Posts Tagged ‘doctor’
A Quick, Easy Guide to The New UK Arrangements For Access To Cannabis As Medicine.
There’s already an awful lot of misunderstanding over the arrangements just introduced for medicinal cannabis and there’s no need for it because, to be fair, the government has been very clear.
There is an interim procedure which will be very, very difficult for most to achieve. You must have very strong support from your doctor and they, together with your local NHS Trust, must be prepared to put in a lot of work, form-filling and pay some substantial licensing fees. It’s all explained here. If you don’t understand it, don’t worry. Your doctor will and it’s only if he/she is prepared to pursue this path for you that you have any chance at all.
There also seems to be an idea that there’s a list of conditions for which cannabis will be available. There’s no truth in this at all. It’s up to your doctor and if they pursue this interim procedure, they will have to make the case why cannabis will work for you.
For most people, you are going have to wait until the autumn when cannabis will be re-scheduled and available on prescription from your GP. It will then be up to you to persuade your doctor. The biggest problem is likely to be that most doctors simply have no understanding of cannabis at all. Now would be a good time to start gathering together all the scientific evidence you can find about using cannabis to treat your condition(s).
Something is going to have to be done about introducing some training for doctors. Since December 2017, the Royal College of GPs has had a set of guidelines ready to issue to doctors but it’s been sitting on them. These were authored by CLEAR, clinical information by Professor Mike Barnes with methods of use and harm reduction information by Peter Reynolds. We are urging the Royal College to make these available to doctors immediately.
Initially the products available are likely to be the Bedrocan range but we expect some of the Canadian companies will quickly make products available. We also expect NICE to re-visit Sativex and reassess its cost-effectiveness. It must be time for some hard negotiation over the price. This is an opportunity for GW Pharma and Bayer to make a significant reduction which would be in their own long term interest.
Home Secretary Invites CLEAR To ‘Enter A Dialogue’ On Cannabis Law Reform.
In a letter dated 15th August 2016, Amber Rudd, the new Home Secretary, has invited CLEAR to raise “any queries and concerns” about present UK policy on cannabis. This is the first time since 2006, with Charles Clarke, that the UK cannabis campaign has had any direct contact with a serving Home Secretary. It reflects the reality, now recognised in government, that changes in cannabis policy are imminent.
In recent months, there has been a manifest and significant change in attitudes within the Home Office. We have seen this through the process of obtaining a low THC cultivation licence for our partnership with GroGlo Research and Development. The response from the drugs licensing department has been enthusiastic. There has been no difficulty with our declared purpose of producing CBD oil for sale as a food supplement and we are now in detailed discussions on our application for a high THC licence, looking towards clinical trials for a medical product for chronic pain.
As soon as Theresa May announced that Amber Rudd would be heading up the Home Office, I contacted my MP, now Sir Oliver Letwin, thanks to Cameron’s resignation honours list. Although he will not openly support our campaign, in the past year or so he has been very helpful indeed, meeting with me on roughly a monthly basis and helping me navigate through the Conservative government. He has now put me in direct contact with Ms Rudd and I will be preparing a written submission as a preliminary to a face-to-face meeting.
In accordance with CLEAR policy, our first concern is how we can enable UK residents to gain access to medicinal cannabis on a doctor’s prescription. In practice that means Bedrocan products as there is presently no other source of prescribable, consistent, high-quality, herbal cannabis. I would expect that to change very soon though. Both Canada and Israel look like potential near-future sources. GW Pharmaceuticals is undoubtedly considering entering the market and our venture with GroGlo could shift gear depending on how quickly UK policy changes.
We will also be addressing the need for wider reform and a legally regulated market for adult consumers. Although medicinal access remains the top priority, there is no doubt that more overall harm is caused by prohibition of the recreational market. It is this that creates the £6 billon per annum criminal market which is the cause of all the social harms around cannabis. This will need to be handled much more carefully as, due to nearly a century of misinformation and media scaremongering, many people still retain great fear as to what legal cannabis will mean.
The one thing that has been very lacking in the cannabis campaign is pragmatism. Most campaigners for recreational use continue to be lost in a swirl of ‘free the weed’, teenage angst, outrage, revolution and delight in being a rebellious outlaw. That was until 2011 when CLEAR introduced a new approach which has led to more engagement with government than ever before. The emergence of the United Patients Alliance and now the End Our Pain campaign has helped this but these campaigns are focused only on medicinal use
The fact is that we need to work with Theresa May’s government and the anti-Tory tribalism that many still adopt is nothing but an obstacle to reform.
In addressing Ms Rudd, our overall strategy for wider reform will be:
1. A final separation from the ridiculous ‘free the weed’ movement and ‘stoner’ groups which are incapable of understanding how they are seen and despised by wider society.
2. Differentiation between medicinal use and the more controversial legalisation for adult, recreational use.
3. Shift public attention onto scientific and medical evidence rather than the very poor standard of media reporting.
4. End the fake policy that says ‘cannabis is dangerous therefore it must be regulated’. Educate that nearly all the harms around cannabis are caused by its prohibition, not by cannabis itself.
5. Emphasise the importance of harm reduction information, education about excessive use and essential investment in treatment for those who do suffer health harms.
6. Clarify that decriminalisation is no solution and is a dangerous option that would probably increase harm. The product needs to be sold within a properly regulated environment, careful that over-regulation would support a continuing criminal market.
Top Jersey Doctor Misinforms and Misleads On Medicinal Cannabis.
Dr Nigel Minihane is the head of Jersey Primary Care Trust which represents all GPs on the island. Recently he contributed supposedly ‘expert opinion’ to an article in the Jersey Evening Post about someone who had been juicing raw cannabis for therapeutic reasons. His comments demonstrate an ignorance and lack of knowledge which is unacceptable in a doctor in such a senior position. In conjunction with CLEAR members in Jersey, we have submitted a formal complaint.
Dear Sirs,
On behalf of our members in Jersey, we wish to bring a complaint of misconduct against Dr. Nigel Minihane concerning comments attributed to him and published in the Jersey Evening Post on 13th February 2016.
The article in question is attached to this email. The passage we are concerned about is at the very end of the article where Dr Minihane gives false information about a recent drug trial in France which resulted in one death and several people suffered brain damage.
The trial to which Dr Minhane refers was not “of a cannabinoid substance”, it was of an FAAH inhibitor, known as BIA 10-2474. This drug is designed to inhibit the natural degradation of endocannabinoids, leading, it was hoped, to pain relief through modulation of the CB receptor network. It was therefore neither a cannabinoid substance nor cannabis. See: http://www.nature.com/news/scientists-in-the-dark-after-french-clinical-trial-proves-fatal-1.19189
Dr Minihane’s words were therefore inaccurate and misleading and contribute to the prejudice and misunderstanding around the use of cannabis and cannabinoids as medicine. Dr Minihane is, of course, entitled to his opinion but based on his other comments in the article he is clearly very poorly informed on the subject. There is a vast amount of peer reviewed, published evidence which supports the safety and efficacy of cannabis and cannabinoids as medicine. See attached paper ‘Medicinal Cannabis: The Evidence’. Furthermore, it is well established in the evidence that cannabis is physically addictive, with about 9% of regular users developing dependence which is characterised by physical withdrawal symptoms including insomnia, lack of appetite and headache.
We understand that Dr Minihane is head of the Jersey Primary Care Trust and the Jersey Evening Post will have asked him to provide an expert opinion. The information he provided was inaccurate, misleading and reckless. In our view it falls well below the professional standard that one is entitled to expect from any doctor. It is woefully inadequate in the case of a doctor in such a senior position who holds himself out as an expert yet communicates false information to the public through the media.
We would be grateful if you would consider this complaint at your earliest opportunity. We are able to provide oral evidence in support and to suggest witnesses resident in Jersey who endure unnecessary pain and suffering due to medicinal conditions that coud be treated by cannabis if the PCT was properly assessing and considering the evidence.
Yours faithfully
Peter Reynolds
President
Another Pack Of Lies On Cannabis From The UK Government.
Yet another cannabis petition amongst hundreds of similar pleas was filed earlier this autumn. This one though is more tightly focused on removing cannabis from schedule 1, which defines it as having no medicinal value. The petition is also commendably concise but characterises itself as a ‘demand‘ that cannabis be rescheduled, an unfortunate choice of words.
Nevertheless, congratulations are due in that it has exceeded the threshold of 10,000 signatures which means the government must respond. That response is now in and it is predictably dishonest, dismissive and authoritarian in its tone. The Home Office has responsibility for drugs policy so it has drafted the response but it surely must have consulted with the Department of Health.
In fact, I was told only this week by a senior minister that “… the search into the medicinal use of cannabis is something that falls within the jurisdiction of the Department of Health.” That may be a subtle shift in policy from which we can draw some hope. But I fear that the response to this petition offers no hope at all. It is stubborn, obstinate, inaccurate and in denial of evidence and experience.
To be clear, the Home Office has been systematically lying and misleading the British people about cannabis for at least 50 years. The Department of Health is timid on the issue, leaves the public statements to the Home Office heavies and seems more interested in generating fee income for the Medicines and Healthcare products Regulatory Agency (MHRA), than in actually treating patients effectively.
I analyse the response paragraph by paragraph.
“Herbal cannabis is listed in Schedule 1 as a drug with no recognised medicinal uses outside research. A substantial body of scientific evidence shows it is harmful and can damage human health.”
By far the majority of scientists and doctors now recognise that cannabis has real and significant medicinal uses. Of course it is possible that cannabis can cause harm, as can any substance. However, there is no scientific evidence that shows cannabis as being any more harmful than over-the-counter medicines or many common foods. Professor Les Iversen, chair of the Advisory Council on the Misuse of Drugs, is on the record saying: “cannabis is a safer drug than aspirin and can be used long term without serious side effects”.
“The Government will not encourage the use of a Schedule 1 controlled drug based on anecdotal evidence. It is important that a medicine is very thoroughly trialled to ensure it meets rigorous standards before being licensed and placed on the market so that doctors and patients are sure of its efficacy and safety. “
It is not the government’s role to encourage the use of any drug as medicine, that is the role of a doctor. Only by removing cannabis from schedule 1 can that decision be placed in doctors’ hands. There is a vast quantity of peer-reviewed, published scientific evidence on the medicinal use of cannabis including human clinical trials. It is false to suggest that only anecdotal evidence is available. See ‘Medicinal Cannabis: The Evidence’. Thousands of doctors and millions of patients are sure of the efficacy and safety of cannabis based on existing research, trials and experience. Many commonly prescribed medicines have nowhere near as much evidence behind them as cannabis.
“Cannabis in its raw form (herbal cannabis) is not recognised as having any medicinal purposes in the UK. There is already a clear regime in place to enable medicines (including those containing controlled drugs) to be developed and subsequently prescribed and supplied to patients via healthcare professionals. This regime is administered by the Medicines and Healthcare products Regulatory Agency (MHRA), which issues Marketing Authorisations for drugs that have been tried and tested for their safety and efficacy as medicines in the UK.”
The lack of recognition for the medicinal purposes of cannabis is a grave error with no evidence that supports it. Cannabis is a traditional medicine which recorded history shows has been used safely and effectively for at least 5,000 years. The only thing that stands in the way of cannabis being prescribed by doctors is its schedule 1 status. The MHRA is a diversion and is irrelevant. It exists to trial and regulate new medicines and requires a £100,000 application fee before very costly clinical trials take place. This is an unnecessary obstacle to a traditional medicine which contains more than 400 compounds. The MHRA process is designed for potentially dangerous, single molecule drugs and is not applicable to cannabis.
“It is up to organisations to apply for Marketing Authorisation for products that they believe have potential medicinal purposes so that these can be subject to the same stringent regime and requirements that all medicines in the UK are subjected to.”
Many substances and drugs which have medicinal purposes are regulated either as Traditional Herbal Products or food supplements. It is the schedule 1 status of cannabis which prevents it being regulated and controlled in this way which is far more appropriate given its very low potential for harm and the very wide range of conditions for which it can be useful.
“Since 2010 UK patients can use the cannabis-based medicine ‘Sativex’ for the treatment of spasticity due to multiple sclerosis. ‘Sativex’ can also be prescribed for other conditions at the prescribing doctor’s risk. ‘Sativex’ was rigorously tested for its safety and efficacy before receiving approval, and is distinguished from cannabis in its raw form. It is a spray which is standardised in composition, formulation and dose and developed to provide medicinal benefits without a psychoactive effect. Due to its low psychoactive profile ‘Sativex’ was rescheduled from Schedule 1 and placed in Schedule 4 Part 1 to enable its availability for use in healthcare in the UK.”
Sativex is a massively expensive form of cannabis oil which is not prescribed because of its cost. It is at least 10 times the price of Bedrocan medicinal cannabis as regulated by the Netherlands government which could be immediately made available in the UK. It is a deliberate falsehood to claim that Sativex does not have a psychoactive effect. The statutory document ‘Summary of Product Characteristics’ describes “euphoric mood” as a “common” side effect. The scheduling of Sativex in schedule 4 is a deception requiring 75 words falsely to distinguish it from other forms of cannabis whereas every other drug in every other schedule requires just one word.
“The MHRA is open to considering marketing approval applications for other medicinal cannabis products should a product be developed. As happened in the case of ‘Sativex’, the Home Office will also consider issuing a licence to enable trials of new medicines to take place under the appropriate ethical approvals. “
Cannabis, which contains 400 + compounds is not suitable for MHRA regulation which is designed for single molecule drugs which are potentially dangerous. There is no significant danger from the use of cannabis when prescribed by a doctor. This is already well established in scientific evidence and the referral to the MHRA is a diversion and an excuse for failing simply to put the decision in doctors’ hands.
“In view of the potential harms associated with the use of cannabis in its raw form and the availability of avenues for medicinal development, the Government does not consider it appropriate to make changes to the control status of raw or herbal cannabis. “
The government has offered no evidence of the potential harms to which it gives such weight. No “development” of cannabis is required. It is a traditional medicine consisting of the dried flowers of the cannabis plant.
“The Government’s view is that the Misuse of Drugs Act 1971 and regulations made under the Act continue to facilitate the development of medicines which are made from Schedule 1 controlled drugs. The legislation is aimed at protecting the public from the potential harms of drugs and is not an impediment to research into these drugs or development of medicines.”
The government’s view is intransigent and as demonstrated by this response is ignorant of the available evidence. This response reinforces the government’s clear intention not to consider the evidence and simply to deny it. The evidence shows that the potential harms of cannabis as medicine are trivial and inconsequential. If its schedule 1 status was not an impediment to research, there would already be a great deal more research into cannabis as medicine.
“In 2013 the Home Office undertook a scoping exercise targeted at a cross-section of the scientific community, including the main research bodies, in response to concerns from a limited number of research professionals that Schedule 1 status was generally impeding research into new drugs.
Our analysis of the responses confirmed a high level of interest, both generally and at institution level, in Schedule 1 research. However, the responses did not support the view that Schedule 1 controlled drug status impedes research in this area. While the responses confirmed Home Office licensing costs and requirements form part of a number of issues which influence decisions to undertake research in this area, ethics approval was identified as the key consideration, while the next most important consideration was the availability of funding.”
The Home Office is entirely untrustworthy and dishonest on anything to do with cannabis. Researchers, scientists, doctors and those already using cannabis as medicine simply do not trust anything it says on the subject based on long experience of its calculated dishonesty and misinformation.
The Weak And Ineffectual Response Of Most MPs To The Cannabis Debate.
CLEAR has been mobilising its members as never before to lobby their MPs in advance of the cannabis debate on 12th October.
There are honourable exceptions but most responses have been unhelpful, dismissive and have completely failed to deal with the arguments put forward. Most MPs are indoctrinated with the false reporting churned out by the press, scared stiff of the subject and not prepared to look any deeper.
It is a terrible indictment of these people, each of whom costs us about £250,000 per year in salary and expenses. Most simply do not do their job properly, certainly not in the interests of or representing their constituents, mainly they just pursue their own political ambitions and interests. They cannot be bothered to deal with the cannabis issue.
Usually, from both Tory and Labour MPs, the responses parrot the official Home Office line. Most are too lazy to inform themselves about cannabis and the facts and evidence around current policy which costs the UK around £10 billion per annum. This vast sum comprises a futile waste of law enforcement resources and the loss of a huge amount of tax revenue. It provides funding to organised crime, including human trafficking, and does nothing to prevent any health or social harms around cannabis. In fact, if anything it maximises these harms, endangering health, communities and the whole of our society by enforcing a policy which is based not on evidence but on prejudice. Source: http://clear-uk.org/media/uploads/2011/09/TaxUKCan.pdf
As Paul Flynn MP, said in the House on 14th September:
“There is [a debate] in a fortnight’s time, on a subject that terrifies MPs. We hide our heads under the pillow to avoid talking about it, but the public are very happy to talk about it in great numbers. That subject is the idea of legalising cannabis so that people here can enjoy the benefits enjoyed in many other countries that do not have a neurotic policy that is self-defeating and actually increases cannabis harm.”
Source: http://www.theyworkforyou.com/whall/?id=2015-09-14a.185.0#g194.0
Below I reproduce a reply from one MP. This is the standard MP line on cannabis. The words may vary slightly but essentially this is the response that the Home Office enforces and, irrespective of party, these are the disingenuous statements that MPs hide behind.
“I believe cannabis is a harmful substance and use can lead to a wide range of physical and psychological conditions. I therefore do not support the decriminalisation or legalisation of cannabis at this time.
I welcome that there has been a significant fall in the numbers of young people using cannabis, and the number of drug-related deaths among under-30s has halved in a decade and I would not want to see this progress undermined.”
Stating cannabis is harmful is meaningless and and an evasion of the question. Anything can be harmful. Such an assertion only has any meaning when in comparison to other substances. In fact, cannabis is relatively benign, even when compared to many foods. It is much less harmful than energy drinks, junk food, all over-the-counter and prescription medicines and, of course, tobacco and alcohol. Compared to these two most popular legal drugs, cannabis is hundreds of times less harmful. Source: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4311234/
If cannabis can lead to a wide range of physical and psychological conditions, what are they and how likely is cannabis to bring them on compared to other substances? In fact, the Royal College of Psychiatrists, whose publications are often presented as evidence of cannabis harms, states unequivocally
“There is no evidence that cannabis causes specific health hazards.”
Source: http://www.rcpsych.ac.uk/healthadvice/problemsdisorders/cannabis.aspx
There is a reported fall in cannabis use from the British Crime Survey. However, the Association of Chief Police Officers reports ever increasing incidents of cannabis cultivation and there has been a massive surge in the use of ‘legal highs’ or novel psychoactive substances. Without exception, these are far more harmful than cannabis and their very existence is the product of government policy. In places such as Holland and the US states that have legalised, there is no problem at all with such substances.
As for “drug-related deaths”, this is classic disinformation. What does it have to do with cannabis? Are our MPs so badly informed that they cannot distinguish between different drugs? Sadly, in many cases the answer is yes. Even so, this is a false claim. The latest figures show an increase in the number of drug poisoning deaths to the highest level since records began in 1993. So much for the claimed “progress”. Source: http://www.ons.gov.uk/ons/dcp171778_414574.pdf
Just recently MPs have started to address the question of medicinal use, almost certainly because of the rising clamour from people in pain, suffering and disability. Also because the UK is now a very long way out of step with the rest of Europe, the USA, Canada, Israel, Australia and most ‘first world’ countries. Source: http://clear-uk.org/static/media/PDFs/medicinal_cannabis_the_evidence2.pdf
“I am aware that one of the issues raised is around enabling the use of cannabis for medicinal purposes. I know that cannabis does not have marketing authorisation for medical use in the UK, and I understand that the Medicines and Healthcare products Regulatory Agency can grant marketing authorisation to drug compositions recognised as having medicinal properties, such as in the case of Sativex.”
A marketing authorisation from the Medicines and Healthcare products Regulatory Agency (MHRA) is a deliberate diversion from the issue. Medicines do not have to have an MHRA marketing authorisation. Doctors can prescribe any medicine, licensed or unlicensed, as they wish. However, since 1971, medical practitioners have been specifically prohibited from prescribing cannabis on the basis of no evidence at all except minsters’ personal opinions. Source: http://www.legislation.gov.uk/uksi/2001/3997/made.
Applying for an MHRA marketing authorisation costs over £100,000 as an initial fee and clinical trials have to be conducted at a cost of at least the same again. Instead, minsters could simply move cannabis from schedule 1 of the Misuse of Drugs Regulations to schedule 2 alongside heroin and or, more logically, to schedule 4, alongside the cannabis oil medicine Sativex. This would place the whole question of the use of cannabis as medicine in the hands of doctors and not in the politically motivated hands of Westminster. Isn’t that where it should be?
This is the most important short term objective of the cannabis campaign – move cannabis out of schedule 1. Not only would this enable doctors to prescribe Bedrocan medicnal cannabis as regulated by the Dutch government but it would mean research could start in earnest. The restrictions presently in place on cannabis, because it is schedule 1, make research very expensive, complicated and are a real deterrent.
If you haven’t lobbied your MP on the cannabis debate yet, you still have time to. If you can, get along and see them in a constituency surgery. Full guidance is provided here but you must act now: http://clear-uk.org/guidance-on-how-to-lobby-your-mp-for-the-cannabis-debate/
Most MPs run surgeries on Fridays so that means you have just this coming Friday, 2nd October and the following 9th October.
Please at least ensure you write to your MP. This is our moment and we are having an impact. Make sure you do your bit.


















