Medical Cannabis: Alleviation of Health Conditions

Jeff Smith Excerpts

Thursday 4th November 2021 Commons Chamber

[Jeff Smith (Manchester, Withington) (Lab)]

I start by congratulating my friend the hon. Member for Inverclyde (Ronnie Cowan), on securing the debate and on his excellent introduction, and my friend the hon. Member for Reigate (Crispin Blunt), my co-chair of the all-party group for drug policy reform, on his wide-ranging assessment of the various complex issues involved in this difficult problem.

It is unusual to have a debate on the same subject on two successive days. The Minister was in Westminster Hall yesterday when we spoke about the slightly more specific issue of cannabis-based treatments for treatment-resistant epilepsy in children. She will have heard the heart-rending stories, which we have heard many times, of the impact of epilepsy on some of those children and their families, with the fear of hundreds of seizures a day, and the way that it completely takes over families’ lives.

We heard very moving testimony from my hon. Friend the Member for Middlesbrough (Andy McDonald) about the death of his son as a result of epilepsy. That was all very difficult. We also heard about the incredible transformation of lives that can be possible as a result of cannabis-based medical products that treat treatment-resistant epilepsy, and the impact on families. I am talking not just about Alfie and the fact that he is no longer in seizures and that he is able to behave like a normal naughty little boy, as he is described, but about Hannah and her family and the fact that she is able to get back to a normal life. That reflects not just the importance of the impact on families, but the wider savings to the public purse through the reduction in hospital visits and the ability of carers to return to work and become part of society again.

We heard about the frustrations of families unable able to get NHS prescriptions and the costs of private prescriptions. I have a constituent who is not a wealthy man, but he pays about £700 a month for cannabis-based products for his grandson; the family were able to get a private prescription, but not an NHS one. We need to help not only all these vulnerable young people, but their wider families too. As my friend the hon. Member for Reigate said, those people are the tip of the spear and get the publicity, but epilepsy is not the only condition that cannabis-based medical products can help. There is abundant evidence from around the world about the effectiveness of cannabis-based medicines against all kinds of conditions, such as multiple sclerosis, pain, anxiety and nausea. There are tests on Tourette’s and there are lots of other conditions that can be treated with cannabis.

In June 2018, Dame Sally Davies—who was then chief medical officer and chief medical adviser to the Government—was looking at the issue for the Government. She said that there was “conclusive evidence” in support of the use of medical cannabis for a number of conditions and “reasonable evidence” in others. It is safe and effective to prescribe these medicines and patients are being given prescriptions via the private route. As we heard earlier, 10,000 private prescriptions have been issued in the UK, but we still face a blockage, as a very tiny number of NHS prescriptions have been agreed. It is a great frustration that the public and many Members may feel that this problem has been solved, when it has not.

I appreciate that there are a number of problems. The Minister has already identified one of them to me: the reluctance of clinicians to prescribe. That is a real problem. The question for us is, how do we give them that comfort to prescribe? There are a couple of ways. The first is evidence, to which I will return in a minute. Another is training. We heard from my friend the hon. Member for Reigate about the difficulty of training clinicians on these issues. The endocannabinoid system—I can never pronounce that word—is a very complex system and it is not part of routine medical training. The 147 different cannabinoids that affect that system are difficult to isolate and the interrelation between them is difficult to identify, but there are people who can provide such training. We need to ensure that it is available to the clinicians, GPs and others who would like to be involved.

Even when a specialist consultant—somebody who is on the register of consultants—has agreed to prescribe, there is another barrier. They have to go to the next level for approval by a higher authority, as I think it is called, which means the trust, the clinical commissioning group or sometimes NHS England, although it is usually the trust. A number of prescriptions have been blocked at that stage, and that is a barrier that private prescribers do not have to surmount, which is a real issue. It seems to be a fault that is built into the system, and I am not convinced that it is a necessary barrier.

We have a set of problems to solve. The Minister knows that I have a private Member’s Bill, the Medical Cannabis (Access) Bill, which is due for debate on 10 December. I hope that it might be an opportunity to address the issue. Somewhat unusually, I guess, I have put that at the disposal of the Government and asked if they will work with me to use this legislative opportunity to find a way forward. I have my own thoughts on how a private Member’s Bill might address the problem and I have made some suggestions that have not yet been supported by Ministers, although in fairness they were supported by the Minister’s predecessor, the hon. Member for Bury St Edmunds (Jo Churchill). I welcome any suggestions or ideas about how we might frame the Bill to get around the problems. Even if we can only make baby steps, I am happy to work with the Government to find a way forward. I really want to make progress, so I make that offer to the Minister again today. I am grateful to her for saying that she will meet me to discuss the issue in the near future.

Let me return to the issue of evidence. As I have said, there is a lot of evidence out there, from around the world, about the effectiveness of cannabis-based products. Lots of work is going on. As the hon. Member for Inverclyde mentioned, the charity Drug Science has a fantastic, academically robust evidence gathering research project called Project Twenty21, in which 1,800 people are currently being treated. I pay tribute to Drug Science. I should declare my interest as a trustee of that charity—an unpaid trustee, of course. The study is an excellent piece of work to try to create a better body of evidence on the issue.

The matter comes down to the medical approvals system in this country, which emphasises so strongly double-blind randomised controlled trials—rightly so, as they are seen as the gold standards of trials. However, that system is set up to look at pharmaceutical products, not at something like whole plant extract medicines. As I mentioned earlier, cannabis contains 147 different cannabinoids, plus terpenoids and various other elements. It is quite a complex interaction on the nervous system. Sometimes a treatment will only work for a particular individual, and individuals have to work out their best balance of treatment.

It is difficult to have randomised controlled trials for such medicines. Leaving aside the moral issue of taking young people who are being treated off their medicine to take a placebo, if it is even possible to get a placebo—from what I hear, I am not convinced that people can really have a placebo for this kind of trial—it is still just a really difficult thing to do. I am not an expert on pharmacology or neurology, but I have spoken to people who are, and some are doubtful that it would be possible to get effective, useful evidence from such randomised controlled trials on whole plant cannabis. It is quite a unique plant that has a unique set of interactions with the body, so it is difficult to carry out those trials effectively.

Randomised controlled trials are not the only method of approval. I am told that 72 drugs have made it on to the approved medicines list without that kind of double-blind controlled study, so there are ways of doing it. The problem is that none of those drugs are plant-based medicines. As I understand it, cannabis is pretty much unique, given the interaction of the elements within it. We need a unique way of looking at the problem and at the evidence.

I made a couple of suggestions to the former Minister about how we might gather evidence and I was knocked back because they might bypass our current system of medical approvals, but I am afraid I have become convinced that part of problem is the current system of medical approvals when it comes to cannabis-based medical products. As my friend the hon. Member for Reigate said, we need Ministers to be flexible and creative, maybe a bit radical—maybe brave, if that is not a word that has been outlawed after its use by Sir Humphrey Appleby. We need Ministers to look at this in a new way. I appreciate that it is really difficult and quite an intractable problem, but we have to look at new ways of breaking the logjam, assessing the evidence base and making it easier for specialists—and perhaps others, such as some GPs—to prescribe.

I appreciate that the Government do not want to give widespread approval for GPs to prescribe these medicines. They are worried about the pressure that GPs might come under from people wanting recreational cannabis; I think that is overstated. Perhaps with some specialist training by an approved body, we might have a register of GPs who are able to prescribe. Most conditions that can be treated by cannabis are what we might call GP conditions—things like pain and anxiety. A survey said that a quarter of GPs would be happy, with the right training, to prescribe medical cannabis. We need to look at how to give people other than specialist consultants on the register a way of prescribing. That is perhaps one way of tackling this problem. Looking at trying to expand the evidence is so important, because there is so much evidence out there. It may not be through randomised controlled trials, but there are lots of other ways we can gather evidence. There are also a number of ways we can build safeguarding into the system, which I am happy to discuss with the Minister, as that might alleviate some of the concern.

The evidence is all around us that cannabis-based products can help patients. Hundreds of thousands of people in the UK are currently self-medicating. One of my relatives does that to treat their IBS. There are lots of conditions that people use cannabis to alleviate. The problem is that most are buying it illegally. It is probably high-THC skunk that they are getting on the streets, which is not the product that is best suited to them. We need to find a way to enable them to use a safer product. Again, my private Member’s Bill may be part of the solution.

I hope we can find a way forward because, as we heard earlier, this is a problem that ought to have been solved by now and has not been. If we do not have a concerted attack on this issue with some new thinking from Ministers, officials and others, then we are condemning people to continue in a situation where they are paying a fortune for their private product, going to illegal drug dealers, or condemned to pain or ill health from other conditions. We have to find a way forward, and I am very happy to work with the Government to try to do so.