Medical Cannabis under Prescription

Tonia Antoniazzi Excerpts

Monday 20th May 2019 Commons Chamber

[Tonia Antoniazzi (Gower) (Lab)]

I thank my co-chair of the all-party group on medical cannabis under prescription, the right hon. Member for Hemel Hempstead (Sir Mike Penning), for securing this Back-Bench debate and the Backbench Business Committee for granting it on the Floor of the House. It is an honour to follow the hon. Member for Henley (John Howell).

I am committed to campaigning for medical cannabis under prescription not only for my constituents but for everyone in the UK who would benefit from access to whole-plant medical cannabis. Whole-plant cannabis contains CBD and THC. It is the interaction of both extracts taken together that provides significant relief from symptoms such as seizures, because it provides the entourage effect. The two extracts interact with the human body and produce a stronger influence than any one component alone.

We must remember the number of desperate families passed from pillar to post and blocked at every turn. Is the Minister going to sit back and watch them continue to suffer? We have families watching us from the Gallery, and their turn is now.

[Mr Alistair Carmichael (Orkney and Shetland) (LD)]

The hon. Lady makes a good point. I first became involved in this campaign in 2002 when I met my constituent, the late Biz Ivol, who had severe advanced multiple sclerosis and who told me that the pain she suffered was like having somebody draw barbed wire through her spine. For the last 17 years, we could have been exploring all the issues being ventilated tonight, but we have not. Does that not illustrate the urgency?

[Tonia Antoniazzi]

The right hon. Gentleman is absolutely right, and I will go on to talk about a very good friend of mine who suffers with MS.

[Michael Fabricant]

I have a constituent who is suffering from very advanced multiple sclerosis. She has been unable to obtain the medication she needs, and her husband is growing small amounts of cannabis to relieve her pain. However, it is not just her who is suffering. Staffordshire police do not want to act, although technically the family is breaking the law. That is an impossible position, is it not? It really is up to the Department of Health and Social Care to find ways in which cannabis can be prescribed more widely and more quickly.

[Tonia Antoniazzi]

The hon. Gentleman is absolutely spot on. The issue of the law and people who are using cannabis as a medicine to relieve their pain is especially relevant to those with multiple sclerosis.

My very good friend Chris Reilly has progressive MS, and this week he had to go to hospital. His wife Beth called an ambulance, and it took an hour for the paramedics to be able to give him the correct amount of pain relief so that he could be taken to hospital. He is in touch with me all the time. When I was selected as the parliamentary candidate for Gower, he was the first person to contact me and tell me that this was a subject very close to his heart, and that he wanted me to become involved with it. I thank him for that, but it makes me cry that I cannot help him and cannot provide the medical cannabis for him. I know that I am standing here and making comments as a politician, and that I am not a medical expert, but we all know that when our constituents and their families visit our surgeries we share their pain and their tears because they cannot access something that would, quite simply, make their lives a lot better.

[Michael Fabricant]

The hon. Lady is being very generous in giving way, and I totally agree with what she is saying. Is it not the case—cruel as it may seem to say this in the Chamber—that for those who are is suffering from advanced multiple sclerosis, there can be only one end to it? Is it not therefore cruel in the extreme that when something could mitigate the pain and the discomfort and is not going to do any more harm to the patient because there is no cure for advanced multiple sclerosis, that palliative care cannot be administered?

[Tonia Antoniazzi]

I completely agree. The families of children with intractable epilepsy are in exactly the same position, as are so many other people throughout the United Kingdom. My friend Chris is a very good example of how wrong it is that people with MS or epilepsy have no access to whole plant medical cannabis. As we know, it will never be a cure for everyone, but, as Chris told me yesterday, it provides the chance of a better quality of life. That is what people want. It is what the parents of children with intractable epilepsy want. They are at the end of the road. They have tried everything from the ketogenic diet to unlicensed drugs, which make the children unreceptive and do not improve their quality of life.

[Sir Mike Penning]

I pay tribute to my co-chair of the all-party parliamentary group: without her support, we would not be here today. I feel for her constituent as well as mine. They are asking us to help, and we are doing everything we possibly can, but we are not medics and we cannot prescribe. Doctors seem happy to sign off and prescribe off-label drugs for purposes that have absolutely nothing to do with what those drugs were licensed for, but they are not willing to license medical cannabis. Does the hon. Lady not agree that that is an imbalance?

[Tonia Antoniazzi]

I do agree. It just does not make sense, which is infuriating, because I like to apply sense and logic to most situations, and the current situation is not logical.

Not being able to access medical cannabis leads people such as Chris and the parents of children with epilepsy to consider alternative ways of accessing cannabis, which—as has already been pointed out—is fuelling a dangerous online trade in which, for all we know, they could be buying anything. That is dangerous and wrong. Clinicians to whom I have spoken often ask parents what they have given their children in addition to over-the-counter drugs. Access to CBD alone has great health benefits that are not recognised by many in the medical profession. The right hon. Member for Hemel Hempstead has referred to its being described as homeopathy. When I say that one of my interests lies in medical cannabis, there will always be someone—even a politician—who will make the pun about wacky baccy, and it is really not appropriate. ‘

There seems to be a theoretical concern about the exposure of children to THC, but that is about recreational use; it is not about medical cannabis. Discussions about the legalisation of cannabis for recreational use and about the rescheduling of cannabis for medical use under prescription must not be conflated in the House. Let me put the position into perspective. The law changed because of one boy, Alfie Dingley, and the campaign spearheaded by his mum, the fantastic Hannah Deacon, who is in the Visitors’ Gallery today.

[Crispin Blunt]

And Billy Caldwell.

[Tonia Antoniazzi]

And Billy Caldwell, yes.

Alfie’s life has been transformed. He has been seizure-free for as long as 300 days, riding a bike and riding a horse. Hannah continues to campaign for parents who cannot gain access to medical cannabis for their children, who need the same treatment for their intractable epilepsy. The fact is that although the law has changed, the rules on access to medical cannabis are even more stringent as a result. Under the guidance provided by the British Paediatric Neurology Association, Alfie would not be eligible for his prescription, which beggars belief. The Government were aware that they were opening the floodgates by providing access for Alfie, but the push-back from certain areas of the medical profession is what is preventing any advance. We have seen that with a number of patients, and it is extremely unfair.

The medical cannabis that is being prescribed is in line with manufacturing practice, which means that it meets European standards. However, these products will have to be subjected to trials that could take three to four years, which is not acceptable to the families with whom we work at End Our Pain. It is not acceptable to the parents of Bailey Williams, who are also in the Gallery. They cannot wait any longer. They did use a CBD, and I think that they are still using it, but it is not working; it has worn off. That is why they need the THC.

These products are available, and they need to be made available to everyone now. There is currently a two-tier system. There are those who have access to medical cannabis because they have the funding, and those who do not because it is not available on the NHS. We must change that.

[Crispin Blunt]

I pay tribute to the hon. Lady for the work she is doing. The situation is worse than that, however: we are driving a number of people into the hands of a criminal supply chain so that they can obtain their medicine, and that cannot be right.

[Tonia Antoniazzi]

I entirely agree, and I am very concerned about it. We have heard in the House this evening that people are growing their own cannabis, and there is a growing trade. There is an online family of people who are helping each other to obtain the most THC possible from different combinations of different plants. It is a complete industry. Why are the Government not getting a grip, and providing a proper, GMP-standard, pharmaceutical product for people?

I also want to talk about the cost, which is extraordinary. Has the Minister or anybody in her office done a cost-analysis? Alfie Dingley’s case provides a classic example: how much has he saved the NHS by not having emergency medication and not using the ambulance service to go into hospital? It seems nonsensical that we are not going down this road.

I want to talk about a couple of my constituents. Only a few weeks ago I had a visit from the parents of a 14-year-old son. My son is 14 too, so their situation struck a chord with me. Their son has intractable epilepsy. Mum has given up her job to look after him—he has a very efficient system around him. He benefits from a ketogenic diet and the next available medicine is Epidiolex. Epidiolex does not contain THC but she wants her child to be on a trial, and the trial is limited. A mum should not come to me begging for her son to be on a trial, but when I spoke to her about medical cannabis with THC she was reluctant to engage because of a fear of breaking the law and of not following the system properly. All our families are following a system. They are at the end of the road in terms of what medicine they can be given, so I want them to be given medical cannabis with THC as soon as we can.

NHS England is drafting terms of reference, and as co-chair of the APPG I appreciate its efforts. These children must have access, however; they must not be waiting three or four years. I urge NHS England to work collaboratively with the devolved nations because we need our children in Scotland, Wales and Northern Ireland to have the same benefits.

[Bambos Charalambous (Enfield, Southgate) (Lab)]

I congratulate my hon. Friend on her excellent speech and the excellent work she has been doing with the APPG. I also congratulate the End Our Pain campaign, which has done so much to raise this issue. Does my hon. Friend agree that NHS England needs to improve its guidance on intractable epilepsy and fast-track it so that children can get the THC they need?

[Tonia Antoniazzi]

I totally agree that a completely different approach is needed if we are to get the medicine to our families now.

It is very upsetting that families are risking getting criminal records by bringing in medical cannabis and are having to fundraise for prescriptions. I pay tribute to families that are fundraising in the public domain—to the parents and the friends, such as Craig who has cycled many, many miles up Pen y Fan recently to raise money for Bailey. I say to all those families that are raising money, “Don’t give up; there is hope, and hopefully we will be able to get you the medicine you need on prescription from the NHS.”

It would be very remiss of me to stand here and not pay tribute to the late Paul Flynn, former Member for Newport West. Paul was an absolute inspiration. I was a patron of an organisation with him and he was inspirational when I went to Birmingham to speak with him. His knowledge of and passion for medical cannabis was second to none, and I know that, as Madam Deputy Speaker mentioned, he is watching over us now and hoping we will get the breakthrough he was working so hard towards.

My hon. Friend the Member for Manchester, Withington (Jeff Smith) spoke of a bespoke medical response and creative thinking, and I ask the Minister to work with us: pull groups of families out of local trusts and set up an immediate observational trial with the 18 families that we have at End Our Pain; get the NHS to pay for the costs of the medicine when a private prescription has been issued until NHS prescribing is more routinely accepted; and allow the guidance from medical cannabis experts to be used. Some excellent UK experts have come together to form the UK Medical Cannabis Clinicians Society, and they have issued prescribing guidance, too. I say, “Please, work with the NHS to give clear central guidance that medical cannabis is legal and that there is an expectation that it will be prescribed as a normal unlicensed medicine when appropriate.”

--- Later in debate ---

[Seema Kennedy]

Of course I could as a parent, but again, I am not a doctor, and I am not here to make that call. What I would say is that I am very happy to meet the hon. Gentleman to get more of the facts he is presenting to me.

What is needed to support such prescription is evidence of efficacy, and for public funding evidence of cost-efficacy. That is the system we apply to all medicines and medical devices in the UK, and cannabis should not be treated any differently. The current evidence base has been summarised by the professional bodies in their interim clinical guidance, and it will be further examined and reported on by NICE shortly.

[Tonia Antoniazzi]

I have one question for the Minister: has the cost analysis been done on a particular case? When I spoke earlier, I spoke about Alfie Dingley. It would be very interesting to see the impact of his case financially–the benefit that has been gained to the NHS and the money that it has saved the NHS since he has been taking the drug.

[Seema Kennedy]

I apologise to the hon. Lady, because she did ask me that, and I am afraid I forgot to send a note to the Box. I am happy to write to her about whether that analysis has been done.

Many hon. Members, including my hon. Friend the Member for South Suffolk, talked about funding. Funding decisions are local decisions with clear local procedures. The process review is looking at this, and as I have said, it will report shortly. I call on the industry to invest in more trials, and to publish the results and the full underpinning data, because we all want to see licensed products that doctors can use with confidence.

Where there is supporting evidence, the Government and the NHS will work with companies to make the products available. Indeed, more than 110 patients are now being treated with a pure CBD extract product—Epidiolex, which numerous hon. Members have referred to—on an early access programme, ahead of a licensing decision by the European Medicines Agency. In developing a licensed product, the evidence has been generated on the safety profile and effectiveness of the product. It is this that provides clinicians with the confidence to prescribe and the system with the evidence it needs to make decisions on routine funding. The NHS does not routinely fund any new medicine until it has been through a process of evaluation to ensure that it is safe, effective and represents value for money.

On another point that the hon. Member for Gower brought up, about one of her constituents going on the Epidiolex trial, the specialist centres around the country are referring patients to GW Pharmaceuticals. There are certain criteria and a certain number of places, but if she wrote to me, I would be happy to meet her and we could discuss that further.

We need to develop further our knowledge base on these products. That is why good-quality clinical trials are imperative. We need to know more about the scale of the benefit of cannabis-based products across a wide range of indications. We also need to understand how this compares with existing treatments and, indeed, other promising new drugs that may be as effective.