Posts Tagged ‘medicine’
British Doctors Don’t Understand Cannabinoid Medicine. They’ve Been Denied Education In The Basic Science.
Today’s letter to the Times from a group of pain medicine consultants (reproduced below) is is an astonishing display of evidence-free ignorance from a profession that needs to challenge its own prejudice.
To compare the addiction potential of cannabis with opioids is ridiculous and demonstrates just how detached from the science and evidence are those making this claim.
Doctors will understandably feel challenged by a medicine that upturns many of their conventional habits. They have been prevented from understanding the science of cannabis as medicine by prohibition policy. Most doctors have received no education at all about the endocannabinoid system which we now know is the largest neurotransmitter network in the body and is the mechanism by which cannabis exerts its therapeutic effects.
Understanding cannabis as a medicine requires a new attitude and mindset which looks at the patient’s overall health and physiological stability or homeostasis. Modulating the endocannabinoid system with cannabis can effect many factors which contribute to illness including pain, mood, memory and perception. It’s actually a much more complex model rather than the simplistic, reductionist theories that modern medicine is based on.
‘Holistic’ is a fashionable but much misused word that is truly expressed in cannabinoid medicine. There are a few progressive doctors in the UK, including some pain consultants, who through experience and self-education have learned how this new approach to medicine works.
Outside the UK, in jurisdictions which have taken a more enlightened approach, cannabinoid medicine is much better understood by many more doctors. The profession in UK needs to open its mind and its doors to education and training from overseas. Then they will start to understand this much more rounded and broadly-based approach which can lead to a long-term, preventative approach with fewer side effects and better outcomes for nearly all patients.
Letter to The Times, 26th October 2018
CANNABIS PAIN RELIEF
Sir, We, as a group of pain medicine consultants, are concerned that the Home Office and NHS England propose to allow specialist doctors to prescribe cannabis for chronic pain from next month. We know only too well the unmet burden of chronic pain and that pain is cited by our patients as a frequent reason to take cannabis.
While there are clear limitations in studying the effects of past illicit cannabis use, caution is required, as 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.
We are also concerned that it will be difficult to deny cannabis prescriptions to patients in pain who might be coerced into diverting cannabis into the community where it will remain illegal and have street value.
We have suffered an opioid crisis and foresee history about to repeat itself. Ironically, the likely cost of medical cannabis will be greater than the saving achieved by the inexplicable decision of NHS England to restrict the use of the clinically effective 5 per cent lidocaine plasters.
We support the change in the law to encourage cannabis research. However, we are concerned that in the interests of political expediency, this mandate to allow prescribing of cannabis for pain relief is premature. That cannabis is an effective treatment for chronic pain is not supported by the evidence and may be associated with significant harm.
Dr Rajesh Munglani, consultant in pain medicine London; Dr Andrew Baranowski, consultant in pain medicine, University College London Hospitals NHS Trust; Dr Stephen Ward, consultant in pain medicine Brighton and Sussex Hospital Trust; Dr Arun Bhaskar, consultant in pain medicine Imperial College NHS Trust; Dr Cathy Price, consultant in pain medicine St Mary’s Portsmouth Solent NHS Trust; Dr Jonathan Bannister, consultant in pain medicine NHS Tayside Scotland; Dr Ilan Lieberman, consultant in pain medicine University Hospital of South Manchester; Dr Dalvina E Hanu-Cernat, consultant in pain medicine Queen Elizabeth Hospital Birmingham; Dr Pravin Dandegaonkar, consultant in anaesthesia and pain medicine; Calderdale and Huddersfield NHS Foundation Trust; Dr Sarang Puranik, consultant in pain management and anaesthesia Kingston Hospital, Surrey; Dr Mike W Platt, consultant in pain medicine Imperial College Healthcare NHS Trust; Dr Jon Valentine, consultant in pain medicine Norwich; Dr Teodor Goroszeniuk, consultant in pain medicine, London W1, UK; Dr Michael Coupe consultant in anaesthesia, pain medicine and intensive care Royal United Hospitals NHS FT; Dr Hadi Bedran, consultant in pain medicine St Georges University Hospitals NHS Trust; Dr Karen H Simpson, consultant in pain medicine Leeds; Dr Aditi Ghei, consultant in pain medicine, West Herts NHS Trust; Dr Kiran Koneti, consultant in pain management City Hospitals Sunderland NHS Trust; Dr Tim McCormick, consultant in pain medicine Oxford pain Management Centre; Dr Sadiq Bhayani, consultant in pain medicine University Hospitals Leicester NHS Trust; Dr Nicholas M Hacking, consultant anaesthetist, Lancashire Teaching Hospitals NHS Trust; Dr Joshua Adedokun, consultant in pain medicine, The Pennine Acute NHS Trust; Dr Neil Collighan, consultant in pain medicine East Kent Hospital NHS Trust; Dr Bela Vadodaria, consultant in anaesthesia and pain management The Hillingdon Hospital; Dr Fraser Duncan, consultant anaesthetist and pain specialist Birmingham; Dr Hoo Kee Tsang, consultant in anaesthesia and pain medicine, Royal Liverpool and Broadgreen University Hospitals NHS Trust; Dr Richard Gordon-Williams, APT, University College London Hospitals NHS Trust; Dr A Tameem, consultant in anaesthesia and pain management Dudley group of hospitals; Dr Marcia Schofield, pain sPecialist West Suffolk NHS Trust Bury St Edmunds; Dr Giancarlo Camilleri, consultant Ashford & St Peter’s Foundation NHS Trust Chertsey; Dr Joseph Azzopardi, consultant in pain medicine London; Dr Dick Atkinson, retired consultant in pain medicine Central Sheffield University Hospitals; Dr Basil Almahdi, consultant in pain medicine London; Dr Katharine Howells, consultant in pain medicine, RUH Bath NHS Foundation Trust; Dr G Baranidharan, consultant in pain medicine, Leeds Teaching Hospitals NHS Trust; Dr Philippa Armstrong, consultant in anaesthesia and pain medicine, York Teaching Hospitals NHS Trust; Dr Lourdes Gaspar, consultant in pain medicine Orthopaedic Hospital Oswestry; Dr Carolyne Timberlake, consultant in pain medicine Kings College Hospital NHS Trust; Dr Intazar Bashir, consultant in pain medicine Worthing; Dr Mark Sanders,consultant in pain medicine at Norfolk and Norwich University Hospital; Dr Andrzej Krol, consultant in pain medicine St George’s Hospital London; Dr Peter Hall, consultant in pain Management York Hospitals NHS Trust; Dr Susmita Oomman, consultant in pain and Anaesthetic Withybush General Hospital Hywel Dda NHS Trust; Dr Sue Jeffs, consultant in anaesthesia and pain Management Abergavenny Wales; Dr Murali-Krishnan, consultant in pain medicine Northampton; Dr Sabina Bachtold, ST7 pain medicine (APT)/anaesthesia London; Dr A Ravenscroft, consultant in pain Management Nottingham University Hospitals; Dr Sanjay Kuravinakop , consultant in pain medicine Dartford and Gravesham NHS Trust; Dr Nicolas Varela, consultant in pain medicine Royal National Orthopaedic Hospital NHS Trust; Dr Michael Atayi, consultant in pain medicine George Eliot Hospital; Dr Carl TJ Broadbridge, consultant in pain medicine and anaesthesia Salisbury District Hospital; Dr Ramy Mottaleb, Kingston NHS Foundation Trust; Dr Richard Sawyer, consultant in anaesthesia and pain management, Oxford University Hospitals NHS foundation Trust; Dr Rajesh Menon, consultant in pain medicine Calderdale and Huddersfield NHS Trust; Dr Jeremy Weinbren, consultant in Anaesthetics and pain medicine Hillingdon Hospital; Dr Paul Rolfe,consultant in pain medicine Cambridge; Dr Brian Culbert, consultant in pain medicine East Yorkshire Hospitals NHS Trust; Dr Rokas Tamosauskas, consultant in pain medicine Addenbrooke’s Hospital, Cambridge University Hospitals NHS Foundation Trust; Dr David Gore ST6 Advanced pain Trainee, Oxford University Hospitals; Dr Manohar Sharma, consultant in pain medicine The Walton Centre NHS Foundation Trust, Liverpool; Dr Jayne Gallagher, consultant in pain medicine Barts Health Trust London; Dr Raju Bhadresha, consultant in pain medicine and anaesthesia East Kent Hospitals University Foundation Trust; Dr Owen Bodycombe, consultant anaesthesia and pain medicine Gloucestershire Hospital’s NHSFT; Dr Ramy Mottaleb,consultant in pain medicine Kingston NHS Foundation Trust; Dr Christian Egeler, consultant in anaesthesia and pain medicine, Swansea ABMU HB; Dr Deepak Malik, consultant in pain Management University Hospitals Birmimgham NHS Foundation Trust; Dr Mohjir Baloch, consultant in pain Management Frimley Park Hospital; Dr Martyna Berwertz, consultant in pain medicine Sheffield Teaching Hospital NHS Foundation Trust; Dr Ron Cooper, consultant pain medicine & anaesthesia Causeway Hospital, Coleraine, N Ireland; Dr Ashish Shetty, consultant in pain medicine, University College London Hospitals; Dr S J Law, consultant in pain medicine West Suffolk Hospital; Dr M Mali, consultant in pain medicine Darent Valley Hospital; Dr S James consultant and Lead Clinician Chronic pain Services NHS Lanarkshire; Dr Sarah Aturia,consultant pain and Anaesthetics Milton Keynes University Hospital NHS Foundation Trust; Dr Henriette van Schalkwyk, consultant in pain medicine North Hampshire hospital Basingstoke; Dr Shamim Haider, consultant in pain medicine East Suffolk & North Essex NHS Foundation Trust Colchester & Ipswich; Dr Simon Thomson, consultant in pain medicine and Neuromodulation, Basildon; Dr Danielle Reddi, Locum consultant in pain medicine University College London Hospitals NHS Trust; Dr Thomas Samuel, consultant in pain medicine East and North Herts NHS Trust; Dr Arindam De, pain Management consultant University Hospitals of Morecambe Bay (UHMB); Dr Evan Weeks, consultant in anaesthesia & pain medicine Addenbrooke’s Hospital, CUHFT; Dr Ravi M Kare, consultant in pain Management and anaesthesia Norfolk & Norwich University Hospitals; Dr Niranjan Chogle, consultant in pain medicine Ulster Hospital, Northern Ireland; Dr William Campbell, consultant Emeritus and Past President British pain Society, Ulster Hospital Dundonald; Dr Subramanian Ramani, consultant in pain medicine Northampton General Hospital; Dr Adrian Searle, consultant in anaesthesia and pain medicine, Derby; Dr Sameer Gupta, consultant in anaesthesia and pain Management DRG Health Clinic Doncaster; Dr Diana Dickson, Retired consultant in pain medicine, Leeds; Dr Attam Singh, consultant in pain medicine West Hertfordshire NHS Trust; Dr James Wilson, consultant in anaesthesia & pain medicine Maidstone & Tunbridge Wells NHS Trust; Dr Sharmila Edekar, pain Specialist Glangwili Hospital Hywel Dda HB; Dr Bernard Nawarski, consultant in pain medicine Frimley Health; Dr Sridevi Ramachandran, consultant in pain medicine, Anglian Community Enterprise; Dr John Wiles, consultant in pain medicine The Walton Centre NHS Foundation Trust; Dr A T Arasu Rayen, consultant in pain Management, Sandwell and West Birmingham NHS Trust; Dr John Titterington, consultant pain Management, Leeds Teaching Hospitals; Dr Deepak Subramani, consultant in anaesthesia and pain Management George Eliot Hospital; Dr Ian D Goodall, consultant in pain medicine, Chelsea and Westminster Hospital NHS Trust; Dr Seshu Babu Tatikola, consultant In pain medicine & Anaesthesia, Hull and East Yorkshire Hospitals NHS trust; Dr Kevin Markham, consultant in pain medicine Surrey Heath Community pain Clinic; Dr Husham Al-Shather ,consultant in pain medicine Royal Berkshire NHS Foundation Trust; Dr K.Dhandapani, York Hospitals NHS foundation Trust York; Dr Chris Naylor, consultant in pain medicine, Southend University Hospital NHS Trust; Dr Sally Ghazaleh, Locum pain consultant Royal Berkshire hospital; Dr Bala Veemarajan ,Sherwood Forest Hosp NHS trust; Dr GR Towlerton, consultant in pain medicine, Chelsea & Westmister Hospital; Dr Mandar Joshi, consultant in anaesthesia and pain medicine, Aneurin Bevan University Health Board; Dr Ashish Wagle,consultant Anaesthetist and pain specialist Cwm Taf University Health Board Wales; Dr A Doger, consultant University Hospitals Birmingham & Associate Medical Director John Taylor Hospice; Dr Salmin Aseri, consultant in pain medicine & Anaesthesia; St Helens & Knowsley Teaching Hospitals NHS Trust; Dr George Harrison, consultant in pain medicine, Birmingham Queen Elizabeth Hospital; Dr Rashmi Poddar, pain consultant Kettering General Hospital; Dr Ashish Gulve; consultant in pain Management The James Cook University Hospital Middlesbrough; Dr Yaser Mehrez,consultant in pain medicine and anaesthesia Milton Keynes University Hospital NHS Trust; Dr Victoria Tidman, consultant in pain medicine University College London Hospitals NHS Trust; Dr Tacson Fernandez,consultant in pain medicine Royal National Orthopaedic Hospital; Dr Kim Carter, consultant Anaesthetist & pain Northampton General Hospital; Dr Anand Natarajan, consultant in pain Management Wirral University Teaching Hospitals; Dr Dominic Aldington consultant in pain medicine Royal Hampshire County Hospital; Dr Emma Chojnowska, consultant in pain medicine and anaesthesia Chichester; Dr Liza Tharakan, consultant in pain medicine and Anaesthesia; Royal Orthopaedic Hospital; Dr Moein Tavakkoli, consultant in pain medicine University College London Hopsital (NHNN); Dr Manojit Sinha ,consultant pain medicine King’s College Hospital NHS Foundation Trust; Dr Sanjay Varma,consultant in pain Management Sunderland Royal Hosptal Sunderland; Dr Shravan Tirunagari, consultant anaesthesia and pain Management, East and North NHS Trust Hospitals; Dr Monica Chogle, consultant in Anaesthetics and pain Northern Health and Social Care Trust Northern Ireland; Dr Subhash Kandikattu, consultant in pain Management, Peterborough City Hospital North West Anglia NHS FT; Dr Jan Rudiger, consultant in Anaesthetics and pain medicine, Redhill; Dr Arun Sehgal, consultant in pain medicine and Anaesthesia,Peterborough and Stamford Hospitals; Dr Matthew LLoyd Hamilton, consultant in anaesthesia and pain medicine, Homerton University Hospital NHS Foundation Trust, London Dr Athmaja Thottungal, consultant and Trust Clinical lead for pain management, East Kent Hospitals NHS Trust; Dr Rubina Ahmad, Title: Locum consultant, work place; Brighton and Sussex University Hospital NHS Trust: Dr Sean White, consultant in pain medicine, London pain Service; Dr Anup Bagade, consultant in pain medicine East and North Herts NHS Trust; Dr Tom Smith, consultant in pain medicine London; Dr Jason Brooks, consultant pain medicine Belfast Health and Social Care Trust; Dr Vinay Anjana Reddy, consultant in pain and anaesthesia University Hospital Lewisham; Dr S Murugesan, consultant in anaesthesia and pain management, Wrightington Wigan and Leigh NHS Foundation Trust; Dr Nancy Cox, APT, University Hospital Coventry and Warwick NHS Trust; Dr Ashwin Mallya, Northern Lincolnshire and Goole Hospital NHS Trust; Dr M Serpell, consultant & Senior Lecturer in pain medicine & anaesthesia Greater Glasgow & Clyde NHS; Dr Srinivas Bathula, consultant in pain Management Heart of England NHS Trust University Hospital, Birmingham; Dr Ann-Katrin Fritz, consultant Alain Management Norfolk & Norwich University Hospital; Dr Ashok Puttappa, consultant in anaesthesia and Chronic pain University Hospital North Midlands Stoke on Trent; Dr Tom Bendinger, consultant in anaesthesia and pain medicine Sheffield Teaching Hospitals; Dr Sumit Gulati,consultant in pain medicine and anaesthesia Walton Centre NHS FT, Liverpool UK;Dr Arun Natarajan, consultant in pain medicine Hillingdon Hospital; Dr Katrina Dick, consultant in anaesthesia and pain medicine Ayrshire and Arran; Dr Shefali Kadambande , consultant in anaesthesia and pain management University Hospital of Wales; Dr Nick Roberts, consultant in pain Management Kettering General Hospital; Dr Somnath Bagchi, consultant in pain medicine University Hospitals Plymouth UK; Dr Lakshman Radhakrishnan, consultant in pain management Royal Lancaster Infirmary; Dr Stephan Weber, consultant in pain Management BMI Goring Hall Hospital; Dr Kiran Sachane consultant in pain medicine NHS Lothian pain Service, Edinburgh Scotland; Dr James Blackburn, consultant in pain medicine, St George’s Healthcare NHS Trust; Dr Srinivas Bathula, consultant in pain medicine, University Hospitals Birmingham NHS FT; Dr Ravi Srinivasagopalan, consultant in pain Management and anaesthesia The Hillingdon Hospitals NHS FT; Dr John Goddard, consultant in Paediatric pain medicine Sheffield Children’s Hospital; Dr Chad Taylor, pain medicine consultant, Jersey (Channel Islands UK); Dr Udaya Kumar Chakka, consultant in pain medicine, Coventry; Dr Pallav Desai, Neuromodulation Fellow, James Cook University Hospital; Dr Azfer Usmani, Dartford and Gravesham NHS Trust; Dr Neal Evans, consultant in pain medicine Bucks Hosps NHS Trust; Dr Kanar Al-Quragooli, Associate Specialist in anaesthesia and pain medicine , Manchester FT; Dr Valentina Jansen, consultant in pain and anaesthetics Glangwili General Hospital Hywel Dda NHS Trust; Professor Emeritus Sam H Ahmedzai, University of Sheffield; Dr Mike Hudspith, consultant in pain medicine Norfolk & Norwich University Hospital;
Will I Be Able To Get Cannabis Prescribed On The NHS?
With the publication of new regulations yesterday, it is now clear how cannabis will be available on the NHS starting on 1st November 2018.
Only consultants will be able to prescribe cannabis and it will be entirely up to each consultant to make a decision about individual patients. The definition of cannabis-derived medicinal products is sufficently wide that both oils and herbal cannabis manufactured to GMP (Good Manufacturing Practice) standards will be available.
There is very little explanation included in the regulations but the intention is that prescribing guidance will be developed over time by NICE (National Institute for Health and Care Excellence). The regulations prohibit smoking cannabis for medical use but if your consultant decides it is appropriate for you, they will be able to prescribe herbal cannabis for vaping. Apart from Sativex, all cannabis products are unlicensed medicines described as ‘specials’, so your consultant is supposed to consider licensed medicines first.
There are no restrictions on which conditions cannabis can be prescribed for. Again, it will be up to your consultant to decide.
So this is marvellous news. It is a fundamental breakthrough and its impact will be enormous but it will take time for it to start working effectively.
The law is no longer an obstacle. The biggest problem now is that very few consultants have any knowledge of cannabis at all and most are probably going to be very reluctant to prescribe. For the best part of a century, doctors, just like the rest of society, have been subject to a relentless flow of propaganda and false information about cannabis. Changing this with medical training, helpful prescribing guidelines and overcoming unjustified prejudice and fear are the new challenges we face.
To begin with, a lot of people will be disappointed because their consultant will be unwilling to prescribe. The first thing you can do about this is ask your GP to refer you to a different consultant but it may be some time before understanding develops and consultants are sufficiently informed. Almost certainly there will be more resistance to prescribing herbal cannabis and it will be easier to get oil.
As ever, the best thing to do is gather evidence on the use of cannabis for your condition(s). If you are well informed and prepared then you can help to educate your consultant. There is now an enormous amount of evidence available online. Just be careful to use proper scientific information and avoid the miracle cures and exaggeration that is still widespread.
Whilst not everyone will immediately be able to get the medicine they need, we are now on the correct path. Instead of politicians imposing their ignorant opinions on you, your doctor will now be making the decisions and that is the way it should be. In time the right to prescribe will be extended to GPs. For now the truly wonderful news is that we are no longer engaged in a battle with the law. What it’s about now is patience and education.
Arrival After A 36 Year Journey.
Today I have arrived at the destination I set out for in April 1983 when I first gave evidence on the use of cannabis as medicine to Parliament at the Home Affairs Select Committee Inquiry into ‘Dangerous Drugs’.
Sajid Javid MP, the Home Secretary, has announced that from 1st November 2018, consultants will be able to prescribe cannabis on the NHS. This will include herbal cannabis produced to GMP standards by organisations such as Bedrocan and Tilray.
I am only one of thousands of people who worked on this campaign and I congratulate all those with whom I have shared this journey. In these 36 years there have been more than 22,000 scientific papers published demonstrating the safety and efficacy of cannabis for a wide range of medical conditions. This is how long it’s taken to get policy changed in the UK in accordance with evidence.
It’s appropriate that it should fall to the son of a Pakistani immigrant finally to sweep aside the prejudice and wilful ignorance that has stood in the way.
The UK Government’s Very Last Excuse For Denying Access To Medicinal Cannabis.
Essentially, UK government policy on cannabis hasn’t altered since 1971. Despite the vast amount of new evidence published since then and revolutionary change, particularly on medicinal use, all across the world, successive governments have stubbornly and obstinately refused to consider any sort of reform.
It doesn’t matter which party has been in power, Conservative, Labour or the coalition, it’s a subject that ministers and MPs simply refuse to engage with. It’s easier that way for them and be in no doubt: laziness, fear of a media backlash and deeply ingrained prejudice are the key factors in this impasse.
Grubby, Corrupt Deal Between Brown And Dacre
We had the downgrade to class C in 2003 and then back up to B in 2009 but this was a turgid and useless effort. No notice was taken of any evidence arising from this experiment. It was enacted to enable police to concentrate more on class A drugs and reversed based on Gordon Brown’s ‘Presbyterian conscience’ and a grubby, corrupt deal with Paul Dacre to win the Daily Mail’s political support. In fact, use went down while cannabis was class C and back up again when it was upgraded but governments have no interest in facts or evidence on this subject, only in political expediency and spinning advantage with the media.
The clamour for medicinal access has increased enormously, just as the evidence for its safety and efficacy has become overwhelming. The UK is now virtually isolated amongst first world countries with a cruel, inhumane and anti-evidence policy which makes us a laughing stock with all who are properly informed. It’s not a laughing matter for the victims though. For those persecuted by this nasty policy it is tears, pain, suffering, disability – all of which could be alleviated to at least some extent just by a stroke of the Home Secretary’s pen. It is sickening that all those who have held that office over the last 45 years escape without any shame or opprobrium on their character.
Home Secretaries Have A Lot To Answer For
CLEAR receives hundreds of letters and emails every year from people who have written to their MP about medicinal cannabis and it is astonishing that unlike almost every other policy, exactly the same words are used by all MPs. They slavishly repeat the Home Office line which is ruthlessly enforced across party lines.
There have been some subtle changes. The marketing authorisation issued for Sativex in 2010 has led to a minor change in the tired and inaccurate line ‘there is no medicinal value in cannabis’. It’s now become ‘there is no medicinal value in raw cannabis’. This is scientifically and factually incorrect. Pharmacologically, Sativex and the ‘raw’ plants from which it is made are identical. It is whole plant cannabis oil and its authorisation by the MHRA as an extract of THC and CBD is fundamentally dishonest. GW Pharmaceuticals reveals it contains more than 400 molecules, the MHRA says it only contains two and “unspecified impurities”.
More recently, and in the face of an explosion of supportive evidence, another line has been added. This states that ‘the UK has a well established process for the approval of medicines through the MHRA and that any company wishing to bring a medicinal cannabis product to market should follow this procedure. In fact, inside sources suggest that the government is very keen to see new cannabis-based medicines approved by the MHRA. It would take the wind out of the sails of the medical cannabis campaign
This is the very last excuse for denying access to medicinal cannabis. It is nothing but an excuse and one that is misleading and based on deception. If we can expose how weak, inappropriate and fake it is, the government will have nowhere else to hide.
Firstly, as demonstrated with Sativex, the MHRA process is incapable of dealing with a medicine that contains hundreds of molecules. It is designed by the pharmaceutical industry for regulating single molecule medicines, usually synthesised in a lab, which have the potential to be highly toxic. CLEAR rejects the tired, boring theory that ‘Big Pharma’ is engaged in a massive conspiracy to deny access to cannabis and to ‘keep people ill’ so it can continue to sell its products to the NHS. The MHRA isn’t engaged in such malevolent conduct, it’s simply incapable of 
properly evaluating a whole plant extract through its existing methods.
The bright, shining truth of this, that totally demolishes the government’s position, is that in every jusrisdiction throughout the world where medicinal cannabis has been legally regulated, it is through a special system outside pharmaceutical medicines regulation. Every other government that has recognised the enormous benefit that medicinal cannabis offers has come to the same conclusion: cannabis is a special case. It is far more complex but much, much safer than pharmaceutical products.
Of course, there is also the ludicrous status of cannabis as a schedule 1 drug, which prevents doctors from prescribing it. If it was moved to schedule 2, alongside heroin and cocaine, or to schedule 4 alongside Sativex (the logical choice), doctors could be prescribing it tomorrow and high-quality, GMP and EU regulated medicinal cannabis from Bedrocan would be immediately available.
So the MHRA is the final excuse, the last obstacle to a revolution in healthcare in the UK. We need an ‘Office of Medicinal Cannabis’ as there is in the Netherlands, or ‘Access to Cannabis for Medical Purposes Regulations’ as administered by Health Canada. Colorado has its ‘Medical Marijuana Registry Program’ and other US states have similar arrangements. Israel’s Ministry of Health has its ‘Medical Cannabis Unit’. In Australia, its equivalent of the MHRA, the Therapeutic Goods Administration, has established its own set of medical cannabis regulations.
This is now the most important factor in achieving medical cannabis law reform. Next time you contact your MP or in any advocacy or campaign work you do, this is where to focus your energy. Cannabis is a special case, it is not like other medicines. Once we can open the eyes to this truth the path ahead will be clear.
The Facts About CBD In The UK. December 2016.
On 3rd October 2016 the Medicines and Healthcare products Regulatory Agency (MHRA) issued notices to a number of CBD suppliers stating that cannabidiol (CBD) was being designated as a medicine and that sale of all CBD products must stop within 28 days, ostensibly by the 1st November.
A lot has happened since. Most importantly, the Cannabis Trades Association UK (CTAUK) has been established to represent the industry and protect the interests of CBD consumers but there remains great confusion as to the legal status of CBD and whether these products will still be available. This article sets out the facts and explains how the market is likely to develop. The most important point is that there is no need for panic. There will be some changes but no one will lose access to CBD for the foreseeable future.
Background
Through the summer of 2016, rumours and half stories had been swirling around about the MHRA taking action on CBD. When the news broke it caused real panic, both for the thousands of people using CBD products and for those working in CBD businesses. It looked like a real disaster for everyone. On the one hand the government, through the MHRA, was finally recognising the truth that CBD and cannabis are medicine. On the other, it seemed that the whole industry was going to be shut down, businesses would close, people would lose their jobs and, most importantly, those who rely on CBD products for maintaining their health were going to suffer real harm. If CBD was going to be regulated as a medicine it would require the investment of hundreds of thousands of pounds to obtain the necessary authorisation to put any products on the market.
It quickly became clear that the MHRA was unprepared for the reaction it received. Its switchboard was swamped by worried callers. Social media exploded with the inevitable Big Pharma conspiracy theories and even the national press covered the story demonstrating that medicinal cannabis is now an issue of mainstream interest.
CLEAR took action to rally our friends and colleagues in the legitimate cannabis business and this led to the creation of CTAUK. The same day the news broke we wrote to the MHRA notifying it of the formation of the trade association and seeking a meeting.
On 13th October, the MHRA issued a statement on its website explaining its actions.
CLEAR’s advisory board members, Professor Mike Barnes issued a statement to the media and Crispin Blunt MP wrote to Dr Ian Hudson, the chief executive of the MHRA. Even the British Medical Journal covered the story.
On 19th October the MHRA finally confirmed a meeting with the CTAUK to take place on 3rd November. On 21st October, Dr Ian Hudson replied to Crispin Blunt’s letter. CTAUK appointed solicitors who in turn obtained counsel’s opinion and on 28th October a solicitor’s letter was sent to the MHRA formally objecting to its action. On 1st November the MHRA updated its statement on its website softening its position by claiming that its notices to CBD suppliers were merely its “opinion” that it should be designated as a medicine.
The meeting took place at MHRA headquarters on 3rd November. It was cordial and constructive and on 16th November CTAUK wrote to the MHRA formally proposing a system for the regulation of CBD. Essentially this suggests that CBD products with daily adult dosage of up to 200mg should continue to be marketed as a food supplement. Products with a daily adult dosage of up to 600mg would require a Traditional Herbal Registration and higher dosage products would require a full Marketing Authorisation. We await the MHRA’s response.
The MHRA has since written to CBD suppliers requiring them within seven days to provide samples of their products along with various information about them. However, CTAUK has been able to negotiate that our members have until the end of January to comply. This is excellent news and demonstrates recognition of the association by the MHRA.
Is CBD Legal In The UK?
Yes, CBD is not a controlled drug under the Misuse of Drugs Act 1971, neither is it covered by the Psychoactive Substances Act 2016. As long as it is marketed as a food supplement without any medicinal claims it is perfectly legal to sell and to buy.
Is The MHRA Going To Ban CBD?
No, the MHRA will have to assess each product on its own merits, particularly taking into account how it is marketed and whether any claims of medicinal benefit have been made.
What Will Happen In the Future?
We hope that the MHRA will accept our proposals for a system of regulation, meaning that only the highest dose products, such as GW Pharma’s soon-to-be- released ‘Epidiolex’ will require a full Marketing Authorisation. However, even if the MHRA tries to take formal action about any other products, this is going to take many months and probably a much as a year before anything changes. We remain confident that we will come to an agreement that will enable everyone to continue to access CBD products.
Cruel And Irresponsible Response from UK Government To Parliamentary Report On Medicinal Cannabis.
Unsurprisingly perhaps, the response to the recent call from MPs and peers to legalise cannabis for medicinal use has come straight from the top. Theresa May’s longstanding reputation as a denier of science and evidence on drugs policy is reinforced by her peremptory dismissal of the expert report. It seems that, at least in the short term, the UK government is sticking by a policy that is discredited, ridiculous and deeply cruel.
It fell to Sarah Newton MP, minister of state at the Home Office, to respond to a parliamentary question from Roger Godsiff, Labour MP for Birmingham, Hall Green.
Roger Godsiff MP
“To ask the Secretary of State for the Home Department, if she will respond to the recommendations of the report by the All-Party Parliamentary Group for Drug Policy Reform Accessing Medicinal Cannabis: Meeting Patients’ Needs, published in September 2016.”
Sarah Newton MP
“The Prime Minister responded to the All-Party Parliamentary Group for Drug Policy Reform’s report ‘Accessing Medicinal Cannabis: Meeting Patients’ Needs’ on the 27 October.
Cannabis is controlled as a Class B drug under the Misuse of Drugs Act 1971 and, in its raw form, currently has no recognised medicinal benefits in the UK. It is therefore listed as a Schedule 1 drug under the Misuse of Drugs Regulations 2001.
It is important that all medicines containing controlled drugs are thoroughly trialled to ensure they meet rigorous standards so that doctors and patients are sure of their efficacy and safety. To do otherwise for cannabis would amount to a circumvention of the clearly established and necessary regime for approving medicines in the UK.”
In other words, this is nothing more than a re-statement of the same position that the UK government has held since 1971 when legal access to medicinal cannabis was halted. Quite clearly the government has given no consideration at all to the vast amount of scientific evidence and international experience that has accumulated over the last 45 years. The latest report which took nine months to produce, took evidence from over 600 witnesses and included a review of over 20,000 scientific studies is simply cast aside. To be honest, I doubt whether it has even been read by Ms May or anyone in the Home Office or Department of Health. This is the standard that now prevails in the UK – government of the people by an unaccountable, out-of-touch, unresponsive cabal of individuals elected by a deeply flawed system that gives democracy a bad name.
On the face of it, the claim that all medicines must be thoroughly trialled seems plausible – but it is not. It is a misleading half-truth clearly intended to squash the call for access to medicinal cannabis by painting a false picture.
Doctors are allowed to prescribe any medicine, licensed or unlicensed, as they see fit, based on their own judgement. But prescribing of cannabis is specifically prohibited by Statutory Instrument despite the scientific consensus that it is far less dangerous than many, probably most commonly prescribed medicines.
So it’s not a level playing field. It’s a policy that is based on prejudice and scaremongering about recreational use of cannabis. Ms Newton’s answer is at best disingenuous but then she probably doesn’t even realise that herself. For many years Home Office policy has been systematically to mislead and misinform on cannabis and evidently under Ms May’s successor, Amber Rudd MP, such dishonesty continues.
Theresa May MP
Something will eventually force the government’s hand to change its absurd position on cannabis. Sadly the very last consideration will be scientific evidence or the will of the people. Such factors hold no sway with UK governments. Only when enough of the political elite open their eyes and examine their conscience, or some key individuals or their family members, experience the need for medicinal cannabis will change become possible. Alternatively, political upheaval may present an opportunity. The Liberal Democrats were too cowardly, weak and concerned with building their personal careers when in coalition to advance the cause they now so bravely advocate. Perhaps the SNP, with 56 MPs, all in favour of medicinal cannabis may be our best hope.
Sarah Newton is merely a puppet of the Home Office bureaucracy. Theresa May’s mendacious position on all aspects of drugs policy is well established and she is as stubborn and bigoted as they come on such matters. Only when she, in person, is subject to sufficient pressure will this cruel, ignorant and hateful policy change.
Guidelines On Cannabis For Medical Professionals.
In a new initiative, CLEAR’s scientific and medical advisor, Professor Mike Barnes, has written to the presidents of several Royal Colleges proposing the development of guidelines around the use of cannabis as medicine.
Professor Mike Barnes
This is a tricky situation for doctors. Surveys and individual reports from CLEAR members indicate that many doctors tacitly endorse their patients’ use of cannabis but clearly cannot recommend the illegal use of cannabis, however safe and effective it may be.
Professor Barnes’ letter refers to the recent APPG report, his own paper ‘Cannabis: The Evidence for Medical Use’ and says:
“…cannabis now has a reasonable evidence base for the management of chronic pain, including neuropathic pain, and the management of spasticity as well as in the management of anxiety and a use in nausea and vomiting in the context of chemotherapy.”
In conjunction with CLEAR, Professor Barnes has written to:
Royal College of Anaesthetists
Royal College of General Practitioners
Royal College of Paediatrics and Child Health
Royal College of Physicians
Royal College of Psychiatrists
His letter goes on to explain that about one million people are using cannabis as medicine:
“I do feel that doctors need guidelines to assist them when patients request advice on the use of cannabis…doctors should be properly informed about harm reduction advice and should be aware of the clinical evidence that is now guiding medicinal use in several other countries around the world.”
Our proposal is for an initial meeting to discuss the idea. If one or more of the Royal Colleges is prepared to back this initiative, CLEAR will set up and fund a working group of clinicians and medical education specialists to develop a set of guidelines.
