Defining the clinically appropriate prescription of medical cannabis

 

CPASS is encouraged by Labour’s manifesto pledge to “progress the clinically appropriate prescription of medical cannabis”. However, the actual details are scant, leaving the door open for multiple interpretations as to what a “clinically appropriate prescription” would actually be.

We are committed to advocating and supporting all cannabis patients and carers. We extend that support to policymakers to help them understand the challenges faced by the community we represent.

It is important to look at this issue in a wider context. A recent survey conducted by YouGov on behalf of CPASS concluded that 1.4 million people in the UK are treating their medical conditions with homegrown or illicitly procured cannabis. They are doing this as an alternative to prescribed medicine from their doctor. 

For the first time we have reliable, representative data regarding the number of people in Britain using cannabis as a medicine,” explains Dr Daniel Couch, Medical Lead, Centre for Medicinal Cannabis. “Over a million people are using cannabis illegally to relieve their symptoms. The findings are astounding and present a national challenge.”

Ann Keen, Chair of CPASS and Fellow of The Royal College of Nursing and Queen’s Nursing Institute, points out, “These figures demonstrate the vast number of patients in the UK with chronic and debilitating diagnosed conditions who feel they have no choice but to expose themselves to all the risks of accessing a medicine that works from the criminal market. Controlled, safe but innovative solutions must be explored as soon as possible”. 

 

These risks include but are not limited to; the risk of being arrested and prosecuted for cultivation of cannabis; risk dealing with criminals to source their medicine; risk of exposure to adulterants within the cannabis (molds, fertilizer residue or other chemicals); risk of taking their treatment into their own hands and away from trained clinicians; risk to mental health to those who are sensitive to high THC ‘street’ cannabis and; risk of being alienated from society due to the fact they perceive an ‘illegal drug’ to be a better way to treat their condition than prescribed medicine.

All these risks can be directly attributed to the legal status of cannabis and not inherent to cannabis itself, which has proven to be of great benefit to patients when administered by health professionals as shown by data emerging from medicinal cannabis programmes from around the world, from Australia to Uruguay.

 

The next thing to consider is, what conditions are people using cannabis to treat? This will help Labour and other parties understand how people are using cannabis to bring symptomatic relief to a broad spectrum of conditions. Research from the United Patients Alliance Patient Survey 2018 identified all the conditions people were treating with cannabis: Pain, depression, anxiety and insomnia being the top four. Surely any “clinically appropriate prescription of medical cannabis” would take this data into account?

Conditions patients are treating with cannabis, source United Patients Alliance Patient Survey 2018.

 

The final question is, how to best integrate medicinal cannabis into a robust health service such as the NHS when there are little clinical trials demonstrating the efficacy of cannabis as a treatment. This is the reason such a blockage exists today. Despite medicinal cannabis being legal now for over a year in the UK only 18 people have received a prescription via the NHS, according to a freedom of information request from the week of 18 November. This figure appears to be 1 million 399 thousand 982 prescriptions short.

To find an answer to this we should look to Denmark. Denmark has a high-quality health service, not too dissimilar to the NHS, they also found themselves in a situation where patients were taking it upon themselves to treat their conditions with illicit cannabis. They approached the issue by taking the wider social context into account and using a little bit of compassion and practicality came up with an elegant solution.

The pilot so far appears to be a success proving popular across the board with politicians of all parties. “It has been an interesting journey to pass legislation concerning the Danish pilot scheme,” explains Jane Heitmann, a Danish politician and MP for the Liberal party. “All parties of the Danish Parliament were in agreement. For the time being hundreds of patients and MD’s have experience with either using or prescribing medicinal cannabis, which is a far greater number than expected.” 

Danish doctors, who are supported by education material on medicinal cannabis, are able to prescribe cannabis for any condition if they feel it will help the patient. They are left to determine the appropriate treatment including the dose. These patients are then monitored in an ongoing research programme that will help the Danish health service to understand how effective cannabis is as a medicine and what, if any, are the risks associated. 

 

“Since January 2018 we have almost 10,000 prescriptions for over 3,000 patients,” explained Dr. Julie Moltke-Huitfeldt, Danish Doctor and editor-in-chief for Dosage Magazine. “The scientific research that has been initiated since 2018 — including several RCTs — is another sign that doctors are taking it seriously and trying to achieve the data we need to be able to prescribe medicinal cannabis in the future.”

After two years of the programme, there have been no reports of adverse effects which is a very encouraging signal. The doctors get the support and freedom they need, the patients get access to safe medicinal cannabis and the health service gets the data it requires. At the same time pressure is taken off politicians and police to justify the enforcement of unpopular laws. You could say that everyone is a winner.

 

Jon Liebling, Co-Founder of CPASS and a medical cannabis patient himself concludes, “Now that we know that there are 1.4 million patients in the UK accessing illicit forms of cannabis to help treat their diagnosed medical conditions, doctors must understand that any decision not to prescribe a quality, standardised CBMP for a patient is a decision to send their patient back to the illicit market for a medicine of unknown strength or quality and exposing them to all associated risks. This must play a part in any clinically appropriate decision.

CPASS is dedicated to helping find solutions for the millions of Britons who could benefit from medicinal cannabis and central to this is a dialogue with policymakers on how to enable this change. We encourage all British political parties to consider an approach similar to that of Denmark and read this policy proposal put together by distinguished UK doctors on behalf of the Centre for Medicinal Cannabis. The proposal is a tailor-made solution for the NHS based on the Danish pilot programme.

Bill Griffin – CPASS Patient Advisor and Writer.

Find out more and register your interest in CPASS here: http://cannpass.org/

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