Discover how, together, EMMAC Life Sciences and Imperial College London are advancing our understanding of the therapeutic properties of medical cannabis for a range of clinical conditions.
EMMAC Life Sciences is committed to investing in research and development to help shape the future of medical cannabis. Here, Dr Mikael Sodergren, an academic clinician based at Imperial College London, UK, and research director at EMMAC, provides an insight into the science underpinning the advances in the industry.
Why is medical cannabis such an exciting advancement in terms of therapeutics?
As you know, cannabis-based medicinal products were rescheduled under UK law on 1 November 2018, so now, for the first time, they can be prescribed by specialist doctors under certain circumstances. This forms part of a global trend in deregulation of medicinal cannabis and represents a very exciting opportunity to truly understand the therapeutic nature of this plant.
On the one hand, we have seen very high-profile media campaigns, particularly concerning children with epilepsy, who appear to gain significant benefit from medicinal cannabis, and we have heard of health benefits for a number of medical conditions claimed by patients who have had to resort to illicit use in the past. But on the other hand, there is really a paucity of high-quality clinical evidence to guide a prescribing clinician. This imbalance is in part related to the inability of doctors to prescribe medicinal cannabis previously and, as such, I expect a big effort by the academic community. This is supported by recent commissioned funding from the National Institute for Health Research to generate the clinical evidence that is required to guide clinicians. Furthermore, the cannabis plant contains over 100 different cannabinoids and a similar number of terpenes, all of which may be responsible for specific therapeutic efficacy for certain medical conditions.
It is therefore incumbent on the scientific community to accelerate these research programmes so that we can gain an understanding of the therapeutic potential of all the constituent parts of the plant, and, in that way, produce targeted treatments for specific medical conditions which are supported by the highest level of clinical evidence.
What must the medical community do to ensure that patients are able to access the correct medication as the industry’s understanding of the benefits of cannabis grows?
The global research to fully understand the medicinal benefits of the cannabis plant is likely to take several decades, due to the potential number of active ingredients and the complexities around studying this plant, but in the meantime there are certainly groups of patients who need to have access to medication from which they derive a benefit. In that aspect, medicinal cannabis is completely different to any other drug development pipeline, in that from both illicit use and, more recently, medicinal use of cannabis-based products in Canada and elsewhere, we have some data on adverse effects and tolerability.
However, in the medical literature study methodologies are largely heterogenous and it is difficult to compare different medical products. Therefore, while we await high-level evidence and licensed medicinal products, the government has legislated to allow doctors to prescribe unlicensed cannabis-based medicinal products under certain strict conditions. As doctors are not familiar with prescribing these medicines it makes sense to concentrate expertise where possible so that a framework which allows access for patients who would benefit, while adhering to strict prescribing guidelines, can be established.
How is EMMAC’s partnership with Imperial College London advancing the industry’s understanding of the therapeutic properties of cannabis for a range of clinical conditions?
The collaborative research programme between EMMAC and Imperial College London aims to investigate cannabis-derived medicinal products from the laboratory to the clinic. In that aspect, there are plans for a significant preclinical work stream evaluating many targets, ranging from cancer to inflammatory conditions.
For example, one interesting focus is how cannabidiol can signal through G protein-coupled receptors to alter the efficacy of chemotherapy in pancreatic cancer models, and if gene expression profiling can be used to understand any possible changes in molecular subtypes following treatment, which may allow us to develop targets for combination treatments in a clinical setting. In terms of clinical research, the initial focus has been on evaluating the opioid-sparing effects of cannabinoids in an acute pain setting through a randomised controlled feasibility trial of patients undergoing major hepatopancreatobiliary surgery.
The first stage in the development of the trial, which consisted of a comprehensive patient and public involvement programme, was completed early this year and the data was presented at the 5th International Emerald Conference in San Diego on 28 February, with a journal paper submitted for peer-reviewed publication. Patient recruitment is anticipated to start later this year.
EMMAC is also establishing a number of research collaborations with a network of universities in the UK and in Europe, and there are currently plans to set up a clinical trial evaluating the efficacy of cannabidiol for the symptom of spasticity for a range of neurological conditions, with preclinical research programmes focusing on fibromyalgia, multiple sclerosis and a variety of inflammatory conditions.
A continent in transition: how the medical cannabis industry is making waves across Europe
Over the past few years, the medical cannabis industry has seen strong growth across North America, fuelled by progressive deregulation and strong financial support for local companies in the USA and Canada. More recently, however, the European market has started to blossom, with a combination of regulatory changes, medical support and widespread changes in public perception contributing towards a higher demand for medical cannabis and cannabis-based wellness products.
According to Alex Brooks, a senior analyst at Canaccord Genuity: “We believe that over the next two to three years, medical cannabis will become generally available across Europe.”
With a population of around 743 million and an annual healthcare spend of €2.3 trillion, Europe has the potential to be the largest – and most valuable – medical cannabis market in the world. The European Cannabis Report (2018) and the Bank of Montreal Report (2018) suggest that the value of the European market could reach €55bn by 2028, assuming all the relevant infrastructure (market, legislative and social) is developed.
With supply and distribution partnerships throughout Europe, EMMAC is working to establish itself as the European leader in the production and supply of medical cannabis and derivative products.
Please note, this article will appear in issue 9 of Health Europa Quarterly, which is available to read now.