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Peter Reynolds

The life and times of Peter Reynolds

Posts Tagged ‘Royal College

NICE’s Draft Guidelines on Cannabis Prove That Its Methods Don’t Work and It Is Causing Harm to Patients

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The draft guidelines produced by the NICE committee are nothing short of ridiculous.  There is a complete absence of common sense and an absurd failure properly to consider all the available evidence.

But it’s actually much more serious than this.  It is now abundantly clear that this committee, its membership and its conclusions were only ever intended to delay, obfuscate and sabotage the reforms which were introduced in November last year because of a public outcry.

The selection of members of the committee is by any standards corrupt.  The most highly qualified people have been deliberately excluded.  Anyone publicly expressing support for the use of cannabis as medicine has been rejected whereas those selected have frequently expressed opposition.  The inclusion of the ‘reefer madness’ advocate Professor Finbar O’Callaghan is both reprehensible and inexcusable. If the man had any ethical standards or conscience he would recuse hismself. The committee is a confidence trick.

The medical establishment, the Home Office and all the various regulators, including the MHRA, the FSA and the Royal Colleges are all institutionally opposed to cannabis and they are doing everything they can to stop it reaching the people who can benefit from it.  Cannabis, the more intelligent approach to medicine it both requires and inspires, threatens too many vested interests and the comfortable, self-satisfied and self-serving model of healthcare that prevails in Britain.

But if any NICE apparatchik or fat cat pharma supremo thinks they can stop cannabis they are fooling themselves.  From right around the world the overwhelming weight of expert opinion and patient experience reveals that what is happening in Britain is merely delaying the inevitable. But in the meantime it is causing great suffering and unnecessary harm to patients.  It is a scandal of the highest order and the people responsible for it must be called to account.

CLEAR has responded to the consultation on the draft guidelines in great detail.  Without reproducing our line by line commentary, these are our three general observations.

1. The entire guideline is characterised by a failure to consider observational evidence and real-world experience.  Cannabis is the oldest medicine known to mankind and failure to give substantial weight to real-world experience of its safety and efficacy is nothing short of absurd. Given its illegality over the past 100 years, the wild scaremongering about its recreational use and therefore the lack of formal clinical evidence, this is simply setting it up to fail. It is irresponsible in the extreme to fail to consider the enormous benefit at very low cost and the very few adverse events associated with illicit cannabis.

2. There is little evidence of potential for harm for cannabis for any medical condition. Given the enormous numbers using cannabis in its most potent form as a recreational drug and/or self-medicating (estimated at 250 million regular users worldwide) there are far fewer adverse events or incidents of harm than for common over-the-counter medicines.

3. The weight given throughout the guideline to the potential for harm of cannabis is wildly disproportionate.  There is no evidence of any significant harm from cannabis when used as a medicine, especially when under the supervision of a medical professional.  At least 10,000 years of human experience shows that cannabis is essentially safe. Seeking to evaluate its safety in the same way as a new, experimental medicine, synthesised in a lab for which there is no real-world experience is a fundamentally flawed approach.  Unlike potentially dangerous or unsafe medicines, cannabis can and should be offered to patients on a ‘try it and see’ basis.  Instead of being over-cautious, clinicians should welcome this approach and can be certain that it will benefit patients whether or not in proves effective in individual cases.

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Asking Politicians to Order Doctors to Prescribe Cannabis is a Futile Quest

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Last year, when Sajid Javid introduced the new regulations permitting prescribing of cannabis-based products for medicinal use (CBPMs) he went much further than anyone could have expected.

For 50 years doctors had been told that cannabis was a highly toxic, dangerous drug with no therapeutic value.  Then, in the space of few weeks they were suddenly told by the Chief Medical Officer that there was “conclusive evidence” of therapeutic benefit. The truth is successive governments and the Home Office had been engaged in systematic disinformation and lies about cannabis. Suddenly they expected doctors to believe exactly the opposite of what they had been told before.

In fact, what Sajid Javid really did was to pass the buck, so while I have some sympathy for the predicament of doctors and total contempt for our pathetic political class, the buck is now in the right place.  However, we have a medical establishment that is so risk averse and so crushed by bureaucracy that it is transfixed by the challenge of getting to grips with cannabis and there is a total lack of leadership from the Royal Colleges or any of the professional bodies. The ultimate demonstration of this is that the British Paediatric Neurology Association wants doctors to consider brain surgery for epilepsy before prescribing cannabis.  This is a profession that has lost touch with reality and common sense.

The result is that doctors will not prescribe cannabis but the idea that they can be ordered to do so by politicians is a non-starter.  It is difficult to understand what campaigners hope to achieve by marching on Westminster and lobbying MPs.

Eventually, the efforts that are being made in medical education will bear fruit and doctors will start to prescribe but this will take time and many will suffer while they wait for doctors to catch up with what is already well understood in many parts of the world.

So what can be done?

Government can take action on two fronts which will accelerate progress. First of all, improve supply.  By its own admission, in response to an FOI Request, the Home Office has done nothing to facilitate production of CBPMs. This could be changed immediately. There is a queue of well qualified and financed companies ready to develop production facilities.  While Sajid Javid cannot order doctors to prescribe, he can order his reluctant and backwards officials to issue licences.  Within a year we can have a domestic supply of CBPMs and the doctors will have something to prescribe and products they can become familiar with.

The second way government can act is on regulation.  Doctors are terrified of cannabis and need reassurance. Everything they have been taught goes against prescribing cannabis.

However, cannabis is safe for 99% of people. We know this from 10,000 years of experience. The hysterical scaremongering from places such as the Institute of Psychiatry are actually aboput a tiny proportion of people using high strength cannabis as a recreational drug, a totally different circumstance to a high quality medicinal product used under close supervision. As a plant-based medicine, cannabis contains 400 – 500 molecules unlike pharmaceutical medicines which are usually a single molecule. It is impossible therefore to regulate cannabis in the same way as pharmaceuticals and given millennia of experience it is unnecessary.

In every other jurisdiction in the world where cannabis has been made legally available for medical use a separate system of regulation for it has been established. Until UK follows this path, the pharmaceutical-funded medical establishment will never accept cannabis as a legitimate medicine.

So what politicans can do is free up the supply chain for CBPMs and regulate them in an appropriate and rational way.  This is where we need to be focused in order to make progress and bring relief and a healthier life to millions.

Written by Peter Reynolds

March 19, 2019 at 1:26 pm