Medicinal Cannabis

Luke Evans Excerpts

Thursday 30th January 2025 Westminster Hall

[Dr Luke Evans (Hinckley and Bosworth) (Con)]

I am grateful for the honour of responding for His Majesty’s Opposition in this debate, Ms McVey.

I thank the hon. Member for Strangford (Jim Shannon) for his tireless dedication to health issues—not just this one, but many others. In my short career on the Front Bench, I think this is already the fourth time in the space of six weeks that I have responded to a debate that he has secured; I congratulate him on his success in doing so. He never ceases to amaze me, because not only does he represent his own constituents—he has told us so passionately about Danielle, Sophia and their story—but he even represents others’ constituents as well, bringing forward and championing their issues. His ability to step forward and raise those issues is a true testament to the parliamentarian he is, and he has my full admiration and respect for doing so.

Today we have heard some moving stories about the difficulties faced by patients who are suffering, and about the plethora of conditions that could benefit from having these medications. I thank Medcan Family Foundation and the Medical Cannabis Clinicians Society for their advocacy on the issue, and for repeatedly bringing that information to the fore so that this country can debate such an important topic.

The debate has focused on the challenges that many children and adults face with accessing medical cannabis, but we appear to be in a new phase when it comes to managing the fact that such prescribing is becoming more prevalent. It is worth recognising, as we have done, that there was no legal route for such treatment only seven years ago. It was Sir Sajid Javid, who, as the Home Secretary, listened to the families and commissioned a review into that area to allow the creation of legal routes for accessing those medications. That decision has led to significantly more people being able to access licensed cannabis-based medicines.

Between January 2018 and September 2024, written answers show that 24,395 NHS prescriptions for licensed cannabis-based medications such as nabilone, Sativex and—even as a doctor, I am struggling to say it—Epidyolex were dispensed across the community in England. However, it must be recognised that that is dwarfed by the number of private prescriptions currently being issued. Where there have been challenges with access to licensed medications, as with Sativex, the last Government worked with the NHS to take steps to increase uptake of prescribing. On 6 September 2021, the NHS wrote to local trusts and integrated care boards reminding them about NICE’s guidance relating to that medication, and their responsibilities to prescribe in line with NICE recommendations. My understanding is that the letter contributed to an increase of prescriptions of Sativex.

However, challenges remain with access to unlicensed cannabis-based medications. We have heard that those medicines must be accessed through individual funding requests, but clinicians are wary of prescribing them, because of concerns about both the evidence base and the legal responsibilities involved. I can attest to the fact that, as a doctor who prescribes unlicensed medications, one looks for guidance on the best way to do so safely. The law was changed in part to encourage more research and clinical trials so that robust evidence can be collected, potentially leading to marketing authorisation and licensing. In the meantime, it is notable that NICE guidance does not prohibit healthcare professionals from considering unlicensed medications. In 2021, NICE stated:

“The fact that NICE made no such population-wide recommendation should not however be interpreted by healthcare professionals as meaning that they are prevented from considering the use of unlicensed cannabis-based medicinal products where that is clinically appropriate in an individual case. Patients in this population can be prescribed cannabis-based medicinal products if a tertiary paediatric epilepsy specialist considers that that would be appropriate on a balance of benefit and risk, and in consultation with the patient, and their families and carers or guardian.”

However, a recent report by Medcan Family Foundation has highlighted that more restricted prescribing in some areas may be leading to serious or unintended consequences. It is concerning to see, when reviewing their research, that three online forums identified 382 families in the UK who are giving their child illegal cannabis products specifically to manage epilepsy. Given the nature of that research, it could be argued that the figure may be significantly higher nationwide. Is that just the tip of the iceberg?

It is worth reflecting on some of the debates that have taken place in this House that have been mentioned previously. I think it was Mark Twain who said, “The past doesn’t repeat itself, but it does rhyme,” which I feel is apt in this case. To that end, it is always wise to try and learn from previous experiences. After all, advice from the wise is like the torch in the dark; it does not walk the path for us but it does light the path. So I looked at Hansard for the last debate and noted a particularly strong contribution from the then shadow Health Minister, the hon. Member for Bristol South (Karin Smyth), who is now the Minister with the power at her disposal. I think it is fair to ask her the questions she posed to the then Minister:

“It would be helpful if the Minister could set out what steps he is taking to empower and accelerate research in this space. I hope he will not dodge the question by saying that the issue is simply one for clinicians. The Government have a responsibility—the Minister is nodding, and we await his reply with interest, but there seems to be a lack of urgency on the issue, which is concerning. People are suffering right now. We have heard again this afternoon about children who are fitting, sometimes 100 times or more. Accessing care is, in some cases, pushing families to the brink of destitution. We should do everything we can to support those people.

If research is needed before clinicians feel comfortable prescribing, then it is incumbent on the Government to support clinicians. We need more streamlined clinical trials and better engagement with clinicians. We do not want to be back here in another two years, having a rerun of this debate. In 2020-21, the then Minister said:

‘It will take time to generate further evidence and see the results of clinical trials. The Health Secretary and I are committed to doing everything in our power to accelerate this work.’

If the Minister could update us on where this work has got to, and whether the Government are any closer to finding a solution, that would be welcomed by people tuning in today, and to the families present.

Finally, I would be grateful if the Minister set out what action he has taken to support people in the system right now—those living in extreme pain who are paying thousands of pounds to access treatment. There is consensus on this issue, as we have heard. The debate has been had and a decision has been made, but we can and should do better. In that spirit of consensus, we would all like to see some progress from the Minister.” —[Official Report, 20 April 2023; Vol. 731, c. 223WH.]

The Minister is clearly a strong advocate, and she is now in a position of power. She has been in post for over half a year, so what steps has she taken to empower and accelerate research in that area? What action has she taken to streamline clinical trials? Since taking office, what steps has she taken to empower clinicians to prescribe and to feel more comfortable? Since being in post, what action have her Government taken to support people in the system now?

It seems to me that the debate has moved on, but it is still rhyming. We are two years on and progress has been made. More than 24,000 prescriptions clearly represent an improvement. As has been said today, however, there is more to do, and we have new problems. The right hon. Member for Dumfriesshire, Clydesdale and Tweeddale (David Mundell) talked about the legal farming industry, the Hilltop Leaf situation and trying to create a virgin industry. My hon. Friend the Member for Broadland and Fakenham (Jerome Mayhew) talked about the clinical pathways and how they need to be specifically looked at. The hon. Member for Strangford highlighted policing, given that there is a growth in use. I will not tempt the Minister to stray into the Home Office brief, but I want to ask what conversations she is having with her Home Office counterparts about legal medical cannabis.

I hope the Government will continue to progress in this space as the issue evolves. They will have the Opposition’s support as they continue to research, educate and raise awareness. I hope the Minister will agree to meet Medcan and the Medical Cannabis Clinicians Society, if she has not done so already. Given the concerns that have been raised today, perhaps as a first step she will write to trusts and ICBs again to highlight the guidance on prescribing these medications. After all, we all want the safest, most effective medications to treat patients as soon as they are needed, and they should be uniformly accessible. I believe that noble aim is distinctly achievable, and I hope the Minister does too.