Medical Cannabis under Prescription: Children with Epilepsy

Ronnie Cowan Excerpts

Wednesday 3rd November 2021 Westminster Hall

[Ronnie Cowan (Inverclyde) (SNP)]

I congratulate the hon. Member for South Leicestershire (Alberto Costa) on securing the debate. It is great to see a Minister from the Department of Health and Social Care responding today, because for far too long we have been talking to the Home Office about these issues. I believe that the Minister is an ex-nurse, if there is such a thing; perhaps it is “Once a nurse, always a nurse.”

Yesterday in Portcullis House, family members came to tell us their heart-rending stories, yet again. As we politicians listened, the feeling of, “What can we do?” sank into us. We went over to No.10 Downing Street and delivered a letter—another letter—explaining the situation to the Prime Minister. During the course of the day I talked to a number of parents, and one of them asked me a question that I have been asked many times, but every single time it hits home: “What would you do if it was your child? What would you do if your child was suffering 30 seizures and more a day? Would you reach for the rulebook, or reach for the medicine— if you could afford it, because right now, in this country, if you cannot afford it, you are not getting it?”.

There have been only three NHS prescriptions, as was mentioned, despite the now Health Secretary promising to do everything he could to help. I am fascinated by that; three means that there is precedent. We have broken the dam. If there were none, it would be a different argument—but there have been three. Why not 30? Why not 300? Why are we still scrambling around for these things? Hannah Deacon, who has been mentioned often in this debate, and whose son Alfie is in receipt of one of those NHS prescriptions, has written to the Health Secretary three times asking him to help, as he promised to do when, as Home Secretary, he wrote to her. All three letters have gone unanswered. Some politicians are hiding behind medical professionals, and some in the medical profession are hiding behind politicians. The parents of these children have no place to hide. They have to manage the reality of the situation day in, day out. We need progress. We need to accept the validity of real world evidence. Asking kids to take part in trials with a placebo is abhorrent.

Many barriers would be broken if GPs were allowed to prescribe medical cannabis. At the moment, they cannot initiate prescriptions but can follow up. Cannabis is largely a GP medicine, given its efficacy in GP conditions such as pain and anxiety. It would be of enormous help to allow GPs to initiate prescriptions. A recent survey showed that about a quarter of GPs would be happy to prescribe it. This would require a simple change to the relevant misuse of drugs statutory instrument; it would not require parliamentary time.

I look forward to tackling this issue in much more detail tomorrow in the Chamber. I hope that we can investigate all the problems, and ultimately come up with solutions. We have talked round and round this subject for a long time. Three years and three months on from a promise by the UK Government to make medical cannabis available, we are still no further on. It is a crying shame that these people are still living in hope—living, I have to say, in desperation at the situation they find themselves in. They are looking to us politicians to do something about this. In my privileged position, I am sick to death of having to say to those people that we are no further forward.

Please, Minister, take on board what we have heard today. Politicians are asking the Minister, cross-party—a very rare thing—to look at the situation and do what she can, now and in the longer term. On what could be done now, if there was a fund that we could reach into to pay for these prescriptions, that would be a massive step forward, including for the parents and guardians of these children, who, day in and day out, are asking us to do something for them.

--- Later in debate ---

[Maria Caulfield]

There are concerns, particularly around the THC element, that there could be some effect on the developing brain and on heart conditions. Research is needed not just on the effect of the drugs, but on their safety.

I want to point out that the Government have made funds available for good-quality research. That does not have to be done by the manufacturers; it can be done by charities, clinicians or researchers. A range of people can come forward to carry out clinical research. The MHRA—

[Ronnie Cowan]

Will the Minister give way?

[Maria Caulfield]

I will not; I have only a couple of minutes left.

The MHRA is well equipped to provide advice to any applicants wishing to conduct clinical trials.

[Maria Caulfield]

I have literally got two minutes left.

Currently, 13 trials are ongoing across the United Kingdom. In the previous 12 months, six of the other trials of cannabis-based products were completed, so some research is coming through the pipeline to help with that evidence base. I want to touch on one—the randomised clinical control trial mentioned by my hon. Friend the Member for South Leicestershire.

It is true that one study has three arms, one of which is a placebo. Having worked in clinical research myself, I reassure my hon. Friend that there are strict ethical guidelines for any clinical research. If someone is allocated to the placebo arm but it is clear when monitoring the research that one arm is doing significantly better than another, the trial has to be unblinded. Anyone on a placebo arm is automatically put on the arm that is doing best. I worked on clinical research for breast cancer, when we were trying to get Herceptin licensed, and for some patients that was the quickest way to get the drug. If there is clear evidence that one arm is working far better than others, patients can be moved on to that arm. It is a way of fast-tracking the drug for licensing.

I reassure Members that I absolutely understand the issue. The Government have changed the law to allow use of medical cannabis, but unless we give clinicians the confidence that the drugs, first, work—a feeling that they do seems to be the consensus in the Chamber—and, secondly, have a safety profile, they will not prescribe them. We can debate it forever in the House, but the clinicians have to be convinced. The way to do that is to get the product licensed, and the way to do that is to get good-quality research that the MHRA can look at to feel confident in licensing that drug.

The Government’s view is that there is funding for such research. My commitment to Members present today is that I will work with other colleagues to see whether we can speed up applications for research, encouraging them to come forward. For many Members, that is not the answer that they wanted to hear; they want me to stand up and say, “The drugs will be available tomorrow and we have people to prescribe them.”

[Ronnie Cowan]

We have to re-categorise cannabis from schedule 2 to schedule 4. That will open the gateway to medical research. Right now, it is hard for a lot of medical researchers to gain access to the product in the first place.