Baroness Meacher
To ask Her Majesty’s Government what plans they have to amend the Misuse of Drugs (Amendments) (Cannabis and Licence Fees) (England, Wales and Scotland) Regulations 2018 to enable general practitioners to prescribe cannabis medicines to patients whose symptoms are being substantially alleviated by such medicines currently purchased privately.
The Parliamentary Under-Secretary of State, Department of Health and Social Care (Lord Kamall) (Con)
The Government share the aim of NHS funding for licensed medicines that have proved safe and effective, rather than patients paying private subscriptions for unlicensed products that are not assured by our medicines regulator. Broadening who can prescribe these products will not achieve this. For this to happen, we need the cannabis industry to invest in clinical trials. Our medicines regulator—and the National Institute for Health and Care Research—has asked it to do so and is ready to support it when it does.
Baroness Meacher (CB)
My Lords, the Minister will be aware of Bailey Williams, aged 20, who has very severe epilepsy and was hospitalised every week throughout his childhood, until the last four years, when he has been on medical cannabis—these have been his best years. His parents are struggling financially and asked Bailey’s consultant to prescribe medical cannabis under the NHS; after all, NICE has approved this in its guidance. The answer was no, but palliative care was an option—palliative care but not a proven medicine that has done so well for this child for four years. The Minister cannot accept that situation. Will he meet MHRA, with me, to discuss the way forward? There has to be a way forward.
Lord Kamall (Con)
First, I thank the noble Baroness for meeting with my colleague, my noble friend Lady Penn, yesterday. When I became a Minister, the Permanent Sec recognised a potential conflict of interest, which I have been told means that I cannot meet with people about this particular issue, but I can answer this Question if I declare my interest. So I better quickly declare it: I used to work for a think tank that received some funding from the medicinal cannabis industry, and I shared a round table. That immediately ruled me out as having a conflict of interest. None the less, I am very happy to facilitate meetings with my ministerial colleagues. As the noble Baroness will be aware, there is a new ministerial colleague in place at the moment. The point remains that we have asked the industry, which makes lots of money in this area, to come forward and fund trials, but it has preferred not to do so.
Baroness Walmsley (LD)
My Lords, I understand that the MHRA is considering extending its compassionate access scheme, particularly regarding the import of Celixir20 from Israel. A number of children with rare forms of drug-resistant epilepsy rely on this medicine. Given the severity of the crisis of access to NHS prescriptions for medicinal cannabis, can the Minister ensure that there are no barriers to the MHRA acting now to extend this scheme?
Lord Kamall (Con)
The noble Baroness raises an important point about working with the importer of those medicines. The MHRA is exceptionally continuing to allow those medicines and is hoping to work with the importer and the Israeli company itself to see whether they will go through the MHRA approval process. In Israel, there are two ways of supplying the product: one is medicinal and the another is for non-medicinal cannabis uses. It has advised us that this is not a licensed medicine in Israel, and therefore we are asking the company to come forward. In the meantime, we are looking at an interim solution.
Lord Dubs (Lab)
My Lords, will the Minister confirm that, for certain very severe forms of epilepsy that affect children, medical cannabis is absolutely appropriate? Can he explain why only three such prescriptions have been issued?
Lord Kamall (Con)
Yes, but I should start by saying that I have been warned a number of times that it is inappropriate for Ministers to tell doctors and clinicians what they can prescribe. In certain cases, given that it has not been regulated as a medicine in this country, doctors can make an exception and ask for it to be prescribed on the NHS. They will go to their CCG—and now to their ICS—and ask for that. However, that has been agreed to in only a few cases.
Lord Farmer (Con)
My Lords, will the Government heed warnings from respected addiction psychiatrists in US states where cannabis has been legalised that medical marijuana acted as a Trojan horse to get recreational use in, that the upward trend in medical potency means that people get addicted, and that super-strength products are associated with a significant rise in cannabis-related psychosis? Are they aware that states are now tightening restrictions on cannabis prescribing, having previously liberalised it, not least given sharp increases in teenage suicides with marijuana in their systems post-mortem?
Lord Kamall (Con)
I thank my noble friend for his question and note his concerns. However, I think we should look at this in two ways: there is medicinal cannabis and there is recreational cannabis, and we must be quite clear on that. Some people clearly want to liberalise both. I cannot comment on my own particular views because I am conflicted on this, but what is really important here is that we take a cautious approach and look at the particular issue of medicinal cannabis. The MHRA is ready to regulate medicinal cannabis; it just needs companies to come forward and spend money on the trials.
Lord Winston (Lab)
My Lords, the Science and Technology Select Committee, which I had the honour to chair some 15 or 18 years ago, looked at the medicinal uses of cannabis. One of the things we clearly showed was that the statement we just heard is not true; in fact, there was no evidence then that the medicinal use of cannabis led to addiction in patients. Indeed, patients who were having medicinal cannabis were trying very hard not to become high and trying to use the doses in very limited amounts so that they could cure their symptoms.
Lord Kamall (Con)
The noble Lord makes a very important point: whatever our personal views, we must distinguish between recreational and medicinal uses of cannabis. We know from observations and many stories that many people believe that they benefit from medicinal cannabis. We know that there is a barrier because companies have not come forward to have it regulated or go through the clinical trials, but we are trying to work with those companies and encourage them to come forward. In fact, we have also found some NIHR research money available to help with those trials. My request to the industry is: “You make a lot of money out of this—please come forward and go through those trials with the MHRA”.
Baroness Jones of Moulsecoomb (GP)
My Lords, there is a suspicion among those of us who think that the Government are being very slow about this that they are arguing it from a medical point of view, just as the Minister has today, but that in fact this is a political decision because the Government’s right wing does not like the idea of cannabis use in this way.
Lord Kamall (Con)
I do not know how to respond to that. All I will say to the noble Baroness is that nothing could be further from the truth. This is clearly an issue based on medicinal cannabis. The noble Baroness will know that my party is a coalition; there are quite a number of libertarians in my party who would take a very different view on banning these issues. What is really important is that, to be licensed as a medicine, it has to be approved by the MHRA; to be approved by the MHRA, except in very exceptional circumstances, you have to go through trials. These companies make a lot of money; they can afford to go through the trials; they are just choosing not to.
Baroness Watkins of Tavistock (CB)
My Lords, NICE has actually supported the limited use of medical cannabis. It has, over many years, supported the limited use of novel drugs in cancer and heart disease, which have been readily available. Does the Minister agree that it is a national scandal that we are discriminating against some of the most vulnerable people with severe epilepsy in our country by not providing this in limited forms on the NHS pre further clinical trials?
Lord Kamall (Con)
What I would say is that it is left up to the doctors, who are able to ask for it to be prescribed on the NHS. In some cases, that has clearly not been accepted and that is why people have to go privately, but the best way to solve this problem is for the industry to come forward and go through trials. The offer is open, the NIHR has money available, but for some reason the companies prefer to sell it unlicensed.
Baroness Butler-Sloss (CB)
My Lords, is there not a way around this? It seems to me extraordinary that we cannot cut through this.
Lord Kamall (Con)
In simple terms, I completely agree. There should be a way around this and I will take this back to the department. In fact, I was quite provocative when I was getting advice on this, but I have also been warned that I am conflicted on this issue, so I will try to push it as long as I am not seen as being in conflict. It is very difficult, but I want to do the right thing.
Baroness Merron (Lab)
My Lords, we look forward to the Minister returning on this point, but to build on the points made by other noble Lords, despite the change in the law, many families are experiencing great anguish in getting treatment for young epilepsy sufferers and are left with little option but to pay thousands of pounds each month. What is the Government’s view on implementing all the recommendations of the recent NHS review of the barriers to accessing prescription cannabis products for medicinal use? If they are not planning to implement all the recommendations, which ones are the Government looking at?
Lord Kamall (Con)
The department has been reviewing the Hodges review and has been looking at the method of data collection. At the moment, I cannot comment on the significance of the statistics in the report, but the important thing here, I think, is that once again we are asking the industry to come forward. It can fund the trials—it can afford this—but for some reason it prefers to sell it unlicensed.
Lord Watts (Lab)
My Lords, just to clarify the point that the Minister made, that it is not for him to tell doctors what medicines to prescribe, is he really saying that if doctors are failing to give their patients the proper and adequate medicines—the only medicines that work—there is nothing he can do?
Lord Kamall (Con)
These are left to clinical decisions, and it is up to individual doctors. Some doctors believe that the evidence is not there to prescribe it; other doctors believe that it is there and they would like to prescribe but they go to their local CCG or elsewhere and they are not given permission or access. What we are trying to do is make sure that there is sufficient evidence, but we really need the companies to come forward. If I can make one appeal to noble Lords, if anyone contacts them from the industry, ask them to come forward and go through the trials.