What more can be done to enable patients to access medical cannabis prescriptions?

What more can be done to enable patients to access medical cannabis prescriptions?
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“The National Health Service has not issued one prescription since November” – Professor Mike Barnes discusses patient accessibility (or lack thereof) to medical cannabis prescriptions.

Speaking at the Europe CBD Expo, Professor Mike Barnes of the Medical Cannabis Clinicians’ Society and The Academy of Medical Cannabis gives us an insight into the current environment within the UK regarding patient access to medical cannabis prescriptions.

Having previously spoken to Health Europa regarding the complicated picture of medical cannabis, we caught up with Professor Barnes at the Europe CBD Expo in early July 2019. Here we gain a deeper understanding of his involvement in the medical cannabis movement, the creation of the Medical Cannabis Clinicians’ Society, how effective the clinics will be for patients and what more can be done to help patients access medical cannabis prescriptions.

Could you give an overview of the current situation in the UK regarding patients accessing medical cannabis prescriptions? What has changed since we last spoke?

Sadly, very little. As you know, the law changed on 1 November last year and that was a cause for celebration: we were hoping that that would open up the possibility of prescription for a lot of people; however, the National Health Service has not issued one prescription since November. In the private sector, to the best of my knowledge only 22 prescriptions have been written. That’s it. Of those prescriptions, I think three doctors in total have prescribed. One was a pain specialist and has prescribed for about 15 people with pain; a paediatric neurologist for seven or eight children with epilepsy; and I’ve continued to oversee prescriptions for Alfie Dingley. And that’s it. It’s really a very sad situation.

In terms of obtaining a medical cannabis prescription – well, it’s impossible for them, frankly. At the moment patients have to get a referral to their hospital consultant and most are already in touch with a hospital consultant for whatever it is they need, i.e. for pain or for epilepsy. They can go to a consultant in the hospital who can write a prescription for them, as there’s nothing stopping them. If they look at the symptoms and evidence from the patient, think and see what is right for them, identify what they have tried already, then there’s nothing to stop that consultant writing a prescription for cannabis-based medicine.

So they need to talk to the doctor, but so far, none of the National Health Service doctors have said yes to that request. Some have simply refused prescribing point blank, some have even threatened or actually have referred the patient or the child to social services, which is quite appalling. Others would like to prescribe for them but have been stopped by the hospital authorities, because they have to get the hospital hierarchy to approve the prescription; patients are stopped at that point and a couple of patients have gotten through that hurdle, but then stopped because the local CCG (Clinical Commissioning Group) who pay for these things have refused to do so. So there are three big hurdles and no one has succeeded in getting over all three hurdles.

What led you to being involved in the medical cannabis space and effectively inspired you to create the Medical Cannabis Clinicians Society?

The start of this story goes back about 15 years ago when I was looking at multiple sclerosis patients – I was a neurologist running a multiple sclerosis clinic. Here the patients began to tell me that they were using cannabis to help their pain on their muscle spasm spasticity. So I asked the people informally in the clinic; and about half of the people in the clinic were using cannabis. I thought there must be something to this, because many people do not want to criminalise themselves by obtaining cannabis. So I was interested in it from then. Also I was little bit involved in development of Sativex, which is the only CBD/ THC licensed product in a country by GW Pharma.

Then more recently, I was asked to do the report for the All-Party Parliamentary Group on Drug Policy Reform, which was published by myself and my daughter, Dr Jennifer Barnes. This then propelled me a bit into the limelight.

Now, having helped to change the law, along with the many other people, my priority is to educate the doctors. In terms of education, we have set up two things:

  1. European Cannabis Holdings have set up the Academy of Medical Cannabis, which is a free online teaching programme; and
  2. The Medical Cannabis Clinicians Society, which has been set up with Hannah Deacon, Alfie Dingley’s mother. We’ve got about 100 members now, the members being doctors, and the aim of that society is to educate the doctors.

We’re planning to have a conference in November, which will produce an online evidence base. This is so that if doctors are worried about evidence for particular condition, they can look up and see the type of disease and supporting evidence to treat the disease much more easily. It is essentially there to educate both the doctors and the public; we have produced new guidelines for doctors which are better than the existing guidelines of the Royal College of Physicians. From this we hope the Society will help to develop medical cannabis prescriptions in the UK.

With the establishment of the medical cannabis clinic in Manchester and the imminent opening of the London clinic, how effective do you believe these clinics will be when it comes to patients gaining access to medical cannabis prescriptions?

It is sad in many ways that the only patient access at the moment is through private medicine; and a lot of people cannot afford that. At the moment the supply chain is so ridiculous that you have to get import for one named patient, for one month’s supply. This means you have got to go through all the bureaucracy, all of the cost that this involves, which all comes down to roughly £700-£800 (€779.20-€890.51) a month for adults and more for the children. It’s a shame they have to go through this process because it is the only way, at the moment, that you can get access to medical cannabis.

I believe the clinics definitely have a role, as some people want private medicine and that’s fine. I hope that others who cannot afford medical cannabis prescriptions in the long term will at least be able to afford the initial few prescriptions and they can then go back to their local doctor or the local hospital and say: ‘Look, it’s worked’; and then perhaps the doctors will change their minds and issue a medical cannabis prescription on the National Health Service.

I hope it is a way of getting prescriptions on the NHS – it’s a definite step in the right direction, as there are 22 people who have gotten a prescription who would not otherwise have a prescription if it was not for those clinics.

What more can be done for patients to access medical cannabis prescriptions?

I believe there are several things. Firstly, it is nearly all about doctor education. That is priority number one. To educate the doctors is vital because there is a lot of ignorance about what medical cannabis is, what to prescribe and in what dosage. Therefore, programmes like the Academy training programme and the Medical Cannabis Clinicians Society are essential.

Number two is that we need better guidelines. This is so doctors can have an objective basis for prescription which is not as restrictive as the current guidelines from the RCP and the BPNA.

Thirdly, we need the NHS to think sensibly about the bureaucracy around the medical cannabis prescriptions, because why should a doctor have to get his or her prescription approved by the trust hierarchies? This unnecessary layer of bureaucracy needs to be removed.

The fourth thing that can be done is to improve the supply chain. If a doctor writes a prescription, the patient should not be waiting eight weeks for it. The UK government can help with the supply chain and get bulk supply to the country. The government is capable of taking action, however at the moment they are saying, we changed the law, it’s up to the doctors, we can’t tell the doctors what to do. But in actual fact, there are things they can do to improve the whole bureaucratic experience.

Ultimately, the government on one hand can help to smooth the process of obtaining medical cannabis prescriptions, and the doctors’ education on the other hand will enable them to write prescriptions.

What does the future hold for the Medical Cannabis Clinicians Society?

I’m very positive and very optimistic. It will take time for doctors to come aboard; the experience in Germany and Canada and the places where medical cannabis is now legal is that it took two to four years for any sizeable number of prescriptions to be issued, but now in places like Canada, Australia and Germany it is picking up.

I hope that through various initiatives, including the Medical Cannabis Clinicians Society, we will get the information out there, get good knowledge and good understanding to the doctors. And optimistically speaking, over the next year, we’ll get more doctors prescribing.

Once you have broken down the initial barrier, once you have got a handful of prescriptions in a few National Health Service hospitals, I believe people will think ‘well, actually this might be worth taking seriously’ and ‘it might help some people’. We don’t need that many prescribing doctors – I would guess that we need just 100 doctors around the country in various specialties and various geographic locations, which should be enough to get the ball rolling; and I hope the society will help to achieve that process.

Professor Mike Barnes
Medical Cannabis Clinicians’ Society
The Academy of Medical Cannabis
www.ukmccs.org
taomc.org

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