Medical Cannabis under Prescription

Crispin Blunt Excerpts

Monday 20th May 2019 Commons Chamber

[Crispin Blunt (Reigate) (Con)]

It is of course a pleasure to follow the hon. Member for Manchester, Withington (Jeff Smith), my fellow co-chair of the all-party group on drug policy reform. He and I followed the hon. Member for Brighton, Pavilion (Caroline Lucas) and of course Paul Flynn, who were our predecessors as co-chairs. Madam Deputy Speaker, you have quite rightly made the point about Paul Flynn’s incessant campaigning on this issue. Tragically, for four decades in this House, he was shouting from the outside at an establishment that chose not to listen.

I am determined, in the remainder of my time in Parliament, to devote myself—as my priority issue, apart from all the things that affect Reigate and the nation—to drug policy reform. Obtaining the benefit for British patients of medicine from cannabis is an enormous potential public good. I draw the attention of the House to my entry in the Register of Members’ Financial Interests.

I welcome the Minister to her place. Her colleague Baroness Blackwood owns this issue at junior ministerial level in her Department. However, it is critically important that Health Ministers understand the potential benefit as this medicine from cannabis is developed and the potential economic benefit for the United Kingdom if we take a leading place in this industry. We have the opportunity to do so because we already do take such a place.

The Minister will be aware of the difficulties that the Home Office had when it managed this issue. I congratulate my right hon. Friend the Member for Hemel Hempstead (Sir Mike Penning) on setting up the all-party group on medical cannabis under prescription, and him and the hon. Member for Gower (Tonia Antoniazzi) on their leadership on this issue.

The first urgent question on this issue was asked about Alfie Dingley by me, and my right hon. Friend, who was sitting behind me at the time I asked it, indicated his support on this issue, and he thought he had begun to open up this issue in the Home Office. However, we had the absurdity that that urgent question was answered by the Minister for Policing and the Fire Service. He had been handed the responsibility at 24 hours’ notice from the Drugs Minister, the Under-Secretary of State for the Home Department, the hon. Member for Louth and Horncastle (Victoria Atkins), not because she had any particular interest in drugs from a health perspective—obviously, the Home Office’s responsibilities include protecting the public—but because her husband is associated with British Sugar. It supplies the cannabis for a great potential British success story in the form of GW Pharmaceuticals, which is one of the global leaders in producing medicinal cannabis—just not for the British people. That is something we need to change.

I want to put this issue in its global perspective and its historical perspective. Unless we understand why there is a such a lack of understanding about this issue, and why we are so behind in the research on medical cannabis and why the medical profession is so intimidated by it, I do not think we will get the necessary pressure from the Minister and her colleagues to continue to push for the necessary advance in this area.

The reason we are so far behind lies in racist American policing of the 1950s: frankly, because African-Americans smoked this stuff, it was seen as ghastly and very dangerous. Therefore, in total disregard of the scientific evidence, cannabis was listed in schedule 1 to the 1961 UN convention, which has made it extremely difficult to research its medicinal benefits. The irony is that we have had medicines derived from opiates for an extremely long time—they are standard medical products—yet medicines derived from cannabis were put beyond the bounds of research.

GW Pharmaceuticals owes its leadership in this area to a licence issued by Lord Boateng, when he was the Minister responsible for drugs policy in the late 1990s, that allowed it in exceptional circumstances to conduct research into medical cannabis. That decision was followed by £1 billion of investment in GW Pharmaceuticals. I want the Minister to understand that it is not only GW Pharmaceuticals but a number of billion-dollar companies in North America, particularly in Canada but also in the United States, that are now investing in this area. There is a tidal wave of investor money coming into the medical cannabis business and, to an extent, the recreational cannabis business—obviously we must focus on the former. We need to ask ourselves why so many people are choosing to invest so much money in the potential of this product.

When the hon. Member for Manchester, Withington and I became co-chairs of the all-party parliamentary group for drug policy reform, our third co-chair Baroness Meacher—I pay tribute to the work that she has done to reform this area—emphasised the need to focus our efforts on securing a legal change on medicinal cannabis. In 2016, the all-party parliamentary group commissioned a report from Professor Mike Barnes—we have already heard about his research in this debate—to identify which conditions medicines derived from cannabis had been established to a medical standard to help treat.

By 2016, it was already established globally, to the highest possible medical standards, that such medicines could be used to help treat epilepsy in children and spasticity associated with MS and that they could be used as an antiemetic for those undergoing chemotherapy. However, I want to emphasise that their potential application is very much wider. The problem is that the scientific research base is in its infancy, because we put in place stupid regulations that were driven by the racism of 1950s American law enforcement, which is why cannabis was listed in schedule 1 to the 1961 convention.

The Minister will know that the National Institute for Health and Care Excellence guidelines will focus on four indications: chronic pain, multiple sclerosis, treatment-resistant epilepsy, and nausea and vomiting due to chemotherapy. However, there is substantial evidence—enough to excite investors around the world to invest billions of dollars in the potential of this medicine—that cannabis or cannabinoids will be effective in improving chronic pain in adults, chemotherapy-induced nausea, short-term sleep outcomes in individuals with deep sleep disturbance, clinician-measured spasticity symptoms associated with MS, symptoms of Tourette’s syndrome, anxiety symptoms in individuals with social anxiety disorders and symptoms of post-traumatic stress disorder. I hope that the Minister will understand that, if we can advance the science satisfactorily in relation to anxiety and depression, this is of potentially vast application.

We have to understand the range of interests arrayed against the development of medicines in this area. We should consider how policy has been developed in both North America and Germany, and indeed here, because the development has come not from the medical profession or the pharmaceutical industry but from outside. In the United States, those states that have approved the use of medical cannabis usually started the process through a referendum that then imposed the answer on the state’s legislature. Twelve of the 25 states that have medical cannabis have now moved on and established a market for cannabis for recreational adult use. An important development is that Canada, which has had medical cannabis for some time, last year introduced a market for legally supplied cannabis for recreational adult use.

I quite understand the political need, reflected in the establishment of the all-party parliamentary group on medical cannabis under prescription by my right hon. Friend the Member for Hemel Hempstead and the hon. Member for Gower, to differentiate between medicinal and recreational adult use. We must of course focus on the medicine first. There is a separate discussion to be had about the important criminal justice, societal and public health benefits that would come from being able to protect the public and children by having a legally supplied and properly regulated and licensed market. What has been absent from the wider political debate about this to date is a proper consideration of evidence. We are 50 years behind on the potential benefit to the public because we have been unable to get the evidence, and that is a result of the policy imposed through the 1961 convention.

I want to draw attention to one potential application relating to chronic pain. The United States is now coping with an opioid epidemic. Last year, 63,000 Americans died of an opiate overdose that started in the doctor’s surgery. These were not junkies on the streets; they were people who went to their doctor to get treated for chronic pain. Many of them were prescribed OxyContin, courtesy of Purdue Pharma, in circumstances that are now subject to a class action. When the state of Arizona held a referendum on legalising cannabis, the result was on a knife edge and it was not clear which side would win. I am advised that right at the end of the campaign a substantial slug of money was put in to achieve a no vote. Nobody knew at the time where the money had come from, but my understanding is that it actually came from a business associated with the rehabilitation of opiate addicts, which is truly shocking. To prevent cannabis-based medicines having an opportunity to replace the much more dangerous opiate-based medicines, which have contributed to this terrible level of dependency on a medicine that is profoundly dangerous if taken incorrectly, cannabis had to be kept out of the business.

What I want to say to the Minister is that I am anxious for the Department of Health and Social Care, in taking this issue forward, to clearly understand where all the interests are here, and, if one begins to roll this forward in the years to come with regard to the potential application, to understand what opportunities there are for the United Kingdom as a provider of medicine from cannabis. GW Pharma ought to be reinforced by other companies supplying pharmaceutical grade cannabis-derived medicinal products to people. If the conditions I listed earlier are anything to go by, this will be a multibillion dollar-industry, particularly if we can get a decent slug of the global market.

This is not just about the economic effect, however. This is about the opportunity costs of people continuing to be prescribed opiates when they could be prescribed a cannabis-based medicine. It is about the opportunity costs of people self-medicating with alcohol to deal with the aches and pains of old age, rather than understanding the benefits they could get from cannabis. We are now at the stage—the Minister will have seen the report about people who have a medical condition for which they have a diagnosis who now cannot get medical cannabis—where people are now growing their own. In certain circumstances, they are being arrested for growing their own medicine. Our policy is in a mess. It will need real drive from Ministers to get a grip of all the regulators and the medical, pharmaceutical and patient interests to keep pushing for sensible reform.

I ask the Minister and her team to look around the world at the jurisdictions leading on this issue. Look at what is happening in North America, particularly Canada and New York state, and in Germany. Germany has moved pretty rapidly following a legal action by two cannabis growers producing their own medicine. The German state lost that legal action and it now enables them to grow their own cannabis for medicine, saying that what these people need is pharmaceutical grade medicine from cannabis. Two years on, I think 80,000 prescriptions have been written in Germany for people to get medicine from cannabis. We can move relatively quickly if we have the will.

If we do not have the will, we will see the continuing misery of families with epileptic children who are chronically ill. It is quite right that End Our Pain and the all-party group have focused on those families, led so brilliantly by the Deacon family, with Alfie, and Charlotte Caldwell, with her son Billy. They are the ones who have pushed this over the line. No politician can turn around to mothers and families in circumstances where they have obtained treatment with medicine derived from cannabis and faced up to the cruelty, on their return to the United Kingdom, of that medicine being taken away from them. Billy Caldwell’s case was the one that drove the Home Secretary over the line, issuing a special licence and beginning the process of reform in this area.

I cannot find anyone in this House who does not accept the principle that if we can have medicine from the opium poppy then surely we can have medicine from a cannabis plant. Find me evidence of someone who has died of a cannabis overdose. I am told there is not any. Of course, people have died in certain circumstances relating to mental conditions associated with very heavy use, particularly by young people, of the kind of dreadful stuff sold on our streets by the criminal supply chain. But we have chosen, by the laws we have passed, to put that business in the hands of criminals who are selling the strongest and most dangerous stuff to our children. Trading Standards is not going around measuring it or checking that consumers are over the age of 18 when they purchase it. That is why it is easier for our kids to get this dangerous form of cannabis than alcohol.

We need to get to grips with an awful lot of reform in this area, but the public benefit from the United Kingdom pushing on with the science and supporting research could be huge. We in this House must remain engaged, and Ministers must really push and lead on this. My fellow co-chair of the all-party group on drug policy reform, the hon. Member for Manchester, Withington, made a very important point. There will have to be a bespoke arrangement to regulate and license the system. There is an endocannabinoid system in all animals. That is not taught at medical school. That is not currently part of standard medical training or assessment, but it would appear to be a reason why this stuff works at a common sense level. It is why, among all the people we represent, there is the knowledge that this stuff does work. That is why hundreds of thousands of people are using it to self-medicate for the conditions from which they suffer. We have to bring those people into the legal framework, so they can access the medicines that will make their lives very much easier. Many of the diseases and conditions likely to be treated by medicinal cannabis are the diseases of ageing. It would be infinitely better if people can use a safe medicine such as cannabis, rather than dangerous medicines such as opiates or legal alcohol.

I ask the Minister to push her colleagues to ensure that we do not simply follow down a pharmaceutical path that just assesses medicine as a molecule with a particular individual effect on a particular individual condition. That will not work in respect of medicines derived from cannabis. We have heard the reasons: the complexity of a plant-based medicine that has many thousands of different variants once one starts spinning them out. There should not be a choice between randomised control trials and observational trials. We need to do both. The opportunity for the United Kingdom and the people we represent—both economically in terms of a highly successful business and in improving public health and reducing the danger of opiate use and so on—is there for us to grasp. That is why investors have got it. They understand the opportunities for innovation and investment with real money in this area.

I urge my hon. Friend the Minister, now that the policy lead is in her Department and not the Home Office, to get the rest of the licensing arrangements off the Home Office and get them into a state where we advance public health, advance the economic interests of the United Kingdom and make a huge difference to public health in the UK, making people safer and healthier, and, ultimately, providing much greater value for money than the alternative treatments that people are using at the moment.

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[John Howell]

I accept that point. In cases of children who need cannabis oil, I am aware of it being crowdfunded, which can be a valuable way of proceeding, but it seems a complete nonsense in a country that is proud of its NHS that people should have to go into the public arena to crowdfund a drug.

I have some questions about this short list that the GMC maintains of doctors who can prescribe medical cannabis. How accessible are these doctors, and what is the waiting time to see one? These are practical barriers to people getting the drugs they need.

A young girl in my constituency—her name is not important—has intractable epilepsy and there is a great hope that medicinal cannabis would improve the quality of her life. Many women who suffer the sort of pain and discomfort she suffers during her menstrual cycle take birth control pills, which eases the pain considerably, but she cannot do that because it reduces the efficacy of her epilepsy medication and leads to a radical increase in the number of serious fits. For Hannah—that is her name—her epilepsy is life-threatening, as she is in a high-risk group of epilepsy sufferers who could experience sudden unexpected death in epilepsy syndrome, and we ought to think about how we can make it easier for her to obtain these drugs and so make her life easier. I mention that because to make these points we need to bring this debate back to examples of real constituents.

My second point is that raised by my hon. Friend the Member for Lichfield (Michael Fabricant) about the availability of guidance and training. In respect of both, there is a great lack of information, and it is not just us who lack information; so does the medical profession. We should do all we can to increase doctors’ knowledge and awareness so that, among other things, we can broaden out that list and GPs and family doctors can have the information they need to make decisions. I have no problem with this being a clinical decision rather than a political decision.

[Crispin Blunt]

We are where we are only because a politician, when faced with the inhuman cruelty of taking away from two children medicine obtained overseas when they returned to the UK, in the end refused to do so and issued a special licence. If this medicine is outside the scope of conventional medicine and the conventional assessment of molecular-based medicines, something will have to give if we are to get the benefit.

[John Howell]

I agree with my hon. Friend. The in-principle decision has been taken and the practical decisions now have to be taken by clinicians who are willing and fully trained to prescribe. The press releases and parliamentary answers are full of talk about finding the limit to the use of cannabis as a medicine. I listened to an exchange—I cannot remember who it was with—on its use to treat pancreatic cancer. From memory, I think the Minister gave a rather mealy-mouthed response. We need to think about extending the limits to other diseases.

In conclusion, I go back to where I started and congratulate my right hon. Friend the Member for Hemel Hempstead on securing this debate, but the matter will not rest here. I do not think this will be the last time we have this debate. I hope we see some progress soon.

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[Tonia Antoniazzi]

I do agree. It just does not make sense, which is infuriating, because I like to apply sense and logic to most situations, and the current situation is not logical.

Not being able to access medical cannabis leads people such as Chris and the parents of children with epilepsy to consider alternative ways of accessing cannabis, which—as has already been pointed out—is fuelling a dangerous online trade in which, for all we know, they could be buying anything. That is dangerous and wrong. Clinicians to whom I have spoken often ask parents what they have given their children in addition to over-the-counter drugs. Access to CBD alone has great health benefits that are not recognised by many in the medical profession. The right hon. Member for Hemel Hempstead has referred to its being described as homeopathy. When I say that one of my interests lies in medical cannabis, there will always be someone—even a politician—who will make the pun about wacky baccy, and it is really not appropriate. ‘

There seems to be a theoretical concern about the exposure of children to THC, but that is about recreational use; it is not about medical cannabis. Discussions about the legalisation of cannabis for recreational use and about the rescheduling of cannabis for medical use under prescription must not be conflated in the House. Let me put the position into perspective. The law changed because of one boy, Alfie Dingley, and the campaign spearheaded by his mum, the fantastic Hannah Deacon, who is in the Visitors’ Gallery today.

[Crispin Blunt]

And Billy Caldwell.

[Tonia Antoniazzi]

And Billy Caldwell, yes.

Alfie’s life has been transformed. He has been seizure-free for as long as 300 days, riding a bike and riding a horse. Hannah continues to campaign for parents who cannot gain access to medical cannabis for their children, who need the same treatment for their intractable epilepsy. The fact is that although the law has changed, the rules on access to medical cannabis are even more stringent as a result. Under the guidance provided by the British Paediatric Neurology Association, Alfie would not be eligible for his prescription, which beggars belief. The Government were aware that they were opening the floodgates by providing access for Alfie, but the push-back from certain areas of the medical profession is what is preventing any advance. We have seen that with a number of patients, and it is extremely unfair.

The medical cannabis that is being prescribed is in line with manufacturing practice, which means that it meets European standards. However, these products will have to be subjected to trials that could take three to four years, which is not acceptable to the families with whom we work at End Our Pain. It is not acceptable to the parents of Bailey Williams, who are also in the Gallery. They cannot wait any longer. They did use a CBD, and I think that they are still using it, but it is not working; it has worn off. That is why they need the THC.

These products are available, and they need to be made available to everyone now. There is currently a two-tier system. There are those who have access to medical cannabis because they have the funding, and those who do not because it is not available on the NHS. We must change that.

[Crispin Blunt]

I pay tribute to the hon. Lady for the work she is doing. The situation is worse than that, however: we are driving a number of people into the hands of a criminal supply chain so that they can obtain their medicine, and that cannot be right.

[Tonia Antoniazzi]

I entirely agree, and I am very concerned about it. We have heard in the House this evening that people are growing their own cannabis, and there is a growing trade. There is an online family of people who are helping each other to obtain the most THC possible from different combinations of different plants. It is a complete industry. Why are the Government not getting a grip, and providing a proper, GMP-standard, pharmaceutical product for people?

I also want to talk about the cost, which is extraordinary. Has the Minister or anybody in her office done a cost-analysis? Alfie Dingley’s case provides a classic example: how much has he saved the NHS by not having emergency medication and not using the ambulance service to go into hospital? It seems nonsensical that we are not going down this road.

I want to talk about a couple of my constituents. Only a few weeks ago I had a visit from the parents of a 14-year-old son. My son is 14 too, so their situation struck a chord with me. Their son has intractable epilepsy. Mum has given up her job to look after him—he has a very efficient system around him. He benefits from a ketogenic diet and the next available medicine is Epidiolex. Epidiolex does not contain THC but she wants her child to be on a trial, and the trial is limited. A mum should not come to me begging for her son to be on a trial, but when I spoke to her about medical cannabis with THC she was reluctant to engage because of a fear of breaking the law and of not following the system properly. All our families are following a system. They are at the end of the road in terms of what medicine they can be given, so I want them to be given medical cannabis with THC as soon as we can.

NHS England is drafting terms of reference, and as co-chair of the APPG I appreciate its efforts. These children must have access, however; they must not be waiting three or four years. I urge NHS England to work collaboratively with the devolved nations because we need our children in Scotland, Wales and Northern Ireland to have the same benefits.

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[Seema Kennedy]

I thank the hon. Gentleman for his comments. Prescription is in the hands of the clinician. Whether the prescription is paid for is ruled on locally and I will talk about that later.

I would like to tell my right hon. Friend the Member for Hemel Hempstead that a report, including any recommendations, is expected shortly. We will carefully consider any further action we might take to improve access in the light of that report and the clinical guidelines that are due to be issued by NICE. Members are rightly frustrated with the slow pace, because of the distressing cases and because of examples they have seen from abroad. NICE guidelines have been expedited. They would normally take two years to produce, but these guidelines will come out in half that time, this autumn.

Members have said that patient expectations are not being met and that clinicians are taking an overly cautious approach. With new medicines, we need a strong evidence base. That base is still in development, partly because of the historical overhang.

[Crispin Blunt]

Will the Minister give way?

[Seema Kennedy]

I was about to refer to my hon. Friend, but I will let him speak for himself.

[Crispin Blunt]

The Minister was probably going to pick up the point I made about the assessment of the risk-reward ratio. Humanity has goodness knows how many thousands of years of use of this plant, and it may need a different risk-reward assessment base from the classic medical variety. Sitting in the background for all the people who regulate our medicines is thalidomide and their anxiety about what might happen. We might need a different framework for this.

[Seema Kennedy]

My hon. Friend raises an interesting point, as he always does. The normal NHS medicines governance systems apply, and they are being used to support good clinical practice and safe and effective prescribing, but we could of course do more to educate and support the health profession.

I want to pick up another point raised by my hon. Friend the Member for Henley, about who does the prescribing of these medicines. These are not frontline medicines, and it is right that specialists who have detailed knowledge of all the treatments available for these particularly difficult cases are the ones who should be responsible for prescribing. Cannabis-based products would not normally be considered until a patient was at the stage in their treatment pathway when they were under the treatment of a specialist.

On education, Health Education England has been commissioned to develop an online training package. The aim of the package is to familiarise those working in the health sector with the change in the law and provide straightforward information about the products and what is known about their mechanisms of action. It will support and underpin the knowledge and understanding gained by specialists as experience in prescribing these products grows.