Psychoactive Substances Bill [HL]

Lord Rea Excerpts

Tuesday 23rd June 2015 Lords Chamber

[Baroness Meacher]

I should like to make one simple point, which is that I agree absolutely with the noble Lord that what we need are clinical trials on medicinal cannabis. The problem is that researchers do not want to go into this area because the substance is illegal. Getting cannabis in is a tremendous problem because it takes a long time to get the licences. I do not know, but there are problems which the noble Lord may know more about than I. However, if adults and children in particular who are in severe pain and distress could be prescribed medicinal cannabis on a named-patient basis, that would be a good option. But certainly we need to get on with a lot of work on clinical trials.

[Lord Rea (Lab)]

My Lords, like the noble Lord, Lord Walton, who spoke last week during the supplementaries on the Question for Oral Answer tabled by the noble Baroness, Lady Meacher, on this topic, I served on the Select Committee which looked into the medicinal use of cannabis. One of the central recommendations was exactly what the noble Lord, Lord Ribeiro, has suggested. We need controlled trials. The noble Baroness has just backed up that suggestion as well. But it is very difficult to get these trials going. As she has said, because cannabis is an illegal substance, it is difficult to get people to agree to do the work. One or two trials have been carried out which resulted in the production of Sativex, but only one firm is producing it. As the noble Baroness said, it is terribly expensive and can be prescribed only on a named basis; it is very difficult for doctors to prescribe it to patients who have been shown to benefit from cannabis by getting it illegally.

One of the problems with getting cannabis illegally is that you do not know the ratio of the different cannabinoids in the illegal drug. It has been shown—this was told to us in our committee—that there is a huge range of effects from different cannabinoids. The one that gives the psychoactive effect, tetrahydrocannabinol— THC—is something that people who take cannabis for medicinal purposes do not like. But it is very difficult to find an illegal version of cannabis that contains a good ratio with more cannabidiol—CBD—which is the calming one that reduces spasms. Sometimes people have thought that it does not stimulate psychotic results but prevents them; it is an antipsychotic drug.

So there are real reasons why it should be made legal for researchers to concentrate on doing proper, controlled clinical trials to work out what cannabis can do, and what components or mixtures of cannabis components are most effective. This is crying out to be done, but as things are, it is very difficult to get scientists to agree to do it because of the illegality of the substance.

[Lord Blencathra]

My Lords, I have no idea whether cannabis is relevant and effective in dealing with nausea or spasms caused by motor neurone disease or other diseases, but I have a wee bit of experience of multiple sclerosis, and I say to the House that I do not want to be used as an excuse to legalise cannabis, because it is not necessary for treating the spasms that come from multiple sclerosis; there is already a fairly large range of drugs on the market that deal with that.

The spasms are difficult to describe and usually happen at night. The main muscles of the body—the torso, the legs and the chest—just spasm, and it is difficult to get a bit of sleep when that happens. In my case, when it started getting bad, my consultant said, “In that case, we must give you a drug that will deal with the spasms”. At the top of the list is baclofen, which is dirt cheap and highly effective. The maximum prescribed dose is 50 milligrams. I take 10 milligrams in the morning and 20 milligrams at night and have had no more body spasms because of it.

Okay, I cannot speak for all multiple sclerosis sufferers. When I was a constituency Member of Parliament, I had constituents come to me who said that they wanted cannabis legalised so that they could deal with their MS. I said that there were clinical trials under way that resulted in the drug Sativex, but they were not so keen to take a pill; they wanted to smoke a joint because it made them feel better in many other ways. Well, it could, but I do not want people who wish to smoke cannabis to get high to use the excuse that it is essential for multiple sclerosis sufferers in order to remove their pain and spasms.

If baclofen does not work—it seems to work for about 95% of people—doctors usually try tizanidine: I will give the Minister the spellings later. Following that, going down the list, is gabapentin. It is not usually prescribed because the other two drugs are usually much more effective. At the bottom of the list is Sativex, which is the cannabis derivative. The problem here, as has been stated already, is that NICE reviewed it and concluded that it was not cost effective. Unfortunately, that is absolutely right, because it costs 10 times as much as baclofen, which I have in my pocket at this precise moment.

I therefore think that the solution is: patients should be prescribed baclofen. If that does not work, they can go on to tizanidine, and if that does not work they can try the next legal drug, gabapentin. If those three do not work, then people can be prescribed Sativex. I suggest that my noble friend the Minister should say to the Department of Health and NICE that in those priority corridors it should be permissible to use it throughout the whole of the United Kingdom. Wales overruled NICE and has allowed Sativex to be prescribed. It is not prescribed, except by private prescription, in England, Scotland and Northern Ireland. I think that that is wrong. It should be allowed to be used by doctors but not as the first port of call.

There is merit in rejecting the amendment as far as multiple sclerosis is concerned. It may be beneficial for other illnesses when people suffer spasms but it is not necessary to deal with the problems that occur with multiple sclerosis. I wish to put my liberal credentials—or near liberal credentials—on the table. A part of me takes the view that if people want to smoke a cannabis joint and get high, okay, let them but do not expect the taxpayer to pick up the bill for the cancers and other illnesses they may get later. Similarly, a part of me thinks that if people want to eat themselves through gluttony into obesity and sit on their backsides, taking no exercise, let them, provided the NHS does not have to pay for that.

As the taxpayer has to pay for these things and for the dangers which smoking cannabis can cause, the taxpayer and the Government must be in a position to say, “No, I’m sorry. You’re not allowed to smoke that because there are alternatives that can deal with the alleged problem”.