Two years on Project Twenty21 helps almost 2,000 patients access medical cannabis

Project Twenty21 has helped almost 2,000 patients access medical cannabis treatment. Two years on from its launch, the project’s development lead, David Horn, reflects on its progress so far.

Project Twenty21 (T21) was in conception long before the expression Covid-19 was even coined. Launched by Drug Science, the UK’s charity for drug reform, its initial aim was to enrol 20,000 medical cannabis patients by the end of 2021, in a bid to build Europe’s largest real-world evidence base for the safety and efficacy of medical cannabis.

But when the groundbreaking project became officially operational in August 2020 the world was well into the depths of the pandemic. The data collection, which had been anticipated to take place through face-to-face consultations and follow-up interviews between patients and their doctors – inside bricks and mortar clinics – was suddenly forced entirely online.

It’s officially 2 years since the launch of our real-world evidence medical cannabis study, #ProjectTwenty21. It’s been a challenging couple of years, but we’re proud to be approaching 2000 patients, and have just added a 5th clinic to our Directory ???? https://t.co/a5HG9cC8Ji pic.twitter.com/NXAG0zXwAQ

— Drug Science (ISCD) (@Drug_Science) November 8, 2021

“At one stage with the emergence of Covid, we wondered whether we would have to shelve the entire effort,” admits Twenty21 project’s development lead, David Horn.

“The impact of Covid has been very interesting; we were subject to lockdowns, which necessitated a redesign of internal processes within T21.”

Twenty21 launch

Since the first patients were enrolled, there are now almost 2,000 participants, a number that is growing every month. It’s not quite the ambitious 20,000 target Drug Science was aiming for, but it’s nonetheless significant in terms of the data it is collecting on cannabis.

“20,000 patients was always a stretch target,” says David.

“We’re certainly nearer 10 per cent of that certainly than was our initial intention, but let’s not lose sight of the fact that 2,000 patients is by far and away from an order of magnitude greater than most studies and certainly significantly bigger than any other study that’s been done in cannabis.”

Dramatic first findings

The first findings from the observational study, which were published earlier this year, have indicated that medical cannabis is having a dramatic improvement in their quality of life.

David Horn, ProjectTwenty21 development lead.

By 13 March 2021, a total of 75 individuals had completed both an initial and three-month follow-up appointment. Results showed a 51 per cent increase in patients’ self-reported health and ability to lead a more normal life, as well as significant improvements in managing debilitating secondary conditions such as anxiety, insomnia and depression.

Almost two thirds (63 per cent) of patients in the study had previously turned to illegal cannabis use in an attempt to treat their conditions, but have been able to avoid criminality thanks to a legal prescription.

“Our first publication has shown very strongly that patients consider cannabis to be very effective in treating their symptoms, based upon the reported levels of symptom abatement as calculated on validated data scales,” David explains.

“Suffice to say that as the numbers in the study grow and the reviews come back, we are increasingly able to make publications around what is effective in what diagnosis and to what extent.”

Twenty21 growth

Through its monthly newsletter, T21 now publishes regular data updates to give followers deeper insights into what it is learning. In August it revealed that 86 per cent of patients reported an improvement in anxiety or depression after three months of treatment – better than is typically seen with commonly prescribed antidepressants. A third of patients also report disrupted sleep or insomnia as a secondary condition.

In September it was reported that the majority of patients enrolled on the project are male (around two thirds) while the number of female patients increases steadily with age. Among those aged 18-25, only 29 per cent identify as female, while the over 75s group is made up of mainly women (64 per cent).

The data also contradicts a popular belief that young people using cannabis tend to be healthy, recreational users, as findings indicate that everyone seeking cannabis starts out with poor health, regardless of their age.

Reducing costs

As well as gathering conclusive data, through subsidising the costs of private prescriptions, T21 has allowed thousands of people to benefit from cannabis-based medicines who likely wouldn’t have been able to access the treatment otherwise.

Indications currently prescribed for include multiple sclerosis (MS), PTSD, Tourettes, substance abuse disorder (SUD) and in recent weeks it added ADHD to its list of prescribed conditions.

But by far the most common diagnoses are chronic pain (59 per cent, according to the latest data) and anxiety (almost 30 per cent).

“Both of those diagnoses significantly impact the economic activity of the patient,” says David.

“The cost of cannabis care is highly significant in relation to the numbers of people who can entertain it.”

Driving down the costs of medical cannabis is another key objective of Twenty21 and it’s one it has been successful in.

Covid has had a hand in this too. The use of telemedicine has not only meant that patients who may not have been able to travel to clinics, due to either financial or health limitations, have had the opportunity to access treatment, but it’s also reduced overall clinical costs.

As David explains: “Covid-19 drove all the clinics onto a virtual platform with only online consultations. This has the effect of driving down the amount of clinical time and the consequent cost to the patient and has resulted in clinic charges being massively reduced since the launch of T21.

“Something that we are particularly proud of is the design and establishment of £5 per gram for flower as an industry price-point that is now well established, and is relatively affordable by economically challenged patients.”

He added: “There is no doubt that the manipulation of the cost of cannabis and the cost of the clinic time that supports the prescription of cannabis has been driven down and has enabled a larger cohort of patients to access cannabis care.”

Boosting numbers

In the last six months, the project welcomed three new clinics on board and hopes to have more to announce soon. It has also ramped up its awareness, with a presence at major sector events such as Product Earth this August and Beyond the Green, the COP26 hemp fringe event in November.

The fact that the data is being collected electronically has also presented the opportunity for expansion overseas, including Germany and Australia, where negotiations are ongoing with stakeholders to launch their own versions of Twenty21.

“We are now aspiring to expand T21 offshore and through this fashion, we hope to accelerate to our goal of enrolling 20,000 patients,” David says.

“We have a particular interest in what we call ‘cannabis naive’ patients, in other words, they are new patients to cannabis, because that provides possibly the greatest insights into the response to cannabis and how that might decay or otherwise with time.

“We are interested in that information whilst it is still available in Europe, as complete deregulation has not yet occurred. Having said that, we are also potentially interested in creating a worldwide cannabis registry.”

Its overarching goal, of course, is to see cannabis-based products available to patients through the NHS. Three years since the change in legislation in November 2018, and with only three prescriptions thought to have been issued through the NHS, it seems like this is still some way off. But David is confident that soon the evidence will be impossible to ignore.

“The fact that it is only available privately underlines the fact that cannabis is still out of UK culture, and still framed as extra-mainstream,” he says.

“One of the prime objectives of Drug Science by publication is to push back against this, and our aim is to play into commissioning decisions to permit cannabis to be prescribed on the NHS.

“This will take some time to come, but the bigger that our database becomes the more irresistible our call will be.”

Twenty21 is always on the lookout for new clinics and clinicians to join the project as prescribers. If you’re interested, please email prescribers@drugscience.org.uk to arrange a chat with the team.