UK’s “broken” system needs urgent repair

“It’s a dire situation”, says Dr Frank D’Ambrosio of the current plight of UK families struggling to access medicinal cannabis.

It’s also indicative of a “broken system”, he believes, since the UK is the biggest producer and exporter of legal cannabis on the planet, “yet the citizens have no access to it”.

As one of the world’s leading campaigners for policy reform on medical cannabis, D’Ambrosio is well placed to comment on the UK picture.

He spent 30 years as an orthopaedic spine surgeon in California, witnessing thousands of patients in chronic pain.

After 20 years in the field, he realised he had an office full of patients addicted to opioids.

Six years ago he stopped prescribing opioids and convinced 90 per cent of his patients to move to the cannabis plant. He’s since treated over 10,000 patients with opioid addiction and successfully transferred them over to the use of cannabis.

Last year he addressed the World Health Organisation – which directs international health within the United Nations’ system – telling its drug dependence committee not to fear cannabis.

He says: “In the UK we’ve essentially had the legalisation or allowance of medical cannabis prescriptions as approved by Parliament. This was then given over to the medical societies which actually formed a roadblock. So it has really did nothing and the NHS has so far issued no prescriptions.

“The only way people can get access cannabis is to go to private clinics where they are paying between £1000 and £2000 a month. If you’re very rich that’s fine but this is ultimately a two-tiered medical system with regards to cannabis.

“There are plenty of families with children with epilepsy who can’t afford £2000 a month. They’re essentially doing fundraising every month, just to get their children medicine. I can’t imagine that this was what they hoped would be the result of allowing medical cannabis to be available to citizens in the UK, or if it was, then it was a pretty duplicitous experiment.”

The situation is all the more bewildering for families given that the UK produces and exports more cannabis medicine than any other country, according to the UN.

A report published last year showed that the UK produced 95 tonnes of legal cannabis in 2016, putting it ahead of Canada in top spot. That UK production accounted for 44.9 per cent of the world total at the time is largely down to production of GW Pharmaceuticals’ cannabis-based medicine, Sativex.

D’Ambrosio says: “If you have a country that’s exporting so much, why can’t patients get access to it? And why can’t you have other companies come in to lower the cost and make it more accessible? It seems incredibly hypocritical that it’s okay for people in the countries you are exporting to to access it but not the citizens of the UK.”

Some argue that the jackhammer to the medical profession’s “roadblock”, might be yet more research into cannabis medicine’s efficacy. For all the existing studies and anecdotal evidence that exists, the Department of Health and other official bodies continually point to the need for an improved “evidence base”.

D’Ambrosio says: “I think the move by Parliament last November to legalise medicinal cannabis was smoke and mirrors. They punted it from their lap into the lap of the medical societies knowing full well that they would stop it there.”

In August, the National Institute for Health and Care Excellence (NICE) said it was “unable to make a recommendation about the use of cannabis-based medicines for severe treatment-resistant epilepsy because there was a lack of clear evidence that these treatments provide any benefits”.

On the same day, NHS England and NHS Improvement issued a report setting out a series of measures to help remove barriers to the appropriate prescription of medical cannabis on the NHS.

Among them were several steps aimed at speeding up the generation of research linking cannabis with various conditions.

Aside from research,  pricing is also an issue that needs to be addressed, says D’Ambrosio.

“I think there’s enough evidence out there already, if you take evidence from other countries. But also, the cost is just so prohibitive. If you only have one producer of medical cannabis in the country, the price is going to essentially be fixed.

“Over time, if you had two or three more companies come into the UK, to be able to compete, that would lower the price and then all of a sudden, you’ve got the studies that will fulfil the requirements of what is a medicine according to the NHS, and you bring the price down.”

In September, D’Ambrosio visited 10 Downing Street to deliver his report on the UK’s medical cannabis landscape as it has emerged over the last two years. This follows two visits to MPs and patients in the UK last year. He will also soon be releasing the full results of an online survey of patients he has conducted.

The study is ongoing but based on responses from the 4,700 patients questioned to date, the top five reasons for using medical cannabis are for: anxiety, depression, headaches, sleep problems and as an alternative to opioids. A further 15,000 to 20,000 people will be surveyed in the coming months.

“One of the big negatives aimed at cannabis is that it’s addictive. The reason people say it’s addictive is because when you stop using cannabis, you may become anxious, depressed and unable to sleep. But that’s not really addiction, because the top three reasons for using cannabis in the first place are because you’re depressed, anxious and you can’t sleep.”

Despite the current lack of access to medical cannabis in the UK, the Californian does see some signs of positive change – but not nearly enough.

“Children with severe epilepsy are slowly starting to be treated via Great Ormond Street which is admirable. However, a whole host of other patients are being left by the wayside.

“The UK’s spiralling opioid addiction can be handled by the adoption of non-addictive medical cannabis as an alternative to opioids. Domestic supply is the way forward for people as a way of beating the prohibitive cost from profiteering pharmaceutical companies.”

Raising medical cannabis awareness on both sides of the doctor/patient divide might also help to improve access.

Most doctors have had little to no formal training in cannabis medicine, while many are also understandably influenced by somewhat restrictive guidelines from official bodies such as the Royal College of Physicians and the British Paediatric Neurology Association.

An added complication is the fact that cannabis is an unlicensed medicine, meaning that the doctor, rather than the manufacturer, must take full responsibility for it should something go wrong.

“GPs are getting more and more comfortable with cannabis medicine because they know the science behind it. As well as educating GPs, it’s about educating patients. They will then go back to their MPs and say ‘this is what we want, how can you make it happen? Open up the doors for the GPs to play their part’ – and don’t hang the threat over them of losing their medical licence if they use cannabis.”

In California, D’Ambrosio’s patients have been able to legally access medical cannabis for 23 years, while recreational cannabis was legalised there in late 2016.

“Has it been a resounding success? It depends who you ask. In my practice, I’ve seen medical cannabis help so many people that I could not be a stronger advocate for it. But there are different agendas, for example taxes are being attached to cannabis, because you can get it both from a medical facility and in shops recreationally.

“The problem with taxation is that there are some people who are so against taxation that they’re turning back to the underground black market. So it’s a work in progress.

“I always tell people that I live my life beta, because I am always going through changes. And I think that’s exactly what cannabis is going to be going through for the rest of our existence. It is always going to be in beta, we’re always going to keep tweaking and figuring out what the next move is.”

The UK medical cannabis model is certainly a work in progress, as is Britain’s burgeoning cannabis wellbeing products sector.

The UK CBD market will be worth almost £1bn per year by 2025, the Centre for for Medicinal Cannabis (CMC) predicts. Does this help or hinder the cause for better access to medical cannabis prescribed by doctors?

D’Ambrosio says: “In an ideal world, accessibility to CBD which is non psychoactive and has well documented beneficial effects to health, wellbeing and recovery, is good. I think what’s going to be a problem, just from speaking to some of the law enforcement officials I met in the UK, is that a lot of the CBD products are not considered THC free.

“The definition of CBD oils sold on the High Street is that they have less than 0.2 per cent THC and that’s why they can sell it. I can see the National Crime Agency cracking down and saying if it has any THC in it at all then this is a dangerous drug and you’re going to get into trouble. I wouldn’t be surprised in the next one or two quarters if you saw CBD products being taken off the shelves.”

Such drastic action has been speculated in the past, although the pace of growth in the sector – and the sheer weight of resistance from consumers and trade bodies – would make it a hugely divisive and controversial move.

While D’Ambrosio is following the UK situation closely, his mission to liberate access to medicinal cannabis goes beyond these shores and his native US.

He is the chief medical officer of London Stock Exchange (NEX) listed Block Commodities, which holds medical cannabis growing licences in Africa.

“The company’s plan is to build cannabis economies on the African continent. The first country we’re working in is Sierra Leone.

“We’re not only looking to create a cannabis economy where we can export cannabis oil from, to countries that are willing to accept the product; but more importantly it is to grow cannabis so that the residents can use the cannabis as medicine. There’s been an enormous increase in the importation into Africa of Tramadol.

“It’s quite addictive, and it can be lethal so we want we want people to be able to grow the medicine and create an economy to not only build the financial welfare of the family, but also the medical welfare of the people.”

Hear more from Dr Frank D’Ambrosio in the next print edition of Cannabis Health. Click here to sign up for your entirely free, no strings subscription.

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