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Calls for cannabis medicines to be added to NHS drug dictionary

Their exclusion could lead to potentially “dangerous” contraindications

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Unlicensed cannabis products are not listed in the NHS dictionary of medicines and devices

Patients have joined calls for cannabis-based medicines to be added to the NHS drug dictionary, saying their exclusion could lead to potentially “dangerous” contraindications.

Patient organisation PLEA (Patient-Led Engagement for Access) has joined clinics in the sector and MPs, calling for cannabis-based products to be added to the NHS dictionary of medicines and devices.

As most cannabis medicines are unlicensed in the UK, they are not listed in the database, with only the licensed cannabis-based medicines Nabilone, Epidyolex and Sativex currently included.

This means that those who have legal prescriptions for medical cannabis currently have no record of this in their GP notes, other than any letters which have been sent from their private clinic.

Experts have highlighted the “danger” this poses, with patients at risk of being prescribed medications with known contraindications if their doctors are not aware they are taking cannabis.

Scottish National Party MP, Alyn Smith, raised the issue in a parliamentary debate on Thursday 4 November. 

Smith, whose Stirling constituency is home to Scotland’s first medical cannabis clinic, also highlighted that bringing all cannabis prescriptions into the NHS drug dictionary would allow for “better assessment of the scale of prescriptions already in existence, along with “better analysis”.

Smith, who was himself diagnosed with arthritis nine years ago, said: “What it has given me is a really keen awareness that pain management and chronic medical conditions are life-defining for millions and millions of the people that we serve. Medical cannabis, anything that can help and alleviate those conditions surely needs to be properly worked through for the benefit of those millions of people… it shouldn’t be held back by outdated thinking.”

Smith has been working closely with Sapphire Medical Clinics, which opened its Stirling clinic earlier this year. 

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Speaking at the summary event of Medical Cannabis Awareness Week on Sunday 7 November, Sapphire’s head of communications, Beth Sweet-Escott said: “One thing that we can push for immediately is for NHS Digital to add cannabis-based medicines –  all the different types of medicines – to the NHS drugs dictionary.  

“At the moment they’re not included and that is actually really dangerous and has impacts for things like contraindications. This is something that needs to happen very quickly… so that it’s transparent and on the record.”

Sweet-Escott, also highlighted that this would help with clinician education around medical cannabis.

She continued: “One of the main focuses is to increase education awareness. The Primary Care Cannabis Network carried out research on GPs earlier this year, and found that there’s still a huge kind of lack of awareness, even though GPs asked on a daily basis about CBD and cannabis by patients.

“All healthcare professionals have so much to learn when they are starting out, but this is a vastly growing patient community who are being helped and there’s no other option but to provide education and support conditions, on safety data, on efficacy data, on adverse events. Cannabis is a very complex medicine.”

Also on the panel, medical cannabis patient Lex Wolfe, revealed that they were almost prescribed an antidepressant with known contraindications with cannabis, due to their prescription not being in their medical records. 

“Nowhere on my health records – other than a couple of letters from my cannabis clinic – does it state that I’m a medical cannabis patient,” said Lex.

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“I’ve had GPs try to prescribe me tricyclic antidepressants, which have known contraindications with cannabis products. They can cause tachycardia and as a patient that already has tachycardia issues that can be really dangerous.”

A spokesperson for NHS Business Services Authority, which manages the NHS dictionary of medicines and devices, told Cannabis Health that products would be added once they received regulatory approval from the Medicines and Healthcare Products Regulatory Agency (MHRA).

They added that the “lack of standardised information” creates challenges when authoring in the dictionary of medicines and devices.

“The NHS dictionary of medicines and devices (dm+d) aims to include any regulatory approved licensed medicine that has undergone robust assessment by the Medicines and Healthcare Products Regulatory Agency (MHRA) to support prescribing and dispensing purposes. Regulatory approved documentation is aligned with credible standards (e.g., Pharmaceutical form) that helps support inclusion of product profiles in dm+d,” they said.

“Many cannabis-based products are not licensed in this country and in the absence of more products not being approved by the national regulatory agency, the lack of reputable and standardised information creates challenges for authoring on dm+d.

 “We’ll continue to review products and as soon as any achieve a reputable regulatory approved status they will be added to the NHS dictionary.”

The Department of Health said that “the majority” of products containing THC and CBD products, are unlicensed and have not demonstrated “clear evidence of their safety, clinical and cost effectiveness”.

They added that they continue to back further research and look at how to minimise the costs of these medicines.

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A spokesperson said: “Three cannabis-based medicines have been made available for prescribing on the NHS for patients with multiple sclerosis or hard to treat epilepsies, where clinically appropriate.

“The NHS dictionary of medicines and devices aims to include information on licensed medicines approved by the UK’s independent regulator, the MHRA, to support both prescribing and dispensing – including Nabilone, Epidyolex and Sativex.

“Currently, many cannabis-based products are not licensed. This means there is a lack of standardised information on these products, which creates challenges for adding them to the dictionary. We are working closely with the NHS and the National Institute of Health Research to establish clinical trials to develop the evidence base to support further commissioning decisions.”

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Scottish MPs back medical cannabis patient following police action

Medical cannabis patient Liam Lewis and his husband are “overwhelmed” by the support they have received.

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Medical cannabis patient
Lerwick police, on the isle of Shetland, seized Liam's medication from his local delivery office.

A Shetland MP has voiced his support for a medical cannabis patient who had his prescription seized by police.

MP for Orkney and Shetland Isles, Alistair Carmichael, has described what happened to medical cannabis patient Liam Lewis as “disproportionate” after Lerwick police seized his medication from his local delivery office on Saturday 22 January.

The 28-year-old, who suffers from functional neurological disorder, has been prescribed medical cannabis for chronic migraines from Sapphire Medical Clinic for two years.

Liam attended the police station later that day with documents and medical notes from the clinic and asked if he could present a copy of his prescription when the clinic reopened on Monday.

medical cannabis patient Liam Lewis and husband

Medical cannabis patient, Liam Lewis and husband Edward

However, officers apparently believed that the documents were fake and issued him with an official warning which will become part of his criminal record.

Liam is now facing up to three months without his medication.

Mr Carmichael, Lib Dem, and MSP Beatrice Wishart are now said to be preparing to make representations to Police Scotland.

Speaking to the Shetland News, Mr Carmichael said: “This is a massively unsatisfactory situation for Mr Lewis or anyone else to be relying on medicinal cannabis which is now legally available in the UK.

“If Mr Lewis had a prescription, as I understand to be the case, then surely he could have been allowed time to produce that for the police officers.”

He added: “Beatrice [Wishart] and I will be making representations to Police Scotland – there is a public policy issue here about them apparently denying access to medicine.

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“There may be some technical reason why the medicine should not have been distributed in this way, in which case that needs to be dealt with.

“In the meantime, this will count as a criminal record, it will stay on his [Liam Lewis] criminal record, and to my mind this is disproportionate.”

Liam and his husband Edward told Cannabis Health that police officers had been in touch following the incident, after his story appeared in the Scottish press.

The couple are calling for a Government-funded identification card to be issued to patients who hold legal prescriptions to avoid them facing law enforcement. 

Edward said: “We are overwhelmed by the support that this issue is getting. The more traction this gets the better, as we want to make sure that others do not find themselves in this situation.”

He added: “I thank Alastair Carmichael for his support and we hope this goes a long way, not just to solve the immediate problem, but also the wider social issues behind this.”

In a statement to Cannabis Health on Wednesday 26 January, a spokesperson for Police Scotland said: “A 28-year-old man was issued with a recorded police warning following the seizure of a controlled substance which had been found by officers within a sorting office in Lerwick on Saturday 22 January.

“He was unable to provide satisfactory evidence to police that the substance had been prescribed legitimately by a medical professional and when the recorded police warning was given to him he accepted it.

“Officers will continue to engage with him as we try to establish the full circumstances of the situation.”

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A spokesperson from Sapphire Medical Clinic, commented: “We are unable to comment on individual cases due to patient confidentiality. However, it’s important to highlight that medical cannabis was legalised for prescription in November 2018 across the UK.  As the only medical cannabis clinic registered by Healthcare Improvement Scotland, we abide by stringent regulations which include assessment by a specialist doctor and the requirement that prescriptions are dispensed by an approved and licensed pharmacy.”

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Boris Johnson faces fresh questions on NHS access to medical cannabis

In the midst of the Number 10 party scandal, the Prime Minister faced questions about NHS access to medical cannabis.

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Prime Minister Boris Johnson, 10 Downing Street in London, medical cannabis

In the midst of the Number 10 party scandal, the Prime Minister faced more questions about when patients would see NHS access to medical cannabis.

Conservative MP Mike Penning, who has been a prominent advocate for medical cannabis access, raised the issue again during Prime Minister’s Questions today (Wednesday 26 January).

Speaking in the House of Commons, Mr Penning, MP for Hemel Hempstead, said: “Many children in this country are suffering from a special form of seizure… which medical cannabis prescribed by a consultant actually helps them live. Only two children in this country get that free on the NHS, the rest are having to beg, borrow and scrape to try and get that prescription issued by a consultant, paid for.”

He added: “I know the secretary of state has the political will, but please push this forward so these children live.”

Karen Gray, whose son Murray has been seizure free for two years on medical cannabis, told the Edinburgh Evening News this month that she was feeling “optimistic” following a “positive” meeting between her MP, Lib Dem Christine Jardine and the Health Secretary, Sajid Javid.

Ms Jardine said her meeting with Mr Javid on Monday had been “much more positive” than her previous contacts with ministers on the issue.

She said: “He is looking for a way to break the logjam to allow the medical profession to feel confident in offering NHS prescriptions for patients with conditions like severe epilepsy.”

Responding in  Parliament, the Prime Minister said he was also “keen to support it” –  before going on to place the responsibility with the MHRA.

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“We’ve already changed the law for doctors to prescribe cannabis products where clinically appropriate,” said Mr Johnson.

“And I’m very keen to support it, provided the MHRA is happy as well.”

Cannabis has been legal for medical purposes in the UK since 2018, but still only three patients are able to access it on the NHS.

The rest are forced to pay up to £1,200 a month for a private prescription.

Charity Medcan Support reached out to the Prime Minister on Twitter following the broadcast.

The organisation, which supports families of children with epilepsy, said: “@BorisJohnson changing the law isn’t enough – we hope to see you at Parliament to hear and meet these families whose children are benefitting at huge costs.”

It might not be the answer many are looking for, but with most political focus on what really happened behind closed doors at Number 10 in the spring of 2020, it’s promising to see some MPs have the will to keep the conversation going.

Irish medical cannabis campaigner, Vera Twomey, pointed out on Twitter: “So happy to see Sir Mike Penning making representation on behalf of UK patients seeking access to medical cannabis. In such turbulent political times it’s great to see the issue raised.”

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Medical cannabis patient ‘distraught’ after medication seized by police

Liam Lewis is “distraught” as he faces three months without his cannabis medication.

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Liam Lewis (left) and his husband Edward Douglas are appealing the decision.

 

A Scottish medical cannabis patient who had his prescription seized by police says he is experiencing a “mental and physical health crisis”.

Liam Lewis, who lives in Lerwick on the island of Shetland, says he is “distraught” as he faces three months without his cannabis medication.

The 29-year-old suffers from functional neurological disorder, which causes severe migraines, which he says left him “bedbound” before medical cannabis treatment.

Liam has been prescribed cannabis through Sapphire Medical Clinics for two years, but on Saturday 22 January, his prescription was seized by police after it arrived at his local delivery office via Royal Mail. 

Liam and his husband say they attended the police station later that day with documents and medical notes from the clinic, and as his prescription had recently been changed, asked if they could present a copy this when the clinic reopened on Monday.

However, officers apparently believed that the documents were fake and threatened to bring charges against Liam.

He was issued with a written police warning on Sunday 23 January.

“Nothing like this has ever happened before,” Liam’s husband and registered carer, Edward Douglas, told Cannabis Health.

“The package arrived on the island on Friday [21 January] but the police dogs were at the delivery office on Saturday morning and the medication was seized. It was only when Liam went to track the package that we saw it had been taken by Police Scotland.

Edward continued: “The sergeant said that people are now coming up with sophisticated ways of sending cannabis and that the evidence we had wasn’t proof enough that it was a legal prescription.

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“We showed him clinical letters and the Sapphire patient portal where the prescriptions are logged, but he said that all of it could be made up. He even said to Liam ‘we know that you are just after drugs’.”

Liam is now in the process of appealing the decision, but says the police warning means that he will be unable to legally access cannabis-based medicines for another three months.

“Before I started using medical cannabis I was practically bed bound and was sick all the time,” said Liam.

“I was agitated and just genuinely dissociated from my body, I was like an observer in my life. Cannabis actually gave me my sense of purpose, because I was able to live again.”

Liam is no longer prescribed cocodamol by his GP – due to the fact that the cannabis was working – so is now left without any pain medication and only anti-sickness tablets to manage his condition. 

“I’m in a mental health and physical health crisis,” he said.

“I feel distraught and I don’t want to go back to feeling completely disassociated from my life again.”

Edward and Liam have 28 days to appeal the decision and plan to approach the Scottish Government’s cross-party group on medical cannabis to urge them to lobby for a state-issued identity card to protect patients from this situation.

“I can be Liam’s voice when he’s too unwell to fight for himself, but there’s people out there who might not have someone who can advocate for them,” added Edward.

“They might be too scared to continue this treatment and that’s who we want to stand up for.”

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A Police Scotland spokesperson said: “A 28-year-old man was issued with a recorded police warning following the seizure of a controlled substance which had been found by officers within a sorting office in Lerwick on Saturday 22 January.

“He was unable to provide satisfactory evidence to police that the substance had been prescribed legitimately by a medical professional and when the recorded police warning was given to him he accepted it.

“Officers will continue to engage with him as we try to establish the full circumstances of the situation.”

Advice for patients

Medical cannabis patients are advised to keep any medication in its original packaging and to have a copy of their prescription to hand, should they be approached by law enforcement.

Abby Hughes, chair of patient advocacy group PLEA (Patient-Led Engagement for Access), said: “Unfortunately some law enforcement officers may not be aware that cannabis medicines are legally available to be prescribed in the UK.

“If meaningful documentation showing legal possession of cannabis is not able to be immediately demonstrated, it is lawful that your medication may be seized. Once sufficient documentation has been provided however, patients are entitled to have cannabis medicines returned.

“If you face any setbacks or are disbelieved even after demonstrating lawful authority, continue to present any thoughts in a calm and structured way. Ask for time to be given to explain that you hold a valid prescription for medical cannabis, and for them to familiarise themselves with the 2018 rescheduling of cannabis-based products for medicinal use in humans, as well as the guidance issued to clinicians by NHS England.”

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A spokesperson from Sapphire Medical Clinic commented: “We are unable to comment on individual cases due to patient confidentiality. However, it’s important to highlight that medical cannabis was legalised for prescription in November 2018 across the UK.  As the only medical cannabis clinic registered by Healthcare Improvement Scotland, we abide by stringent regulations which include assessment by a specialist doctor and the requirement that prescriptions are dispensed by an approved and licensed pharmacy.”

Patients can contact PLEA for support on hello@pleacommunity.org.uk

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