Medical Cannabis: Alleviation of Health Conditions
(2 years, 5 months ago)
Commons ChamberRead Hansard Text Read Debate Ministerial Extracts
Ronnie Cowan (Inverclyde) (SNP)
I beg to move,
That this House has considered the matter of the use of medical cannabis for the alleviation of health conditions.
I would like to start by paying tribute to the mums and dads, brothers and sisters, grandparents, guardians, extended families and friends who have campaigned diligently, respectfully and passionately to bring about the reform in access to medical cannabis that they so desperately desire. Many are full-time carers, with all the pressure and time constraints that that entails, yet they have found the time and the commitment to energise a campaign—a campaign that far too many politicians and medical professionals have turned a blind eye to.
I would like to thank the Backbench Business Committee for supporting me in bringing this debate forward today. I would also like to thank those Members who have reorganised their diaries and travelling arrangements to be here today. There are a number of MPs who would normally be here today to debate a subject that is close to their hearts, but for a variety of reasons, not least COP26, they are not. I guarantee they would all support any move by this Government to make it easier to access or research medical cannabis. I have never heard any MP argue against those objectives. There is confusion about drugs in general, which tempers some people’s desire to speak out, but the provision of medicine to sick people is not an issue.
Catherine West (Hornsey and Wood Green) (Lab)
I congratulate the hon. Gentleman on securing cross-party support for this debate. On research, does he agree it is encouraging to see the potential curative effects of various elements of this drug, as we call it, in treating very serious forms of epilepsy?
Ronnie Cowan
It is great to see that research has now been undertaken, and I have a list of five or six projects looking at medical cannabis across a range of different medical conditions, but there is still the issue that many academic organisations cannot get access to the cannabis or hemp plants they require because they are graded as category 2, which keeps the plants out of their hands. The paperwork and processes they have to go through to access the raw product are prohibitive, and recategorisation from category 2 to category 4 would aid the research of a host of academic establishments.
Why are we not making it easier for people to access medical cannabis? Why are people who would benefit from medicine derived from the hemp plant being denied that opportunity? Why can some medicines be purchased on private prescription only? Why are we not making medicines that are widely available in other countries available in the United Kingdom?
Margaret Greenwood (Wirral West) (Lab)
I congratulate the hon. Gentleman on securing this debate. He is making some important points. One of my constituents lives with progressive myelopathy of uncertain cause that affects his mobility and causes him to suffer brain fog, exhaustion and almost constant pain, which he has described as feeling like “hot wires” being pulled through muscles and skin. Does the hon. Gentleman agree there is real urgency to this issue because of people like my constituent who are suffering on a daily basis?
Ronnie Cowan
Of course I agree, and I understand the difficulty in which the Government find themselves, particularly the Under-Secretary of State for Health and Social Care, the hon. Member for Lewes (Maria Caulfield), who is new in post. We need solid research that proves the efficacy of medicines, but behind that we have people who are living with these extreme conditions, day in, day out, for an awfully long time. We have been slow to get to this stage, so there is every reason why the Government should accelerate the research in such cases.
Over the last week or so I have met representatives from the Multiple Sclerosis Society and End Our Pain, and over the years I have heard representations from a much wider range of organisations and individuals that see medical cannabis as at least part of the solution to their or other people’s health issues. There are two licensed cannabis medicines, Epidiolex and Sativex, which are both made by GW Pharmaceuticals. There is nothing wrong with these medicines, but they are isolates, or very nearly, and isolates simply do not work as well as full spectrum products, and they have more side effects.
A full spectrum cannabis product contains all the different cannabinoids and terpenes found in that strain, whereas an isolate product contains only one chemical, such as cannabidiol in Epidiolex. There is published evidence that the full spectrum products are twice as good as the licensed Epidiolex in the treatment of seizures.
Then there are the unlicensed cannabis products that account for virtually all privately prescribed products. Unlicensed products are not routinely prescribed by NHS clinicians, but they can be prescribed by a specialist doctor on the General Medical Council’s specialist register. There are now about 10,000 private prescriptions, 60% for pain, 30% for anxiety and similar conditions such as post-traumatic stress disorder, and 10% for other conditions including neurological conditions, such as epilepsy and MS, and some cancer and gastrointestinal disorders such as Crohn’s. It is clear that medical cannabis can aid a wide range of conditions.
All imported products are imported because the Home Office has been slow in granting cultivation licences for high-THC plants in the United Kingdom, and matters are made worse by the cumbersome import process. Three years and three months after the current Secretary of State for Health and Social Care, while he was Home Secretary, changed the law to allow prescriptions for medical cannabis, we still have only three NHS prescriptions.
As I mentioned in yesterday’s Westminster Hall debate, and it is worth repeating, Hannah Deacon, whose son Alfie is in receipt of one of those NHS prescriptions, has written to the Health Secretary three times to ask him to help, as he promised her he would in writing when he was Home Secretary, but all three letters have been ignored. Why, three years and three months later, are there so few NHS prescriptions?
Basically, doctors are not trained in cannabis medicine, although several teaching programmes are now available. However, the main barrier is the rather unhelpful guidance produced by the National Institute for Health and Care Excellence, which has looked at cannabis as if it were a pharmaceutical product, but it is not. We need better guidance written by people who understand the plant, not by those who understand only pharmaceutical medicine.
We also need acceptance of the validity of real-world evidence. The British Paediatric Neurology Association recently reviewed its guidance on prescribing medical cannabis in cases of intractable epilepsy, about which I have a number of serious concerns. If a family go ahead with a private prescription for medical cannabis, the guidance appears to say that the NHS paediatric consultant should insist that the private paediatric consultant takes on 24/7 care.
I am extremely concerned that this is a further attempt to make private prescribing so burdensome as to deter private prescribers. No private prescriber will have the infrastructure to provide this level of wraparound care. My concerns are further increased as this appears to have happened to one family already, and I have a letter supporting my concerns. I am pretty sure that washing their hands of patients in this way is not legal. Will the Minister immediately examine this issue and seek clarification from the BPNA that this is not the interpretation, and will she insist that the guidance is removed or changed?
Many barriers would be broken if general practitioners were allowed to prescribe, and a recent survey shows that a quarter of GPs would be happy to do so. That would require a simple change of the necessary statutory instrument under the Misuse of Drugs Regulations 2001 and would not require parliamentary time. I notice that, as of today, a leading UK insurer is now offering insurance cover at rates not dissimilar to normal cover for doctors prescribing medical cannabis.
To make this easier, there should be a focus on where the evidence lies for prescribing indication-specific, medicalised, pharmaceutical-grade cannabis. We must build on the legitimacy and efficacy of these medicines through the implementation of structured approaches to prescribing, which would help the UK healthcare system to be more inclined to prescribe cannabis sensibly.
In our debates in this place on refusing access to immigrants, health and safety in the workplace, poverty and welfare, I have heard the question many times: “Does somebody have to die before we take action?” Well, people are dying and people are living in unnecessary pain and discomfort.
I have four questions for the Minister. Will the Government recognise the value of real-world evidence, such as the research of Drug Science—including Project Twenty21—as proof of the efficacy of medical cannabis and stop insisting on randomised controlled trials, which are particularly unsuitable for rare forms of epilepsy in children? Do the Government have any plans to conduct a health economics analysis to investigate the cost-effectiveness of medical cannabis? Will the Government meet the costs of prescriptions for children requiring Bedrocan’s Bedrolite or similar products? And if a child was suffering from an epileptic seizure and the Minister had the medicine in her hands, would she administer it? I am sure the answer to the last question is yes, so will she please help to put that medicine into the hands of those who care for these children?
Finally, access to medical cannabis will someday be the norm. We need to confront the obstacles that exist today and clear the path for better access tomorrow.
Crispin Blunt (Reigate) (Con)
I am delighted to follow the hon. Member for Inverclyde (Ronnie Cowan) and have worked with him actively in the past few years on this issue, and I wish we had made more progress. I am delighted to welcome the Minister to her place, answering this debate. I have an interest recorded in the Register of Members’ Financial Interests on this, but it is a non-financial interest. It is in recognition of the fact that I chair an organisation that I have set up, the Conservative Drug Policy Reform Group Ltd, whose objective is to find the resources to bring arguments based on science and research into this debate, on all of drugs policy, and to have this academically peer-reviewed, so that the arguments for the huge challenge of a policy change that is required can be put in a proper, calm way, based on all the available evidence and a proper scientific assessment of that evidence.
I say to the Minister at the beginning of my remarks that this issue is not just about medicine from cannabis. That is one element and one casualty of how we have conducted our nation’s drug policy over the past five or six decades, but it is a huge missed opportunity. My journey into this issue arose as prisons Minister, when I saw the impact of taking a criminal justice approach to drug misuse as the first lever, rather than a public health approach. As I saw at first hand, the cost to the criminal justice system is just enormous. Indeed, the Government’s own statistics talk of a cost in the order of £19 billion a year. When one then thinks that half of acquisitive crime in the UK is driven by drug misuse and drug addiction, we see that we should be asking some serious questions about the whole of our drugs policy.
However, that is a separate debate. It was made clear to me when I became the first Conservative to co-chair the all-party group on drug policy reform, when I decided to make this issue one of my central areas of focus, after I ceased to be chair of the Select Committee on Foreign Affairs, that we needed to focus on the arguments for medicine, which had not been able to be researched and developed because of our drugs policy. Focusing on the arguments associated with prohibition and criminal justice, and the parallels with alcohol in the United States in the 1920s and 1930s, is not where the discussion is; the Government are completely clear on where their policy sits on those issues. There is now a big global debate on those issues, with a Global Commission on Drug Policy reform, but it was put to me that we must focus on getting medicines from cannabis for the people who are suffering because they are not able to get access to it.
I became co-chair of the all-party group in September 2017 and I took the advice I was given by people who had been in this field rather longer than I had, and we got behind the family of Alfie Dingley. A national newspaper had got involved and a petition was signed by 300,000 people. The family had gone to a holiday camp in Holland in order to access medicine from cannabis, because they could not get it in the UK. The Bedrocan oil that Alfie was getting then stopped his epileptic fits, but the family had run out of money, so they had to come back to the UK and they could not access the medicine here. On the day of the presentation of the petition to Downing Street, I was able to ask an urgent question in the House on the matter. The issue was raised with Ministers and we were given assurances that the Dingley family were going to be helped to find their way through the complicated licensing process in order to enable Alfie to be able to access the medicine. Three months later, of course, they still had not got it. The cost of the licence application process—simply buying the licences to access this oil—was £20,000; we are talking about £5,000 a licence, so enormous barriers were put in the way.
Then we had the case of Charlotte Caldwell and her epileptic son Billy, who had been in the United States getting treatment. When they returned to the UK, wisely doing so via Dublin, because she lived in Northern Ireland, her GP gave her a prescription for the medicine she had brought back from the US. When the manufacturer of that medicine changed and it became a Canadian company, she needed a new prescription, at which point it all fell apart. The doctor was told, “You are not allowed to prescribe that medicine for this epileptic child to stop him having his fits.” With the support of Richard Branson and others, Charlotte went to Canada, collected the medicine, came back and presented it to customs at Heathrow on the Monday, when it was confiscated. By the Thursday the boy was in hospital fitting, and his consultants were on the steps of the hospital saying, “It really doesn’t matter. What is unacceptably cruel is to take a medicine that is working off a child.” The current Health Secretary, to his huge credit, then issued a special licence for Billy Caldwell to be able to get his medicine back from customs. That led to the then chief medical officer being invited to offer an opinion as to whether there was anything in this cannabis stuff as far as medicine is concerned. It only took her two weeks to come back with a strongly affirmative answer, based on the evidence available around the world. That then led to the regulations that the Government passed in November 2018, which have not solved the issue. As the hon. Member for Inverclyde said, only three prescriptions have been made on the NHS.
You will be familiar, Madam Deputy Speaker, as we all are in our constituencies, with the position of multiple sclerosis sufferers. There are about 50,000 people in this country growing their own medicine. They are committing quite a serious criminal offence in the process, but they are trying to treat their health condition. What we have failed to do on the back of the regulations passed in November 2018 is get an evidence-based approach to medicine from cannabis, and educate the health service, prescribing doctors and the rest about the potential benefits and how we should have developed a position from the first go at the regulatory change in 2018.
Dr Julian Lewis (New Forest East) (Con)
My hon. Friend is making a fascinating case, because I, like many other Members of the House, I am sure, thought that this problem had largely been solved. Why does he think it is that the Government or the Department find it is so difficult to grip this? I recall having back surgery 35 years ago and being very grateful for some pain relief. I asked whether I could have some more, but I was told, “No, you can’t, because it is morphia. It is related to heroin and you might get addicted.” If it was possible properly to prescribe something related to heroin for a proper medical condition 35 years ago, why can something similar by way of the arrangements needed not be sorted out for this particular problem?
Crispin Blunt
My right hon. Friend has alighted on a huge area of interest, which is pain control, not least end-of-life pain management. On the difference between opiate-based medicines, which he had, and cannabis-based medicines, the evidence is now all over the place about how much better the latter are, because people do not then have the addiction issues of the opiate-based medicines and they are not knocked out with what is, in effect, a chemical cosh towards the end of their life. They retain much better control of their faculties. They can enjoy a much better quality of life, even where they are being managed in terminal care, let alone where they are managing pain when they are not terminally ill. That is part of a missed opportunity. We are missing a huge bioscience opportunity for the United Kingdom because we have not got the regulations right, or their implementation has meant that these medicines have not begun to find the place they deserve in the pharmacopoeia and among the treatments available to doctors.
Of course, the private sector has stepped in where the NHS has not, and has used the special licence arrangements in the 2018 regulations, so we now have a two-track system. There have been three prescriptions on the NHS, but if someone has the means, they can pay roughly £2,000 a month for cannabis-based prescriptions. People can access cannabis-based medicines if they are prepared to go private and pay for it. That is an assault on the fundamental provisions of the national health service. Desperate parents of seriously ill epileptic children have moved countries to try to access this vital medicine. Of course, we will not know, because they will not tell us, how many have taken the illicit route and got their medicine from criminal sources. No parent or patient should face a prison sentence for treating a medical condition, and prioritising their health and the interests of those for whom they care and provide.
Access to healthcare in our country is, in principle, free at the point of use. Three years into the current system, that ought to be the case for medical cannabis as well. We should have made much more progress. The NHS’s own report on barriers to accessing cannabis-based medicine highlights the stark inequalities in, and problems with, the current regime. Although progress has been made on some preliminary fronts since the publication of that report, the most important outcome—appropriate, risk-based access to these medicines on the NHS—has simply not happened. We are being held back for a combination of reasons, including the risk aversion of a medical profession that is untutored and untaught in respect of the benefits—the endocannabinoid system does not appear in the syllabus for medical students—so the opportunity to have a cadre of doctors with the expertise to prescribe cannabis-based medicines now sits wholly in the private sector, and that expertise is available only at great expense.
This is not just about children with epilepsy, although they are of course the point of the spear, and everyone has huge empathy for them. Huge credit goes to End Our Pain, which got behind the Dingley family and put together the initial petition that got the issue into the public consciousness. That, combined with the Caldwell family, then got us formally over the line. I thought, as my right hon. Friend the Member for New Forest East (Dr Lewis) did, that this was done; but it was not. That is the tragedy: we have built up expectations. Out there in our constituencies, people have legitimate expectations that they can now get this medicine legally—that they do not have to criminally grow it or go to a drug dealer and get God knows what, because trading standards do not exactly apply to the supply of medicine that is criminally delivered.
Behind those children with epilepsy—our hearts go out to the families, and I give them huge credit for the effort they put into the campaign, along with the people from End Our Pain and the associated parliamentary group—there are tens of thousands of people with multiple sclerosis and chronic pain who could, by now, be benefiting from this medicine. The Government have gone to great lengths to try to address the issue of the epileptic children. I pay tribute to the Minister’s predecessor, my hon. Friend the Member for Bury St Edmunds (Jo Churchill), for all the time and passion that she put into engaging with this issue, meeting colleagues who represent epileptic children and getting into the detail of the prescribing barriers and the difficulty of moving cannabis-based medicines across international frontiers.
The Department of Health and Social Care also has to work through the Home Office regulations, which is not easy. If a Minister finds it difficult to enable medicines to be got to children who desperately need them, imagine how difficult it is for everybody else. I have huge confidence in the Minister, my hon. Friend the Member for Lewes (Maria Caulfield), who has empathy and understanding from her service as a nurse. She faces the challenge of having to grasp this complex issue.
The basis of the problem arose more than half a century ago. When cannabis was banned in the United States and then globally under the 1961 convention on drugs, it was put in the most restricted category of all for a reason that should shock and shame us: because 1950s American law enforcement thought that the principal users of cannabis were black Americans, so “It must be absolutely frightful. There can’t be any benefit in this.” Subsequently, cannabis found itself in schedule 1 of the Misuse of Drugs Regulations 2001, which made research almost impossibly expensive. That was utter madness, because the harms associated with cannabis-based medicines are fleeting and it is difficult to find evidence of them. That should be set alongside the potential benefits of treatments that ought to be available to people.
This research vacuum has meant that the Government are caught in a complex situation, and regulators are understandably highly risk-averse. We do not have the necessary skills, understanding or expertise among the medicine and health regulators who currently advise the Government. The medical and research community and the regulatory community are having to play catch-up because of the barriers that we politicians put in place in respect of a policy that has been around for more than 60 years.
Let me suggest to the Minister how we can move this issue forward, do our duty and serve UK citizens who find themselves in the wretched position of having to self-treat their conditions criminally because they cannot access the medicine otherwise. The public expect us to support them, and do not want sick individuals to be prosecuted for trying to obtain a medicine; that is where all registered public opinion sits.
My first suggestion is, of course, on funding for the epileptic children with the most serious conditions. There are so few of them, but the British Paediatric Neurology Association suggested that neurologists assess the parents’ finances before issuing a private prescription, lest they be unable to pay for treatment in future. Is that really the place where we want to be? It is inappropriate and impractical for doctors to make assessments of their patients’ financial circumstances because those patients have been driven into the private sector.
The issue has to do with the public stigma around the word “cannabis”, but that is utterly unrelated to any assessment of the evidence of risk. We have to take ourselves away from coming to a view having seen that word. That is no way for those of us to proceed who are charged with responsibility for legislating, for regulating, and for serving our citizens. If we put our reputation ahead of the evidence and what we ought to enable for our citizens, shame on us.
In the case of Orkambi for cystic fibrosis, my right hon. Friend the Member for West Suffolk (Matt Hancock) and his predecessor, my right hon. Friend the Member for South West Surrey (Jeremy Hunt), were prepared to go the extra mile to find different routes to enabling the use of that drug through a managed access agreement. That shows that we can find creative solutions in this space if we are prepared to look for them. I urge the Government to return to this issue in a creative frame of mind to find a solution that will work.
Sitting behind this is the claim that we are a bioscience leader. Cannabis-based medicines should be part of that bioscience development. In the United Kingdom, another set of drugs—psychedelic-class drugs—suffer from similar problems. Some $6 billion has been invested in companies in north America to develop what is seen as the next leap forward in mental health treatment for addiction, trauma and depression. That sum is completely explicable if one considers the scale of those mental health conditions. If we are on the verge of enabling psychotherapy to work effectively for the people with the most difficult and challenging conditions, it is no wonder that the financial markets found $6 billion to invest in that—but by and large, they are not investing in it here, and this nation is a bioscience leader.
It is the experience of many prescribers of medical cannabis and their patients that medicines that contain additional cannabinoids—not just tetrahydrocannabinol and cannabidiol—are the most effective. As a result, children with treatment-resistant epilepsy are benefiting from prescription of those cannabis-based medicines, although largely privately. However, the manufacturers have struggled to respond to the calls for research from the National Institute for Health Research. The NIHR must engage with manufacturers more directly and, again, more imaginatively, and provide sufficient support and detail to help them through the regulatory minefield and over the regulatory barriers that are stopping the delivery of these medicines.
The fact that the research is so immature is a direct consequence of the blanket censorship of scientific inquiry around cannabis, because the attitude to it was formed, racistly, on the basis of who used it illegally. There was no regard to the evidence on cannabis. It is the same with the psychedelic class of medicines. There is very little evidence of risk, or of deaths arising from the misuse of these medicines in their pure form, and we have perhaps put mental health treatment back five decades by not investing in, and exploring, these medicines in the way that their risk deserved.
We must learn lessons from the way that the policy developed in the lead-up to the November 2018 regulations, which failed to deliver the reform and change that we seek in order to treat sick, epileptic children, and those with so many other conditions.
I offer my hon. Friend the Minister the solution, and I hope that she will take it up. I am conservative in the proper sense—in terms of machinery of Government changes, and in terms of uprooting public administration and then replanting it to solve a problem. However, we are in desperate need of an office for drug control to enable all the interested Departments to take counsel together in Government. When the business is led by the Home Office, we find that its job is to protect the nation and to stop things happening. It has certainly succeeded in that, as far as research is concerned. It is the former Home Secretary, now the Health and Social Care Secretary, who opened up progress on this. I have great hopes that we will push on with this when it is on the health agenda, as well as the science agenda, and the agendas of the Department for Business, Energy and Industrial Strategy and, given the amounts of money being invested, the Treasury. [Interruption.] I am not sure about the level of demand for this debate, Madam Deputy Speaker. I appreciate that everyone would like to get away as soon as they reasonably can.
I am passionate about this, because we can do some real good here. If we push forward with creating an office for drug control, we will bring together all the interests in making progress in this area—for example, the Department for Environment, Food and Rural Affairs with regard to the growing of hemp in the United Kingdom. One begins to see a picture of how some Departments that Carol Black did not mention in her review as engaging in the treatment of those suffering from drug misuse still ought to be involved in the whole drug policy conversation. Opportunities for treatment and for better healthcare are being missed, quite apart from the economic opportunities that should be available for the nation.
Mr Deputy Speaker, I know that you want me to bring my remarks to a close. NHS England and NHS Improvement were tasked in 2019 with designing clinical trials appropriate for children who, in many cases, have made significant improvements and cannot ethically have their treatment withdrawn as would be required in a standard randomised control trial. We can and we must be flexible. The urgency of enabling timely access to medicines for these children was made clear, but it has not happened. These trials must happen and must present a route to access.
Sitting behind that are children who naturally tug at our heartstrings, given their conditions and the extraordinary cornucopia of steroid treatment and everything else that has been thrown at them. They deserve our sympathy. Behind them sit tens, hundreds and possibly millions of our fellow citizens who can also benefit if we get the bioscience, the research and the regulatory framework right. I look forward to conversations with my hon. Friend the Minister as we go forward. I recognise her need and that of her fellow Ministers in the Health and Social Care Department to make sure that the advice of the regulatory agencies that advise them is properly taken. In the first instance, though, those regulatory agencies require the right expertise, knowledge and understanding, and they need to acquire it in order to give her and her colleagues the right advice.
Jeff Smith (Manchester, Withington) (Lab)
I start by congratulating my friend the hon. Member for Inverclyde (Ronnie Cowan), on securing the debate and on his excellent introduction, and my friend the hon. Member for Reigate (Crispin Blunt), my co-chair of the all-party group for drug policy reform, on his wide-ranging assessment of the various complex issues involved in this difficult problem.
It is unusual to have a debate on the same subject on two successive days. The Minister was in Westminster Hall yesterday when we spoke about the slightly more specific issue of cannabis-based treatments for treatment-resistant epilepsy in children. She will have heard the heart-rending stories, which we have heard many times, of the impact of epilepsy on some of those children and their families, with the fear of hundreds of seizures a day, and the way that it completely takes over families’ lives.
We heard very moving testimony from my hon. Friend the Member for Middlesbrough (Andy McDonald) about the death of his son as a result of epilepsy. That was all very difficult. We also heard about the incredible transformation of lives that can be possible as a result of cannabis-based medical products that treat treatment-resistant epilepsy, and the impact on families. I am talking not just about Alfie and the fact that he is no longer in seizures and that he is able to behave like a normal naughty little boy, as he is described, but about Hannah and her family and the fact that she is able to get back to a normal life. That reflects not just the importance of the impact on families, but the wider savings to the public purse through the reduction in hospital visits and the ability of carers to return to work and become part of society again.
We heard about the frustrations of families unable able to get NHS prescriptions and the costs of private prescriptions. I have a constituent who is not a wealthy man, but he pays about £700 a month for cannabis-based products for his grandson; the family were able to get a private prescription, but not an NHS one. We need to help not only all these vulnerable young people, but their wider families too. As my friend the hon. Member for Reigate said, those people are the tip of the spear and get the publicity, but epilepsy is not the only condition that cannabis-based medical products can help. There is abundant evidence from around the world about the effectiveness of cannabis-based medicines against all kinds of conditions, such as multiple sclerosis, pain, anxiety and nausea. There are tests on Tourette’s and there are lots of other conditions that can be treated with cannabis.
In June 2018, Dame Sally Davies—who was then chief medical officer and chief medical adviser to the Government—was looking at the issue for the Government. She said that there was “conclusive evidence” in support of the use of medical cannabis for a number of conditions and “reasonable evidence” in others. It is safe and effective to prescribe these medicines and patients are being given prescriptions via the private route. As we heard earlier, 10,000 private prescriptions have been issued in the UK, but we still face a blockage, as a very tiny number of NHS prescriptions have been agreed. It is a great frustration that the public and many Members may feel that this problem has been solved, when it has not.
I appreciate that there are a number of problems. The Minister has already identified one of them to me: the reluctance of clinicians to prescribe. That is a real problem. The question for us is, how do we give them that comfort to prescribe? There are a couple of ways. The first is evidence, to which I will return in a minute. Another is training. We heard from my friend the hon. Member for Reigate about the difficulty of training clinicians on these issues. The endocannabinoid system—I can never pronounce that word—is a very complex system and it is not part of routine medical training. The 147 different cannabinoids that affect that system are difficult to isolate and the interrelation between them is difficult to identify, but there are people who can provide such training. We need to ensure that it is available to the clinicians, GPs and others who would like to be involved.
Even when a specialist consultant—somebody who is on the register of consultants—has agreed to prescribe, there is another barrier. They have to go to the next level for approval by a higher authority, as I think it is called, which means the trust, the clinical commissioning group or sometimes NHS England, although it is usually the trust. A number of prescriptions have been blocked at that stage, and that is a barrier that private prescribers do not have to surmount, which is a real issue. It seems to be a fault that is built into the system, and I am not convinced that it is a necessary barrier.
We have a set of problems to solve. The Minister knows that I have a private Member’s Bill, the Medical Cannabis (Access) Bill, which is due for debate on 10 December. I hope that it might be an opportunity to address the issue. Somewhat unusually, I guess, I have put that at the disposal of the Government and asked if they will work with me to use this legislative opportunity to find a way forward. I have my own thoughts on how a private Member’s Bill might address the problem and I have made some suggestions that have not yet been supported by Ministers, although in fairness they were supported by the Minister’s predecessor, the hon. Member for Bury St Edmunds (Jo Churchill). I welcome any suggestions or ideas about how we might frame the Bill to get around the problems. Even if we can only make baby steps, I am happy to work with the Government to find a way forward. I really want to make progress, so I make that offer to the Minister again today. I am grateful to her for saying that she will meet me to discuss the issue in the near future.
Let me return to the issue of evidence. As I have said, there is a lot of evidence out there, from around the world, about the effectiveness of cannabis-based products. Lots of work is going on. As the hon. Member for Inverclyde mentioned, the charity Drug Science has a fantastic, academically robust evidence gathering research project called Project Twenty21, in which 1,800 people are currently being treated. I pay tribute to Drug Science. I should declare my interest as a trustee of that charity—an unpaid trustee, of course. The study is an excellent piece of work to try to create a better body of evidence on the issue.
The matter comes down to the medical approvals system in this country, which emphasises so strongly double-blind randomised controlled trials—rightly so, as they are seen as the gold standards of trials. However, that system is set up to look at pharmaceutical products, not at something like whole plant extract medicines. As I mentioned earlier, cannabis contains 147 different cannabinoids, plus terpenoids and various other elements. It is quite a complex interaction on the nervous system. Sometimes a treatment will only work for a particular individual, and individuals have to work out their best balance of treatment.
It is difficult to have randomised controlled trials for such medicines. Leaving aside the moral issue of taking young people who are being treated off their medicine to take a placebo, if it is even possible to get a placebo—from what I hear, I am not convinced that people can really have a placebo for this kind of trial—it is still just a really difficult thing to do. I am not an expert on pharmacology or neurology, but I have spoken to people who are, and some are doubtful that it would be possible to get effective, useful evidence from such randomised controlled trials on whole plant cannabis. It is quite a unique plant that has a unique set of interactions with the body, so it is difficult to carry out those trials effectively.
Randomised controlled trials are not the only method of approval. I am told that 72 drugs have made it on to the approved medicines list without that kind of double-blind controlled study, so there are ways of doing it. The problem is that none of those drugs are plant-based medicines. As I understand it, cannabis is pretty much unique, given the interaction of the elements within it. We need a unique way of looking at the problem and at the evidence.
I made a couple of suggestions to the former Minister about how we might gather evidence and I was knocked back because they might bypass our current system of medical approvals, but I am afraid I have become convinced that part of problem is the current system of medical approvals when it comes to cannabis-based medical products. As my friend the hon. Member for Reigate said, we need Ministers to be flexible and creative, maybe a bit radical—maybe brave, if that is not a word that has been outlawed after its use by Sir Humphrey Appleby. We need Ministers to look at this in a new way. I appreciate that it is really difficult and quite an intractable problem, but we have to look at new ways of breaking the logjam, assessing the evidence base and making it easier for specialists—and perhaps others, such as some GPs—to prescribe.
I appreciate that the Government do not want to give widespread approval for GPs to prescribe these medicines. They are worried about the pressure that GPs might come under from people wanting recreational cannabis; I think that is overstated. Perhaps with some specialist training by an approved body, we might have a register of GPs who are able to prescribe. Most conditions that can be treated by cannabis are what we might call GP conditions—things like pain and anxiety. A survey said that a quarter of GPs would be happy, with the right training, to prescribe medical cannabis. We need to look at how to give people other than specialist consultants on the register a way of prescribing. That is perhaps one way of tackling this problem. Looking at trying to expand the evidence is so important, because there is so much evidence out there. It may not be through randomised controlled trials, but there are lots of other ways we can gather evidence. There are also a number of ways we can build safeguarding into the system, which I am happy to discuss with the Minister, as that might alleviate some of the concern.
The evidence is all around us that cannabis-based products can help patients. Hundreds of thousands of people in the UK are currently self-medicating. One of my relatives does that to treat their IBS. There are lots of conditions that people use cannabis to alleviate. The problem is that most are buying it illegally. It is probably high-THC skunk that they are getting on the streets, which is not the product that is best suited to them. We need to find a way to enable them to use a safer product. Again, my private Member’s Bill may be part of the solution.
I hope we can find a way forward because, as we heard earlier, this is a problem that ought to have been solved by now and has not been. If we do not have a concerted attack on this issue with some new thinking from Ministers, officials and others, then we are condemning people to continue in a situation where they are paying a fortune for their private product, going to illegal drug dealers, or condemned to pain or ill health from other conditions. We have to find a way forward, and I am very happy to work with the Government to try to do so.
Christine Jardine (Edinburgh West) (LD)
It is a pleasure to follow the hon. Member for Manchester, Withington (Jeff Smith). I thank the hon. Member for Inverclyde (Ronnie Cowan) for securing this debate on medicinal cannabis.
I am sure I am not alone in this place in often being asked by people, “What is it that makes you want to be an MP?, “What is it about being an MP that is rewarding?”, or, particularly after days like yesterday, “Is it not frustrating?” When I am asked that, I point them to what happened a couple of years ago, when my constituent Karen Gray came to my office with her wee boy Murray, who, up until that point, had been the subject of lots of conversation and lots of letters back and forward to the Scottish Health Minister and to the then Health Secretary about the availability of cannabis oil. She brought him into the office and he sat and explained to me all about why he liked dinosaurs. That might seem unremarkable. But before then—before he had cannabis oil—Murray was likely to have up to 100 seizures in a day. He had spent much of his life in hospital and missed much of his education, and his parents were worried for his future.
Three years ago, when the then Home Secretary, now Health Secretary, made cannabis oil legal, it gave Murray’s family hope that their lives would change, and their lives have changed, Murray’s life most significantly. But it still is not fixed, because now the specialist who was prescribing cannabis oil for Murray has retired. When they did, earlier this year, they wrote to the Secretary of State asking what was to happen, because there would now be only one clinician in the country prescribing cannabis oil for hundreds of children for whom Epidiolex is not appropriate but for whom cannabis oil does change their lives and keep them safe. I have spoken to Murray’s mum about this. She is of the opinion—and says that the specialist was as well—that many GPs and doctors in this country want to be able to help their patients with cannabis oil, and that will be possible only if the Department of Health changes its policy and encourages the profession to do so.
This is the third debate on this subject that I have taken part in in the past couple of months. Each of them was secured by an MP from a different party. Today’s debate was secured by the hon. Member for Inverclyde, who is a Scottish National party Member. Yesterday’s debate in Westminster Hall was secured by a Conservative Member. I secured the other debate, as a Liberal Democrat Member, and we had support from Labour Members. I am at a loss as to how an issue that is so emotive, and has so much support across this House and across this country, has to keep coming back. We have to keep asking the same questions. We have to keep saying that clinical trials will not work because cannabis oil is not suitable for clinical trials. Even the NHS has said so. In its report of 8 August 2019, it recommended that there should be alternative trials. By that I assume it means observational trials.
I wonder what motivated the Government and the then Home Secretary to change the law: I suspect that he wanted to do it in the best interests of a child, and children, who were suffering and could be helped by that change in the law. I also wonder how frustrated he, and other politicians who took part in that decision, including all of us who worked hard and campaigned for it, must now be that despite that significant—in some terms, massive—change by this Government, we have not made the intended progress. People are still in pain in this country. Families are spending, as we have heard, upwards of £1,000, sometimes £3,000, a month to secure legal medication for their children that they cannot get on the national health service—the national health service of which we are so proud and that is supposed to deliver free-at-point-of-delivery care from cradle to grave.
Crispin Blunt
A few of us have constituents with a child with epilepsy and have invested the time to get a detailed understanding of many of the issues. The problem, as alluded to by my right hon. Friend the Member for New Forest East (Dr Lewis), is that most of our colleagues think we have done it. After the decision was taken in November 2018—or when the licence was given for Billy Caldwell to get his medicine—the conclusion was that one would not be able to find anyone who was objecting, because if one can have medicine from the Asian poppy, why on earth can one not have medicine from cannabis? There was probably no opposition in this place at all. But the tragedy is that the evidence is that we have not done it. We must get back into the complexity. We will support the new Minister in fighting her corner to ensure that people can get these medicines, along with all the other interests that are engaged here too.
Christine Jardine
I thank the hon. Member for his intervention. He is absolutely right; I could not agree more. We all thought it was done, but more importantly, and more upsettingly, so did the families of the hundreds of children, and adults, who would benefit—adults with conditions such as multiple sclerosis for whom it would be life-changing. They all thought it had been done and cannot understand why it is not. I have to be honest: I cannot understand why it is not either, and why it simply cannot be done. Will the Government please consider using observational trials instead of insisting on clinical trials, which are not appropriate?
Daniel Kawczynski (Shrewsbury and Atcham) (Con)
The hon. Lady and I have locked horns on a number of occasions on the radio over the European Union, but I would like her to know that she has support on the Tory Benches, particularly when she talks about children and the conditions they are facing. I hope she will take comfort from the fact that she has support from all political parties in the House in trying to change the legislation on this very important issue.
Christine Jardine
I thank the hon. Member for his comments, and I do take comfort from that, but more importantly, the many hundreds of families watching to see what we do will take comfort from the fact that they have support on the Government Benches as well as the Opposition Benches. I ask the Government and the Minister to take that on board. Will they consider the suggestions that have been made today, as well as using discretionary funding to support those prescriptions that families are currently paying for until we can resolve this issue? Then we can finally achieve what the then Home Secretary and the Government wanted to achieve three years ago when they made cannabis for medical use legal. They did not intend that we would be here now with only three prescriptions issued.
Mary Glindon (North Tyneside) (Lab)
It is an honour to follow the hon. Member for Edinburgh West (Christine Jardine). I congratulate the hon. Member for Inverclyde (Ronnie Cowan) on securing this debate, which, as everyone has said, is yet another debate on the same issue. Three years on from when we had such hope, it is disappointing that we find ourselves still here.
I am going to speak yet again about one of my constituents, a very brave and formidable woman who is known to many in the House, because she has been courageously campaigning for the medical use of cannabis by highlighting the problems she has faced in recent years to access the drug Bedrocan. Lara Smith is a wife and the mother of three children. She was a paediatric nurse and a county fencing coach before her health deteriorated because of cervical and lumbar spondylosis. For over 20 years, she has had 35 different medications, as well as a number of operations for her condition. Unfortunately, she has been left with permanent nerve damage, limited mobility and a constant, annoying and debilitating tremor in her right hand. Her quality of life has been completely impaired. That is not just because of her medical condition, but because of the awful side effects of the drugs she has been prescribed over all those years. This has meant that Lara was not able to be the full-time mother that she wanted to be to her daughters and son.
Fortunately, Lara’s pain management consultant in the north-east prescribed Bedrocan, and the transformation was such that she was able to come off all the other medications. Her young family said that they felt they had their mam back. The downside was that for a time, Lara could access the drug only by travelling to a Dutch pharmacy to collect it on a private prescription. I have said it before, so I will not go into it again, but she made that arduous journey every three months, bearing in mind the pain she was in. She had to notify full details of her prescription and her travel to Border Force each time. The costs of the medication and travel were very expensive for her family, but they thought that the sacrifice was worthwhile, because of the difference the drug made to Lara.
A couple of years ago, I was successful in raising the issue at Prime Minister’s questions. I received a response from the appropriate Minister at the time, who said that
“there should be no barriers to patients getting access to the appropriately prescribed medicine. The Department of Health and Social Care…has been working closely with suppliers and NHS procurement pharmacists to ensure that prescribed CBPM are available when needed.”
If only that were the case.
Fortunately, Lara no longer has to travel to Holland for her drugs—they are prescribed on a private prescription—but her consultant has unfortunately been unsuccessful in obtaining an individual funding request for her, which is a great disappointment to us all. That is because unfortunately the Northumbria trust—it is a well-respected and well-known trust in many ways, and I always support our trust for a lot of the good things it does, but I am rather frustrated in this instance—followed guidelines that do not advocate the use of cannabinoids, citing a lack of evidence for effective pain relief, because of the difference in the trials put forward to prescribe the drugs, and we have already heard about that issue. On that score, there has been no progress. Perhaps the biggest irony of all is that the trust advocates and allows the prescription of synthetic cannabinoids. For Lara’s drug, a synthetic cannabinoid is £588 a month and unfortunately leaves her quite ill; she pays £100 less for her private prescription. Such a state of affairs seems ludicrous.
There is nothing much I can add to what has been said today. All the speeches are always passionate, and Members speak with such knowledge on the subject—knowledge that has had to be acquired over all the years there has been the fight to win the case. I know that the new Minister, having worked with her on all-party parliamentary groups, is compassionate and knowledgeable, so we put great hope in her that we will see some progress after today’s debate and the other debates that have gone before. I wish her the best of luck in taking this forward, and I am sure she knows we are all behind her. We hope there will be change for the adults and children whose quality of life needs to be improved and can easily be improved if some changes are made in law.
Alyn Smith (Stirling) (SNP)
It is a great pleasure to close for the Scottish National party in what has been a consensual and informative debate with a great deal of good sense and passion from all parts of the political compass and all points of the House. I warmly congratulate my hon. Friend the Member for Inverclyde (Ronnie Cowan) on securing this important debate.
It is important that we take good note of the reality on the ground. Passing laws and changing regulations are easy for a legislature, but effecting change on the ground is deeply important for millions of the people who we represent and serve. I have a personal insight to this issue: nine years ago, I was diagnosed with arthritis. It is a family thing. We knew that it was probably in the post. It is well-managed and I am relatively lucky—Versus Arthritis is a great organisation with a lot of good support and advice—but what it has given me is a keen awareness that pain management and chronic medical conditions are life-defining for millions and millions of the people who we serve. Anything that can help alleviate those conditions surely needs to be properly ventilated and worked through for the benefit of those millions of people. Medical cannabis should not be held back by woolly sentiment and outdated thinking. I think there is still a job to be done to move where the state is on that.
I also have a constituency interest, in that in Stirling we host Sapphire Medical Clinics, which is Scotland’s first and so far only medical cannabis prescribing clinic. Since March this year, it has had great success, with upwards of 1,000 referrals of medical cannabis for people across Scotland with chronic pain, anxiety, insomnia and other conditions. That is not to say that medical cannabis is a silver bullet, but it does work for millions of people worldwide, and it deserves to go further. Those 1,000 patients are all part of the UK medical cannabis registry, which has data on 20,000 prescriptions UK-wide, so there is a lot of data being brought through. Sapphire also collaborates closely with the University of the West of Scotland on analysis and research into the efficacy of the treatments. There is a lot of data building, and that is where we need to evolve the thinking of the state in viewing these things.
Obviously I would prefer to see the devolution of drugs policy to the Scottish Parliament. I think we would make a better fist of it than has been made thus far, but there is a challenge to the Minister: let us do it properly and well. Let us make sure that this technology is brought forward. Pending that, there are a number of action points that could be taken, not least in the NHS’s report into the subject, which contains several good points and deserves to be higher up the agenda than it seems to be.
Does the Minister agree that bringing all cannabis prescriptions into the NHS drug dictionary would allow a much better assessment and analysis of the scale of prescription already in existence? There needs to be a change in tone from the Government about drugs policy. We need to view drugs as a health issue through the health prism, rather than the criminal justice prism. If we look at the issue in the right way, we will surely get better answers. I wish the Minister well and I have high hopes that she will agree that that is the way we need to look at it.
Medical cannabis does not work for everybody. It is not a silver bullet, so calls to put things into the NHS system are perhaps premature in some cases, but we need to ventilate that promising technology properly. It could help millions of people. For the people for whom it does work, it works very well, and it could work for an awful lot more. I wish the Minister well in taking it forward. If she does something useful and sensible for the millions of people who are suffering, she will have our support.
Alex Norris (Nottingham North) (Lab/Co-op)
I thank the Backbench Business Committee for granting this important debate and the hon. Members for Inverclyde (Ronnie Cowan), for Edinburgh West (Christine Jardine) and for Reigate (Crispin Blunt) and my hon. Friend the Member for Gower (Tonia Antoniazzi) for securing it. I also thank the cross-party campaigners in this place beyond that group, including the hon. Member for South Leicestershire (Alberto Costa), the right hon. Member for Hemel Hempstead (Sir Mike Penning) and my hon. Friend the Member for Manchester, Withington (Jeff Smith), for all that they have done over the years to put it on the parliamentary agenda.
Progress in making cannabis-based medical products available to those who need them has been slow, so it is right that we have the opportunity to debate the frustrating lack of progress. As hon. Members have said, this is the second debate in two days, which I hope gives those watching confidence that we in this place are taking the issue seriously.
I associate myself with the remarks of the hon. Member for Inverclyde in his opening speech about the families who are dealing with incredible, unthinkable challenges and who handle themselves with such dignity and make such powerful cases. I hope—I feel—that we have done them justice today and will continue to do so. In particular, I hope that the Minister will touch on his points about the limiting factors in research.
The speech of the hon. Member for Reigate was a characteristic tour de force. I always stop to listen when he is talking about the issue, because he speaks with such power. He made the point that it is unacceptably cruel to take effective medicines away from a child, which we all agree with. He linked that to palliative care, and I share the view that we want people at the end of their life to get whatever treatment might make their final days the best that they can be. Actually, that applies to adults throughout their lives: if people are living in pain and do not have to be, I would want to do anything I could to avert that.
The hon. Gentleman spoke about the 2018 regulations and the sense that we thought they had solved it, as the right hon. Member for New Forest East (Dr Lewis) also said. The hon. Member for Reigate gave us a hopeful way forward by concluding that we need to be creative and solution-focused. The Opposition share that view—I do not think there is a lot of politics on this issue—and support coming together to find a practical, effective, safe and risk-aware solution.
My hon. Friend the Member for Manchester, Withington spoke in that spirit. He is fortunate to have been drawn in the private Member’s Bill ballot, which is precious for any right hon. or hon. Member. He is keen to work with the Government. I know him well and know the spirit in which he will work with them, so I hope the Minister will take that up. That private Member’s Bill would be a perfect vehicle to move the issue forward. His point that it is about not just epilepsy was well made. I double underlined the phrase that we need to give clinicians the “comfort to prescribe”, which was elegantly put. I completely support that goal and will come back to it.
The hon. Member for Edinburgh West spoke about her constituency case of Murray. Many right hon. and hon. Members will recognise similar cases in their surgeries. The daftness of that story is that the UK’s prescribing could grind to a halt on the basis of a single person retiring. Where else in the health service would that ever be the case or tolerated? It is an absurd set of affairs.
My hon. Friend the Member for North Tyneside (Mary Glindon) kindly facilitated the opportunity for me to meet her constituent, who is a doughty campaigner, as she says. To hear the impact on her constituent’s life, it is hard to understand why we are not doing everything we can to make sure that she can live with as little pain as possible. I will get on to the counterargument about the lack of evidence, but she is that evidence, because we know what her life was like before and after, so I find that argument hard to accept.
The common theme of the contributions has been frustration or, more positively, a desire to redouble our efforts in this area, which cuts both ways. There are opportunities in research, which I hope the Minister will talk about, with regards to epilepsy, long-term pain relief and mental health. We also need a stronger position on the regulation of products such as cannabidiol, which proliferate on the internet and can be found in various shops, in all sorts of forms, promising all sorts of things that are hard to establish. We need better regulation in that space.
When the Government accepted the therapeutic use of cannabis, it was met, as we have heard, with much relief from campaigners, such as the families of Billy Caldwell and Alfie Dingley, who has now gone 508 days without an epileptic fit thanks to his medicinal cannabis treatment. It has changed his life, but not everyone has been so lucky.
Bailey Williams has been denied access to medicinal cannabis for his epilepsy and his parents are forced to raise £1,200 a month for his treatment. The mother of 11-year-old Teagan Appleby spends about £2,000 a month to treat her daughter’s Lennox-Gastaut syndrome, as she has not received a prescription. In the time that she has been taking that treatment, she has to go to hospital only once—when it ran out. That is the impact on her life.
I think of my constituents and how few, if any, could spare £2,000 a month. Of course, all of them, and I daresay all of us, would go to whatever lengths necessary for our children—that is the tragic paradox—but it is not acceptable. We are letting people down on an issue that we thought we had resolved.
In 2018, cannabis-based products were rescheduled. Guidelines were produced by the National Institute for Health and Care Excellence and three products got through: Epidyolex for rare forms of epilepsy, Nabiximols for multiple sclerosis-related spasticity and Nabilone for side effects from chemotherapy. The regulations said that initial prescriptions must be made by a specialist medical practitioner and, in all cases, would be considered only when other treatments were unsuitable or had not worked.
Dr Lisa Cameron (East Kilbride, Strathaven and Lesmahagow) (SNP)
The hon. Gentleman is making an excellent point. Does he agree that the psychological pressure and stress of having to campaign constantly and raise money at that level is simply unfair? My constituent Lisa Quarrell has had to raise thousands of pounds for her child Cole Thomson and has been under that stress continually for years. It is time for us to work collectively to overcome any hurdles to achieving success.
Alex Norris
I have seen the fundraisers online, as other hon. Members will have. When people have to raise that amount of money each month, they must not be able to do anything else and they must live with that anxiety constantly. We want to relieve people of that as far as we can.
We know that the number getting through has been dreadfully low. The previous Minister said in February that 413 unique eligible patients had been identified, but no estimate had been made of the number who had received prescriptions. End Our Pain believes that only three prescriptions have been issued on the NHS—goodness me, that is not what we thought it would be three years ago. If the Minister has more up-to-date information, we would be keen to hear it, but there is definitely a sense that it is not going anywhere near far enough.
Last year, a Care Quality Commission report found that a meagre 6.5% of cannabis-based items were prescribed on the NHS. Again, that is a paradox because we are told that there is real anxiety about prescribing it, but if people pop it into a search engine, they can find an awful lot of private treatments that do not seem anxious at all—there seem to be fewer shy bairns there. I am not sure that that is quite the defence that those who use it think it is.
It is a matter of justice if people are missing out or are left with the horrendous choice between paying over the odds for medication and suffering. The founding principle—the settled political point—of the national health service is that we do not tolerate that or think that people’s access should be based on their ability to pay, but we are tolerating that here, so I hope we can do better.
Dr Julian Lewis
I have been looking at the Hansard of yesterday’s debate—there is an opportunity for the Minister to refer to it when she makes her remarks—and I see that one of the main points she made yesterday was the fact that there is insufficient evidence on the safety aspects and the possible harm effects. Given that families are paying all this money and finding other ways of getting the cannabis-based products, would it be a way forward if families were asked to sign a waiver if it were prescribed, so that the people doing the prescribing would be protected against any subsequent action if in fact something went wrong? It might be for the family to take that decision on the balance of benefit and harm.
Alex Norris
I am grateful for that intervention. I am slightly torn in the sense that I have absolutely no doubt that families would take it on that basis, but as a former trade union official, I would never have advised a member to sign away their rights. I think that is what we are getting at when the hon. Member for Reigate says that we have to come up with something creative that means we can clear this hurdle, and that is one such option.
Let me link that back to a previous intervention by the right hon. Member for New Forest East on opiates—if you will briefly indulge a thought experiment, Mr Deputy Speaker. If the reverse were true and we routinely prescribed cannabis-based products to deal with pain issues, would anybody really be advocating at the Dispatch Box that we should instead swap them for opiates and that they would be a better alternative? I think the answer to that is an obvious one, and that should be guiding our thinking.
Ronnie Cowan
A vital point was made there about who should be prescribing this. Dr Martinez, the retiring private prescriber of medical cannabis, has written to the Secretary of State for Health and, on the group she prescribes for, she said:
“I know that a majority of the GPs dealing with this group of children wish to prescribe, but, in order to do so, this requires a change of policy from the Health Department because it is CBD medication which has been treated differently to other controlled drugs.”
The solution is there. I get the point that parents can agree to a waiver, but they should not have to. This can be changed, and the Secretary of State for Health has been asked to do this by a consultant.
Alex Norris
That is very handy timing from the hon. Gentleman because I was just about to make that point. Following that retirement, Robin Emerson, the father of Jorja Emerson—he is behind the Jorja Foundation and has been campaigning tirelessly—has written to the Secretary of State and the Prime Minister asking them to intervene, but my understanding is that he is yet to receive a reply. I hope the Minister will commit to that being immediately addressed because this is very important indeed.
I will make a couple of final points before I finish. I listened very carefully to what the Minister said in the debate yesterday—we are in a novel position of having them on consecutive days, which is helpful—and it is clear that the Minister considers it a clinician issue rather than a political one, but that is not working at the moment. We are in a strange situation of there being so much concern about the nebulous long-term effects of these prescriptions that that is seen as better than, say, leaving a child fitting 100 times or more a day. It is rather like not throwing a rope to a drowning person for fear of their burning their hands on it. I find that hard to imagine, but we are in such a situation.
I fear that merely putting this at the door of clinicians is defending the status quo. I feel that we in this place do have agency and, indeed, a responsibility to act. I hope to hear from the Minister that there is going to be a greater drive from the Department to encourage clinicians. My hon. Friend the Member for Manchester, Withington offered suggestions on the training that I know is out there, and again I am keen to hear what we can do to have that picked up more reasonably.
Across this debate and the debate yesterday, clear themes have emerged: better research, or perhaps creative research, as the hon. Member for Edinburgh West said; better engagement with clinicians, again with the points my hon. Friend the Member for Manchester, Withington made; and, for goodness’ sake, immediate relief for families in the system now. They are going through things we would never tolerate for ourselves or would absolutely hate for ourselves, and I feel we that have a real responsibility to step that up.
I think there is broad consensus on this, and we now need to come together on a flexible solution to do it. Just as the SNP spokesman, the hon. Member for Stirling (Alyn Smith), said, we will support the Government if they bring that forward. This is something I think we all share, and the families are watching us and waiting for us to do it.
The Parliamentary Under-Secretary of State for Health and Social Care (Maria Caulfield)
I congratulate the hon. Member for Inverclyde (Ronnie Cowan) on bringing forward this debate. As has been said, this is the second day in a row that we are debating this important issue, and I appreciate the depth of feeling on it. I know there are many Members who wished to speak today but who have not been able to, including the hon. Member for Gower (Tonia Antoniazzi) and my hon. Friends the Members for Dover (Mrs Elphicke)—Teagan Appleby is her constituent—and for South Derbyshire (Mrs Wheeler).
As I said yesterday, I have huge sympathy for the issues, problems and struggles that patients and their families are facing. They are trying desperately to access these drugs. No one wants a resolution to this more than me and the Secretary of State, who, as has had been said a number of times, changed the law when he was Home Secretary to try to resolve this situation.
Yesterday, I confirmed the Government’s absolute commitment to take an evidence-based approach to unlicensed cannabis-based products for medicinal use in order to ensure that there is evidence that they are effective but also safe. A number of colleagues have asked why the Government cannot accept non-randomised controlled trials as evidence. The Government are not involved in the process of licensing the medicines; that is done by the independent regulator. The Government’s responsibility is in changing the law, which has already been done, but I very much take the point that we should be able to influence the speed at which the licensing process can take place. I will point out in my remarks how we are doing that.
I am willing to work with colleagues across the House, whether that is the hon. Member for Manchester, Withington (Jeff Smith), with his private Member’s Bill, or SNP Members. This is a non-political issue that we want to see resolved, but the Government are not the body responsible for licensing medication or assessing the worthiness of the research, whether that is randomised controlled trials or any other form of evidence.
Before I set out what is being done, I want to provide an update on the matter of Bedrocan, because the hon. Member for North Tyneside (Mary Glindon), my hon. Friend the Member for Reigate (Crispin Blunt) and the hon. Member for Inverclyde all mentioned it. The commercial agreement between Transvaal Apotheek and UK specialist medicines manufacturer Target Healthcare is progressing, and the MHRA and the Home Office are working with those companies to ensure that all regulatory standards for manufacturing these medicines are met.
On 16 September, the Home Office granted a six-month licence, which will allow Target to move on to testing its equipment and procedures using cannabis from the Netherlands and validating their production of Bedrocan oils. Departmental officials continue to work closely with the Dutch Government, Transvaal, the Home Office and the MHRA to ensure continuity of supply until domestic production can be established, and I will keep the House updated on progress. I hope that is a little glimmer of hope on that issue.
I am aware that there is huge patient demand for access to medical cannabis, and that many are convinced it is helping them with an array of medical conditions from chronic pain to cancer. To date, however, much of the evidence suggesting cannabis could be effective as a treatment is anecdotal. While that has some strength in observational studies, from the regulator’s point of view it often needs more robust clinical data.
There are two licensed cannabis-based products and one synthetic cannabinoid that mimics the effects of THC, which is the element I think most campaigners are looking for. We do have Sativex to treat severe spasticity in adults with multiple sclerosis, Epidyolex for the treatment of two rare forms of epilepsy and Nabilone for nausea and vomiting, so we are making some progress. I hear from campaigners that the THC element remains outstanding. Those products that are licensed are proof that when manufacturers invest in clinical trials, the potential of cannabis as a medicine can be realised. Clinical trials generate the data needed by our world-leading medicines regulator, the Medicines and Healthcare products Regulatory Agency, to assess for safety, and it is then for NICE to approve the NHS funding element of that.
Let me reiterate that this is a multiple-step process. Orkambi has been mentioned; the issue with that was not licensing—it had a licence—but NHS funding. If we get to the licensing stage, the Government can do a huge amount more to fast-track things and be involved in discussions. Licensing, however, is an independent process, and that is the point at which we are stuck.
Crispin Blunt
I used that parallel as an example. I totally respect my hon. Friend’s point about licensing progress—of course she is correct—but this is about thinking imaginatively to work our way through the problems to the right solution. That applies desperately in this situation, as it did with Orkambi.
Maria Caulfield
Absolutely. The Government are committed to trying to resolve the blockage to licensing, which is the main factor hindering the prescription of these drugs. The Health and Social Care Secretary changed the law when he was Home Secretary, but that was not the end of the issue, and that is why we are taking these next steps. It is important not to dismiss the importance of licensed medication. We know from history that when medication that may have a good clinical effect is not tested thoroughly, there can be grave consequences, just as with thalidomide. The safety of a medicine is as important as its efficacy. I am not casting aspersions on cannabis, but the regulator has responsibility for all medicines, and it takes that issue very seriously.
Dr Julian Lewis
That argument would surely carry more weight if the people doing the testing outlined some sort of timeline and plan for concluding a testing programme, rather than apparently letting things drift on aimlessly for years on end.
Maria Caulfield
I take my right hon. Friend’s point. I will come on to that, and to timelines for the research that is in progress. Many of the products that we are talking about have not been licensed by any licensing authority across the world, including the Food and Drug Administration, the European Medicines Agency and our domestic MHRA. This is not just a UK problem; it is not the UK Government who are holding this back.
As I said yesterday, I encourage manufacturers of these products to invest in clinical trials. Part of the Department’s work is providing funding for the National Institute for Health Research, which is actively opening its arms to charities, academics, researchers, manufacturers and third-sector organisations. Funding is available for clinical trials, if anyone wants to come forward with one, be it a randomised control trial, an observational study, a randomised control trial without a placebo arm, or a phase 1, 2 or 3 clinical study. The MHRA is willing to provide advice and support to any potential applicants who want to conduct a clinical trial or seek a licence for their medicines. There is funding and support; we need researchers to come forward with clinical trials.
Ronnie Cowan
A lot of research institutes are restricted in what they can do because they are trying to access a category 2 product. If it was category 4, life would be a lot simpler for them.
Maria Caulfield
The hon. Gentleman makes an excellent point, and going forward we perhaps need to unblock some of the blockages in that area. I take that point on board.
Clinical trials and the licensing process provide evidence and information that doctors rely on to support their treatment decisions. Many clinicians have fed back that they are reticent to prescribe these products until there is more evidence, because ultimately they are responsible for their patients when it comes to a treatment’s safety and effectiveness. Doctors are particularly unwilling, given the THC element of cannabis products; there is some emerging data and evidence of harm, particularly to children, including effects on the developing brain and heart. That is why the evidence base is so crucial, but I am happy—I say this especially to the hon. Member for Manchester, Withington, who sponsors the Medical Cannabis (Access) Bill—to consider what blockages could be unblocked to speed that process up.
Doctors are right to be cautious when prescribing any product if they are not confident in the evidence base. As I said yesterday, I am clear that prescription remains a clinical decision, as does prescription of any medication. It would be inappropriate for the Government to force clinicians to prescribe a medicine, but we will try to unblock some of the licensing blockages.
Let me highlight some of the studies that are starting to take off. This might have been mentioned, but from 1 April we have the establishment of clinical trials for NHS England and the NIHR. We have introduced a national patient registry, which will record patient outcomes, with a view to its being rolled out across the devolved Administrations. It is England-only at the moment. We are aiming to record the data of those who receive the medicines, and to consider side-effects, efficacy and a whole range of issues, in order to support clinicians working with patients, and to start to build an evidence base.
In addition, a randomised control trial is being set up. It has three arms, which will include one arm with CBD or THC, and one arm with a placebo. We expect it to open fairly soon. Those looking to access these drugs—children in particular—will be able to do so in a blinded way and can take part in the study. If the data come through relatively quickly, that will open up opportunities to submit evidence to the MHRA.
Ronnie Cowan
Who would offer a child who is on medication that stops them having 100 seizures a day a random test that potentially contains a placebo?
Maria Caulfield
I take the hon. Gentleman’s point, but many children are not accessing this medication, and this is a route to that. As I explained in yesterday’s debate, clinical randomised control trials with a placebo arm have extremely strict rules, and if one arm of the study is showing incredible progress and doing better than the other arms, the study must be stopped, patients unblinded, and everyone switched to the arm that is doing the best. In some circumstances, that has enabled people to access drugs under clinical research in a much quicker way. It does have some advantages.
Christine Jardine
That is all very well, but it brings us back to the fact that there are children who are already benefiting from the drugs. Even the NHS has asked whether it would not be beneficial to have an alternative trial, such as an observational one, and to use that evidence, rather than having a clinical trial with all these pitfalls.
Maria Caulfield
I take the hon. Lady’s point, but the MHRA, which is the regulator, and other regulators around the world have a tier of research that they will accept. The randomised controlled trial method is the gold standard, and the more randomised controlled data someone has, the more likely they are to get a trial approved quickly. Of course observational studies will be used. That is why, if researchers have a large group, want to do observational studies—we heard about the Sapphire clinic from the hon. Member for Inverclyde—and come forward with observational data, I encourage them to speak to the MHRA to see whether that is the sort of research that would be acceptable. It is important that they have those discussions with the regulating body, because it may well accept some of that evidence.
Until manufacturers, researchers, academics and those using these drugs in practice come forward with whatever research they feel would be acceptable and have those discussions, we will go round in a circle. I am keen that if observational studies are acceptable, we support them to happen. Whatever it takes, in research terms, to get a licence through, the Government are there, providing funding, advice and support. However, ultimately, they are not the body that can make that decision; but I think there is a willingness around the House to try to find a resolution.
It will take time to generate further evidence and see the results of clinical trials. The Health Secretary and I are committed to doing everything in our power to accelerate this work. There have been some helpful suggestions this afternoon that we may need to go away and look at.
I thank everyone again. Although this is the second debate on this subject in two days, I know that it will not be the last; the private Member’s Bill will come forward next month. I want to put on the record my commitment to this issue. It is extremely difficult. In yesterday’s debate, we heard constituents’ stories relayed by their MPs, including the hon. Member for Middlesbrough (Andy McDonald). They really are very moving testaments, and we want to find a way forward. We have changed the law, but that has clearly not been enough. We need to find a resolution, so that we can get these medications licensed if the clinical evidence is there, and we need to work with the regulator.
Dr Cameron
I know that the Minister is committed to this issue. Could the Government perhaps appoint a lead clinician for this issue, to give clinicians across the United Kingdom confidence, and to drive the issue forward at pace, so that we see movement in the short term?
Maria Caulfield
The hon. Lady makes a good point. If there are clinicians who want to take a lead on this, there is obviously scope to look at that, but we must be clear that we have to license and support research for this medicine in the way we would any other. I have given a commitment today to working with hon. Members on both sides of the House to demonstrate how seriously the Government take this issue.
Ronnie Cowan
I thank everyone who attended the debate and spoke. I want to pull the Minister back to one thing that I asked about. Will she please look at the most recent information from the BPNA? If I am interpreting that correctly, it will make prescribing more difficult. I hope I am wrong, but she has far more medical experience than I have.
We developed a covid vaccine in under a year, and rolled it out across the country to massive numbers of people, and it was free to those who needed it. I ask that we bring the same sense of urgency to this debate. To all the parents and others watching the debate—I know they are watching, because they have been texting me since I sat down an hour and a half ago; many of the questions I put to the Minister came from parents from around the United Kingdom—I say: thank you for driving this campaign forward. I hope that it does not end here, and that the fight goes on—hopefully in an amicable fashion. I hope we can all do better for all of you.
Question put and agreed to.
Resolved,
That this House has considered the matter of the use of medical cannabis for the alleviation of health conditions.
Adjournment
Resolved, That this House do now adjourn.—(Gareth Johnson.)