Medical Cannabis under Prescription

Debate between Lord Field of Birkenhead and Jeff Smith

Monday 20th May 2019 Commons Chamber

[Jeff Smith]

My hon. Friend makes a key point. Those hopes were raised. People were promised medicine but that promise has not been delivered upon. It is a source of great frustration.

[Frank Field]

I cannot quite understand how the mechanics work. If a patient gets a private prescription and they remain in this country, they get the drug, but if a patient gets a national health service prescription, it does not work. How can we have such a system? A person can go to a private doctor and to a chemist, who will provide NHS drugs but will also do a private prescription. Who is preventing them from giving the same prescription to somebody who cannot afford to pay, such as this great socialist who is paying money for his grandchild?

[Jeff Smith]

I am about to come to that point, which is the key question. The root of the problem is that we are not talking about an illegal prescription; these are legal prescriptions, but our NHS is unwilling or unable to make them and deliver on them. The question we need to ask today is, what can Ministers and the Government do to help to sort out the situation? What can we do? It is clearly not good enough for us to say, “Well, Parliament has legislated so we’ve done our bit. It’s now all down to the medical establishment.” The system clearly is not working.

At the root of the issue is evidence. The Government have issued a call for research on this, which is fine as far as it goes, but we need to look creatively at that because research and evidence take different forms. After writing to the Department, I received a letter from a Minister saying that cannabis is legal to be prescribed, but should only be prescribed where there is

“clear published evidence of benefit”.

That little phrase is difficult. Cannabis has been listed under schedule 1 until very recently. When a drug is in schedule 1, it is incredibly difficult to do research on it.

[Frank Field]

We would cut our drugs bill in half if we applied that to all medicines.

[Jeff Smith]

My right hon. Friend makes a good point.

The Minister’s letter said that cannabis should only be prescribed where there is

“clear published evidence of benefit…and need…and where established treatment options have been exhausted”.

My question to the Minister is, do we really think all those hurdles are correct? If cannabis is the best treatment for a condition, we should not have to exhaust all those other options; we should be able to trust our clinicians to prescribe in such circumstances.

The root of the problem is clinicians’ lack of confidence to prescribe. The biggest barrier is concerns over the evidence. The Government have issued a call for evidence and research, but they are insisting on randomised controlled trials, which bothers me greatly. I am really concerned about the insistence on evidence from randomised controlled trials, to the exclusion of other ways of gathering evidence. I strongly advise Ministers and others to go back and look at some of the evidence recently given to the Health and Social Care Committee by Professor Mike Barnes, who is a noted expert on this subject. He has produced a study on the evidence for the efficacy of cannabis for a variety of medical uses. There is plenty of evidence around the world for the efficacy of cannabis for medical use. However, we are not accepting that evidence because it has not been produced in randomised controlled trials.

In his evidence to the Health and Social Care Committee, Professor Barnes said that we are trying to force cannabis into a particular pharmaceutical route with regards to trials, when that is not an appropriate way to go. He said,

“cannabis is not just cannabis…Cannabis is a whole family of plants”

and

“it does not lend itself very well to the standard pharmaceutical approach. It is not a single molecule that we can compare against a placebo. There are over 2,500 varieties of cannabis, each with a different structure…each with subtle differences.

He told the Committee that each variety interacts with the others differently. So which one of those varieties do we pick for our randomised controlled trial for a standard pharma model?

Professor Barnes said that we need to take a range of other evidence into account, including anecdotal evidence. When there are tens of thousands of anecdotes that build an evidence base, there is substantial anecdotal evidence for the efficacy of cannabis for medical approaches around the world.”

--- Later in debate ---

[Jeff Smith]

That is absolutely right. There is almost an irrational fear about the risk of cannabis compared with the risk of some of what we might call more conventional treatments that people are already using.

[Frank Field]

I thank my hon. Friend for giving way again; I am not going to speak in the debate. Is it not true that in all the evidence that has been sent to us by parents, no one has written to say, “I’ve used the drug and it’s made me worse”? All the evidence shows that it either has no effect or leads to a radical improvement.