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“Access to medical cannabis is a human rights issue”



"I think it's really important that we start to build up the evidence base for medical cannabis"
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Drug policy expert, Dr Melissa Bone, discusses the pitfalls in UK cannabis regulations.

Dr Melissa Bone is an Associate Professor at the University of Leicester and has been working in drug policy for the last 10 years.

She is also a member of the Policy Advisory Council for the Conservative Drug Policy Reform Group and the co-investigator for the Drug Policy Voices project, which aims to include the voices and values of those with experience of substance misuse in debates surrounding drug policy reform.

Bone recently published a book called Human Rights and Drug Control: A New Perspective, published last year, which explores alternative methods of regulating cannabis and other illegal substances.

Here, Dr Bone shares her thoughts on the 2018 rescheduling of cannabis, the power of cannabis social clubs and how she believes the system could be improved.

CH: When did you first become interested in drug policy?

Dr Bone: My interest really started when I was an undergraduate student at the University of Leicester. I was studying law at the time, and to me at least, I always thought the law was designed to protect us from harm, to promote our health, to promote our human rights and to ensure that we’re safe.

But the more I started looking at drug policy issues, I started thinking that, actually, the law doesn’t really work like that.

The way that we’ve implemented the Misuse of Drugs Act, the Psychoactive Substances Act and the policy of prohibition that we have in the UK, actually does the exact opposite of protecting us from harm, ensuring our safety and promoting our human rights.

I became extremely passionate about wanting to change the law in this area, so I went on to do a master’s in applied criminology and then I did my PhD at the University of Manchester looking at how a human rights perspective can change the way that we think about issues of drug control.

CH: What is your opinion on the regulation of cannabis?

Dr Bone: For me, I would decriminalise cannabis in this country and I would look to the very influential reports, which look at decriminalising cannabis all across the globe. I would do this as a first step, to protect all people from criminal sanctions and I would also explore alternative models for regulating cannabis.

1.4 million people use cannabis medicinally but there have been only 10 NHS prescriptions, it just shows that the law is not working. So it does need to change, we need to secure access in practice and not just in theory.

I believe medical cannabis should be seen as a human rights issue. Because if we’re able to frame access to medical cannabis in human rights terms, then we can see it in a different light. And that can allow us to change the way that we think about drug control issues.

CH: Why do you think that medical cannabis should be deemed a human rights issue?

Dr Bone: Cannabis is regulated by the criminal law. The reason why we use the criminal law to regulate certain actions or behaviours is often to either to prevent us harming others, to prevent us from harming ourselves, or because certain actions or behaviours are morally wrong in themselves.

But when you change that perspective, and you look at these issues from a human rights angle, then you start to question that rationale and those justifications for why we use the criminal law. People who use cannabis medicinally could argue that it’s prohibition itself that is harming them, harming others, and is morally wrong.

This is because it affects their right to health, it infringes upon their human right to personal autonomy and they’re not empowered to have control over their own health.

CH: You have been quite critical of the rescheduling of cannabis in 2018. What do you believe to be to be the key issues with the law change?

Dr Bone: I would argue that the cannabis regulations of 2018 provide access in theory, but not in practice.

In practice, the cannabis has to be classified as a medical product, it has to be a hospital consultant that prescribes you the cannabis, and the early professional guidance only allows certain patients to access it for a very small number of medical conditions.

The vast majority of people who are sourcing cannabis from the illicit market are using it for other conditions such as depression and anxiety and those conditions aren’t covered by the early professional guidance.

CH: How has the rescheduling changed the landscape for those using cannabis medicinally?

Dr Bone: The legal change isn’t really affecting that many people in a positive way. I would argue it’s not a victory for human rights because it’s left the police confused, it’s left all the stakeholders confused, and it’s also left patients feeling very scared, because not only can they not access their medicine, they could potentially face criminal penalties.

As far as I’m aware, this legal change came in two years ago and there’s been fewer than 10 NHS prescriptions. And I’m also aware that there have been hundreds of reports of people going to private clinics to access cannabis, which can cost up to and over 1000 pounds a month.

This means the vast majority of people are sourcing it from the illicit market. The Centre for Medical Cannabis, has recently reported that 1.4 million people are using it medicinally in this country, which is three percent of British adults. So that’s a huge number of our population that are sourcing it from the illicit markets, growing their own or joining cannabis social club.

CH: Cannabis social clubs, as a concept, have been around since 2005 helping people safely cultivate and consume cannabis. Why do you think cannabis social clubs are so important?

Dr Bone: They produce their own guidelines as to how many plants a club should cultivate and grow. They’ve tried to ensure that the amount they grow is kept under the sentencing guideline limit or what would be seen as a domestic operation. They advocate that there should be no more than nine plants grown in any one growth site.

Having that knowledge and clubs being able to disseminate that legal knowledge to each other and be able to support each other to create a framework that could mitigate against the effects of prohibition if caught is very powerful in itself.

CH: Do cannabis social clubs have the power to drive change?

Dr Bone: With cannabis social clubs there is a power of coming together as a collective. Many have been able to get in touch with more powerful stakeholders such as treatment providers, the police, and the media, to get across the idea that cannabis prohibition is causing more harm than good.

There have been a number of police bodies in the UK that have been in touch with cannabis social clubs to say that they won’t prosecute people who use clubs and grow a certain amount of cannabis for personal use.

Although the legislation doesn’t reflect what’s happening on the ground, the law is being changed from the bottom up from these grassroots initiatives of people taking control and taking action to try and change the law in this area.

Cannabis social clubs are quite powerful in the way that they can potentially do that.

CH: What do you think are the mains issues with medical cannabis users sourcing the substance illegally?

Dr Bone: A big issue is that patients don’t know what they’re getting; they don’t know the potency of the cannabis and they don’t know the strains.

There’s also an awful lot of uncertainty in terms of criminal penalties. You could just get a slap on the wrist, or the police could use their discretion to let you go, or you could be sentenced just for possessing cannabis, even if you’re using it medicinally.

CH: How could the situation surrounding medical cannabis be improved?

Dr Bone: There is a perceived lack of evidence at the moment into how effective cannabis is for treating a number of medical conditions, so I think it’s really important that we start to build up the evidence base and that we don’t just necessarily rely on randomised control data.

Although that’s seen as the gold standard of evidence in medical research, I think it is important to start including smaller case studies to adopt more patient centred approaches. It’s going to be a long time before we have that RCT data and people are needing medical cannabis now. We ought to have more innovative ways of getting the evidence into the efficacy of medical cannabis.

I also think we should look at having GP prescribed medical cannabis as well, to take some of the weight off of hospital consultants that are currently the only people who are permitted to prescribe it.

This has been problematic for the last two years, it’s going to be even tougher now, thanks to COVID and the pandemic. So, I think we need to look at educating GPs and seeing if we can help them prescribe.

I think it’s very important as well to address the stigma associated with cannabis. Cannabis has been criminalised for the best part of the 20th century, so certain attitudes and stigmas are entrenched. I think we need to engage more with the public with training and educational themes to try and challenge some of the myths around this substance.

CH: You have spoken before about race and equality in the cannabis landscape. Could you tell us more about how these issues factor into the future of cannabis regulation?

Dr Bone: Black people in London are nine times more likely to be stopped and searched than white people. Asian people are three times more likely. Those statistics really aren’t great, and something needs to be done about that.

We ought to look at implementing social equity models when we are thinking about regulating cannabis. And we need to ensure that people who have been most affected by prohibited drug laws aren’t then affected in terms of trying to get a job in the industry, so that the cannabis industry isn’t just dominated by wealthy white men.

The law for accessing cannabis legally in this country for medical use is discriminatory. There is a two-tier system.

It’s very hard to get cannabis on the NHS and the vast majority of people in this country aren’t able to access the medicine based on how much money they have. On a private prescription, you have to be rich; you have to be able to afford to pay around a thousand pounds a month in order to access it privately. That is discriminatory. That basically says that the rich people who need to access medical cannabis get one system and poor people who need it get another.