Tight NHS restrictions mean private patients have better access to drugs, experts say

This article is more than 1 year old

This article is more than 1 year old

NHS patients are being refused access to medical cannabis while private doctors prescribe it, in an emerging “two-tier system”, experts and campaigners have said.

While private patients have enjoyed much greater access to medical cannabis following its legalisation last year, paying hundreds of pounds a month for appointments and prescriptions, the picture is very different for patients relying on the NHS, according to the Centre for Medicinal Cannabis and the campaign group End Our Pain.

The health secretary, Matt Hancock, claimed this week that more than 80 children had been given NHS prescriptions since the law was changed in November to allow the supply of medical cannabis, including THC-based drugs.

However, pressure groups say they are unaware of a single new NHS prescription for medicine in which THC – the component that is an effective treatment for epilepsy – is the dominant ingredient.

The mother of a severely epileptic girl had a supply of medical cannabis confiscated while trying to enter the UK on Saturday after she was previously refused an import licence. Emma Appleby’s nine-year-old daughter Teagan can have up to 300 seizures a day.

Appleby said she only wanted the best thing for her daughter and that preferential access to medical cannabis based on wealth was a betrayal of the founding principles of the NHS.

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“To see a system where only families with money access medical cannabis is a betrayal of the NHS,” she said. “Families like mine are of modest means. The NHS should provide the best healthcare available and it should not be about whether you have money or not.”

Dr Dani Gordon, an expert in cannabis medicine, said: “Private doctors do not have to report to an NHS trust hierarchy, so if they deem that medical cannabis is a good therapeutic option after careful assessment they can prescribe directly without going through the highly bureaucratic process of receiving approval from their NHS trust.”

Carly Barton, a campaigner with the United Patients Alliance, lives with fibromyalgia and uses medical cannabis to relieve her chronic pain after strong opioids including morphine and fentanyl failed to improve her conditions. She said an NHS doctor wrote her a prescription for medical cannabis but it was blocked by the local clinical commissioning group “on the basis that there is not enough evidence” for its efficacy.

“I am now left with no other choice than to return to being a criminal,” Barton said. “I am a criminal only because I can not maintain a £1,400-a-month prescription.”

Prof Mike Barnes, the director of The Medical Cannabis Clinics, a specialist medicinal cannabis centre, criticised how access to medical cannabis was apparently much easier for wealthier people.

“It is appalling that we’ve got this effectively two-tier system, because most people simply cannot afford private sector fees for appointments and the cannabis itself,” he said. “You have a system where if you can afford it you can get it. It’s time the NHS got its act together and caught up with reality.”

According to NHS England, cannabis-based medicinal products should be prescribed only where there is “clear published evidence of benefit” and patients have exhausted other treatment options.

The British Paediatric Neurology Association guidance to clinicians reads: “There is evidence that chronic high exposure to THC during recreational cannabis use can affect brain development, structure and mental health.”

However, campaigners have criticised such advice for conflating the potential effect of smokeable street cannabis with pharmaceutical-grade oils containing low quantities of THC and taken in small doses.

It is believed that the vast majority of prescriptions Hancock referred to were for Epidiolex, a CBD-dominant medicine not including THC.

Access to THC-dominant cannabis oils has only been provided by private doctors, say campaigners, with 10 prescriptions at one clinic alone.

A limited number of children, including Alfie Dingley, were granted emergency prescriptions as the home secretary introduced an interim system last summer.

Hancock acknowledged in the House of Commons on Monday that the current system for prescribing medical cannabis was not working, and said the medicine confiscated from Appleby over the weekend had been held, not destroyed, while a second clinical opinion was sought.

He told MPs he had asked NHS England “rapidly to initiate a process evaluation to address barriers to clinically appropriate prescribing [of medicinal cannabis]”.

A Department for Health spokesperson said: “We have asked the National Institute of Health and Care Excellence to develop additional clinical guidelines and are working with Health Education England to provide additional training. We are also promoting more research through the National Institute for Health Research to further improve the evidence base.”

• This article was amended on 10 April 2019 to correct a reference to the role of Prof Mike Barnes.