Medicinal Cannabis

Debate between Esther McVey and Jim Shannon

Thursday 30th January 2025 Westminster Hall

[Jim Shannon (Strangford) (DUP)]

I beg to move,

That this House has considered medicinal cannabis.

I invite Members to consider the benefits of medicinal cannabis, and I will address the challenges facing patients across the country. It is a pleasure to serve under your chairship, Ms McVey; I always appreciate the opportunity to do so, and it is good to see you in your place. It is also a pleasure to see other hon. Members in the Chamber for the debate. I look forward very much to the contribution from the shadow Minister, the hon. Member for Hinckley and Bosworth (Dr Evans), and particularly to hearing from the Minister. I know that this issue is not the Minister’s responsibility, but she always does her best to answer our queries. I spoke to her before the debate, and there are some things I want to ask her for, if that is all right.

I have been interested in this issue for many years, and I thank the Backbench Business Committee for granting this debate. Many Members will have been introduced to the issue of medicinal cannabis by constituents who got in contact with them. In a way, it is a bit of a niche debate, and those Members who are here have specific asks. The right hon. Member for Dumfriesshire, Clydesdale and Tweeddale (David Mundell) has been a stalwart on this issue over the years. I am pleased to see him here to provide support, and he will probably ask the more difficult questions, given his particular knowledge.

Many Members will have been told by their constituents about the real difference medicinal cannabis has made, or could make, to their lives or those of their families. I asked a former Conservative Minister, Nick Hurd, for a meeting about a constituent some years ago, which he very kindly granted. I asked, “Would it be okay if I brought over the mother of Sophia, the young girl we are trying to help?” I knew that if I brought Danielle over —formidable lady that she is—she would be much more able to push the case, and of course she did. In all fairness to the Minister, he was impressed by her commitment on behalf of Sophia.

In my office, I have a picture of that wee girl when she was a five or six-year-old. At that age, she was having multiple seizures, but through the Minister here and back home, she was allocated medicinal cannabis. Her seizures, which happened multiple times every day, have been reduced to either none in a day or just one. If that is not an evidential base to prove the case for medicinal cannabis, I would like to know what is. That campaign is one that I have been wholeheartedly behind. Sophia Gibson’s mum and dad told me about the needs of their beautiful daughter, and I was absolutely won over to the fight for medicinal cannabis for very defined purposes. I have fought hard for Sophia and those like her.

Sophia’s mum and dad have sent me some information that is relevant to this issue, which I will quote for the record. Sophia was six when we first met, but she is now 13, and everyone involved in her care agrees that

“this is the most stable she has ever been”—

that is what her neurologist and paediatrician said at the last appointment Sophia had just before Christmas. Her school principal described the change Sophia has experienced since receiving this medicine, saying:

“I remember the times poor Sophia had a seizure and we were waiting on ambulances”—

that was when she was five or six, and I remember that. But her principal went on to say:

“what a change it has been for her in school since the medicine.”

Sophia’s mum says:

“with less seizures Sophia’s skills are growing and even her speech therapist and physio have said she’s doing really well all thanks to wholeplant medicinal cannabis.”

Now Sophia has reached her 13th birthday, and I put on my record my thanks to the former Minister for that. He got that medication prescribed for my constituent Sophia—Danielle and Darren’s young girl.

The legislation on medicinal cannabis in 2018 was a significant step forward for patients, as it ended the potential criminalisation of those living with, or just trying to manage, chronic conditions, but access to medicinal cannabis remains limited. There is compelling evidence that it can improve the quality of life of individuals with chronic conditions, including neurological disorders such as Parkinson’s, attention deficit hyperactivity disorder, epilepsy and multiple sclerosis.

However, since medicinal cannabis was made legal, only five patients have been prescribed it on the NHS. I was pleased that young Sophia was one of them, and although she is undoubtedly not a well child, her parents believe that medicinal cannabis has played a part in her still being with them to brighten their days with her smile and her infectious joy. I know young Sophia personally, and I can vouch for the difference I have seen between her at the age of five or six and the 13-year-old she is today. Her improvement has brought joy to her parents, and indeed to every one of us who knows her. Her epileptic fits are down to zero, or one and no more, so that treatment really is important.

I also wish to bring the case of Ben to hon. Members’ attention. Joanne, his mum, is here on his behalf, and their MP, the hon. Member for South Ribble (Mr Foster), would have been here, but unfortunately he had other engagements. I spoke to the Minister beforehand, so she knows what I am going to ask. The hon. Gentleman is very supportive of Ben, Joanne and her husband, and is keen to help.

Young Ben’s story is also incredible, and his mum can vouch for his problems. He was having up to 300 seizures per day. Can you imagine that? That wee boy was having seizures almost every other minute of the day. His parents are providing the medication themselves, but the NHS should be playing that role. It costs the family £2,000 a month, but they love their child and will do anything to help him.

To get the correct medication, people have to go through trials, and Joanne told me that Ben had failed 14 medications. The NHS says that if someone fails seven medications, they go directly on to medicinal cannabis. For the life of me, I cannot understand why that has not happened for young Ben. I ask the Minister whether it would be possible for her to meet Joanne and her MP, so that Joanne can put forward her case and find out why medicinal cannabis has not been approved for that wee boy.

Today, I saw a quick video of Ben when he was having all those problems and showing what he can do when he has access to medicinal cannabis. If ever we needed straightforward evidence that looks us straight in the eye, it is that. These exceptional circumstances require exceptional assistance.

Ben has now had a 98% reduction in seizures, because his mum and dad are paying for the medicinal cannabis, even though they should qualify for it. There seem to be some problems, so I ask the Minister to please meet the parents and their MP, so that they can make that case. I want to put that on the record for Joanne.

There is compelling evidence that medicinal cannabis can improve quality of life. The state of legality, but inaccessibility, is incredibly difficult for clinicians, who believe that their patients merit additional help. Subsequently, patients are not being given the proper care, because of challenges including a lack of awareness of the legislation and poor signposting of the treatments. It is incredibly hard to comprehend why we cannot get everyone on a pathway to better care. But when you meet the mums and dads and some of the children that I and other Members have met, you can understand the alternative and what it means.

A recent survey of 250 practising doctors by Alternaleaf —some of its staff are here in the audience today as well—found overwhelming support for widening the accessibility of medicinal cannabis to treat chronic pain. It found that 84% of UK doctors—the figures are massive —said they would be open to prescribing medicinal cannabis to manage chronic pain if it were part of the NHS toolkit.

I welcome the commitment from the Government and the Secretary of State, who told us in the main Chamber that £26 billion will be available for the NHS over the next few years. That is a good plan, and everybody, no matter their political persuasion, will welcome it, but we need to see some of that going towards this critical issue.

Alternaleaf patients rated the effectiveness of medicinal cannabis to be 8.5 out of 10, versus only 4.5 out of 10 for traditional medication prescribed on the NHS. We are not being critical, but we are pointing to the facts —the evidence is there. If it is better to have medicinal cannabis, let us have it if the alternative is not as effective.

Unlike many conventional painkillers, medicinal cannabis offers relief from symptoms without the high risk of dependency, overdose or debilitating side effects. Only 17% of Alternaleaf patients reported side effects from medicinal cannabis that affected their personal or work life, versus 88% for medication prescribed by the NHS. So there is a case to be made, and there are answers to be given.

Although private specialist clinics and pharmacies such as Alternaleaf support thousands of patients across the UK, they often receive conflicting guidance from regulators on product labelling, which can impact the availability of medicines for the patients who may benefit the most. We are here to raise awareness of that and to put the case for all those patients who might benefit most.

The UK has one of the strictest regulatory regimes in the world for the prescribing of medicinal cannabis, and I agree that that must be the case—that is not an issue. But if there is evidence that medicinal cannabis can do good, then let us act on it.

The regime includes a prohibition against prescriptions being issued electronically to patients. However, we must allow doctors to access medicinal cannabis for their patients in the same way that we allow them to access opioids for them—under strict and certain circumstances. There are rules in place, and I understand that.

I challenge the suggestion that electronic prescribing is always unsafe; it is not. Physical prescriptions are understandably at risk of being lost, damaged or destroyed, whereas electronic records can permit greater real-time oversight and control of prescribing practices, both by private clinics and by regulatory bodies such as the Care Quality Commission. The reason I believe that that could be done electronically is that controlled drugs such as morphine are routinely prescribed electronically on the NHS. If we can do it for morphine, we can do it for medicinal cannabis. That is my point. And it can work as well, which is more important.

However, there must be strict measures in place to ensure that electronic prescription can never be a route to simply legalising cannabis in general. I am not pro drugs in any way, but I see the goodness and benefits of medicinal cannabis. That is why we are here: to prove that case and to put forward the evidential base. Although the benefit of medicinal cannabis to individuals and their families, as well as the economic benefit that is starting to arise, is reason enough to review the current approach and address the challenges, this is absolutely not a call to legalise cannabis wholesale, in the same way that we could never consider wholesale opioid legalisation.

Medicinal cannabis has offered a lifeline to another of constituents, Richard Barber. He spent years struggling with chronic conditions. Initially, an injury led to a misdiagnosed shoulder condition, which resulted in prescribed painkillers that not only proved ineffective, but caused distressing side effects, such as night terrors. Those things cannot be ignored either.

After extensive research, Richard discussed medicinal cannabis with his GP. After trying three different pain medications without success, his GP suggested exploring medicinal cannabis as an alternative treatment approach. Richard was prescribed medicinal cannabis through Alternaleaf and the results have been transformative for his condition. He has regained the ability to do the little things that people take for granted, such as going to the shops and walking his dogs, which he was unable to do in the past due to mobility issues, pain and seizures.

Richard’s story highlights some of the challenges that patients across the UK are facing. When Richard was first prescribed medicinal cannabis, he got in touch with his local police force—that is the right thing to do—to ensure that it was aware of the legality, yet the officers had never been informed about legal medicinal cannabis prescriptions. In fact, one in five police officers does not know that medicinal cannabis is legal and 89% of police officers say that they would benefit from more training on medicinal cannabis. That is not the Minister’s responsibility, but there is a role for another Government Department to look at that. That lack of awareness can manifest in patients being challenged in public when using legal products to manage their conditions, causing unnecessary distress to those in receipt of medicinal cannabis for a medical reason.

Patients are also finding that their landlords are unaware that medicinal cannabis is legal, when the Equality Act 2010 mandates that landlords, housing associations and property managers make reasonable adjustments to accommodate tenants’ medical needs, including the use of prescribed medicinal cannabis where appropriate. There are lots of issues, including the need for better awareness among the police and more accessibility for all our constituents across this great United Kingdom of Great Britain and Northern Ireland.

This debate is not new. The End Our Pain campaign has presented ways forward, and I ask the Minister once again to consider its trials; I am ever mindful that she will be conveying what we are asking for to another Minister. In 2019, the Health and Social Care Committee recommended initiating observational trials for patients already using cannabis-based medicines who cannot enter the randomised controlled trials. That recommendation initially had support from the Government, but that was retracted during the covid-19 pandemic.

In 2023, the Home Affairs Committee reaffirmed the need for increased access to these vital treatments. We all understand that there were pressures from all sides during covid-19, but that unfortunate suspension of support threw the trials back a few years. If the Home Affairs Committee reaffirmed that need for increased access in 2023, however, we need to make sure that that happens, and fully.

There is a notable precedent from 2013, when the Government granted a licence to GW Pharmaceuticals to supply Epidyolex to a child given only six months to live. These are true stories; I am not making any of them up. That decision not only saved that child’s life, but provided valuable evidence to the National Institute for Health and Care Excellence, highlighting the need for similar decisive action today. The treatments make lives better—they save lives—contribute to easing the pain and suffering of children and adults and give peace of mind to families.

End Our Pain proposes two observational trials. The operative word is trial—if they are not suitable, they can and should be shut down. Observational trial 1 would support individuals who are already prescribed medicinal cannabis and cannot undergo a dangerous washout period to enter a traditional RCT trial. Those patients could be funded to provide crucial data on the long-term use of their current and previous cannabis oil medicines. That was the original plan. Observational trial 2 would focus on children in desperate need—just like Sophia, Darren and Danielle’s wee girl, and Ben, the son of Joanne, who is in the Public Gallery. Many families are resorting to the black market due to insufficient private paediatric prescribers and wish to find a regulated, safer option for their children while maintaining their anonymity.

EOP has engaged with Melissa Sturgess, the CEO of Ananda Developments, which is willing to supply trial medicines early to those in urgent need—patients who may not survive the wait for trial recruitment to begin in 12 months. I have heard stories of people who are waiting for medicinal cannabis and whose health has been quite severely affected. Perhaps I view things too simply, but if I see a way of doing things, I think that we should just do those things and make a difference. There are patients who may not survive for the trial recruitment to begin in 12 months, for instance. Where will they be in 12 months? Where will their health be in 12 months? It will be worse, so we should be doing something right now.

EOP also believes that the data from current full extract prescriptions can be a significant aid in developing future treatments and improving long-term outcomes. It is estimated that the observational trial for those who are currently prescribed cannabis-based medicines but who cannot participate in other trials would cost approximately £2.7 million annually. That figure is based on an estimate of 150 children and young adults participating, with an average cost of £1,500 per patient per month. Given the good that that treatment could do and the difference it could make to people’s lives, that is a small price to pay for improved health for all those children and adults who could have a better life as a result.

It is imperative that the commitments to families are honoured, as the consequences of inaction could be devastating for those children. Many of their parents can no longer afford the cost of medication. I have given Members an idea about Joanne, who is here in the Public Gallery on behalf of her boy Ben, and what it costs her to provide the medication each month to ensure that Ben’s life-threatening seizures can be managed. It is really important that we get this matter right.

This debate will help to highlight the real impact that medicinal cannabis can have not only on patients and their families but on economic growth and how we can better spend the £26 billion that the Government have allocated for the NHS. It will also highlight how we can ensure that medicinal cannabis can make a difference for young people in my constituency and in Scotland, Wales and England. The Minister is a compassionate and understanding lady and, by her very nature, she wants to make lives better—that is what we are all here for. We beseech our Government and our Minister to make decisions that we can all support.

The hon. Member for Mid Dunbartonshire (Susan Murray), the Liberal Democrat spokesperson, told me before the debate that she will also talk about some personal experiences. We express such experiences on behalf of our constituents and others who, when we meet them, make us suddenly realise, “Yes, there is a simple way forward. There is a way that we can do it.”

We are also asking for consistency; it should not just be about the postcode that people live in. There has been an allocation of medicinal cannabis, and my constituent is one of those who benefited from that; I believe that others who could benefit should also be allowed to. We need consistency and coherence for the industry and to enable wider access to medicinal cannabis for those who could benefit in certain medically defined circumstances. We need the signposting of treatments, and we need to break down the persistent stigma and discrimination that patients face—perhaps from police, and from employers and landlords.

I have taken up enough time, and I am keen to hear the helpful contributions from other hon. Members who are here to back my plea on behalf of my constituents and others. Collectively, the parties can come together and act. We look beseechingly to the Minister and the Government to ensure that the offer of medicinal cannabis can be available for every child and adult in the United Kingdom of Great Britain and Northern Ireland who can benefit from it. If we have a goal and a way of achieving it, the Government might consider that it is cheaper to have medicinal cannabis available on prescription under very strict conditions to make sure that people’s lives are better. If we do that, we will have done a lot.

[Esther McVey (in the Chair)]

I remind Members that they need to bob if they wish to be called. I also remind Members that, if they wish to speak, they need to be here for both the opening and closing speeches.

Suicide and Mental Health of Young People: Tatton

Debate between Esther McVey and Jim Shannon

Tuesday 26th November 2024 Westminster Hall

[Esther McVey (Tatton) (Con)]

I beg to move,

That this House has considered the matter of suicide and mental health of young people in Tatton constituency.

It is a pleasure to speak under your chairmanship, Mr Dowd. I would like to convey my appreciation to the Minister for replying to this extremely important and sensitive debate on the management of withdrawal from antidepressant medication, specifically selective serotonin reuptake inhibitors, and the profound impact that that process can have on the mental health and suicide risk of young people.

I would like to begin by conveying my sincere thanks to my constituent, Gina Russell, who met me and bravely shared the experience of her daughter, Olivia, who tragically took her life in September 2021, following withdrawal from SSRI medication. Olivia’s mum is unable to be with us in Westminster Hall today. However, I know that she and her family are watching this debate at home, as they are determined to help prevent others having to suffer the same fate as Olivia.

I would also like to place on record my thanks to the charities Mind, Rethink Mental Illness, PAPYRUS Prevention of Young Suicide, as well as to The Children and Young People’s Mental Health Coalition and the House of Commons Library for the information provided to me before this debate. While the information was insightful, it was deeply disturbing, as it revealed that Olivia’s experience of declining mental health as medication was withdrawn was far from unique and was a known risk, which made me determined to pursue this debate on behalf of her family and thus bring Olivia’s story and her family’s suffering to a wider audience.

Let me start by painting a picture of Olivia, who was an intelligent, creative and hard-working 25-year-old who had just left Tatton to live in London. Her parents remember her as wonderful and vibrant—a loving daughter and a loving younger sister to her brother, Luke; a cherished and adored granddaughter; and a loyal, kind and supportive friend. She lit up a room and was admired by all who knew and loved her.

In November 2020, during the pandemic, Olivia became anxious. She began taking an SSRI—citalopram—to manage her anxiety. Initially, Olivia responded well to treatment. However, when the time came to discontinue the medication in June 2021, she experienced a rapid decline in her mental health, which was far worse than what she had previously faced. She then resumed SSRI treatment in August 2021, finally taking her life in September 2021. When she first came off her medication it was without consulting her GP, because she was feeling better. She should have been warned about stopping taking the antidepressant. The family was later to discover that citalopram is one of the most difficult antidepressants to come off.

Tragically, the Royal College of Psychiatrists suggests that between a third and half of people who take antidepressant medications experience withdrawal symptoms to some extent. The severity and duration of these symptoms, and whom they affect, is not certain. In Olivia’s case, the withdrawal symptoms were severe and the resulting deterioration in her mental state ultimately led to her taking her own life. Members should bear in mind that suicide remains the leading cause of death among young people under 35 in the UK, and the mental health of young people has declined alarmingly in recent years.

[Jim Shannon (Strangford) (DUP)]

I commend the right hon. Lady for the very sensitive way in which she is delivering her speech. In Northern Ireland, the worrying thing about suicides is that we have had an 8% increase in the last year. It worries me greatly that people are unable to cope with life. Does the right hon. Lady not agree that the inability of GPs—I think she mentioned this—to refer patients to early intervention on mental health is something that must be tackled? Early support for young people, and easy access to it, is the only way to give a lifeline to those who are struggling at a very young age.

[Esther McVey]

I thank my colleague and friend for that pertinent intervention.

The pandemic lockdown exacerbated the mental health crisis, as it brought isolation, uncertainty and disrupted routines at home, in education and in the workplace, taking an immense toll on young people’s wellbeing. During that period, the use of antidepressants, including SSRIs, rose significantly. Meanwhile, access to in-person medical support was often severely limited, which may have worsened the challenges faced by patients navigating their mental health and medication.

Last year, the closure of England’s only dedicated antidepressant withdrawal helpline, the Bristol and district tranquilliser project, left a further gap in support services for patients, at a time when mental health services are under immense strain. Analysis from the children and young people’s mental health coalition shows that 1.5 million children and young people could need new or increased mental health support as a result of the pandemic.

Those factors combined to create a perfect storm for young people struggling with mental health challenges, with many prescribed SSRI medication as a solution by their medical practitioners. It is important to note the life-changing and positive impact that such medication has had on many people across the country, and I do not seek to contest that or the ability of those medications vastly to improve the mental health of many patients. However, we must also acknowledge that the process of withdrawing from SSRIs can be fraught with challenges that leave patients vulnerable.

In Olivia’s case, her family believed that she was left in the dark. Her mother recalls that the information provided by her GP was limited and did not adequately warn of the risks of sudden or poorly managed withdrawal. As a result, following her death, the exceptional decision was taken by the coroner to produce a prevention of future deaths report. It found no evidence that Olivia was explicitly warned about the risks of relapse or the potential signs of withdrawal, or told that she might feel worse before feeling better. The report concluded that while advice may have been given, it was not conclusive and concern was expressed regarding the inconsistency of advice that each GP might give patients. The report could not say with confidence that every GP within Olivia’s practice was discussing the key risks associated with SSRI medication withdrawal.

That requires our immediate attention, as the principle of informed consent, which underpins our healthcare system, requires that patients are fully aware of the benefits and risks of any medical procedure or treatment. The General Medical Council’s professional standards for decision making and consent stipulate that doctors’ discussions should recognise the effect of the patient’s individual clinical circumstances on the probability of benefit or harm occurring.

Guidance from the GMC acknowledges that the amount of information doctors provide to patients can vary due to time constraints. Where such time constraints exist, doctors are encouraged to involve other medical professionals, such as clinicians, or to refer patients to the patient information leaflet accompanying their medication. Patients are legally entitled to a patient information leaflet with their prescriptions, but the responsibility for providing it lies with pharmacies. That places the onus on patients, potentially in a vulnerable position, to navigate complex decisions alone. The leaflets are often lengthy and rely on a patient reading and understanding information provided.

The issue is compounded by outdated guidance. Until recently, guidance from the National Institute for Health and Care Excellence—NICE—suggested that withdrawal symptoms typically last one to two weeks. That has now been updated to reflect the fact that symptoms can be more severe and prolonged, but the updates have not yet translated into comprehensive and systematic changes to ensure that patients are adequately supported. Inconsistent guidance on antidepressant withdrawal has resulted in many patients experiencing distressing and debilitating symptoms. Patients have been misdiagnosed as suffering from a relapse of their original mental health condition, and others have been left fearful about stopping using their antidepressants. That may have contributed to many individuals staying on their antidepressant medication for longer than is necessary, with a report in 2023 suggesting that 2 million people are taking antidepressants for five years or more.

What improvements can be made to ensure the better facilitation of SSRI withdrawal? Olivia’s family believe that there are measures that could be taken that would go far in protecting patients when withdrawing from the medication. A move as simple as placing a warning label on the packaging of SSRI prescriptions would be a straightforward way to convey the dangers of the medication. It would not replace the more comprehensive information provided in a patient information leaflet, or the guidance of a GP. However, it would act as a safeguard in circumstances should those fail. The safety of patients’ prescribed medications must be guaranteed, not left to change based on appointment time constraints or whether a patient has read in full the often lengthy patient information leaflet.

The story of Olivia and her family is a painful reminder of the urgent need to address the risks associated with SSRI withdrawal, and the broader mental health crisis facing young people today. While SSRIs have transformed countless lives, we cannot overlook the vulnerability of those navigating withdrawal. We owe it to families like Olivia’s to ensure that no one feels unsupported or uninformed when taking such important decisions. Simple measures, such as enhanced warnings on medication packages, improved guidance for medical practitioners and comprehensive advice can make the process of withdrawal palpably easier and safer, potentially offering better outcomes for individuals navigating the complex process of withdrawal from SSRIs.

I would be grateful for the Minister’s consideration of the issues I have discussed. Finally, in Olivia’s instance, the coroner produced a prevention of future deaths report, so I ask the Minister how such a report can become wholesale advice to the medical profession? Will he work with me to ensure that it does, in order to prevent lives like Olivia’s being cut tragically short?