Advertisements

Peter Reynolds

The life and times of Peter Reynolds

Posts Tagged ‘medical education

NHS Guidelines Offer People Who Need Cannabis As Medicine Two Choices. Go Private Or Carry On Being A Criminal.

with 4 comments

Go Private…

…Or Be A Criminal

 

 

 

 

 

 

 

Following the new Misuse of Drugs Regulations, which came into force on 1st November, the NHS has issued guidelines on cannabis for medical use, both for clinicians and for the public.

The best that can be said about these is that they are NOT the law.  In fact they are inaccurate, misleading and provide a seriously distorted picture both of the new regulations and of the evidence that is available on the use of cannabis as medicine.  The crucial points are these.  There are NO RESTRICTIONS on what conditions cannabis may be prescribed for.  As well as oils, raw herbal cannabis may also be prescribed – for vaping only, smoking is prohibited. All the decisions are entirely in the hands of the prescribing consultant.

Of course, the problem is your consultant likely knows nothing about cannabis.

Action is being taken on medical education but it is going to take time.  On the authority of the prescribing NHS consultant depends the funding to acquire whatever form of cannabis is required, in itself a difficult process as export licences will have to be obtained in the country of origin, either the Netherlands or Canada.  So for those that can afford it, going to a private clinic could be the quickest and most efficient way of getting the medicine that they need. In fact, it’s becoming increasingly clear, it may be the only way.

For most people, already using cannabis as medicine, this means they will carry on as before, either growing themselves, sourcing supply from friends, acquaintances or dealing with the criminal market, dealers who cannot be trusted, product of unknown quality.

My advice? In the present circumstances, I really believe the state no longer has any moral authority to prosecute anyone who can show they are using cannabis for medicine.  As the state has now recognised ‘conclusive evidence’ of medicinal benefit, the position has changed since the infamous R v Quayle case of 2005. I believe the Court would now support medical necessity as an argument.

So I advise you to grow.  If you are able and have the space, it is the best option. For an investment of a few hundred pounds, purchase a fully configured set up of tent, light, irrigation and ventilation. Grow autoflowering seeds, just one or two plants at a time will meet most individual needs. With modern equipment, it really is much easier and more reliable than you might think.

This is a radical change in my advice and in CLEAR policy but as explained it is now fully justified.

But for those that can afford it, there is now a huge unmet need that surely private operators will step in to fulfil?  It is a huge opportunity. It’s now perfectly legal to establish a private cannabinoid medicine clinic.  This will represent the cutting edge of the new medical cannabis market. It will require highly specialised doctors who are on the GMC’s specialist register. With a few months intensive training in Canada or the USA, possibly the Netherlands, an admin team that gets efficient with the procedures necessary to import.  This is the makings of a very exciting, profitable new, private medicine enterprise, charging very expensive fees.

I understand this will offend some but I believe it must be encouraged.  This is what will push the NHS to catch up.  Historically, advances in medicine have always happened in the private sector first. This is how cannabis medicine has prospered in other countries and it will be the same in the UK.

So, the problem is still far from solved. For some years, many people will continue to suffer unnecessarily but we have made huge strides and the war is won. Now we must make the peace.

Advertisements

Written by Peter Reynolds

November 5, 2018 at 12:26 pm

Cannabis Advocates Really Need To Stop Accusing Doctors of Being Bribed By Pharmaceutical Companies.

with 3 comments

There may well be some doctors who are corrupt and there are still, despite much improvement, serious questions over the relationship between pharma companies and doctors but the idea that every member of the Faculty of Pain Medicine who signed that letter to the Times is taking bribes is ridiculous.

The real reason is ignorance and that’s not an attack on doctors, it’s a reason.  They have been subject to the same relentless torrent of reefer madness propaganda from government and media as the rest of society.  They have been prevented even from learning about the endocannabinoid system by the authoritarian policy of prohibition and any doctor in the UK who has any experience of cannabis as medicine will have been in breach of professional ethics as well as the law.

CLEAR has been working with some of the very few enlightened doctors since way before the cause of cannabis as medicine became fashionable.  Working with members, their MPs and doctors, we have organised lobbying of ministers and MPs over more than the past 10 years. In several instances we had doctors, both GPs and consultants, contact the Home Office to enquire about obtaining a licence for a specific patient.  In at least three instances these doctors were then contacted by Home Office officials who warned them off using threats and intimidation.  Shocking but completely true.

It is and it always has been government – stupid, prejudiced, bigoted and self-opinionated politicians – who have prevented access to cannabis, even in the face of overwhelming evidence.  This means that there has been no education at all and doctors are as poorly informed as everyone else. They’re also, and understandably, worried, even scared.  They don’t understand cannabis, many will not even have heard of the endocannabinoid system and they are concerned about being sued, professionally disgraced, losing their job and now of being swamped by patients demanding cannabis about which they know nothing.

Of course, it was thoroughly stupid to assert in the letter that “the evidence suggests that the prescribing of cannabis (containing the psychoactive and addictive tetrahydrocannabinol component) will provide little or no long-term benefit in improving pain and may be associated with significant long-term adverse cognitive and mental-health detriment.”

There is no reasonable interpretation of the evidence that supports this. THC can be addictive in a very modest sense but the withdrawal symptoms and negative effects are trivial compared to those from opioids which doctors prescribe readily and frequently.  There is excellent evidence from many sources that cannabis containing THC and CBD benefits pain and while there may be some cognitive and mental health effects, to suggest they are significant or even come remotely close to those from opioids is false and in opposition to the evidence.

I repeat, doctors aren’t saying this because they are bribed by pharmaceutical companies, it’s because they have no idea what they are talking about.

The urgent requirement now is medical education.  It is amazing how radical the new regulations are and many people still don’t seem to realise how far the government has gone.  They go much further than we at CLEAR had even dared to dream and the definition of cannabis-derived medicinal product (CDMP) is very broad.  When we were consulted on it by the Department of Health and MHRA we never thought they would accept all our recommendations.  They enable the prescription of every form of cannabis, including flower, oil and concentrate, provided they meet quality standards.

So the problem with the law is gone. Literally, it is all over. It is absolute and total victory. Now two big problems remain. Education is the first but this is being addressed.  NICE has acted commendably fast to start recruiting a panel to advise on prescribing guidelines and Professor Mike Barnes, CLEAR’s scientific and medical advisor has already developed a series of introductory online training modules. Early in November his Medical Cannabis Clinicians Society launches and this will be an important forum for the future.

The second big problem is supply.  Where are the CDMPs to come from?  Sativex falls into the definition and this was GW Pharma’s big opportunity to act responsibly and imaginatively.  The possibility still exists that it will substantially reduce the absurd, rip-off price that it has been charging for Sativex since 2010.  If it had the imagination it could very easily turn over some of its production to unlicensed CDMPs for which there is now a ready market. I fear that it is wedded to licensed products only, hugely expensive and, in my judgement, unnecessary clinical trials and very high prices for its end products.  If so, then I will be selling my shares.  I admire the company for its courage, innovation and high standards but if it does not seize this opportunity then I believe it is failing in its duty to shareholders and also to Britain, which let’s remember has gifted it a privileged and unique opportunity in the world.  Fail now to provide for the needs of UK patients and that amounts to betrayal.

So for now the only possible sources of supply that meet the definition will be Bedrocan in the Netherlands and some of the Canadian licensed producers. US companies cannot export.  Neither can the Israeli companies and they would also face a thoroughly deserved boycott of their products even if Netanyahu was to issue export licences.  Bedrocan can barely meet demand from its existing customers and there is talk of it having difficulties with a ceiling on its export licenses. Only some Canadian producers meet the required GMP quality standards and they too are facing shortages as they also supply the recently legalised recreational market which is seriously short of product.

So the Home Office has to act and start issuing domestic production licences and it has to do so immediately.  Whether it will, remains to be seen.  Its drugs licensing department is a shambles, staffed by officials who do not even understand the law they are supposed to administrate, who regularly give different, contradictory answers on different days and exceed their lawful authority as a matter of course.  If there is a ‘hostile environment’ for immigration in the Home Office, for drugs licensing and cannabis production it has been hostile but also aggressive, paranoid and stupid ever since the Misuse of Drugs Act 1971.

The urgent need is for prospective British cannabis producers to mobilise their MPs and for immediate pressure to be brought on the Home Office at the highest level.  Sajid Javid has shown he can act decisively.  Expanding domestic cannabis production is the inevitable next step in what he has already achieved.  He must act now.

So the future in the UK for those who need cannabis as medicine is brighter than could ever have been imagined.  The next steps are challenging but nowhere near as difficult as the campaign to reform the law that CLEAR has fought for nearly 20 years.  Don’t blame doctors, continue to blame the government and hold their feet to the fire until they act on medical education and cannabis production as they must.