Medical Cannabis (Access) Bill

Lia Nici Excerpts

Friday 10th December 2021 Commons Chamber

[Dr Allin-Khan]

Absolutely. I thank my hon. Friend for his contribution. To take any further step backwards from the progress we have made in a cross-party collegiate manner would be a travesty. We would be letting down families across the country.

[Lia Nici (Great Grimsby) (Con)]

The way the discussion is going at the moment is that we are talking about going backwards. The reason my hon. Friends are having those discussions is that the law has already changed, and I do not believe we need to legislate. We need to say, “We need to get these medicines that are approved already on the NHS.”

[Dr Allin-Khan]

I thank the hon. Member for that contribution. That is exactly right. The Bill seeks to move that forward, not frustrate the process. I welcome any intervention that underscores that.

[Lia Nici]

When we talk to members of the public and our constituents about the debates we have, we explain that we learn a lot by having this exchange of views. It is wonderful. Every school and business should have such debates in this collegiate way. It is not that we are against the Bill, but that we believe the law is already in place. We just need action on NHS funding and to get more of these approved, tested medicines on the lists.

[Dr Allin-Khan]

In three years, we have had three prescriptions on the NHS. In three years, we have seen people in fear of not having roofs over their heads because they cannot afford to give life-changing medication to their children.

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[Elliot Colburn (Carshalton and Wallington) (Con)]

I join others in congratulating the hon. Member for Manchester, Withington (Jeff Smith) on securing time for us to debate the Bill today. He is clearly very passionate and knowledgeable about this issue, and I learnt a huge amount from his opening speech, for which I am extremely grateful. I also pay tribute to the hon. Member for Middlesbrough (Andy McDonald) for his moving testimony. It is characteristic of sitting Fridays that we tend to work more collegiately across the House. My hon. Friend the Member for North Devon (Selaine Saxby) said that it is not a question of whether we do but of how we do, and I entirely agree with her.

I am really here today at the behest of a constituent who asked me to come to the House and share his experiences, but before I delve into those, it may be helpful for me to give some of my own perspective. Before coming to this place, I too was employed in the NHS, although not as a frontline practitioner; I was not a doctor or a nurse. I worked for the sustainability and transformation partnership, the footprint of the new integrated care systems in south-west London. Along with commissioners across six south-west London boroughs, I looked at all the services that those boroughs provided, and this was a topic that arose during that time. It was obvious to me, when I spoke to colleagues, that there was almost a nervousness, almost a—confusion, I suppose, is the word I am looking for; it is a bit hard to describe—about commissioning medicines of this type.

I thought it might be helpful for the Front-Bench team to hear a bit about the experience of frontline commissioning, but, as I said earlier, I am really here at the behest of one of my constituents to share his story. I hope the House will indulge me if I go into a bit of detail, because I did find this very profound, and I hope that other Members will agree with me. My constituent sent me an email, in which he wrote:

“I would like to explain to you a little of my life which unfortunately has been plagued with intractable chronic migraines and the fallout from such.

Although suffering all my life with Migraine attacks, 5 years ago I was diagnosed with severe chronic migraine which after a long wait I was prescribed 9 different medications to try and bring the migraines under control, none of which worked only causing nasty side effects.

Having…sickness constantly with added migraine pain—1 was left diagnosed with intractable chronic migraine with attacks 6 days out of 7, putting me out of work and putting me in a state of deep depression.

I was fortunate to meet a Dr. who was testing the benefits of Cannabis in neurological cases and after a discussion I decided to follow her strict advice and started self-medicating Cannabis which unfortunately meant sourcing off the black market, something that I’m not in any way proud of but the impact of using cannabis for my ailment was profound.

Within three days of my first use, my migraine frequency dropped significantly as did…the usual nausea which accompanies my attacks. Within a week, I felt for the first time somewhat normal, depression had lifted, I was able to start work again almost immediately (I was open and honest with my employer who welcomed me back into the workplace and to this day has been extremely supportive).

Summarising my experience, I went from someone who saw no hope in any way with modern medicine to someone who almost overnight got their life back.

I have one son—aged 12 who has got his father back, and my wife although extremely anti-drugs (a doctor who works in the dental profession) has seen the relief I experience, especially after seeing me for many years hiding in a dark room, in pain, hiding from the world most days to someone who now is relishing in family life.”

My constituent went on to say:

“The stigma of the word Cannabis is something that I have had to deal with”.

This, he said, included

“seeking out black market providers which in its self I would not want anyone to go through”,

and I think all Members would agree with that.

[Lia Nici]

On that point, which I was going to raise later, quite often the issue is semantics. There is a fear about the word “cannabis”, be it medical or not, and we need to get over that. One of my concerns about the Bill is the use of the broad term “cannabis”. I think that my hon. Friend’s constituent has been fighting with that issue.

[Elliot Colburn]

My hon. Friend has taken the words right out of my mouth. When talking to Carshalton and Wallington residents, I have found that there is a sense of stigma, and a stereotype, associated with the word “cannabis”.

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[Lia Nici]

The case that my hon. Friend is outlining highlights real concerns about the side effects of smoking recreational drugs, including potential mouth cancer, potential throat cancer and potential psychosis, as well as the unpleasant social activities. I have had constituents who have had to live next door to people who take recreational cannabis, and it really is not a pleasant situation to be in—and then we get into the issue of potential secondary smoking and all those kinds of things. That is why constituents such as my hon. Friend’s should not have to go through that route.

[Elliot Colburn]

I totally agree. It might be of some use to the House if I read a little more of my constituent’s reflections, as he went on to say:

“Then came along the introduction of Drug Science and their Project Twenty 21, this gave me the ability to seek professional help, to be able to get a prescription to legal Cannabis flower to which I vape as a preventative and when needed as a pain killer. I still get migraines but luckily now I have a medicinal way to cope and quell most of the side effects, literally giving me my life back.

Although this does sound like a fairy tale, with a happy ending, there is a darker side to this.

Currently the expense and experience of being with a private clinic and private dispensary/pharmacy is quite strained, adding anxiety and stress into the situation. We rely on the ability of both the clinic’s and Dispensary’s to keep us in prescription which does not happen and is quite literally floored. Medication is imported into the UK, its very often caught up in customs and the added issues with Covid has broken supply chains.

Dispensary’s are often out of product and the clinics are not kept abreast of this so many re-writes of prescriptions have to happen and thus costing time to get the needed medication and cost for re-writes. This all breaks down to us the patients being without medication, sometimes up to a month, putting us back at square one (prescriptions have to be written monthly).

On top of the supply and demand issues, quality is also something that has been with issue, many reporting to Yellow Card unusable medication due to sub-standard product and often mould that cannot be used – with no way of a refund or quick turnaround of a re-stock.

Without a shadow of a doubt this would never happen under the NHS but as we have no other choice in the matter its either suffering under private clinics or unfortunately breaking the law and turning back to the black market.

There are many thousands like me in this position, I’m but a single drop in a large ocean of people with similar experiences, I would like to draw your attention to this so you may air this as unfortunately the situation is not getting better. I understand that the primary concern is for children with epilepsy though there is a much larger footprint of people benefiting from medical cannabis and this should whole heartedly be pulled into the NHS to better control and support patients.

I would be grateful if you could keep this all”—

he refers to all of us in this place—

“in the back of your mind so you have some real world information from one of your local constituents of the big picture surrounding medical cannabis, it’s time for this to be pushed forward as it was supposed to have been back in 2019…

Luckily medical cannabis has given me my life back, I hope others can benefit in the future but it needs to be under the protective umbrella of the NHS.”

I thank that constituent for sharing what was obviously a harrowing story, and for permitting me to raise it on the Floor of the House this afternoon. I am sure colleagues will agree that that was incredibly brave, so I am very grateful to that person for allowing me to do so.

We have heard many constituents’ stories during the debate, although we have explored just two elements of them—childhood epilepsy and the migraines that my constituent has suffered. I would like quickly to bring in one more, which is the exploratory research being conducted on the use of CBD for fibromyalgia and other treatment-resistant neuropathic pain.

I know the suffering that those conditions can cause, especially when there is so little known or understood about them; I have many family members who have been diagnosed with fibromyalgia or similar conditions. Again, I have seen the benefits that CBD can bring, but I agree with colleagues about the need for robust research. I do not think it is a question of whether we will get there, but a question of how. I hope that the Minister has been able to take on board the experience—

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[Sally-Ann Hart]

I agree with my hon. Friend, because we have a regulatory pathway in place—I will come back to this a little later, when I can move on with my speech—under the Misuse of Drugs Act 1971 regulations and medicines regulation, through which cannabis-based medicines have already been approved for use in the NHS.

To go back to prescribing, the prescriptions are limited to specialist doctors and GPs working with those specialist doctors. They are not the first-line treatments, and patients will always be at a stage in their treatment pathway where they are in the care of a specialist doctor. While the evidence base remains limited—we have all spoken about how important it is to ramp up that evidence base—it is right that the decision to prescribe unlicensed products lies essentially with specialist doctors, because they have that expert knowledge in their field, and they take the responsibility for prescribing.

I completely understand why some groups have campaigned for greater access to unlicensed cannabis-based products for medicinal use funded by the NHS. However, I feel very strongly that these products—we are looking at a drug that has multiple chemicals in it, and I will come back to that later—have not had their safety and quality, and whether they work and are efficacious, assessed or assured by the Medicines and Healthcare Products Regulatory Agency or their clinical or cost-effectiveness assessed by NICE, and that has to be the basis for all NHS routine funding. The NHS has a duty of care. People trust it. We trust the NHS. We trust our doctors to ensure they are giving us the best possible advice and prescribing the best possible medicine that has been rigorously tested and has a clinical evidence base.

When GPs are looking at medicines and whether something is approved, they are looking at a cost-benefit analysis. Throughout covid, we have been looking at what age to give people vaccines. At the beginning, a cost-benefit analysis was made about whether the benefit of giving an over-18 a vaccine outweighed the cost or risks involved. We have to be very careful about that when taking any medication forward.

It is critical to progressing public funding decisions that manufacturers of these products invest in clinical trials and prove that their products are safe, effective and work. The National Institute for Health Research remains open to receiving good-quality proposals for research in this area as a priority, and it is clear, as I said earlier, that there is huge potential in cannabis-based medicines. Manufacturers need to ramp up putting quality proposals forward for research, so that more cannabis-based medicines can be approved for NHS use. That is not for us in this House to dictate, but for those businesses to put forward their proposals to get clinical trials going, so we have a much wider selection of drugs available for NHS prescriptions.

[Lia Nici]

Does my hon. Friend agree that it is not just about drug companies missing out on a huge business opportunity, as well as the health benefits? It is for the NHS and clinical commissioning groups to ask for, and to promote the fact that they are looking for good-quality research and good-quality products to put in their systems.

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[Dr Mullan]

I completely agree. I would just add that processes are in place because we are at the greatest risk of making mistakes when we are faced with people in very desperate circumstances. The risk is greatest when a parent is extremely concerned for the welfare of their child, or when someone has a terminal illness. Those are the types of scenarios where people are most at risk of having the wrong treatment. I gave the example, which is incredibly important to remember in the wider discussion, of the MMR cases. Parents were advocating very, very strongly that that treatment had caused damage and distress to their children. Doctors were involved in amplifying and giving credibility to that circumstance. As a result, fewer people took their vaccines. I say this with all compassion to individual parents, but we have to retain a degree of objectivity, and I am afraid that parental passion is not a substitute for the systems we put in place.

[Lia Nici]

We all know there are a huge amount of emotions around this argument. All of us, I think, across the House would like to see the situation move forward. The issue is that the proposed legislation will not move things forward. In fact, it has the potential to slow the whole process down. If I understand it correctly, a private Member’s Bill cannot bring forward any money resolutions. What we need here is money, and for CCG and NHS processes to be working properly. We do not need primary legislation to do exactly what hon. Members across the House want. We just need to get on with it via the NHS and CCGs.

[Dr Mullan]

My hon. Friend is correct to say that in other circumstances funding and pots of money are sometimes set aside to deliver improvement in a particular area. However, as she says, the Bill is incapable of bringing forward funding in that regard.