Medicinal Cannabis: Economic Contribution

(Limited Text - Ministerial Extracts only)

Thursday 20th April 2023 Westminster Hall

[The Minister for Health and Secondary Care (Will Quince)]

It is a pleasure to serve under your chairmanship, Mr Stringer. I congratulate my right hon. Friend the Member for Dumfriesshire, Clydesdale and Tweeddale (David Mundell) on securing this important debate, which would be considerably better attended if it was held on any other day, because I know from my inbox and from speaking to Members from across the House that there is considerable interest in this issue.

Although this is the first debate on this important topic that I have responded to as a Health Minister, I know that the House has debated medicinal cannabis at great length in the past, in good, constructive debates. I appreciate the depth of passion that hon. and right hon. Members from across the House have on this issue. I recently met members of the all-party parliamentary group for access to medical cannabis under prescription and, as mentioned by my hon. Friend the Member for Strangford (Jim Shannon), I visited one of Jazz Pharmaceuticals’s sites to learn more about the industry, the applications of its products—the medicines—and the challenges that it faces. I also learned about the huge opportunities for not just UK life sciences and UK plc, but, importantly, our NHS and patients.

I note that the interest from my right hon. Friend the Member for Dumfriesshire, Clydesdale and Tweeddale is largely a constituency one; he talked about Hilltop Leaf. He has long championed investment in Scotland, particularly in rural and remote areas, where it has sometimes been a challenge in the past to attract certain high-skilled jobs. This issue is an example of that—and here, the investment would be accompanied by research capability. My right hon. Friend has eloquently and articulately made his case. I am very much alive to the fact that this is a complex issue, and complex issues rarely have simple solutions. I will try to respond to as many of the points that he and other hon. Members have made in the available time, which is reasonably substantial—in a Westminster Hall debate, it is rare to have more than seven or eight minutes in which to respond.

As my right hon. Friend pointed out, this issue crosses multiple Departments—the Department for Science, Innovation and Technology, the Department of Health and Social Care, the Department for Business and Trade and, vitally, the Home Office, which has been alluded to, and NHS England. There was mention of the calls to grow the UK CBD industry, and hemp farmers’ harvests. I am straying somewhat out of my health remit for a moment to polish off some of these points, in so far as I have the bandwidth to do so. I understand that the Home Office has no plans to permit cannabis cultivation without a licence—my right hon. Friend pointed to the licensing programme and the challenges thereto—or to remove the distinction between the industrial hemp regime and the standard cannabis cultivation regime. I cannot say anything more specific on that. As I hope my right hon. Friend will agree, it is well outside my area of knowledge and expertise, and my brief. However, I do understand, having done some rudimentary research and obviously from my conversations with Jazz Pharmaceuticals, that this relates to plants being grown outside versus inside, and the use of leaves and flowers specifically.

[Ronnie Cowan]

If the Minister is struggling to understand, I am more than happy to give him a copy of the report by the all-party parliamentary group on industrial hemp and CBD products called “A Plan for a Legal and Regulated UK Hemp and Cannabis Sector”.

[Will Quince]

I thank the hon. Member for that; I will gladly take a copy on the way out. I hope he will excuse the fact that I am not an expert in this field, but I will happily take that report as my weekend reading and read up on the subject. I certainly agree to take this up with my counterpart in the Home Office, as my right hon. Friend the Member for Dumfriesshire, Clydesdale and Tweeddale requested, and I am sure he will, too. I will especially take away my right hon. Friend’s important points on licensing, and on how the Government can support companies that want to invest in the UK, or that are here and want to diversify their agricultural business, and want to get the licences required to grow these products.

[Sir Jeremy Wright]

All of us understand that the Minister does not speak for each of the Government Departments responsible for this area, and I know he will take away from this debate that nobody is arguing that there should not be licensing of this process. There are obvious concerns that need to be met by regulatory intervention. The concern is the fragmentation of the regulatory landscape that applies to those seeking to grow these products. I am sure that the Minister can assist us by helping to better co-ordinate the way in which regulation is applied, as we are not seeking a removal of licensing.

[Will Quince]

I thank my right hon. and learned Friend for his intervention. I think we are probably in violent agreement on this point. I cannot specifically speak to regulation or licensing from a Home Office perspective. We are talking about a controlled drug; that may come as a disappointment to the hon. Member for Inverclyde, but it is—and is likely to remain, I hasten to add—a controlled drug. I will turn later to regulation from the perspective of the Department of Health and Social Care, but it is really important that there be consistency and coherence, and that we treat these products as we would any other medicinal product. However, my right hon. Friend the Member for Dumfriesshire, Clydesdale and Tweeddale makes his point well, and I will raise it with Home Office colleagues.

More broadly on growing a UK CBD industry, I am of course aware of the growing consumer CBD wellness market. One only has to walk down any high street to see CBD products advertised in windows, and indeed in major supermarkets. DEFRA, which I did not mention, and the Food Standards Agency are taking action to regulate this side of the market. Importantly, that will protect consumers by ensuring that only safe, high-quality products are placed on the market. That is vital. Consumers will also be protected against misleading health claims. I was recently told about CBD products that come in aluminium cans, but in fact the CBD remains on the aluminium and is not contained in the product. That is just one example. This is a very complex area that I do not want to delve too much into, as it is very much a DEFRA and Food Standards Agency lead.

The Food Standards Agency is working closely with the Home Office on how CBD products are regulated, considering their composition and the possible presence of a controlled substance. This is very much a live issue, and I am told that the Home Office has sought the advice of the Advisory Council on the Misuse of Drugs. I understand that the Government intend to respond to the ACMD recommendations on this matter shortly.

My right hon. Friend the Member for Dumfriesshire, Clydesdale and Tweeddale and my right hon. and learned Friend the Member for Kenilworth and Southam (Sir Jeremy Wright) both raised a point about regulatory barriers. Not that this reminder is needed, but it is perhaps helpful if I remind the House that cannabis- based medicines are controlled drugs and are therefore regulated by the Home Office, which is responsible for all controlled drug regulation legislation. Then there is the controlled drugs licensing regime, which supports cultivation, research and, where the issue crosses over into the health sphere, clinical trials in the UK. This licensing regime enables the possession, supply, production and import and export of those controlled drugs to support industry, pharmaceutical research and healthcare. However, more and more these products are being grown in the UK, including Jazz Pharmaceuticals, for use in research.

[Ronnie Cowan]

This time, when the ACMD makes recommendations to the Government, will the Government acknowledge and accept them? They have knocked back its recommendations a couple of times in the past, most recently over nitrous oxide.

--- Later in debate ---

[Will Quince]

The hon. Member tempts me—it is always tempting—to respond on behalf of another Government Department and Minister. I mentioned that because it is my understanding that the Government intend to respond to the report and the recommendations. I am not the responsible Minister, so it would not be appropriate to comment, but I will gladly point the hon. Member in the direction of the Home Office Minister who will have responsibility for responding, and will ensure that he has the opportunity to have a conversation with them.

The point I was making is that the overall legislative framework on illicit drugs seeks to control harmful substances while enabling appropriate access to those drugs for legitimate medicinal research and, in exceptional cases, for industrial purposes. The example I touched on is Jazz Pharmaceuticals, which—I do not believe this is a secret—is providing a product for clinical trials here in the United Kingdom. That is something that I think we all welcome. I know that the legislation has recently been reviewed by the independent ACMD, which concluded that no legislative amendments are currently required, as there is not yet sufficient evidence that the law needs amending.

Turning to a key point of the debate—cannabis for medicinal use, which falls firmly within my sphere of influence—I am hugely moved by so many of the cases that I have heard about, and I will come back to the specific cases that right hon. and hon. Members have raised today. These are really difficult, because my overriding priority as a Health Minister must always be to ensure that patients have access to medicines that are proven to be safe and effective. That is the biggest challenge, and it is why I am committed—the hon. Member for Bristol South (Karin Smyth) rightly challenged me on this—to galvanising research in this area; that is key to unlocking so much of this debate.

The prospect of a future in which more licensed— I put the emphasis on “licensed”—cannabis-based products that are proven to be safe and effective can be prescribed on our NHS to help relieve suffering is genuinely exciting. That is where I desperately want us to get to as quickly as possible, but herein lies the problem. There are clinical concerns, which, having spoken to clinicians, I share, about the limited evidence on the safety and efficacy of unlicensed cannabis-based products. Only in a few cases have enough clinical trials been done to prove scientifically that the drug is safe and effective. However—I want to labour this point—progress is being made.

Let me turn to the cases of Sophia and Alfie, which were raised by the hon. Member for Strangford and my right hon. and learned Friend the Member for Kenilworth and Southam. I have two young children and am deeply moved by these stories. The debate around medicinal cannabis often centres on children with difficult-to-treat epilepsy, for whom I think the law was changed under my right hon. Friend the Member for Bromsgrove (Sajid Javid), when prescribing was made legal in November 2018. Of course, as right hon. and hon. Members have pointed out, that was to enable those children to access a product that their families believed would ease the symptoms of their desperately difficult-to-treat conditions, if a prescriber deemed it clinically appropriate.

I know acutely, because I have spoken to campaigners and members of the all-party parliamentary group, that there is disappointment that the law change did not relate to routinely being able to get these products, funded, on the NHS; that is rightly governed by a range of processes and procedures, to ensure the equitable distribution of funding. The NHS prioritises medicines that have proven their safety, quality, efficacy and cost effectiveness. Coming back to the heart of the issue—the hon. Member for Bristol South is right to push me on this—that is why research is absolutely essential, and I will talk about that a bit more in a moment. The Government have done all we can to remove legislative barriers, but it is now largely up to the cannabis industry to prove that its products are safe and effective for children.

[Ronnie Cowan]

What you are saying is that if I can afford to pay for a private prescription, I can access medicine that you are saying is not proven to be effective, because you are not going to allow its use on the NHS; it has to pass other tests. What about bedrocan? That is manufactured in the United Kingdom, so we do not have to import cannabis from the Netherlands anymore. Hilltop Leaf wants to grow and help to produce the product. The supply chain is already there for us, but you will not allow it to be prescribed. You will not train GPs, and you will not give them the legal framework to work in so that they can actually prescribe that for children on the NHS, but if I can afford to buy it privately, I can buy it privately.

[Will Quince]

The hon. Gentleman raises a fair point, but he raises it as if this is something new or novel; it is not. All medicines in this country are either unlicensed or licensed. For use and prescription in the NHS, they need to be licensed. That means that they have gone through both the Medicines and Healthcare products Regulatory Agency process and the National Institute for Health and Care Excellence process, which proves that they are safe, effective and—through the NICE element—cost effective. That is the difference here.

The “cost effective” factor relates to NICE. That is the reason I talk about why it is important that the cannabis industry steps up and proves that its products are safe and effective. I did not talk about cost effective; I am talking about safe and effective, because that element is through the MHRA. Let us not forget that many of these cannabis-based companies are multinational; they are not telling me that they cannot afford to go through the same process that any other pharmaceutical company can go through and has done to get their products prescribed through the NHS. Part of it is research and part of it is those companies stepping up and proving that their products are safe and effective for these children, more generally, through the MHRA process.

[Ronnie Cowan]

I am curious. What we have done is—

[Ronnie Cowan]

The Minister is saying that he is allowing a licence for a product to be manufactured in the United Kingdom, in East Kilbride, so that is okay. We are allowing it to be manufactured here in the United Kingdom—that is all right. We are saying that people cannot get it on the NHS, but it is okay for other people to have it. Surely it has passed all the tests that we need it to.

[Will Quince]

I do not want to labour the point, but the point is that it has not passed those tests. It is either a licensed product or an unlicensed product. To be licensed, a product must go through the MHRA process. That is something that these products have not done to date. Yes, they can be manufactured here and prescribed privately, at the risk of the doctor—the private general practitioner—but for a product to be prescribed on the NHS, it needs MHRA and NICE approval.

There are some exceptions to that, because the law was changed in 2018, as my right hon. and learned Friend the Member for Kenilworth and Southam referred to, for a specialist doctor or for some very specific conditions. He asked why there have been only three prescriptions. I did not know that that was the exact figure, but I will check; regardless, it sounds very low. I suspect that the reason is that the decisions are taken at the doctor’s own risk, and among general practitioners there is reticence to prescribe an unlicensed product that has not gone through the MHRA and NICE process.

[Sir Jeremy Wright]

The Minister is probably right, but I am sure that when he looks at this again he will also want to look at the NICE guidelines that apply, which are extremely restrictive. The risk to an individual doctor from making a decision to prescribe will be perceived to be much higher if the NICE guidelines appear to deter such a prescription. The Minister is right that there are many elements to this, but one of them is how much we encourage doctors to believe that this is the right thing to do. I go back to the point that I was making: there is some logical dissonance here. We have said already that it is right to reschedule these products as far as the Home Office is concerned. We are starting to see prescriptions in the NHS, but not in the numbers that will benefit the maximum number of patients.

[Graham Stringer (in the Chair)]

Order. We have not been short of time this afternoon, and every hon. Member has had the opportunity to speak. Interventions should be brief and to the point.

[Will Quince]

Thank you, Mr Stringer. My right hon. and learned Friend makes a good point. When we meet the members of the APPG, it is very hard not to be moved and to want to do all in our power to bring about the change that people want to see. I have considered the calls to change NICE guidelines, which have recently reviewed the basis of these products, but I am afraid the guidelines are unlikely to change until the evidence base develops, and that will happen through clinical trials and evidence. That is why I say all roads lead back to building an evidence base and a clinical trials base. That is the crux of this debate.

In January, the National Institute for Health and Care Research issued guidance recommending that the NHS prescribe cannabidiol to patients with a rare, seizure-causing genetic disorder, which is, I think, the fifth condition for which a cannabis-based treatment has been approved by regulators and offered to NHS patients in England. I understand that the treatment is also available and approved in Scotland and Northern Ireland. The NHS now funds thousands of these medicines each year.

I mentioned Jazz Pharmaceuticals earlier. I am not sponsored by it; it just happens to be the manufacturer and provider that I visited. It is a good example of the trailblazers in this space that not only create, but undertake the research, manufacturing and—the key part—licensing of cannabis-based medicines. It has shown what can be done. The key is very much in the research.

My right hon. Friend the Member for Dumfriesshire, Clydesdale and Tweeddale mentioned consistency and coherence in policy, which is why it is key that we treat cannabis-based products as we would any other medicinal product that we wanted to prescribe on our NHS. There is an economic case as well, although that is not what drives the Government. My whole focus in this is what is right for our NHS and patients. I am aware that there is huge hope and patient demand for access to medicinal cannabis, and that it is claimed that it can help with an array of medical conditions from chronic pain to anxiety; I believe there is also research under way at the moment on how cannabis-based products might be able to help with psychosis. I very much hope that those trials are successful. That is the right approach.

To date, much of the evidence suggesting cannabis could be an effective medical treatment is anecdotal or observational. As I mentioned earlier, only for a handful of conditions have enough clinical trials been done to prove scientifically that the drug is safe and effective. However, I am acutely aware that there are thousands of patients who now pay to access those unlicensed products on private prescriptions. Having spoken with campaigners and members of the APPG, I also know that some patients believe that funding cannabis on the NHS will reduce overall healthcare costs by alleviating symptoms and reducing the extent of hospital visits and other treatments. I understand and hear that case, but—I apologise for labouring the point; I have to keep coming back to it—before any new medicine can be proven to be cost effective, it must be proven to be safe and clinically effective. That is why research is so essential.

The Labour Front-Bench spokesperson, the hon. Member for Bristol South, asked what steps we are taking. That is a challenging question, because it is a pioneering area of research. Following collaborative work with clinicians and patient representatives, the NIHR and NHS England have confirmed support for two clinical trials into early onset and genetic generalised epilepsy. If you will permit me, Mr Stringer, I would love to use this debate to highlight a tender opportunity that will be launched by University College London in the next few weeks. UCL is seeking a supplier to assist in a world-first randomised control trial comparing cannabis-based medicines containing CBD and THC in the treatment of drug-resistant epilepsies in adults and children. I hope that that tender process is successful and that UCL finds a commercial partner to supply products for the trials so that they can commence as soon as possible.

[Ronnie Cowan]

I have three kids and two grandkids. If one of them was suffering from intractable epilepsy and I had them on bedrocan, and they were either seizure-free or had the condition under control, I would not want to hand them over to a random control test where they might be fed a placebo and therefore incur more damage. Would the Minister?

[Will Quince]

That is a difficult question to answer. We need people to take part in clinical trials, which are the answer to so many of the challenges that we face in the health sphere. That is how we build the evidence base. I do not know what the study will involve in terms of the detail and the potential for a placebo, but I will put the hon. Gentleman in touch with UCL and those who are looking to run the trial so that they can give him a measure of comfort and reassurance. On his point more generally, the biggest risk is that the industry does not engage with the tender process. Notwithstanding the hon. Gentleman’s point, I hope that all right hon. and hon. Members here today will help me by amplifying my call for the cannabis industry to come forward and engage with this pioneering and world-first research. I have also committed to a roundtable with the all-party parliamentary group, and I invite all right hon. and hon. Members in the Chamber today to attend that, too, because it is very important that we hear all of the issues.

Once again, I thank my right hon. Friend the Member for Dumfriesshire, Clydesdale and Tweeddale for securing this really important debate. I look forward to engaging with him and Members from all parties. To the point made by the hon. Member for Bristol South, I am absolutely committed to better determine why the cannabis industry is not, in the way that so many other pharmaceutical companies do, investing in the routine research required to prove that its products are safe and effective. I will of course explore how best to engage with industry on the issue. Until then, I implore companies to explore supplying their products to the UCL clinical trials. As I have said, they will be a world first and will give us the evidence that we need to determine whether the products should be funded in the NHS. I wish them every success. I genuinely hope that they provide that evidence base.

On the matters concerning the cultivation and licensing of cannabis and cannabis-based products, I will, as I promised my right hon. Friend the Member for Dumfriesshire, Clydesdale and Tweeddale, raise that with my counterpart, the Minister for Crime, Policing and Fire, who I know will champion this cause, too. I thank all right hon. and hon. Members for their contributions to this afternoon’s debate.