“What I find disappointing with the current government response is that we know that the long-term consequences COVID aren’t going to be chronic lung disease, they’re going to be psychiatric problems.
“We’ve already got a massive rise in the number of healthcare professionals, and people who’ve had COVID, with post-traumatic stress disorder (PTSD). We haven’t got very good treatments for PTSD, and cannabis is a potential treatment, particularly nightmares and flashbacks. Why don’t we start trying medical cannabis in these people?”
However, Nutt concedes that there are numerous barriers to overcome before medical cannabis could be used readily, for COVID-19 or any other health issues.
“Very few people in Britain using medical cannabis are getting it through the NHS or a private prescriber, many are getting it through the black market. That’s unacceptable – people don’t know what they’re getting and are running the risk of a conviction if they get caught,” Nutt says.
The UK’s medical cannabis regulations are “backwards,” despite the fact it could be the most important revelation in medicine over the lifetime of doctors practicing today, he says.
Since changing the law in November 2018 to allow specialist doctors to prescribe medical cannabis, the government has “taken away with one hand and given with the other hand, in a series of perverse and bureaucratic hurdles”.
Nutt described the series of changes needed to get medical cannabis to those who need it at this week’s Prohibition Partners online event.
Since November 2018, no NHS doctor has prescribed cannabis to a patient, which Nutt says is because practitioners have very little independence.
“The NHS is very monolithic organisation,” he says. “Every person in the NHS comes under a spotlight – if a doctor in Cornwall prescribes cannabis, someone in the Department of Health knows about it and questions can be put to bear. This has extinguished individual creativity and thought in doctors.”
Instead, the prescribing of medical cannabis should be opened up to GPs, Nutt argues, because they “see the value” in it.
“Specialists, by their nature, tend to be more academic, more concerned about doing things differently, whereas GPs are in the real world, they have to help people and reduce suffering.”
More widely, Nutt blames bureaucracy for the lack of progress in the UK with allowing patients access to medical cannabis.
“Maybe part of it is that, reluctantly, patients dragged [the government] into a new world and they’re clinging onto the fact that if we make difficult for long enough people will give up, partly because of bureaucracy, and there’s no coordinated decision-making.”
In March this year the government changed import restrictions to allow patients with prescriptions faster access to medical cannabis. However, Nutt argues that the government needs to liberate imports and import a year’s supply into the UK at a time to allow for continuity.
There are concerns doing so would leak cannabis onto the unregulated ‘black’ market, but, Nutt argues, this market is already saturated and the benefits would outweigh the costs.
Responsibility for drug control, he adds, should be taken from the Home Office and given to the Department of Health.
“We’re one of the few countries in the world that divides decision-making about cannabis between two government departments – getting two government departments to agree on anything is very difficult,” he says.
Nutt argues that medical cannabis will save the NHS money, and that the current cost of not properly prescribing medical cannabis in the UK is driven of bureaucracy.
“If we liberated importation, got rid of the scheduled two status and maybe make it schedule four, if we had a rational approach to the regulation and stopped being so hysterical and fearful about it, it would halve the cost. There’s so much cost involved in importation and regulations.”
Nutt is chair of the Drug Science’s Medical Cannabis Working Group, comprising stakeholders from patient organisations, academics and industry members, with the remit to develop and research and policies for the UK.
Last year, Nutt set up TWENTY21, which has since published a number of policy documents, including one looking at clinical approaches to prescribing medical cannabis, and a pending report looking at potential dependence of medical cannabis compared to recreational cannabis use. The group is also developing teaching materials for doctors.
“We’re aware that most doctors don’t have an understanding of cannabis medicines,” Nutt says, who have spent years “vilifying them as dangerous drugs that cause psychosis and dependence”.
“Getting doctors to change from that prohibitionist view is challenging, and the way to do it is to educate them, which is difficult, but less difficult than educating med students.”
Nutt has set up groups of medical students in different medical schools to educate doctors on medical cannabis.
Also, last year Nutt launched the project TWENTY21, an initiative of prescribing medical cannabis for anxiety disorder, chronic pain epilepsy, MS, PTSD, substance use disorder and Tourette’s syndrome, overseen by academic experts working voluntarily, who are collecting data on the treatments.
“Let’s see if we can get prescribing set up in a way which is useful in terms of gathering data and monitoring potential harms of these drugs, and hopefully it’ll assuage some of fears of psychosis development and dependence,” Nutt says.
There are currently 7,000 people signed up to the registry, and Nutt aims to get 20,000 patients signed up by the end of 2021. They each pay £150 per month, which is estimated to be what they’d be paying through the unregulated market.
Researchers will collect data about their quality of life and self-reported outcomes, and can follow patients up for up to two years.
“One of the things that became clear when talking to patients who use medical cannabis is that they find it very helpful but doctors aren’t interested in what they think. We think patients should be driving this,” Nutt says.
The registry has built a network of independent prescribers, and has trained 15 doctors so they can prescribe “in a sensible, evidence-based way,” Nutt says.
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