‘Confused’ medical cannabis report ignores lack of patient access

A Government report into the impact of the legalisation of medicinal cannabis has been criticised for ignoring some of the key issues facing patients.

The Advisory Council for the Misuse of Drugs (ACMD) has this week published its report on the impact of the rescheduling of medical cannabis in November 2018.

Following the landmark law change, the ACMD was commissioned by the Home Office in February 2019, to conduct a longer-term review of cannabis based products for medicinal use (CBPMs).

Its findings confirm what has been widely reported – that fewer than five NHS prescriptions for unlicensed medical cannabis products have been issued in the last two years, despite an increase in the number of products becoming available.

But the review has been criticised for failing to highlight the ‘significant harms’ caused to patients by this lack of affordable access.

Responding to the report, patient-led advocacy group PLEA (Patient-Led Engagement for Access) said that it was ‘disgraceful’ that the lack of access and the impact this has had on patients was not more prominent.

“We welcome the ACMD assessment of the impact of rescheduling CBPMs, including the development of a CBPM patient registry. However, two years on from the rescheduling – patients are in desperate need of NHS access,” they commented.

“Thankfully initiatives such as Project Twenty21 are building the evidence base in the interim, but remain inaccessible to patients who are unable to afford private healthcare costs.

“It is disgraceful that the significant harms caused by the lack of patient access is not further highlighted within the assessment.

“We hope that a full review of international approaches to legislation of medical cannabis will lead to access to CBPMs for patients who urgently need them.”

The ACMD recognised that the number of patients obtaining private prescriptions has risen considerably, but its projection that between 149 and 224 have been issued throughout 2020 has been described as ‘way out’ by experts.

The actual figure is thought to be more like 2,500, according to Professor Mike Barnes, in keeping with the rise in the number of import notifications made for medical cannabis to the Medicines and Healthcare products Regulatory Agency (MHRA).

Specialist importers must notify the MHRA of their intention to import unlicensed cannabis medicines into the UK.

According to the Government’s figures the number of packs of medicines notified for importation rose significantly from 1,992 to 37,543 between March and November this year, suggesting huge demand in the private sector.

While around 800 patients a year have been prescribed one of the UK’s three licensed cannabis medicines –  Epidiolex, Nabilone and Sativex – on the NHS, Prof Barnes also pointed out that full extract, unlicensed medicines are ‘far superior’ when it comes to treating conditions such refractory epilepsy.

“Overall, the underlying assumption seems to be that as we have licensed cannabis medicines we don’t really need unlicensed ones,” he said.

“The ACDM, along with NICE and other bodies, don’t seem to realise that  full spectrum products are far superior to the available licensed medicines and that is why these are not being used.”

The price of unlicensed cannabis products is said to be ‘high’ compared to that of licensed medicines, but the report doesn’t acknowledge that the cost is thought to have fallen by around three quarters in 2020.

“They should have recommended a thorough health economic appraisal,” added Prof Barnes. 

“It suggests that cannabis products are expensive without recognising that the cost has come down about 75% this year.

“They have failed to consider that the cost of the product needs to be offset against savings on other medicines such as anticonvulsants, anti-anxiety drugs and opioids.”

Although he agreed with the report’s recommendations that a full review of international approaches to the legislation of cannabis based medicinal products was needed and a patient registry would be ‘crucial’ for assessing the impact of these medicines.

Campaigner Hannah Deacon, whose son Alfie now has an NHS prescription for an unlicensed medical cannabis product described the report as ‘confused’ and said it failed to make clear the inconsistencies in access.

“Even though three licensed medicines are available access is still very limited,” she said.

“They can only be prescribed for a very limited number of conditions and we know that some CCGs and NHS trusts are not even allowing funding for these medicines.

Hannah continued: “The report also states that individual funding requests (IFRs) have to be made for unlicensed medicines and to get this sort of funding you must prove that the patient is unique or rare in diagnosis, this incredibly difficult to do with most patients.

“There is however an NHS trust in Northern Ireland funding an unlicensed medication for an epileptic child, which isn’t made clear in their report.”

She added: “The report should have been carried out by someone who actually understands the cannabis sector and its market.”