Medical Cannabis: Alleviation of Health Conditions

Julian Lewis Excerpts

Thursday 4th November 2021 Commons Chamber

[Crispin Blunt (Reigate) (Con)]

I am delighted to follow the hon. Member for Inverclyde (Ronnie Cowan) and have worked with him actively in the past few years on this issue, and I wish we had made more progress. I am delighted to welcome the Minister to her place, answering this debate. I have an interest recorded in the Register of Members’ Financial Interests on this, but it is a non-financial interest. It is in recognition of the fact that I chair an organisation that I have set up, the Conservative Drug Policy Reform Group Ltd, whose objective is to find the resources to bring arguments based on science and research into this debate, on all of drugs policy, and to have this academically peer-reviewed, so that the arguments for the huge challenge of a policy change that is required can be put in a proper, calm way, based on all the available evidence and a proper scientific assessment of that evidence.

I say to the Minister at the beginning of my remarks that this issue is not just about medicine from cannabis. That is one element and one casualty of how we have conducted our nation’s drug policy over the past five or six decades, but it is a huge missed opportunity. My journey into this issue arose as prisons Minister, when I saw the impact of taking a criminal justice approach to drug misuse as the first lever, rather than a public health approach. As I saw at first hand, the cost to the criminal justice system is just enormous. Indeed, the Government’s own statistics talk of a cost in the order of £19 billion a year. When one then thinks that half of acquisitive crime in the UK is driven by drug misuse and drug addiction, we see that we should be asking some serious questions about the whole of our drugs policy.

However, that is a separate debate. It was made clear to me when I became the first Conservative to co-chair the all-party group on drug policy reform, when I decided to make this issue one of my central areas of focus, after I ceased to be chair of the Select Committee on Foreign Affairs, that we needed to focus on the arguments for medicine, which had not been able to be researched and developed because of our drugs policy. Focusing on the arguments associated with prohibition and criminal justice, and the parallels with alcohol in the United States in the 1920s and 1930s, is not where the discussion is; the Government are completely clear on where their policy sits on those issues. There is now a big global debate on those issues, with a Global Commission on Drug Policy reform, but it was put to me that we must focus on getting medicines from cannabis for the people who are suffering because they are not able to get access to it.

I became co-chair of the all-party group in September 2017 and I took the advice I was given by people who had been in this field rather longer than I had, and we got behind the family of Alfie Dingley. A national newspaper had got involved and a petition was signed by 300,000 people. The family had gone to a holiday camp in Holland in order to access medicine from cannabis, because they could not get it in the UK. The Bedrocan oil that Alfie was getting then stopped his epileptic fits, but the family had run out of money, so they had to come back to the UK and they could not access the medicine here. On the day of the presentation of the petition to Downing Street, I was able to ask an urgent question in the House on the matter. The issue was raised with Ministers and we were given assurances that the Dingley family were going to be helped to find their way through the complicated licensing process in order to enable Alfie to be able to access the medicine. Three months later, of course, they still had not got it. The cost of the licence application process—simply buying the licences to access this oil—was £20,000; we are talking about £5,000 a licence, so enormous barriers were put in the way.

Then we had the case of Charlotte Caldwell and her epileptic son Billy, who had been in the United States getting treatment. When they returned to the UK, wisely doing so via Dublin, because she lived in Northern Ireland, her GP gave her a prescription for the medicine she had brought back from the US. When the manufacturer of that medicine changed and it became a Canadian company, she needed a new prescription, at which point it all fell apart. The doctor was told, “You are not allowed to prescribe that medicine for this epileptic child to stop him having his fits.” With the support of Richard Branson and others, Charlotte went to Canada, collected the medicine, came back and presented it to customs at Heathrow on the Monday, when it was confiscated. By the Thursday the boy was in hospital fitting, and his consultants were on the steps of the hospital saying, “It really doesn’t matter. What is unacceptably cruel is to take a medicine that is working off a child.” The current Health Secretary, to his huge credit, then issued a special licence for Billy Caldwell to be able to get his medicine back from customs. That led to the then chief medical officer being invited to offer an opinion as to whether there was anything in this cannabis stuff as far as medicine is concerned. It only took her two weeks to come back with a strongly affirmative answer, based on the evidence available around the world. That then led to the regulations that the Government passed in November 2018, which have not solved the issue. As the hon. Member for Inverclyde said, only three prescriptions have been made on the NHS.

You will be familiar, Madam Deputy Speaker, as we all are in our constituencies, with the position of multiple sclerosis sufferers. There are about 50,000 people in this country growing their own medicine. They are committing quite a serious criminal offence in the process, but they are trying to treat their health condition. What we have failed to do on the back of the regulations passed in November 2018 is get an evidence-based approach to medicine from cannabis, and educate the health service, prescribing doctors and the rest about the potential benefits and how we should have developed a position from the first go at the regulatory change in 2018.

[Dr Julian Lewis (New Forest East) (Con)]

My hon. Friend is making a fascinating case, because I, like many other Members of the House, I am sure, thought that this problem had largely been solved. Why does he think it is that the Government or the Department find it is so difficult to grip this? I recall having back surgery 35 years ago and being very grateful for some pain relief. I asked whether I could have some more, but I was told, “No, you can’t, because it is morphia. It is related to heroin and you might get addicted.” If it was possible properly to prescribe something related to heroin for a proper medical condition 35 years ago, why can something similar by way of the arrangements needed not be sorted out for this particular problem?

--- Later in debate ---

[Alex Norris]

I have seen the fundraisers online, as other hon. Members will have. When people have to raise that amount of money each month, they must not be able to do anything else and they must live with that anxiety constantly. We want to relieve people of that as far as we can.

We know that the number getting through has been dreadfully low. The previous Minister said in February that 413 unique eligible patients had been identified, but no estimate had been made of the number who had received prescriptions. End Our Pain believes that only three prescriptions have been issued on the NHS—goodness me, that is not what we thought it would be three years ago. If the Minister has more up-to-date information, we would be keen to hear it, but there is definitely a sense that it is not going anywhere near far enough.

Last year, a Care Quality Commission report found that a meagre 6.5% of cannabis-based items were prescribed on the NHS. Again, that is a paradox because we are told that there is real anxiety about prescribing it, but if people pop it into a search engine, they can find an awful lot of private treatments that do not seem anxious at all—there seem to be fewer shy bairns there. I am not sure that that is quite the defence that those who use it think it is.

It is a matter of justice if people are missing out or are left with the horrendous choice between paying over the odds for medication and suffering. The founding principle—the settled political point—of the national health service is that we do not tolerate that or think that people’s access should be based on their ability to pay, but we are tolerating that here, so I hope we can do better.

[Dr Julian Lewis]

I have been looking at the Hansard of yesterday’s debate—there is an opportunity for the Minister to refer to it when she makes her remarks—and I see that one of the main points she made yesterday was the fact that there is insufficient evidence on the safety aspects and the possible harm effects. Given that families are paying all this money and finding other ways of getting the cannabis-based products, would it be a way forward if families were asked to sign a waiver if it were prescribed, so that the people doing the prescribing would be protected against any subsequent action if in fact something went wrong? It might be for the family to take that decision on the balance of benefit and harm.

[Alex Norris]

I am grateful for that intervention. I am slightly torn in the sense that I have absolutely no doubt that families would take it on that basis, but as a former trade union official, I would never have advised a member to sign away their rights. I think that is what we are getting at when the hon. Member for Reigate says that we have to come up with something creative that means we can clear this hurdle, and that is one such option.

Let me link that back to a previous intervention by the right hon. Member for New Forest East on opiates—if you will briefly indulge a thought experiment, Mr Deputy Speaker. If the reverse were true and we routinely prescribed cannabis-based products to deal with pain issues, would anybody really be advocating at the Dispatch Box that we should instead swap them for opiates and that they would be a better alternative? I think the answer to that is an obvious one, and that should be guiding our thinking.

--- Later in debate ---

[Maria Caulfield]

Absolutely. The Government are committed to trying to resolve the blockage to licensing, which is the main factor hindering the prescription of these drugs. The Health and Social Care Secretary changed the law when he was Home Secretary, but that was not the end of the issue, and that is why we are taking these next steps. It is important not to dismiss the importance of licensed medication. We know from history that when medication that may have a good clinical effect is not tested thoroughly, there can be grave consequences, just as with thalidomide. The safety of a medicine is as important as its efficacy. I am not casting aspersions on cannabis, but the regulator has responsibility for all medicines, and it takes that issue very seriously.

[Dr Julian Lewis]

That argument would surely carry more weight if the people doing the testing outlined some sort of timeline and plan for concluding a testing programme, rather than apparently letting things drift on aimlessly for years on end.

[Maria Caulfield]

I take my right hon. Friend’s point. I will come on to that, and to timelines for the research that is in progress. Many of the products that we are talking about have not been licensed by any licensing authority across the world, including the Food and Drug Administration, the European Medicines Agency and our domestic MHRA. This is not just a UK problem; it is not the UK Government who are holding this back.

As I said yesterday, I encourage manufacturers of these products to invest in clinical trials. Part of the Department’s work is providing funding for the National Institute for Health Research, which is actively opening its arms to charities, academics, researchers, manufacturers and third-sector organisations. Funding is available for clinical trials, if anyone wants to come forward with one, be it a randomised control trial, an observational study, a randomised control trial without a placebo arm, or a phase 1, 2 or 3 clinical study. The MHRA is willing to provide advice and support to any potential applicants who want to conduct a clinical trial or seek a licence for their medicines. There is funding and support; we need researchers to come forward with clinical trials.