hallucinogens
F18 Mental and behavioural disorders due to use of volatile solvents
F19 Mental and behavioural disorders due to multiple drug use and use of other psychoactive substances

Secondly, the figure is not just for primary diagnosis but for secondary diagnosis.  So the primary reason for one of these cases might be a broken leg or any other medical condition. The secondary diagnosis might be that the person was high on speed or any of the drugs mentioned.  The primary diagnoses for all these codes adds up to about 8,000 FAEs but the figure is inflated ten-fold by the inclusion of secondary diagnoses.  Why do this?  Why have the figures been presented in this way?  With what purpose?

If the whole premise of her article is about the mental health effects of cannabis, why does Martina Lees use this massively larger figure for all illicit drugs when the specific figure for cannabinoids is easily available?  And if the purpose of the article is to investigate the effect of cannabis on mental health, why look at secondary diagnoses – except that it handily inflates the figure ten-fold?

Three other important points about this data:

1. ‘Finished admission episodes’ is not the same as people, its caseload, so those 1606 cases in 2015-16 almost certainly includes cases where the same person has been admitted more than once.

2. ‘Cannabinoids’ includes synthetic cannabinoids such as Spice and anyone with any knowledge of current affairs will know how problems with Spice have exploded in recent years.  It is a fact that Spice is much more harmful to mental health than cannabis so the increase in F12 FAEs in recent years is almost certainly explained by this.

3.  I’m not a believer in always comparing any data about cannabis with equivalent data for alcohol but it is worth noting, to put these figures into perspective, in 2015-16 the number of FAEs for mental and behavioural disorders due to use of alcohol was 44,491.   As there about 10 times more people use alcohol regularly than cannabis, that means anyone is nearly three times as likely to be admitted for ‘alcohol psychosis’ as ‘cannabis psychosis’.

I have written to Martina Lees asking her to comment on this data and explain why she has used it in such misleading fashion.

 

 

Irresponsible, Reckless BBC Broadcasts Dangerous Claim That So-Called ‘Skunk’ is More Harmful Than Heroin.

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Louisa Philips Kulukundis. Psychotherapist at Soul Counselling, counsellor at Steps2Recovery, member of the British Association for Counselling and Psychotherapy.

“I would say give me a room full of heroin addicts than skunk addicts…

I remember saying to my older son I would prefer you to take heroin than to smoke skunk…

There will be generations of kids with severe mental health issues.”

Source: ‘Cannabis: Time for a Change?’ From 28:20

There is huge and justifiable righteous anger about the idiotic words spoken by this woman on the BBC Newsbeat documentary ‘Cannabis: Time for a Change?’

It would be easy to launch into a tirade against Ms Kulukundis but her words and their crass stupidity speak for themselves. I wonder how many kids, listening to her recommendation on the BBC’s ‘yoof’ channel will think ‘Well I’ve smoked weed loads of times with no trouble, now this woman who’s an expert says heroin is safer, maybe I’ll see if I can get hold of some.’

I understand that Ms Kulukundis supports the idea that cannabis with a higher proportion of CBD should be legally available instead of so-called ‘skunk’ which with zero or very little CBD dominates today’s illegal market.  She deserves credit for this and I would be very surprised if she wasn’t already regretting the very serious mistake she has made.

Ms Kulukundis does however subscribe to the falsehood that cannabis is a major cause of mental health problems.  The facts of hospital admissions and GP/community health service treatment prove this is not the case.  While we shouldn’t turn away from protecting those very few people who can be vulnerable, it is about time that the media started reporting accurately instead of the gross distortions and misrepresentation seen recently, particularly from the brazenly dishonest and ‘fake news’ Daily Telegraph.

Far, far more serious and the place where responsibility really lies for this broadcast is with the BBC.  Its negligence in allowing these words to be broadcast is unforgivable and CLEAR is pursuing a complaint.  The BBC’s complaints procedure is of course notorious for its determination to brush aside viewers’ concerns with anodyne responses that mean nothing. Many don’t realise that until you get to stage three you’re not even communicating with the BBC but with Capita to whom it outsources its complaints handling.  We will pursue this complaint until it reaches the BBC Editorial Complaints Unit and if necessary we will appeal it to OFCOM which, with the demise of the BBC Trust, is now the independent regulator.

It is a shame that the BBC has spoiled what is a clear shift in its position on cannabis.  Instead of mindless obedience to the government’s bad science and propaganda it is now recognising that reform is the only rational way forward.  As usual its coverage is dominated by stereotypical caricatures of what it regards as cannabis users.  It still seems incapable of recognising that most of the three million regular cannabis consumers in the UK are not relics of the hippy era but hardworking people with families and ‘ordinary’ lifestyles.  It also allowed its debate programme ‘Newsbeat Debates. Legalising Cannabis’ to be dominated by the ‘Gateway Theory’, an idea comprehensively disproven many times over, which even our prohibitionist government recognises is invalid.  What is the point of debate if it is hijacked by misinformation and not informed by science and evidence?

The BBC should take the initiative in apologising, correcting and broadcasting a full explanatuion of why Ms Kulukundis’ claim is scientifically inaccurate and extremely dangerous. Sadly, it will almost certainly have to be dragged kicking and screaming to provide any meaningful response at all.