Let’s be Blunt: a less conservative approach to medical cannabis

Let’s be Blunt: a less conservative approach to medical cannabis
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Medical Cannabis Network sat down with Crispin Blunt MP at the Global Cannabis Institute’s London conference to discuss his support for access to medical cannabis in the UK.

Crispin Blunt is a Conservative MP who Chairs both the All-Party Parliamentary Group for Drug Policy Reform, and the Conservative Drug Policy Reform Group. Medical Cannabis Network spoke with Blunt at the Global Cannabis Institute’s London conference to discuss his support for access to medical cannabis in the UK, the challenges surrounding this, and the work his groups are doing to improve the situation for British patients.

You recently announced your personal view that you expect cannabis to be legalised in around five years, if politicians get over their timidity; do you believe access to medical cannabis via the NHS is going to improve in that five year period or are there still too many barriers?

We’ve already seen a very important change with NICE licensing Sativex and EPIDIOLEX and that is a game changer for many people who are going to benefit from those products. For example, the health service in Wales has already moved on to Sativex. I believe that there’s going to be progress across the board on this issue.

However, it is difficult to identify how long this will take in any particular area. Nevertheless, I’m confident that in the end we will get policy based on evidence. Yet, there are an awful lot of interests kicking around in this space who have different agendas (for example, there are commercial interests and media agendas already engaged). The objective of the Conservative Drug Policy Reform Group Limited (CDPRG) is to have policy based on evidence; therefore, our work is to try and promote an evidence-based approach to policy, and we don’t advocate for a particular outcome.

If you look at Canada, Uruguay, or the 12 American States who have gone down the legalised adult use market with licence conditions and regulations and then apply the appropriate licence conditions and regulations in the UK, you would have an infinitely better public policy outcome here in Britain.

Now, we have got to establish those arguments. There are particular anxieties in the UK around this because of the nature of the UK supply chain as 95% of the illegal cannabis here in the UK is very high in THC and if you are a heavy cannabis user as a teenager or you are under 24 years old, then your mind is still growing and there is evidence which seems to demonstrate an association with schizophrenia (if you have a predisposition to it).

We need to have a proper public health conversation, but it also has to sit alongside a criminal justice conversation, as well as a wider economic conversation. The Canadians were absolutely clear that their case for this was to protect children and reduce criminality. Those are the two major public benefits that are potentially achievable in Britain. There is so much evidence now, with other nations moving in this direction, and we just need the UK government to take the evidence into consideration. If they think they can secure those public benefits by legalisation, then it comes down to working out what regulations and licence conditions should be applied within the UK context.

Do you think that there is a danger that medical cannabis products will have to follow the same developmental pathway as typical pharmaceutical products which are, of course, both expensive and time consuming?

That is indeed the present danger. Of course, this is moving onto a separate set of issues which are about medicine from cannabis, and of course we are over the line in policy terms regarding recreational adult use; we don’t want to confuse the two because there are opponents of reform.

There is a link between the world’s approach to narcotic drugs which it took in 1961, so we have to be clear about what the actual position is here. However, in Parliament, you will be hard pushed to find an opponent of medicine from cannabis. If you can make it from the poppy, why can’t you have medicine from the cannabis plant? That is the basic point here.

It took quite a long time for the penny to drop, and it was when the Home Secretary was faced with a very sick young boy in the Chelsea Westminster hospital who had his medicine confiscated. Some of that confiscated medicine could be returned to him, and that then led to the Chief Medical Officer being asked for a formal opinion on whether there are benefits for medicine from cannabis. This then takes us to the position we are in now, which is the regulators and the medical profession wrestling with the question of ‘how do we now access these benefits for patients in a safe way.’ You have also got regulators who will always have issues from the past such as thalidomide and contaminated blood sitting at the forefront of their minds in terms of unknown potential risks.

Of course, there is a lot of evidence about the potential benefits and the standard pharmaceutical assessment route of one molecule’s action on one disease; blind trials going on for years simply doesn’t work. If we try to drive medicine from cannabis through that prism, we will eventually do what GW Pharma did, but it took them 20 years and they’ve invested £1bn (~€1.1bn) to get to the point where today Sativex has just been not only authorised by the FDA and the European Medicines Agency, but NICE are going to buy it for people for whom it is prescribed. However, do we really need to wait 20 years and invite all these companies to invest £1bn in research into products whose benefits are now very well established so but only need to be re-established to a medical standard? That is going to be a different route, in all probability, to the current pharmaceutical assessment process.

It is worth noting that the CDPRG are preparing a paper on adaptive methodologies. It will be looking at these shortcomings in clinical trials that we all know are there, as well as at alternative methodologies that can collect data that is robust enough to satisfy the regulators but can do it a bit quicker and more flexibly – that will be out next year.

Another paper that the CDPRG is putting together at the moment with the lawyers Mackrell Turner Garrett will look at the regulation of medical cannabis in the UK and the barriers and opportunities there. That is going to be quite a big and comprehensive piece of work and will be launched in January 2020.

One of our policy objectives is to encourage the government to establish its own unit to look at what is happening in other jurisdictions around the world in the medical cannabis space, and in the legal, adult use space as well, which is a separate issue. A lot of evidence is emerging about how different countries have wrestled with the issue of getting the benefits of medicine from cannabis in a safe way, and so I don’t think that the UK has to reinvent the wheel, and it certainly shouldn’t say ‘well this is a medicine so it has got to go through a standard pharmaceutical assessment process,’ because all we have there is 20 years of frustration and people being driven to criminality to grow their own medicine, as is the case now.

On the subject of your All Party Parliamentary Group and your Conservative Drug Policy Reform Group, what are both groups doing to improve access to medical cannabis?

We are working with the All Party Parliamentary Group, with another APPG that is chaired by Sir Mike Penning and Antonia Antoniazzi – they have an All-Party Group for medical cannabis by prescription. They are in a very narrow space, and so we want to work with them because the agendas overlap. The CDPRG as far as possible mirrors the work of the APPG but is restricted in the amount of resources it has got for capacity. That was intentional as I didn’t want the APPG to have a commercial interest associated with the group. The CDPRG have chosen quite deliberately to put that restriction down because there are very substantial economic interests on the part of those businesses who wish to invest in this area and investors who wish to support those business.

As the Chairman, I made sure that I can answer this charge of a conflict of interest as by ensuring that I see no financial benefit from my involvement. I know that if we can advance and change this agenda then we will be doing a massive public good. The satisfaction I get from my work in this area is huge.

We are currently working on a campaign and supporting a lady called Lesley Gibson in Carlisle, who has been prosecuted for growing medical cannabis even though she was unable to access it on the NHS; she can’t afford the cost privately so it is a case that really highlights the incoherence in the law at this point. Just 17% of people support prosecuting Leslie and individuals like her who are accessing medical cannabis illegally for medicinal purposes, according to CDPRG polling last year. There is no public support for this. There was an APPG meeting recently which was incredibly powerful, and a number of patients stood up in Parliament and gave powerful personal testimony about having to access cannabis illegally and being afraid of being arrested. There is something not right here.

We think that Lesley Gibson and her husband will go to trial in January 2020 and we want to produce the best quality of defence for her and the best quality scientific and medical evidence in the trial. If we can go beyond her case, if we can establish a legal fund which will actually fight to defend the interests of people who are patients in this position, then hopefully we can, in the end, change the policy of the DPP at some point, before we change the law itself.

If we have got a place where the government has formally said there is benefit in medical cannabis, which it did just over a year ago, then why are we prosecuting people for growing their own medicine because they can’t afford to pay thousands of pounds a month? Indeed, most people are not in a position to afford costs of that scale.

If we see legalisation, do you think it will be possible to keep prices down to the same level that people are paying on the black market now?

The obvious conclusion from looking at the North American experience in the 12 States that have slowly gone down this route is that it might be an idea for the politicians and regulators not to be greedy up front. What we need to do is to compete out the illegal supply chain; if we start off by taxing the product in the legal space and regulating so hard that it becomes more expensive than the illegally produced product, we are not going to eliminate the criminal supply chain.

It is also worth noting that CDPRG polling found that 25% of the cannabis users surveyed said that they would prefer less potent forms of cannabis to that which is currently available on the black market, so evidently the black market isn’t working for everybody. If you go to United States and ask people about schizophrenia and psychosis in children, this is something that they haven’t heard of because the cannabis they consume is of a different order and a lower strength than it is in the UK.

What would you say are the main reasons that the UK hasn’t progressed as much in reforming policy on medicinal cannabis when it comes to other European countries?

Things have changed in terms of the cost of obtaining a licence in the UK. In order for Alfie Dingley to access the product he was prescribed when the family were living in a holiday camp in Holland for presumably hundreds of pounds or less in the UK under the old licensing system, the person applying for the licence had to pay £5,000. The doctor administering it was also required to obtain a special licence that cost £5,000, the pharmacy that imported it and then oversaw it had to have an import licence for £5,000, and then another licence at a cost of £5,000 was required in order to handle it when it got to the pharmacy. Therefore, one bottle of cannabis oil for one child cost £20,000.

The system has changed since then, but you can see how easy it is for the system to load cost. NICE is now positioned around other products and their licences need to go through the same process of assessment. They could then make all these products undergo a 20 year assessment process that will cost however many hundreds of millions of pounds in the same way as any pharmaceutical currently on the market, at which point they will become too expensive for NICE to buy. They are left in a ‘catch 22’ position, where NICE’s requirements will then put the product out of their own reach.

The NHS in the UK is less driven by the consumer care markets within health, and I think that is a big factor because we have to go through slightly different processes. Thinking back to the court case in Germany, the ruling led to insurers being forced to pay for cannabis for medicinal use. I am hopeful that Lesley Gibson’s court case sparks similar systemic changes here; we just have to tackle the barriers.

Crispin Blunt MP
Chair
All Party Parliamentary Group for Drug Policy Reform & Conservative Drug Policy Reform Group
crispinbluntmp@parliament.uk
Tweet @CrispinBlunt
www.drugpolicyreform.net
www.cdprg.co.uk

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