Doctors ‘don’t like being told what to do’

Over one million people are using cannabis to self-medicate their health conditions but only around a dozen have received a prescription since last November’s law change.

Baroness Meacher, one of the country’s leading advocates for medical cannabis, is unimpressed.“This is an unbelievable situation; a slow start was perhaps inevitable but we need to find ways to take this from three to one million. We have to help turn patients’ dreams into a reality.”

The Life Peer is backed by Hannah Deacon, the mum of epilepsy sufferer Alfie Dingley. Hannah was instrumental in securing last year’s changes in UK regulations following her battle to secure medical cannabis for her son.

She said: “We find ourselves in a disgraceful situation; many doctors are telling me they are being threatened with the sack if they prescribe medical cannabis, and some parents are telling me that if they ask for medical cannabis for their child, their doctors are saying they will report them to social services.”

Prof Mike Barnes, a neurologist and one of the country’s leading experts on medical cannabis, says the regulations as drafted by the Government are more than adequate, allowing clinicians wide scope to prescribe.

He said: “The government’s regulations themselves are surprisingly liberal. I don’t know of any other country aside from Canada that has issued so few restrictions on the use of medical cannabis.

“The overwhelming problem is the doctors. They are hiding behind the guidelines which have been issued by their professional bodies.

“There is strong evidence on the benefits of medical cannabis and it is extraordinary that they are not prepared to embrace this yet.”

Baroness Meacher

One Midlands hospital has even posted a notice for patients saying that “pain consultants and allied staff will not be recommending or prescribing medical cannabis for chronic pain patients.”

Prof Barnes, Baroness Meacher and Hannah were all speaking at a Drug Science Medical Cannabis Symposium in London recently. As well as campaigners, academics and businesses, a number of GPs and consultants were in attendance.

Baroness Meacher pressed these audience members why – four months after the law change – progress has been glacial.

One GP acknowledged that ‘doctors don’t like being told by anyone what to do’. “There are a lot of people involved in this and it just becomes political,” he said.  With 80% of medical cannabis users self-medicating for severe pain one consultant explained how it can take 18 months for a consultation, following a GP referral.

Prof David Nutt, one of the country’s leading drug experts and the former government drugs adviser, says the evidence shows cannabis is effective and so all prescribing decisions ‘will now be political’.

The chair of Drugs Science, and MC for the symposium, said: “Some 300 people die every year in institutions as a result of their epilepsy, this current situation is an insult to these people and their families and an indictment of the medical professions.

“Doctors are too scared to prescribe cannabis after 50 years of disinformation and lies.”

One cannabis-using patient told the symposium how she had been told by her consultant that they would not be prescribing cannabis, and that they would try 15 other medications and brain surgery before doing so.

The General Medical Council (GMC), which works to protect patient safety and improve medical education and practice across the UK said, that as with any other prescription, doctors must make decisions about prescribing cannabis-based products ‘only when they are satisfied that the drugs or treatment serve the patient’s needs, based on the evidence available’.

A spokesperson said: “When prescribing an unlicensed medicine doctors must be satisfied that there is sufficient evidence or experience of using the medicine to demonstrate its safety and efficacy.

“Doctors should follow our existing prescribing guidance, and take into account the clinical guidance issued by NHS England, British Paediatric Neurology Association, Royal College of Physicians and Royal College of General Practitioners.

“The regulations set out that only doctors on the specialist register can prescribe these treatments.”

A spokesperson for the Royal College of Physicians said: “The public would expect us to only make recommendations based on quality evidence and at the moment there isn’t any. We would welcome high-quality studies into the use of cannabis-based medicinal products for pain treatment.” It referred to an Australian review of the evidence of cannabis use in the treatment of pain published last year.

The spokesperson said: “This analysis showed that, statistically, the risk of harm is greater than the potential benefit.”

“We have undertaken to keep our recommendations under review until formal guidance is published by the National Institute of Health and Care Excellence, expected in October 2019.  This analysis showed that, statistically, the risk of harm is greater than the potential benefit.

“We have undertaken to keep our recommendations under review until formal guidance is published by the National Institute of Health and Care Excellence, expected in October 2019.”

Legal and medical position

From November 1, 2018, all cannabis-based medical products were moved out of Schedule 1 of the Misuse of Drugs Regulations 2001. GPs wanting to prescribe cannabis for a patient have have to refer them to one of 80,000 specialists on the GMC register. These medics can also prescribe other cannabis-based drugs, known as ‘specials’, but in doing so they also have to seek approval from a higher medical body.

In practice doctors are currently relying on the restrictive guidelines of the Royal College of Physicians (RCP) and the British Paediatric Neurology Association (BPNA). The RCP say there is not enough evidence of the therapeutic benefits of cannabis for chronic pain.

However, this runs contrary to the position taken by the Chief Medical Officer of the UK, Professor Dame Sally Davies. Last year she concluded ‘there is now conclusive evidence that cannabis is effective for the treatment of chronic pain in adults’.

The BPNA has meanwhile said that Epidolex, a pure form of CBD, might be considered for use in children with epilepsy only when all other options – including surgery – have been exhausted. The substantial evidence that children with epilepsy respond well to full-extract cannabis, including THC, was discounted.

Prof Mike Barnes said: “Together, these guidelines are incredibly restrictive, and some doctors are conveniently interpreting them as mandatory, which they aren’t.”

Cannabis campaigners appalled

The inability of the medical profession to meet the needs of its patients has come under fire from campaign groups.

Peter Reynolds, of CLEAR, said: “It is no longer against the law to use cannabis for medicinal purposes and I congratulate Sajid Javid on taking the law out of the equation completely.

“The problem now is an appalling ignorance of the science and the evidence amongst doctors. While lack of knowledge can be excused, bigotry, refusal to educate themselves and placing their caution and fear above the interests of patients cannot.

“The guidelines have been prepared by people who are still locked in the ‘reefer madness’ mindset that cannabis is a highly toxic dangerous substance. They are completely misinterpreting the scientific evidence.

“This is at its most tragic with their refusal to treat our kids. It’s sheer madness that under no circumstances will they allow cannabis with THC to be given to youngsters with epilepsy; a stance which appears to be based on studies about adolescents smoking high-THC content cannabis as a recreational drug.

“This is absolutely nothing to do with children receiving small doses of THC as a medicine, under medical supervision. It’s incredible that a highly qualified professional can conflate these two things. Yet at the same time they will dish out handfuls of opioids, and if these are taken half a dozen at once people will kill themselves, it’s difficult to understand. It’s pure ignorance and prejudice.”

CLEAR is encouraging its supporters to take the law into their own hands; “The dreadful NHS guidelines are preventing patients accessing the medicine they need and it seems only private doctors have the courage to make their own decisions. In these circumstances the ethical and economical choice is to grow your own,” says Mr Reynolds.

Jon Liebling, political director of the United Patients Alliance said: “The legislation as set out by the Home Office proposes no policy restrictions on conditions for which it can be prescribed for, nor for either strengths or types of cannabis that can be prescribed giving it the potential to be the most open and accessible policy in Europe.

“However, currently our medical profession is taking a very cautious approach and are seriously lacking in both education and the evidence they need.

“All these things must be worked on as a matter of urgency so that patients can access the medicine they already know helps them.”