What is medical cannabis?
Medical cannabis differs from cannabis available on the black market in a couple of key respects. It has to be carefully produced to ensure it is of high quality (containing all of the different cannabinoids), and the chemical composition needs to remain the same from batch to batch so that patients and doctors can have certainty about its effects.
What are you campaigning for?
We’re calling for a change in the law to allow doctors to prescribe cannabis to their patients, where they consider that is appropriate and likely to alleviate their symptoms. Patients would then be able to go with their prescription to a pharmacy to get their cannabis, just as they would with any other medicine.
Who are you fighting for?
For the estimated 1 million people in the UK who use cannabis for medical reasons, and who currently risk arrest and prosecution by buying cannabis from drug dealers or growing it themselves. Many of these people are in severe pain, and find that cannabis is the only method to manage their symptoms effectively and without the debilitating side-effects that accompany many conventional treatments. We are also fighting for the many people who would like to be able to use cannabis to help with their medical condition, but are unwilling to break the law.
What kind of conditions would cannabis be available for?
That is up to medical professionals to judge, based on the scientific evidence.
There is reasonably good evidence from clinical trials into the use of cannabis for therapeutic purposes for the following conditions:
• chronic pain
• neuropathic pain
• spasticity in various neurological conditions, including multiple sclerosis
• nausea and vomiting related to chemotherapy
• loss of appetite, especially in HIV/AIDS.
In addition, there is some evidence from clinical trials to support the use of cannabis for the following conditions:
• Crohn's disease and other gastrointestinal disorders
• Inflammatory conditions, including fibromyalgia
• Tourette's syndrome and some aspects of Parkinson’s disease.
There is some emerging evidence of the efficacy of cannabis in cancer treatments.
The organisation Americans for Safer Access provide good summaries of the research evidence for different medical conditions, which can be read here: http://www.safeaccessnow.org/asa_condition_based_booklets
If the scientific evidence isn’t conclusive, surely it is premature to change the law?
There are clear indications of effectiveness for certain conditions. But we need more top-quality research studies that might give us definitive answers on some of the conditions for which individual patients tell us they find cannabis useful.
In the meantime, the question is whether we wait potentially many years for the evidence to reach the level of certainty that some would like; or whether we act now out of compassion for patients, and allow cannabis to be made available under prescription.
The EndOurPain campaign strongly takes the latter view. Of course the evidence base needs to be developed further, but it is strong enough to support a change in the law now. People who are in pain are either missing out on an effective treatment, or risking criminal prosecution. We need to act now to put control back into the hands of doctors, and to allow further medical trials to proceed unhindered.
Why isn’t there more research into the benefits of medical cannabis?
In the UK, cannabis is designated as a Schedule 1 drug under the Misuse of Drugs Regulations. Schedule 1 is a list of drugs which the government considers have no medical benefits. This is bizarre, as it flies in the face of the evidence, it goes against settled medical opinion in many other parts of Europe, and it directly contradicts the fact that Sativex (see below) has proven medical applications.
As well as preventing doctors from prescribing cannabis, the Schedule 1 designation makes it is extremely difficult to conduct research into the medical uses of cannabis.
The second problem is that medical trials tend to be funded by pharmaceutical companies which hold the patent for the drugs they are developing. Cannabis by contrast is a naturally-occurring plant which contains hundreds of different cannabinoids, and therefore cannot be patented. So the financial incentives to carry out research are not there, with the consequence that much of the medical potential of the cannabis plant remains untapped.
Should patients be able to grow their own cannabis?
That isn’t the focus of the campaign. The issues around growing of cannabis at home are more complex. Our campaign aim is simple and specific to changing UK law so that doctors have the right to prescribe it for medical use.
What is the legal status of cannabis currently in the UK?
Cannabis is a class B drug in the Misuse of Drugs Act 1971. That means you can receive a prison sentence of up to 5 years for possessing it, and up to 14 years for growing it or selling it.
There are medicines available that are based on cannabis such as Sativex. Why aren’t you just campaigning to make this more widely available?
Sativex contains the two main cannabinoids, THC and cannabidiol (CBD), that are found in herbal cannabis, in equal proportions. It is taken in the form of an oral spray. It is only licensed for use in the treatment of muscle spasms in people suffering from Multiple Sclerosis. Many people receive excellent relief of their symptoms using Sativex. It has been prescribed for some other conditions by a small number of doctors, but the restrictions make it difficult for them to do so.
However, Sativex is expensive, costing around £500 per patient per month. The National Institute for Clinical Excellence (NICE) recently announced that while they consider it to be an effective treatment, they do not consider it cost-effective, and will no longer recommend it. This decision has made it even harder for patients to access the drug.
Many patients who use herbal cannabis have tried Sativex, and have found that it is insufficiently strong to help with their symptoms. They rely insteadon herbal cannabis, cannabis oil, edibles, or suppositories.
While greater availability of Sativex would certainly be a good thing, it would be expensive for the taxpayer and it wouldn’t help everyone. Herbal cannabis is a cheap and effective alternative for many people. For these reasons we believe that doctors should be able to prescribe medical grade herbal cannabis to their patients.
If cannabis is legalised for medical use, surely this is just the start of the ‘slippery slope’ to total legalisation for recreational use too?
Medical and recreational cannabis are two different issues. Our focus is on helping people who are in pain and who are being failed by the current restrictive approach to cannabis. It is a simple matter of compassion for people who are being denied access to a medicine they find helpful.
Isn’t there a risk of schizophrenia and other side effects, particularly for young people?
There is some evidence that heavy, daily use of cannabis is associated with an increased risk of some individuals developing psychosis, particularly where there is an underlying predisposition.
This is associated with street cannabis, which tends to have high levels of THC and low levels of the anti-psychotic compound CBD. Medical grade cannabis can avoid some of these problems by ensuring a more appropriate balance between THC and CBD.
More generally, many medicines have negative side-effects (which can be very serious, including the risk of psychosis or fatal physical reactions). We trust doctors to know when to prescribe them and when not to; the same should be true of cannabis.
Some people say that there is evidence that taking cannabis causes serious harm to brain structure, particularly in young people. What is your view of their claims?
There is evidence that heavy use of cannabis by children and young people when the brain is still developing can cause long-term issues, although the research is not conclusive and it is also true to say that heavy use of tobacco or alcohol by young people causes permanent effects on the brain. Again, we would not expect doctors to prescribe large amounts of cannabis to people who fell into this at-risk group.
Is medical cannabis available in other countries?
Yes - in fact the UK is increasingly out of step with the rest of the world. Herbal cannabis is available for medical purposes in 24 US states and Washington DC, Canada, Australia, Israel, Mexico, Uruguay, Colombia, the Netherlands, Germany, Spain, Italy, Malta, the Czech Republic, Portugal and Croatia.
Do people who take cannabis for medical reasons get ‘high’?
Sometimes yes, although the effects vary according to the method of delivery, and diminish with regular use as the individual builds up tolerance. Varieties that contain high levels of CBD tend not to cause a “high” – like Sativex. Most people who use medical cannabis report that the side-effects are manageable, and less debilitating than those of many conventional medicines. In fact, many medical cannabis patients find that cannabis is the only way that they can manage their pain well enough to hold down a job.
Surely you don’t want people to smoke it? No other medicine is administered by smoking.
There are many other ways to take cannabis which don’t involve smoking (for example, vaporising it or making it into edible form). We would not expect that any doctor would recommend smoking as a delivery method, and would strong discourage combining with tobacco.
If cannabis is dispensed from a pharmacy, how will you stop people just passing it on to other people who want to use it for recreational use?
Cannabis will be prescription-only. The doctor would decide how much the individual needed, and at what strength. There is no evidence of diversion with conventional medicines which begs the question as to why would medical cannabis be any different?
We have no intention of replicating the model in some US states where medical cannabis is easily available at the request of patients with very few questions asked. We want to put control in the hands of the doctors who will use their professional judgement about whether its use is appropriate.