Cannabis

Lord Howarth of Newport Excerpts

Thursday 7th September 2017 Grand Committee

[Lord Howarth of Newport (Lab)]

My Lords, the noble Baroness, Lady Meacher, has laid out the case admirably and I support her appeal to the Minister. I will simply tell the Committee about the experience of one person which illustrates how lamentable are the consequences of the present confusion in government policy and the Government’s refusal to remove obstacles to making cannabis-based medication available on prescription in this country beyond the extremely limited basis that now applies.

The person I shall refer to as TW got in touch with me to tell me about her situation. She suffers from advanced degeneration of the lumbar and cervical spine and she experiences chronic neuropathic back and leg pain. It is tough, not just for her but for her husband and children. Over the last 15 years, she has been prescribed some 35 different medications: anti-nausea, antispasmodic, anti-inflammatory and antidepressant medications. At one point she was on the equivalent of 180 milligrams of morphine a day. She has had caudal and facet joint injections. In 2015, she underwent major surgery, which most unfortunately has left her in yet greater pain and disability.

However, TW has been able to come off these high-dose morphine-based medicines and all her other medications, with their horrible side effects, because she has been prescribed, privately, Bedrocan. The active ingredient in Bedrocan is dronabinol, derived from cannabis. Bedrocan is not licensed in this country, though it is in Holland, Finland, Germany, Switzerland and Italy. TW has a letter from Her Majesty’s Customs informing her that she is legally permitted to bring Bedrocan, as prescribed for her personal use, into Britain from Holland. If Sativex, also derived from cannabis, were suitable for her she could, on the other hand, legally collect it on prescription from her local pharmacy. She was previously prescribed morphine, an opioid in same class as heroin and far more dangerous than cannabis, and then Fentanyl, of terrifying power, as we see in the crisis of opioid addiction in the United States of America. Both were on NHS prescription, and she was able to collect those prescriptions from her pharmacy. Yet, as a patient for whom no other medication is effective to relieve her chronic pain without unbearable side effects, TW has to endure an arduous, painful, exhausting and costly journey in her wheelchair, four times a year, to collect her prescription of Bedrocan from a Dutch pharmacy. She very reasonably asks how this can be reasonable.

Cannabis, absurdly, is in Schedule 1, the schedule for controlled drugs deemed to be of no medicinal value. Bedrocan, cannabis-based, is in Schedule 2, the same schedule as morphine, diamorphine—which is heroin—and Fentanyl. Sativex is in Schedule 4. The scheduling is a mess. For the Home Office and the Department of Health between them to force TW and others like her to go to Holland to obtain the only medication that is truly effective for them is to taunt them in their suffering. We should do better, and I look forward to the Minister explaining how the Government will do so.

--- Later in debate ---

[The Minister of State, Home Office (Baroness Williams of Trafford) (Con)]

My Lords, first, I also declare an interest in MS. As the noble Lord, Lord Dubs, knows, I worked with MS patients for many years before I got involved in politics—I do not know quite how I made the transition, but that was the case. Some of the noble Lord’s anecdotes from patients chime with things that I heard. I know that there is significant feeling in the House on this issue. It is also clear from noble Lords’ remarks that they are keen that government policy on this issue should be led by evidence—as my noble friend Lord Norton of Louth said, I confirmed that yesterday—but also should not prevent patients from obtaining relief from symptoms using effective medicines.

As the noble Baroness, Lady Meacher, said, the WHO’s Expert Committee on Drug Dependence has committed to reviewing the scheduling of cannabis under the UN’s 1961 convention. The review will consider therapeutic use as well as dependence, and the abuse potential of several constituent parts of cannabis, including the cannabis plant itself and cannabis resin, cannabidiol, or CBD, THC, isomers of THC and extracts and tinctures of cannabis. The review is due to conclude by early 2019 and I, like most people here today, am very interested in its outcome and look forward to future opportunities to debate this issue—as I know we will—as and when the WHO concludes its work. I must add that the recognition of CBD as having medicinal application necessarily means that the other constituent parts will do so as well. Each compound ought to be assessed on its merits.

As noble Lords have said, cannabis in its raw herbal form continues to be listed in Schedule 1 to the Misuse of Drugs Regulations 2001 as a substance with no recognised benefits in the UK, but I must underline that this is in its raw form. The system of scheduling does not preclude medicines based on cannabis from being developed. The Misuse of Drugs Act 1971 regime, along with the associated regulations, enables the availability of controlled drugs which have recognised medicinal uses in UK healthcare—of which there are many.

We are already able to rely on a process, administered by the Medicines and Healthcare products Regulatory Agency, MHRA, in parallel with the Home Office’s licensing system, to enable medicines, including those containing controlled drugs such as cannabis, to be developed, licensed and made available for medicinal use to patients in the UK. In the case of a Schedule 1 drug such as cannabis, the Home Office is willing to consider applications for research licences to facilitate the development of new medicines, as long as the appropriate ethical approvals have been given, as we have done in the past. I am very happy to meet again with the noble Baroness, Lady Meacher, as we do regularly, to discuss this issue.

In the case of the cannabis-based drug Sativex, the Government have, as noble Lords have said, placed the product in Schedule 4 of the Misuse of Drugs Regulations to allow it to be legally supplied on prescription. Sativex was granted a marketing authorisation by the MHRA and was rigorously tested for its safety and efficacy before receiving approval for this application. This rigour should equally be applied to future medicinal products containing cannabis.

As has also been pointed out today, the MHRA has offered an opinion that products containing CBD, when used for a medical purpose, should be regulated as medicinal products. A CBD or cannabidiol product in its pure form is not controlled under the Misuse of Drugs Act 1971, so where it can be extracted and isolated from the controlled substances in cannabis it would not require a licence from the Home Office. However, a CBD product that contains any trace of psychoactive compounds that are found in cannabis, such as THC or tetrahydrocannabinol, is considered to be a controlled substance under the 1971 Act and therefore unlawful to possess and supply unless it fits the criteria for an exempt product under the Misuse of Drugs Regulations 2001. The MHRA is working with individual companies and trade bodies to make sure that products containing CBD used for a medical purpose which can be classified as medicines satisfy the requirements of the Human Medicines Regulations 2012.

We continue to facilitate forward-looking research involving cannabis and cannabinoids. There were 19 cannabinoid clinical trial authorisations granted between 2005 and 2015. These trials cover MS, dental applications, psychotic disorders, addiction to cannabis, type 2 diabetes, epilepsy, interaction with other medicines and brain diseases. Research in this area is ongoing.

The noble Baroness, Lady Greengross, asked about research into synthetic cannabinoid changes. I know that my right honourable friend the Home Secretary has commissioned the ACMD to look into whether there are barriers to research into Schedule 1 drugs as a result of changes to synthetic cannabinoid generic legislation. The Home Secretary has asked the council to provide its advice before the end of this year.

The noble Baroness, Lady Meacher, and the noble Lord, Lord Dubs, asked about Epidiolex. Our position on it is that, as for any other medicine and as we did with Sativex, it must be put through the same stringent process to ensure its safety and efficacy, for the benefit of patients.

My noble friend Lord Crickhowell suggested that the Department of Health and not the Home Office should be responsible for this. I quietly nodded there. Like the previous strategy, the 2017 drug strategy takes a cross-government approach that reflects the need for co-ordinated action to tackle the problem in all its dimensions. Given the strong link between drug use and offending, the Home Office has and will continue to provide the governance and accountability essential to the effective delivery of this cross-departmental approach. The Department of Health leads on the building recovery strand of the strategy and, together with the Home Office, leads on the reducing demand strategy, along with Public Health England. To ensure that we are doing all we can—and following my meeting with the noble Baroness, Lady Meacher—I have recently written to my noble friend Lord O’Shaughnessy, who is the Minister for Health in your Lordships’ House, to ask him to consider how the Government can facilitate the development and availability of cannabis-based medicines such as Sativex.

We are open to the development of new products based on cannabis and look forward to the review from the WHO’s expert committee. I am sure that the ACMD will follow its conclusions with great interest.

[Lord Howarth of Newport]

The Minister has not made any mention of Bedrocan in her response to the debate. Does she think it reasonable that TW, in the circumstances I described, has to make these visits to Holland to collect her medication, which has been prescribed for her in Britain but which she is not permitted to obtain from her local pharmacy? Is that a reasonable state of affairs and if the Minister thinks it is, why? If she thinks it is not, what will the Government do?

[Baroness Williams of Trafford]

I noted the noble Lord’s mention of Bedrocan. I had not heard of it and I am very willing to look into that specific drug. There are of course many drugs available in other parts of the world that are not necessarily available here and vice versa. I will write to him on that point. I will also take up the point about Alfie separately.