The three barriers blocking access to cannabis in the UK

In a letter to the Advisory Council for the Misuse of Drugs (ACMD), Drug Science has highlighted the three main barriers blocking access to medical cannabis in the UK.

Following the release of the Advisory Council for the Misuse of Drugs (ACMD) report on medical cannabis in November last year, the independent drugs charity, Drug Science has responded with three key issues which “hamper” the clinical use and research of medical cannabis.

In an open letter to Owen Bowden-Jones, chair of the ACMD, Professor David Nutt chair of Drug Science, referred to three barriers related to scheduling, importation and prescriptions which block patients’ access to cannabis.

The Schedule 2 status

The statement begins by criticising the legal status of cannabis-based medicinal products which primarily fall under Schedule 2 apart from Sativex, a THC-containing medication for treating spasticity, which is a Schedule 4 substance.

Drug Science suggests that moving all cannabis-based medical products to the lower schedule would improve patient access by removing some of the complexities of prescribing storing and importing the products.

“Schedules relate to the relative safety of medicines and define safe-keeping and prescribing regulations,” Prof Nutt said.

“Decisions on the correct Schedule for any medicine should therefore reflect risk of harm from inappropriate prescribing, theft and diversion.

“Where the risks of medical cannabis products are no different from those of Sativex, which is in Schedule 4.1, we would suggest putting medical cannabis products into that same Schedule.”

The organisation also questioned the scheduling of CBD-based epilepsy medication, Epidyolex as a Schedule 5 substance.

“Given it has no abuse liability there would appear to be no reason to Schedule it, or indeed other cannabidiol products at all,” Prof Nutt said.

Import restrictions

In the wake of Brexit, many of the UK’s medical cannabis patients have found their supply of medication from the Netherlands under threat.

Drug Science criticised ACMD’s approach of limiting importation to reduce the diversion of cannabis to recreational use and argues that this causes more damage to health than it protects.

“Increasing importation quantities to a year’s supply per patient would greatly improve the provision and flow of cannabis medicines,” Prof Nutt said

“Allowing companies to bring product into the UK without having to first provide clinical need letters from individual doctors would ease the importation and reduce delay in product supply to the UK.”

Not allowing GPs to prescribe

Drug Science’s third barrier to access is the UK’s current model for prescribing cannabis medicines, which must be initiated by a specialist doctor.

The statement points out that the majority of patients who take medical cannabis do so to treat conditions that are commonly cared for by GPs, such as pain and anxiety.

“Surely now it is time to allow those who would like to, to initiate prescribing,” Prof Nutt added. “We know a number of GPs who are interested in doing such training

Drug Science suggests that this could be allowed for a limited number of symptoms. Pinpointing pain as an example, Bowden Jones noted that this could facilitate a reduction in the use of pain-killing opioids.

The open letter makes frequent references to its flagship Twenty21 initiative which aims to create the UK’s largest body of evidence for the effectiveness and tolerability of medical cannabis.

So far, the Twenty21 database is being used by over twenty-five clinicians and over six hundred patients. According to Nutt, this is expected to grow to “many thousands” in 2021.

The statement also refers to the organisation’s audit of clinical outcomes in children and young people with epilepsy who are taking cannabis-based medical products, published last year.

Nutt said: “This has revealed that full-spectrum medical cannabis products from Bedrocan Holland have significantly reduced seizure frequency in all ten patients, some becoming completely seizure-free.”

Its report found on average, patients using Bedrocan oils experienced an 80 percent reduction in seizure frequency, in what the Nutt describes as “convincing proof”of the improved efficacy of this form of medical cannabis, compared to commonly used isolate-based products, Sativex and Epidyolex.