Medical Cannabis (Access) Bill
Debate between Katherine Fletcher and Crispin Blunt
Katherine Fletcher
My hon. Friend anticipates a couple of points I was about to make. I am talking not just about the individual who is prescribing, but about the medical system. There are rightly in our wonderful NHS medically qualified people engaged in lots of layers—my hon. Friend the Member for Gedling (Tom Randall) talks about bureaucracy—but they are people who have taken the Hippocratic oath. That is not just the person on the one-to-one with patients; it goes all the way through the system, and that is what I am worried about, basically.
Crispin Blunt (Reigate) (Con)
Where my hon. Friend talks about the challenge that faces us, she is absolutely on point. The medical profession of course wants a reliable pharmacopeia to be able to turn to, with all the supporting evidence and the rest. The problem that our profession has inflicted on our constituents is that we are 50 years behind in the research. Outside the regular pharmaceutical assessment there is all the knowledge that is on the streets. It is unreliable, but it is there, so people believe that the medicine works in all sorts of ways. We have a responsibility in this place. People are obviously turning to the criminal supply chain to get such products. That is our fault, and the hon. Member for Manchester, Withington (Jeff Smith) is trying to find a way through so that we can get the service to patients that they deserve. That is why I think this Bill at the very least deserves a Second Reading, so that these issues can be pursued in Committee.
Katherine Fletcher
I am not sure I completely agree with my hon. Friend on the translation between the two. He almost makes my point for me. He talks about the ubiquity of cannabis on the streets, which I recognise, and the normalisation of that being within people’s purview.
Crispin Blunt
There is a wholesale difference between people using cannabis for recreational purposes, which we have made illegal and is one for debate, and people using medicines—medicines that we have made illegal and stopped the research—for therapeutic purposes. That is a quite different issue.
Katherine Fletcher
I thank my hon. Friend for the clarification. I think I might have used slightly clumsy language. What I am trying to get at is that for therapeutic use, there is still a required research standard. While cannabis is ubiquitous and lots of people use it for non-therapeutic and currently not legal uses—to quote Marshall Mathers III:
“Marijuana is everywhere, where was you brought up?”—
that does not translate into something that I feel I am comfortable in asking clinicians to engage with.
I want to develop my argument. If I may, I will mention my hon. Friend the Member for Crewe and Nantwich (Dr Mullan) and the five years of blood, sweat and tears—literally, I imagine—through medical school to achieve his title of doctor and take the Hippocratic oath. For those of us who have not gone through that journey, it is worth listening to the oath. The original version—its language is a bit dated now—is:
“I will use my power to help the sick to the best of my ability and judgement; I will abstain from all intentional wrong doing or harm”.
I think that touches on the point my hon. Friend the Member for Penrith and The Border (Dr Hudson) made about how, to avoid doing harm, there needs to be some certainty either way. In its more up-to-date form—this is the oath that doctors from the University of Exeter take—it states:
“I…pledge”—
I am not pledging myself—
“that I will do my best to serve humanity—caring for the sick, promoting good health and alleviating pain and suffering.”
Doctors are coming in wanting to do that, and I do not think the “blockage” that was referred to is anything to do with intention or fuddy-duddyness. Another of the lines they say is:
“I will care for all patients equally and not allow prejudice to influence my practice.”
Again, any doctor looking at a child as sick as Ben can be when his seizures are bad are not, having taken that oath, going to go, “Oh, well, there’s something I could prescribe.” Forgive me for continuing to emphasise the point, but the oath goes on:
“I will respect the autonomy and dignity of my patients, and will uphold their confidentiality. I…support…teachers, colleagues and all those who sustain the NHS.”
Then it gets to these lines:
“I shall never intentionally cause harm to my patients, and will have the utmost respect for human life.
I will practice medicine with integrity, humility, honesty and compassion.
I recognise that the practice of medicine is a privilege with which comes considerable responsibility and I will not abuse my position.”
This oath is a signifier of the integrity of individual doctors and medical ethics. It is their loadstone at the core of what they do, and I agree with them that it needs to be protected at all costs. Each doctor needs to weigh their own decisions, but for these complex cases—especially for some of the people who, by anecdote and, as I would put it, a good old case of looking at, have hugely benefited from medical cannabis—there is not one doctor in the system, but a series of them. While Ben has secured one NHS professor’s support for prescription and one private doctor’s support for prescription—I draw no distinction between the scale of the personal challenge and the qualifications that somebody has regardless of where they work—other medically qualified professionals within the CCG or funding panel are saying that they need more evidence.
Katherine Fletcher
I thank my hon. Friend. I reassure the House that it is not only a surname that we have in common.
I think we are getting somewhere. We need a scientific evidence base that we can prescribe to doctors or the system more broadly that will give them more confidence—or, as the hon. Member for Manchester, Withington suggests, effectively a bypass mechanism that says, “I know we haven’t got any evidence, but on this we’ll have to look at the very compelling but relatively small numbers.” There is an implication that we should just throw out what is working very well.
This is where the hon. Member might welcome what I am trying to get at—well, he might. The gold standard randomised controlled trial requires a very strongly controlled placebo. There are two cohorts of people who absolutely do not know whether they are on the placebo or the real thing, because there are a series of cognitive biases that can kick in if they think they are receiving a medicine and are not. I agree 100% with, and understand why, anybody whose child is currently taking medicinal cannabis and is stable and happy, would never put themselves in a position where they would have a one in x chance of receiving a placebo as opposed to the medicine. I spoke with Joanne Griffiths directly about that and I understand that.
However, during the covid pandemic the scientific establishment has changed trial design and its ways of doing things, so it has to be possible to find a placebo cohort of children with similar conditions who are not taking additional cannabis medicine. There are a number of reasons why people might choose to not use it. The UK is not an island. The other problem is that the numbers are fantastically low, so there is a relatively low pool of people to play with. However, the UK has shown itself to be a leader in global science. I think it would be possible to find, in other countries where they have not taken the progressive steps we have taken in the UK to legalise medicinal cannabis, a group of children with similar medical conditions and use them as the placebo. There is an opportunity for the scientific community to maintain the gold standard of a double-blind trial, but not necessarily put people in the position where they need to come across.
My call to Government would be to speed up the current observation trials and to engage with scientific leadership—remember, it is this Government who are putting extra billions into research and development because we are a science superpower—on a more creative RCT trial, looking for the placebo that proves or disproves it over a series of numbers on a global scale.
I will draw my remarks to a close. It is in the pincer between medical ethics and standards of evidence where, tragically, young men like Ben sit, and we see the distress. There are potential solutions. I see the sense of measures in the Bill, but they come back too much to the idea that by voting for the Bill as an MP and as an unqualified individual, I will be telling a medical professional what to do. That is how I read the Bill.
Katherine Fletcher
I am very conscious that others want to come in, so I am going to crack on.
While I am a nerd and I can understand the science, I think we are on shaky ground if elected individuals get into a position where we are strongly incentivising the system or telling medically qualified people who have taken an oath what to do. I do not think it is possible for us to say, “Okay, I know we do not have peer review evidence that that particular drug x on that percentage formulation can work, but the family says it does and I can see it does, so off you go and prescribe it.” Simply put, I do not think we can tell doctors what to do. I say that with a genuinely heavy heart.
I hugely commend the hon. Member for Manchester, Withington for bringing the Bill before the House today. I thank the hon. Member for Gower for her passionate contribution. I know she will continue to stick pins in me to make sure I continue to work behind the scenes. [Laughter.] My final message to Joanne is this: “I know you think I don’t care. I do. I just cannot support the Bill today.”
Crispin Blunt (Reigate) (Con)
What a terrific debate to have the privilege of taking part in. I have spoken on this subject before, so I will try to keep my remarks to a minimum, because many of them are already on the record, and I want to respond to the points raised in the debate.
First, I record an interest—it is not a financial interest—as I chair the Conservative Drug Policy Reform Group Ltd. I am unpaid for it and have no stake in it, but it is a think-tank that I have set up to try to get evidence-based policy delivered and to make the case on drug policy in its widest forms. We are dealing today with the opportunities we have missed due to the absence of drugs from the development of medicine. Given also the awful criminal justice consequences of our wider drugs policy over 60 years, I believe it is vital to get proper evidence into this space to guide our policy. That is why I welcome the Government’s drug strategy, published just a few days ago, with its commitment to evidence and data, and it is on evidence and data that we should be formulating policies.
It has been a terrific privilege over the past four years to work with the promoter of the Bill, the hon. Member for Manchester, Withington (Jeff Smith), who has become my friend in this cause. To colleagues, and in particular to my hon. Friend the Member for South Ribble (Katherine Fletcher)—she gave a very brave speech to juxtapose the almost unanswerable case of her constituent with the wider challenge of exercising our duty as Members of Parliament—when she says she wants to oppose the Bill, I say to her, “Not yet.” The issues that have been engaged in here, and the debate that is being had, deserves to go to a Committee of this House so that discussion can continue. It would be quite wrong to oppose this Bill on Second Reading. It is fine that, after all the efforts of the Government, who have been trying to engage with the hon. Member for Manchester, Withington to find a route that they could support, we have not yet been able to get that route, but let us continue that discussion in Committee. The debate will continue anyway; we are trying to find the right construction of our analysis of the evidence in order to arrive at a better answer than we have today.
The raw emotion engaged by the magnificent speech from the hon. Member for Middlesbrough (Andy McDonald), and the emotion surrounding speeches made by other colleagues on behalf of their constituents, is incredibly powerful in its own right, but my hon. Friend the Member for South Ribble quoted the doctors’ oath, which says:
“I will…not allow prejudice to influence my practice”.
If only our profession had done the same, because the position of cannabis and the psychedelics in schedule 1 to the Misuse of Drugs Regulations 2001 is not supported by any evidence. Why on earth is heroin subject to fewer controls for research purposes than the psychedelics? I am not aware of any cases where the psychedelics have directly caused harm—obviously nothing like the scale of harm caused by drugs that have been made legal, such as alcohol and tobacco, or by the opiates. In response to parliamentary questions, the Home Office has been unable to produce the evidential base.
The rotten truth about cannabis is that its position in the regulatory framework rests on the racist policing of the United States in the 1950s, which is the basis of the world’s approach to drugs policy, and that basis is morally bankrupt. When we have now to deal with the consequences, we ought to bear that in mind. We have a duty to try to find a way to make good the damage that we have done. When I say “we”, I mean 50 or 60 years of politicians, who have avoided engaging in these difficult questions. We have put ourselves on a moral high mountain, and have not been prepared to engage with the difficult trade-offs that are engaged by this issue. Our objective should be to protect the public good and to have a positive outcome for society through medicines and treatments—the positive things that drugs can do—as well as to minimise the damage that they can do.
I want to draw the attention of the House to the work of the magnificent people who work at Conservative Drug Policy Reform Group Ltd. The organisation is not part of our party, but I fully accept that its principal objective is aimed at our party because the position on the centre right is naturally rather more resistant to change than, perhaps, other parts of the political spectrum. Eighteen months ago, the group produced a terrific review of where we are on medicinal cannabis, called “The UK Review of Medicinal Cannabis”, which identifies, as a consequence of our policy, how many people are being driven into criminality in order to get the therapeutic use of a medicine based on cannabis.
It is not right that there are about 50,000 people growing their own cannabis to try to treat their multiple sclerosis. We should be in a better place and serve people better. We should not need Carly Barton to have to produce a pass to say that people have a diagnosis that might suggest that they would need medicinal cannabis in order for them to avoid arrest. All those people are formally at risk of 14 years in prison in order to access a therapeutic product. We are not in the right place on this issue, and it is up to us to try to correct it.
I totally agree with my hon. Friend the Member for South Ribble that we should not impose the answer on medical professionals, scientists and researchers, but I am afraid that that is what we have done, which is why we are held in collective contempt by the body of science and research. Opportunities have gone begging over decades because our drugs policy, in its widest sense, has not been informed by evidence and data.
Katherine Fletcher
My hon. Friend paints a picture that I recognise in part, but I am sure that he would welcome recent innovations and changes in the law, such as the Government allowing psilocybin—magic mushrooms—to be used in research on clinical depression. Does he welcome the fact that there is movement in this space despite, I grant you, more than a century of ignorance in the area?
Crispin Blunt
I fear that I missed what my hon. Friend refers to, because it still sits in schedule 1. When my team first presented the case for moving psilocybin out of schedule 1 so that we could actually do some research at scale, I thought that the case was so blindingly obvious that it would take about five minutes to speak to a Minister and get it done; indeed, I had a conversation with a Minister that rather implied that. But then we ran into what colleagues might in other circumstances call the blob—the endless circuit on which the family of Teagan Appleby have found themselves, as my hon. Friend the Member for Dover (Mrs Elphicke) explained.
I simply say to colleagues, given the data that I will publish through the Conservative Drug Policy Reform Group next week, that it is a substantial majority position in this House that our drugs policy is not working and we need to do something about it. The worst signal that we could send would be that we are not going to continue the conversation about the proposal in the Bill by sending it into Committee. If we do not give it a Second Reading, that is what we will be doing. Let us get it into Committee and continue to have the conversation. Whether it is fit for Third Reading, or for the Government to support, is a decision we can take later.