The Bristol Cable

Specialist doctors – but not GPs – will be able to give out cannabis on prescription from November.

Medicinal cannabis will be available on prescription for the first time in the UK from next month, the government has announced, but experts in Bristol are concerned that the reforms may not go far enough.

Home secretary Sajid Javid first announced the relaxing of laws in July, following outcry over two prominent cases of children Alfie Dingley, 6, and Billy Caldwell, 12, who suffer from severe epilepsy.

Their families had to battle to get hold of cannabis oil, which they found reduced the number of seizures suffered by their sons. As a result, they joined calls by campaign groups for the government to make it easier to get cannabis prescribed as a medicine, which is most likely to benefit those suffering from epilepsy, multiple sclerosis (MS) and chronic pain.

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This week, the home secretary confirmed the new regulations would come into force on November 1st, allowing expert doctors to legally issue prescriptions for cannabis-based medicines for the first time in the UK. He stressed, however, that the reforms were “in no way a first step to the legalisation of cannabis for recreational use”.

The government’s drugs advisors, the Advisory Council on the Misuse of Drugs (ACMD), recommend in July that cannabis should be made a schedule two drug, allowing doctors to prescribe products if they met certain standards. Until now, Cannabis has been a schedule one drug, meaning it was thought to have no therapeutic value and could not be lawfully possessed or prescribed, but could be used for research with a Home Office license.

“The easing of the current legislation in respect of prescribing cannabis-based medicines can only be a good thing for patients who would benefit in order to manage their symptoms of pain or muscle spasticity, but it doesn’t go far enough”

Although the reforms represent an important change in drug policy and have received widespread praise, some campaigners say they haven’t gone far enough and that people will have to jump through lots of hoops to access cannabis-derived medicines.

Under the new regulations set to come into force from November, only specialist doctors, not GPs, will be allowed to prescribe cannabis to patients when they have proved that other medication hasn’t worked. The new law does not limit which condition can be considered for treatment.

Joanne from the Bristol Compassion Cannabis Club told the Cable: “The more I look into it, the less I think that it will change a lot for a lot of people.” She doesn’t see why the process is so rigid when drugs such as Sativex, a cannabis-derived medicine that is produced in the UK, are normally used as an add on, not as primary treatment.

She said the fact that only pediatricians and neurologists have been listed as specialists so far in the government announcement made her think that the process for obtaining these medicines will be difficult for many people whose conditions don’t fit into these specialisms. “But I’m definitely going to try,” she said.

“The more I look into it, the less I think that it will change a lot for a lot of people”

Joanne has been diagnosed with Fibromyalgia, a long-term condition that causes pain all over the body. At the age of 29 she had an accident that complicated her existing condition, and in 2008 ‘complex regional pain syndrome’ was added to her diagnosis. She thought she would be stuck in a wheelchair for the rest of her life.

After self-medicating with street cannabis to manage her pain, she later started purchasing Sativex. Her symptoms began improving, but Sativex isn’t easily available on the NHS, so she had to buy it privately from outside the UK – sometimes at huge expense – more than £200 a week.

Joanne said she recognised the negative impact cannabis can have on people’s lives, particularly the strong strains of ‘street cannabis’, but following her personal experience, she has become an advocate for using cannabis for medicinal purposes.

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Members of the West of England MS Therapy Centre in Bristol took part in clinical trials involving Sativex and found that medicine to be hugely beneficial. Doro Pasantes, the centre’s director, told the Cable: “The easing of the current legislation in respect of prescribing cannabis-based medicines can only be a good thing for patients who would benefit from these in order to manage their symptoms of pain or muscle spasticity, but it doesn’t go far enough.”

“Many of these treatments are still too expensive for GPs to prescribe to their patients with long term neurological conditions,” she added.

“There are still thousands of people living with MS and other long-term neurological conditions in our region who cannot access cannabis-based medicines like Sativex because of the high cost and it is a shameful postcode lottery.”

“Massive cultural change” needed

There has been a big delay between the production of cannabis in the UK and doctors being able to prescribe to patients, as the UK is the world’s largest producer and exporter of medicinal cannabis. In 1998, GW Pharmaceuticals, was granted a licence from the Home Office to grow cannabis plants for medical use, and in 2010 the UK became the first country in the world to authorise a prescription medicine derived from cannabis.

Cannabis has been used as a medicine for thousands of years. In the 19th and 20th centuries it was used around the world to treat migraines, and neuropathic and musculoskeletal pain, and in childbirth. In the UK, cannabis was made illegal in 1928 but doctors could prescribe it up to the introduction of the Misuse of Drugs Act in 1971.

“Compared to many pharmaceutical drugs, medical cannabis products are remarkably safe and, as recent high-profile cases have shown, can produce dramatic improvements for patients”

According to the MS Society, which has also been campaigning to make medicinal cannabis widely available, one in five people with MS use cannabis to help with their symptoms.

Professor Mike Barnes, the medical cannabis expert who secured the first long-term licence for its use by Alfie Dingley said many of his medical colleagues were unsure about the benefits, but added: “Compared to many pharmaceutical drugs, whole plant medical cannabis products are remarkably safe and, as recent high-profile cases have shown, can produce dramatic improvements for patients.”

Peter Carroll, the director for the campaign group ‘End Our Pain’ said a “massive cultural change” was needed in how the medical profession is briefed and trained about medical cannabis.

Since the announcement in July, an Independent Expert Panel was set up to provide clinical advice on individual license applications. However, families wanting to apply to the expert panel have said local medical teams and their governing trusts seem extremely reluctant to even apply to the panel.

A clear definition of what constitutes as a cannabis-derived medicinal product is being developed by the Medicines and Healthcare Products Regulatory Authority (MHRA). In addition, the ACMD will be conducting a long-term review of cannabis and the National Institute for Health and Care Excellence (NICE) has been commissioned to provide advice for clinicians by October next year.

In September, the Home Office said: “We are confident that the definition and additional access restrictions that officials have recommended, alongside the checks and balances that exist in current medicines regulation, medical practice and the additional clinical guidance that is under development, will provide a safe and supportive environment for both prescribers, patients and their carers to make informed decisions about treatment, whilst minimising the risks of harm and diversion.”

When announcing that the changes would come in from November, Sajid Javid said: “Having been moved by heartbreaking cases involving sick children, it was important to me that we took swift action to help those who can benefit from medicinal cannabis.

“We have now delivered on our promise and specialist doctors will have the option to prescribe these products where there is a real need,” he added.

“I’m grateful to the expert panel – who have been considering cases in the interim – and to those who’ve worked hard to bring about this change at the earliest possible opportunity.”

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