Medical Cannabis: Alleviation of Health Conditions

Ronnie Cowan Excerpts

Thursday 4th November 2021 Commons Chamber

[Ronnie Cowan (Inverclyde) (SNP)]

I beg to move,

That this House has considered the matter of the use of medical cannabis for the alleviation of health conditions.

I would like to start by paying tribute to the mums and dads, brothers and sisters, grandparents, guardians, extended families and friends who have campaigned diligently, respectfully and passionately to bring about the reform in access to medical cannabis that they so desperately desire. Many are full-time carers, with all the pressure and time constraints that that entails, yet they have found the time and the commitment to energise a campaign—a campaign that far too many politicians and medical professionals have turned a blind eye to.

I would like to thank the Backbench Business Committee for supporting me in bringing this debate forward today. I would also like to thank those Members who have reorganised their diaries and travelling arrangements to be here today. There are a number of MPs who would normally be here today to debate a subject that is close to their hearts, but for a variety of reasons, not least COP26, they are not. I guarantee they would all support any move by this Government to make it easier to access or research medical cannabis. I have never heard any MP argue against those objectives. There is confusion about drugs in general, which tempers some people’s desire to speak out, but the provision of medicine to sick people is not an issue.

[Catherine West (Hornsey and Wood Green) (Lab)]

I congratulate the hon. Gentleman on securing cross-party support for this debate. On research, does he agree it is encouraging to see the potential curative effects of various elements of this drug, as we call it, in treating very serious forms of epilepsy?

[Ronnie Cowan]

It is great to see that research has now been undertaken, and I have a list of five or six projects looking at medical cannabis across a range of different medical conditions, but there is still the issue that many academic organisations cannot get access to the cannabis or hemp plants they require because they are graded as category 2, which keeps the plants out of their hands. The paperwork and processes they have to go through to access the raw product are prohibitive, and recategorisation from category 2 to category 4 would aid the research of a host of academic establishments.

Why are we not making it easier for people to access medical cannabis? Why are people who would benefit from medicine derived from the hemp plant being denied that opportunity? Why can some medicines be purchased on private prescription only? Why are we not making medicines that are widely available in other countries available in the United Kingdom?

[Margaret Greenwood (Wirral West) (Lab)]

I congratulate the hon. Gentleman on securing this debate. He is making some important points. One of my constituents lives with progressive myelopathy of uncertain cause that affects his mobility and causes him to suffer brain fog, exhaustion and almost constant pain, which he has described as feeling like “hot wires” being pulled through muscles and skin. Does the hon. Gentleman agree there is real urgency to this issue because of people like my constituent who are suffering on a daily basis?

[Ronnie Cowan]

Of course I agree, and I understand the difficulty in which the Government find themselves, particularly the Under-Secretary of State for Health and Social Care, the hon. Member for Lewes (Maria Caulfield), who is new in post. We need solid research that proves the efficacy of medicines, but behind that we have people who are living with these extreme conditions, day in, day out, for an awfully long time. We have been slow to get to this stage, so there is every reason why the Government should accelerate the research in such cases.

Over the last week or so I have met representatives from the Multiple Sclerosis Society and End Our Pain, and over the years I have heard representations from a much wider range of organisations and individuals that see medical cannabis as at least part of the solution to their or other people’s health issues. There are two licensed cannabis medicines, Epidiolex and Sativex, which are both made by GW Pharmaceuticals. There is nothing wrong with these medicines, but they are isolates, or very nearly, and isolates simply do not work as well as full spectrum products, and they have more side effects.

A full spectrum cannabis product contains all the different cannabinoids and terpenes found in that strain, whereas an isolate product contains only one chemical, such as cannabidiol in Epidiolex. There is published evidence that the full spectrum products are twice as good as the licensed Epidiolex in the treatment of seizures.

Then there are the unlicensed cannabis products that account for virtually all privately prescribed products. Unlicensed products are not routinely prescribed by NHS clinicians, but they can be prescribed by a specialist doctor on the General Medical Council’s specialist register. There are now about 10,000 private prescriptions, 60% for pain, 30% for anxiety and similar conditions such as post-traumatic stress disorder, and 10% for other conditions including neurological conditions, such as epilepsy and MS, and some cancer and gastrointestinal disorders such as Crohn’s. It is clear that medical cannabis can aid a wide range of conditions.

All imported products are imported because the Home Office has been slow in granting cultivation licences for high-THC plants in the United Kingdom, and matters are made worse by the cumbersome import process. Three years and three months after the current Secretary of State for Health and Social Care, while he was Home Secretary, changed the law to allow prescriptions for medical cannabis, we still have only three NHS prescriptions.

As I mentioned in yesterday’s Westminster Hall debate, and it is worth repeating, Hannah Deacon, whose son Alfie is in receipt of one of those NHS prescriptions, has written to the Health Secretary three times to ask him to help, as he promised her he would in writing when he was Home Secretary, but all three letters have been ignored. Why, three years and three months later, are there so few NHS prescriptions?

Basically, doctors are not trained in cannabis medicine, although several teaching programmes are now available. However, the main barrier is the rather unhelpful guidance produced by the National Institute for Health and Care Excellence, which has looked at cannabis as if it were a pharmaceutical product, but it is not. We need better guidance written by people who understand the plant, not by those who understand only pharmaceutical medicine.

We also need acceptance of the validity of real-world evidence. The British Paediatric Neurology Association recently reviewed its guidance on prescribing medical cannabis in cases of intractable epilepsy, about which I have a number of serious concerns. If a family go ahead with a private prescription for medical cannabis, the guidance appears to say that the NHS paediatric consultant should insist that the private paediatric consultant takes on 24/7 care.

I am extremely concerned that this is a further attempt to make private prescribing so burdensome as to deter private prescribers. No private prescriber will have the infrastructure to provide this level of wraparound care. My concerns are further increased as this appears to have happened to one family already, and I have a letter supporting my concerns. I am pretty sure that washing their hands of patients in this way is not legal. Will the Minister immediately examine this issue and seek clarification from the BPNA that this is not the interpretation, and will she insist that the guidance is removed or changed?

Many barriers would be broken if general practitioners were allowed to prescribe, and a recent survey shows that a quarter of GPs would be happy to do so. That would require a simple change of the necessary statutory instrument under the Misuse of Drugs Regulations 2001 and would not require parliamentary time. I notice that, as of today, a leading UK insurer is now offering insurance cover at rates not dissimilar to normal cover for doctors prescribing medical cannabis.

To make this easier, there should be a focus on where the evidence lies for prescribing indication-specific, medicalised, pharmaceutical-grade cannabis. We must build on the legitimacy and efficacy of these medicines through the implementation of structured approaches to prescribing, which would help the UK healthcare system to be more inclined to prescribe cannabis sensibly.

In our debates in this place on refusing access to immigrants, health and safety in the workplace, poverty and welfare, I have heard the question many times: “Does somebody have to die before we take action?” Well, people are dying and people are living in unnecessary pain and discomfort.

I have four questions for the Minister. Will the Government recognise the value of real-world evidence, such as the research of Drug Science—including Project Twenty21—as proof of the efficacy of medical cannabis and stop insisting on randomised controlled trials, which are particularly unsuitable for rare forms of epilepsy in children? Do the Government have any plans to conduct a health economics analysis to investigate the cost-effectiveness of medical cannabis? Will the Government meet the costs of prescriptions for children requiring Bedrocan’s Bedrolite or similar products? And if a child was suffering from an epileptic seizure and the Minister had the medicine in her hands, would she administer it? I am sure the answer to the last question is yes, so will she please help to put that medicine into the hands of those who care for these children?

Finally, access to medical cannabis will someday be the norm. We need to confront the obstacles that exist today and clear the path for better access tomorrow.

--- Later in debate ---

[Ronnie Cowan]

A vital point was made there about who should be prescribing this. Dr Martinez, the retiring private prescriber of medical cannabis, has written to the Secretary of State for Health and, on the group she prescribes for, she said:

“I know that a majority of the GPs dealing with this group of children wish to prescribe, but, in order to do so, this requires a change of policy from the Health Department because it is CBD medication which has been treated differently to other controlled drugs.”

The solution is there. I get the point that parents can agree to a waiver, but they should not have to. This can be changed, and the Secretary of State for Health has been asked to do this by a consultant.

[Alex Norris]

That is very handy timing from the hon. Gentleman because I was just about to make that point. Following that retirement, Robin Emerson, the father of Jorja Emerson—he is behind the Jorja Foundation and has been campaigning tirelessly—has written to the Secretary of State and the Prime Minister asking them to intervene, but my understanding is that he is yet to receive a reply. I hope the Minister will commit to that being immediately addressed because this is very important indeed.

I will make a couple of final points before I finish. I listened very carefully to what the Minister said in the debate yesterday—we are in a novel position of having them on consecutive days, which is helpful—and it is clear that the Minister considers it a clinician issue rather than a political one, but that is not working at the moment. We are in a strange situation of there being so much concern about the nebulous long-term effects of these prescriptions that that is seen as better than, say, leaving a child fitting 100 times or more a day. It is rather like not throwing a rope to a drowning person for fear of their burning their hands on it. I find that hard to imagine, but we are in such a situation.

I fear that merely putting this at the door of clinicians is defending the status quo. I feel that we in this place do have agency and, indeed, a responsibility to act. I hope to hear from the Minister that there is going to be a greater drive from the Department to encourage clinicians. My hon. Friend the Member for Manchester, Withington offered suggestions on the training that I know is out there, and again I am keen to hear what we can do to have that picked up more reasonably.

Across this debate and the debate yesterday, clear themes have emerged: better research, or perhaps creative research, as the hon. Member for Edinburgh West said; better engagement with clinicians, again with the points my hon. Friend the Member for Manchester, Withington made; and, for goodness’ sake, immediate relief for families in the system now. They are going through things we would never tolerate for ourselves or would absolutely hate for ourselves, and I feel we that have a real responsibility to step that up.

I think there is broad consensus on this, and we now need to come together on a flexible solution to do it. Just as the SNP spokesman, the hon. Member for Stirling (Alyn Smith), said, we will support the Government if they bring that forward. This is something I think we all share, and the families are watching us and waiting for us to do it.

--- Later in debate ---

[Maria Caulfield]

I take my right hon. Friend’s point. I will come on to that, and to timelines for the research that is in progress. Many of the products that we are talking about have not been licensed by any licensing authority across the world, including the Food and Drug Administration, the European Medicines Agency and our domestic MHRA. This is not just a UK problem; it is not the UK Government who are holding this back.

As I said yesterday, I encourage manufacturers of these products to invest in clinical trials. Part of the Department’s work is providing funding for the National Institute for Health Research, which is actively opening its arms to charities, academics, researchers, manufacturers and third-sector organisations. Funding is available for clinical trials, if anyone wants to come forward with one, be it a randomised control trial, an observational study, a randomised control trial without a placebo arm, or a phase 1, 2 or 3 clinical study. The MHRA is willing to provide advice and support to any potential applicants who want to conduct a clinical trial or seek a licence for their medicines. There is funding and support; we need researchers to come forward with clinical trials.

[Ronnie Cowan]

A lot of research institutes are restricted in what they can do because they are trying to access a category 2 product. If it was category 4, life would be a lot simpler for them.

[Maria Caulfield]

The hon. Gentleman makes an excellent point, and going forward we perhaps need to unblock some of the blockages in that area. I take that point on board.

Clinical trials and the licensing process provide evidence and information that doctors rely on to support their treatment decisions. Many clinicians have fed back that they are reticent to prescribe these products until there is more evidence, because ultimately they are responsible for their patients when it comes to a treatment’s safety and effectiveness. Doctors are particularly unwilling, given the THC element of cannabis products; there is some emerging data and evidence of harm, particularly to children, including effects on the developing brain and heart. That is why the evidence base is so crucial, but I am happy—I say this especially to the hon. Member for Manchester, Withington, who sponsors the Medical Cannabis (Access) Bill—to consider what blockages could be unblocked to speed that process up.

Doctors are right to be cautious when prescribing any product if they are not confident in the evidence base. As I said yesterday, I am clear that prescription remains a clinical decision, as does prescription of any medication. It would be inappropriate for the Government to force clinicians to prescribe a medicine, but we will try to unblock some of the licensing blockages.

Let me highlight some of the studies that are starting to take off. This might have been mentioned, but from 1 April we have the establishment of clinical trials for NHS England and the NIHR. We have introduced a national patient registry, which will record patient outcomes, with a view to its being rolled out across the devolved Administrations. It is England-only at the moment. We are aiming to record the data of those who receive the medicines, and to consider side-effects, efficacy and a whole range of issues, in order to support clinicians working with patients, and to start to build an evidence base.

In addition, a randomised control trial is being set up. It has three arms, which will include one arm with CBD or THC, and one arm with a placebo. We expect it to open fairly soon. Those looking to access these drugs—children in particular—will be able to do so in a blinded way and can take part in the study. If the data come through relatively quickly, that will open up opportunities to submit evidence to the MHRA.

[Ronnie Cowan]

Who would offer a child who is on medication that stops them having 100 seizures a day a random test that potentially contains a placebo?

[Maria Caulfield]

I take the hon. Gentleman’s point, but many children are not accessing this medication, and this is a route to that. As I explained in yesterday’s debate, clinical randomised control trials with a placebo arm have extremely strict rules, and if one arm of the study is showing incredible progress and doing better than the other arms, the study must be stopped, patients unblinded, and everyone switched to the arm that is doing the best. In some circumstances, that has enabled people to access drugs under clinical research in a much quicker way. It does have some advantages.

--- Later in debate ---

[Ronnie Cowan]

I thank everyone who attended the debate and spoke. I want to pull the Minister back to one thing that I asked about. Will she please look at the most recent information from the BPNA? If I am interpreting that correctly, it will make prescribing more difficult. I hope I am wrong, but she has far more medical experience than I have.

We developed a covid vaccine in under a year, and rolled it out across the country to massive numbers of people, and it was free to those who needed it. I ask that we bring the same sense of urgency to this debate. To all the parents and others watching the debate—I know they are watching, because they have been texting me since I sat down an hour and a half ago; many of the questions I put to the Minister came from parents from around the United Kingdom—I say: thank you for driving this campaign forward. I hope that it does not end here, and that the fight goes on—hopefully in an amicable fashion. I hope we can all do better for all of you.

Question put and agreed to.

Resolved,

That this House has considered the matter of the use of medical cannabis for the alleviation of health conditions.

Adjournment

Resolved, That this House do now adjourn.—(Gareth Johnson.)