Positive Health Online

Despite the legalization of medical cannabis in November 2018, only a small proportion of the people who could benefit from the drug have been able to receive it. Here Ramya Sriram, digital content manager of online platform for freelance scientists Kolabtree, discusses how the negative stigma associated with medical cannabis needs to change to improve access for patients.

Cannabis Plant. The UK is the world’s main producer and exporter of cannabis-based medicines.
So, why is a world-leading cannabis producer unable to provide its own patients
with the medical cannabis they need?

The active pharmaceutical ingredient in medical cannabis is cannabidiol (CBD). Most cannabis-derived medicines also contain a certain amount of tetrahydrocannabinol (THC), which is the ingredient largely responsible for the recreational use of cannabis due to the high effect it produces. It is a result of the drug’s recreational use and the dangers it could potentially pose that the drug has negative associations.

On November 1, 2018, a change in the law allowed specialist doctors in the UK to prescribe medical cannabis. Prior to the change, medical cannabis was classed as a schedule one drug under the Misuse of Drugs Regulations 2001, which meant it was not recognized to have any therapeutic value. After the change, it became a schedule two drug, meaning it has a recognized medical use and can be prescribed for certain conditions. This is an important step towards improving access to medical cannabis, but much more needs to be done.

It’s Legal, but it’s Not Enough

Despite it now being legal, medical cannabis is still not licensed for medical use. This means doctors can only prescribe it for certain conditions – children and adults with rare, severe forms of epilepsy and adults with vomiting or nausea caused by chemotherapy. In addition, it can only be prescribed if a patient has a need that cannot be met by licensed medicines. Therefore, of the many patients who could benefit from medical cannabis, only a small proportion can be prescribed it.  

Even some patients who meet the criteria for a medical cannabis prescription may still not be prescribed it, due to doctors’ reluctance to prescribe a drug they are not experienced with. In October 2019, the National Institute for Health and Care Excellence (NICE) will publish new guidelines that may provide doctors with the information they need to confidently prescribe medical cannabis. Alongside new guidelines, we also require better communication with UK doctors about existing information on medical cannabis. Also, ongoing research must remain a focus to increase our knowledge of the drug’s efficacy, safety and the patient populations it may benefit.

Prescription is Only the First Step

Former university lecturer Carly Barton was the first person to be prescribed cannabis in the UK after the new law was introduced. However, she was turned away by an NHS pharmacist when she tried to obtain the medication, because it had not been imported. Of the patients who have since been prescribed the drug, very few have been able to access it.

The UK is the world’s main producer and exporter of cannabis-based medicines. According to the International Narcotics Control Board, the UK produced 95 tonnes of cannabis in 2016, which accounted for almost 50 per cent of the world’s total production. So, why is a world-leading cannabis producer unable to provide its own patients with the medical cannabis they need?

Morphine is also a schedule two drug under the Misuse of Drugs Regulations 2001. However, unlike cannabis, it has a well-established medical use, so processes are in place to import and regulate it. In contrast, importers of medical cannabis in the UK must apply to the Home Office for a license and the process can take up to 28 days, by which time a patient’s prescription may have expired. Bulk imports of medical cannabis may be necessary for demand to be met.

To make sure access to medical cannabis improves for patients in the UK, we must change the perceptions that decision makers have about the drug. If we can reduce the fear, uncertainty and negative stigma that they associate with CBD, they will be more likely to induce positive change. There are two important ways to change minds — effective scientific communication and further research.

Scientific Communication

Last year, the story of Billy Caldwell and his mother Charlotte Caldwell flooded the media and triggered the move to legalize medical cannabis in the UK. Billy has a severe form of epilepsy and, until he began treatment with cannabis oil, experienced approximately 100 seizures a day.

Billy began taking medical cannabis in the US, where it is legal, in 2016 and the frequency of seizures he experienced reduced significantly. In 2017, he was prescribed the medication on the NHS, despite it being illegal, and then went 300 days without a seizure. However, in May 2018, the Home Office ordered Billy’s doctor to stop prescribing the drug. As a result, Billy and his mother had to go abroad again to access it and returned only after receiving reassurance that the NHS Trust in Belfast would ensure Billy could gain continued access to medical cannabis.

The public outcry surrounding Billy’s story led Home Secretary Sajid Javid to intervene, which eventually resulted in the legalisation of medical cannabis in the UK in November 2018. This result demonstrates the positive impact that communication can have when it reaches key decision makers.

It is important that we continue to talk about stories like that of the Caldwell family, to increase awareness among decision makers of the scale of the issue and how it can be resolved. There are several societies, non-governmental organizations (NGOs) and patient advocacy groups already helping to facilitate these conversions. For example, last year, the Royal College of Physicians declared that it is in favour of decriminalizing cannabis use. Also, the British Medical Journal announced that it “is firmly behind efforts to legalise, regulate and tax the sale of drugs for recreational and medical use. This is an issue on which doctors can and should make their voices heard.”

A key target of our communication strategies should be UK doctors, many of whom may not be prescribing medical cannabis to patients who need it, due to a lack of knowledge and experience. Medical students should be taught about the endocannabinoid system, the biological system that CBD acts on, and should also be kept informed on the latest clinical research into the use of medical cannabis to treat a range of conditions.

Collect More Data

Much of the research that has already been conducted into the use of CBD in healthcare has been in the form of reports, observational studies and surveys. These methods rely on self-reporting from patients, do not use control groups and do not use standardized strains of the drug. This means they do not contribute to the formal regulatory approval process that a drug must go through for it to become a licensed medication. Thorough data from randomized clinical trials on the efficacy and safety of medical cannabis is required for the healthcare industry to increase its confidence in the drug and license it for a greater number of patients.

These trials need to provide more information on the conditions that medical cannabis is an effective treatment for. Currently, it is only legalized for a small number of conditions, but there is some evidence to suggest it could also be an effective treatment for many other conditions including AIDS, Alzheimer’s, anxiety, diabetes and chronic pain.

Scientific research could also help to improve the medical cannabis supply issues that the UK currently faces. In Canada, a collaboration between cannabis production company RavenQuest Biomed and McGill University in Montreal is investigating how changing growing conditions of the cannabis plant can be used to manipulate the cannabinoid profile for cannabis-derived medicines.

“We are looking into three beneficial bacteria that have the potential to alter the cannabinoid profiles of the cannabis plant,” explained Rachel Backer, postdoctoral fellow at McGill University. “Cannabinoids are synthesised by the plant to moderate stress and these bacteria are able to induce stress responses in plants, without the actual stress being present.

“By applying the beneficial bacteria, there are two things we hope to achieve,” Backer continued. “First of all, we believe we can increase the yield of the plant, which would help increased the supply of cannabis for medicinal use.

“Secondly, we believe that applying the beneficial bacteria will alter cannabinoid expression by the plants. We can use this to understand what controls the expression of the molecules responsible for the therapeutic effects of cannabis, such as CBD. In the future, we may be able to modify the cannabinoid profile of plants to allow for targeted treatment of a variety of medical conditions.”

It is still early days for the use of cannabis-derived products in healthcare and unfortunately, medical cannabis is far from achieving its potential. There are many patients in the UK whose lives could be improved with the use of medical cannabis, but considerable barriers must be overcome before these patients can access the drug. While the legalization of medical cannabis in the UK in November 2018 was a crucial step towards achieving this goal, the industry needs a lot more help, via communication and scientific research.

Further Information

Kolabtree puts businesses and research organizations in touch with freelance scientists. The company has a database of over 5500 scientists and academics with expertise in areas including data analysis, scientific consulting, secondary research, experimental design, literature searching, scientific writing and scientific editing. Project owners can post a project for free and then receive bids from relevant experts before deciding on a freelancer to work with.

If you are involved in researching or spreading the word about medical cannabis and lack the in-house skills and specialities you need, post your project on Kolabtree to hire a highly qualified freelance scientist https://www.kolabtree.com/.