Skip to main content

Cannabis-based Medicines

Volume 643: debated on Tuesday 19 June 2018

With permission, Mr Speaker, I would like to make a statement on the medical use of cannabis.

Over the weekend, I issued an emergency licence to allow Billy Caldwell’s medical team to access cannabis-based medicine to treat life-threatening seizures caused by a severe form of epilepsy. This was an emergency procedure, which was led by a senior clinician with the support of the medical director at the Chelsea and Westminster Hospital.

I am pleased to say that Billy has now been discharged from hospital. It is now for his senior clinicians to develop a long-term care plan. I am sure that the whole House would like to join me in expressing our sympathy for what Billy and his family have been going through and the very difficult time that they have faced.

The course of action in this case was unprecedented. There is strong scientific evidence that cannabis can harm people’s mental and physical health and damage communities. There are currently no legally recognised medicinal or therapeutic benefits. To date, under successive Governments, Home Office policy has been to permit the production, supply and possession of raw cannabis solely for the purposes of research with a Home Office licence. The cannabis-based medicine Sativex can, however, be prescribed in the UK because there is a proven case for its safety and efficacy. However, cases such as Billy’s, Alfie Dingley’s and others like them, have shown that we now need to look more closely at the use of cannabis-based medicines in the healthcare sector in the UK.

It has become clear to me since becoming Home Secretary that the position we find ourselves in is not satisfactory. It is not satisfactory for the parents, it is not satisfactory for the doctors, and it is not satisfactory for me. I have now come to the conclusion that it is time to review the scheduling of cannabis. Before I go into the detail of the review, let me be absolutely clear that this step is in no way the first step in the legalisation of cannabis for recreational use. This Government have absolutely no plans to legalise cannabis, and the penalties for unauthorised supply and possession will remain unchanged. We will not set a dangerous precedent or weaken our ability to keep dangerous drugs off the streets.

The approach that we will be asking the review to consider will be no different than that used previously for controlled drugs where there is evidence of medicinal benefits. The Government review will take place in two parts. Part 1 of the commission will consider the evidence available for the medicinal and therapeutic benefits of cannabis-based medicines. Professor Sally Davies, who also serves as the Chief Medical Officer, will take that part forward. It will then inform exactly which forms of cannabis or cannabis-based medicines should be taken forward to part 2.

Part 2 will be led by the Advisory Council on the Misuse of Drugs. The ACMD will not reassess the evidence issued by Professor Sally Davies, but will provide an assessment, based on the balance of harms and public health needs, of what, if anything should be rescheduled. If the review identifies that there are significant medical benefits, we will reschedule. We have seen in recent months that there is a pressing need to allow those who might benefit from cannabis-based products to access them. It will, of course, take time for Sally Davies and the ACMD to complete their work and for the Government to consider their recommendations.

In the short term, my hon. Friend the policing Minister announced yesterday that the Government would be establishing an expert panel of clinicians to advise Ministers on any applications to prescribe cannabis-based medicines. This is intended to ensure that advice to Ministers on licensing in these cases is clinically led, based firmly on medical evidence and as swift as possible. The chief medical officers across the UK have already been actively working together on the panel, and the expert panel will start considering applications within a week.

Earlier today, my hon. Friend the policing Minister also spoke to Alfie Dingley’s mum, Hannah Deacon, and informed her that we would issue a licence for Alfie later today. All of the work I have outlined today is about making sure that we keep in step with the latest scientific evidence, and that patients and their families have access to the most appropriate course of medical treatment. I pay tribute to the Policing Minister for all his excellent and sustained work on this important issue.

As a father, I know there is nothing worse than seeing your child suffer. You would do anything to take away their pain. That is why I have the utmost sympathy for Billy Caldwell, Alfie Dingley and many others like them, and for their parents who have been under unimaginable stress and strain. I know that they are following a gut parental instinct to do whatever is in their power to alleviate the suffering of their child. Today I would like to say to this House that I will do everything in my power to make sure that we have a system that works so that these children and these parents get access to the best medical treatment. I commend this statement to the House.

I thank the Home Secretary for prior sight of his statement. I am well aware of the damage that cannabis consumption can cause, whether it is the health of very young consumers or ganja psychosis. The newer forms of cannabis, notably skunk, are very much stronger than the cannabis available a generation ago. However, I am also aware, as the Home Secretary will be, that a former chairman of the Advisory Council on the Misuse of Drugs, Professor Nutt, has said that cannabis is less harmful than alcohol. I note that Baron Hague of Richmond is calling for complete decriminalisation.

The Opposition welcome the Home Secretary’s statement that he will look more closely at the use of cannabis-based medication in healthcare in the UK. We agree that this is the right time—if not long overdue—to review the scheduling of cannabis, and we are glad to hear that the policing Minister has spoken to Alfie Dingley’s mother. After the meeting in 10 Downing Street, she was very concerned about the length of time that it was taking to issue a suitable licence.

The Home Secretary has released some of the supply of medication that Billy Caldwell’s mother brought into the country, but does he intend to release the complete supply? Is he aware of the concern at the delays in the current process? Although we welcome the review, something must be done to manage the current process more effectively, including the use of an advisory panel. It is simply not acceptable that parents and families have to suffer, as they have been, as a result of the interminable delays in agreeing licences.

Cannabis and the drug issue generally are big issues of concern for the community. It is important that we base whatever we do on scientific fact and evidence, and we do not just bow to what might be popular sentiment. There are harms connected with cannabis consumption, but it is time to move forward and establish once and for all the potential of cannabis-based medicine to alleviate pain and suffering.

I thank the right hon. Lady for her comments and her support for my statement. I think she agrees with me that it is absolutely the right time for the Government to look at this issue. She will be aware that under successive Governments, policy in this area has not changed for a long time, but given what we have all seen and heard all too clearly on our television screens, on the radio, and given the many meetings that my hon. Friend the policing Minister has had with the families affected, it is the right time to look at this issue and act as quickly as possible.

There are two parts to our action. I wish to reassure the House—all hon. Members will appreciate that rules of this type cannot be changed overnight. The changes have to be based on evidence. If they are not and are not properly made, some people out there may have different views and may try to challenge the rules legally. They have to be sufficiently robust. That is why we have put in place this process and why we wanted to act as quickly as possible. Professor Sally Davies’ office has said that she can complete her work within a week. We are moving as fast as we possibly can, and I hope that the ACMD can then act within weeks.

At the same time, we do not want any other families to suffer, so we want to ensure that we have a process in place to act much more swiftly. That is why we have established the expert panel. The chief medical officers from all the devolved nations, including Northern Ireland, are involved in that, so we are co-ordinating and will work well together. The expert panel will be able to act very swiftly and Ministers will be able to take action very quickly based on medical advice, which is what we all want to see.

The right hon. Lady asked me about Alfie Dingley. As I mentioned, we will be issuing the licence today. Alfie’s mother has already been informed and is of course very happy with the decision. I am sorry that she has had to wait so long and go through all the distress that she has faced. I am grateful to the policing Minister for all the work that he has done, and to Alfie’s mother’s Member of Parliament—the Attorney General, my right hon. and learned Friend the Member for Kenilworth and Southam (Jeremy Wright)—for all the work that he has done.

The right hon. Lady asked me about Billy Caldwell’s situation. We are working very closely with the family. Now that the licence has been issued, we will ensure that the right amount of medicine is available for the right time. The situation depends somewhat on whether Billy Caldwell’s mother decides to go back to Northern Ireland, because licensing is an entirely devolved matter. We are working closely with the Northern Ireland authorities to ensure that, if she does decide to go, the move is seamless and does not affect Billy Caldwell in any way.

The right hon. Lady is interested in how quickly we acted. The first time we received a request from a clinician in the case of Billy Caldwell was at around 11.15 am on Friday just gone; by noon I had issued a licence and the drug was in possession of the family. I do not believe that we could have acted any quicker from the point at which we received a request from the clinician.

Once again, let me say that I really appreciate the right hon. Lady’s comments. By working together, we can bring to an end the suffering of all these families and help in every way that we can.

I thank my right hon. Friend for his statement and the rapid way in which he has gripped this issue. As co-chair of the all-party parliamentary group for drug policy reform, let me say that this is a very welcome step forward. There is a substantial amount of medical evidence out there, including a 2016 paper on this issue—commissioned by my predecessor co-chairs of the APPG—by Professor Mike Barnes, who has been associated with the Alfie Dingley case. Will my right hon. Friend make it clear that Professor Sally Davies has been given two tasks, including one on the expert panel to advise on immediate applications for licences? Will he confirm that people will not be asked to pay the swingeing fees that were being asked of the Dingley family in respect of their licences? Finally, what is the expected timescale for the second task that my right hon. Friend has asked the chief medical officer to undertake?

I welcome my hon. Friend’s comments, the work that he has done in this area over a number of years and the interest that he takes in the issue. I can confirm that Professor Sally Davies is helping—first with the expert panel so that we can bring help before the review is complete, and then of course with the review itself. He also mentioned the important issue of fees, which I am looking at to see how we can help.

I thank the Home Secretary for his statement. May I just gently say to him that it would be nice if the third party could have a little bit more advance notice than the statement literally being put in my hand as he gets to his feet? That said, I am pleased about the statement.

The Home Secretary is making significant progress in this area. I am particularly pleased for the individual families concerned, and to read about the review, but of course there are thousands of people across the United Kingdom who want to access these medicines for the treatment of conditions for which there is evidence that they can alleviate the symptoms and pain. These individuals and their families are worried about the bureaucracy and the hurdles that have to be crossed to access the medicines. Can the Secretary of State give me some assurance that his review will focus on removing bureaucracy and hurdles? Does he agree that this matter should eventually be seen as a public health matter that should be taken out of the Home Office and put into the hands of health departments across the UK?

In the meantime, I am pleased to hear that the chief medical officers of the devolved countries are involved, but will the Secretary of State confirm what other liaison there is—with the Scottish Government, for example—in relation to both health and policing, which has been mentioned, as these are devolved matters?

I thank the hon. and learned Lady for her comments. She is right to highlight that thousands of people may be suffering. No one knows the exact number, but it is estimated that at least 10,000 children in the UK have a drug-resistant form of epilepsy. That really puts into focus what a big difference these measures can make. I can also give her an assurance about bureaucracy and hurdles. Frankly, there has been a lot of bureaucracy and many hurdles in the way until now. The decision that we made on Friday was unprecedented, as are the measures that we are putting in place. The expert panel will make a huge difference. Its whole purpose is to make the process as smooth and quick as possible, based on medical advice at all points. I do not want to prejudge the review, but I am sure that the hon. and learned Lady can sense the direction.

As chair of the all-party parliamentary group on cannabis: harmful effects on developing brains, I thank my right hon. Friend for his assurances that any future medicinal use of cannabis will not be conflated with any weakening of the Government’s position on recreational use. Is he aware of the increasingly clear evidence of permanent psychosis and depression among young people who are users of what we see on our streets more regularly—skunk cannabis?

I am very much aware of that. It is perfectly correct for my hon. Friend to highlight this point. As I made clear in my statement and I am happy to make absolutely clear again, there are no plans at all to decriminalise cannabis. It is a controlled class B drug under the Misuse of Drugs Act 1971, and that will not change.

All of us must want children—and also adults—to get the medical treatment that they need without additional hurdles that have nothing to do with medicine. I welcome the Home Secretary’s announcement that he will look at the scheduling of cannabis, because it is incredibly hard to explain the scheduling classification of cannabis compared to opiates, and the additional burdens that that scheduling poses for the health service if such products are needed for treatment. May I ask him again to look more widely at the barriers and obstacles in his review? Will he look at whether these kinds of scheduling or licensing decisions should be passed to the Department of Health and Social Care, and whether much more drugs policy should, in fact, be led by that Department?

The right hon. Lady makes a number of good points. She is right to highlight that there are currently drugs that are under schedule 2, meaning that the medical benefits are accepted, but which can be a lot more harmful than other drugs if they are used in the wrong way. She asked about the role of the Department of Health and Social Care in these kinds of decisions. This requires a cross-Government approach, with the Home Office and the Department of Health and Social Care working closely together, as we have seen. We have an issue in that these drugs are categorised as illegal under the Misuse of Drugs Act, but we need to recognise, where appropriate, that some of them have medicinal benefits, as has already been recognised with, for example, cocaine and morphine. It is therefore appropriate that the two Departments work together.

I absolutely understand the Government’s review of this policy, and I welcome it for those who suffer and need this drug to make them better, but may I just say that, from my own life experience, I am delighted that the Government are not going to decriminalise the use of drugs. All too often, people start on cannabis and end on something far worse, and I have personally seen the devastation to families and the loss of children because of drugs.

I welcome the move that the Home Secretary has made, on behalf of my constituents. It is really important to me that the grandfather of Charlie Jones and the parents of Jace Newton-Sealey know how to go about applying for a licence. Will the Home Secretary and his Department make the process clear, so that people know how to access a licence?

Yes, I think that there is a need to make the process clearer. I have been quite open that I do not think that the current process is a friendly one at all. The decision made in the case of Billy Caldwell was unprecedented; no Government in the past had recognised the medicinal benefits of cannabis by making such a decision and issuing a licence. We need to make the process—even the interim process, through the expert panel—much smoother and more straightforward. Once the panel is set up, which will happen by next week, we will set out exactly how the process will work for the hon. Lady’s constituents and others.

Clinical leadership may have its place, but for years the crying need has been for political leadership, so may I thank my right hon. Friends the Secretary of State and the Policing Minister for providing it?

I genuinely welcome this announcement, which does mark a significant shift, but is there not a dreadful hypocrisy in Government policy on drugs more generally? Probably most of the Cabinet drinks alcohol, the most dangerous drug of all. Probably half the Cabinet has used cannabis—maybe even the Home Secretary—unless it is a very odd group of people, but perhaps that is the case. Should not the Home Secretary follow the advice of the former Conservative leader, Lord Hague, who makes the case for a regulated, legalised market, which would be the best way to protect from harm people who, at the moment, buy from criminals who have no interest in their welfare at all?

This is about making sure that the best possible medical treatment is available for everyone in the UK, but especially our children. It is about medical treatment, not the recreational use of drugs, which can cause severe damage to people. I am afraid that I do not agree with the right hon. Gentleman on that point, and nor, on this occasion, do I agree with Lord Hague.

I thank my right hon. Friend for very much humanising this issue. As chairman of the all-party group on multiple sclerosis, I welcome his announcement about the medical aspect of cannabis. May I offer the services of the MS Society in any inquiry and call for evidence that he might have? May I also associate myself with his remarks about drugs? I am frankly staggered that my right hon. and noble Friend Lord Hague—or indeed anybody else—could advocate such a thing. We will all have seen at first hand in our constituencies the devastation that cannabis causes. This is not recreational use—it steals lives and futures, and we must be robust in ensuring that it stops.

My hon. Friend is absolutely right on that point. He will know that Sativex, which has a cannabis base, is already licensed for those with MS, but today’s announcement is about how we can improve on the medical use of cannabis even further.

I, too, genuinely welcome the licence for Alfie today, but what a scandal it is that it has taken three months since Hannah Deacon met the Prime Minister and was promised swift and compassionate action, and what an outrage it is that, frankly, it is only the press attention that has finally shamed the Government into action. With regard to the expert panel, what assurance can the Home Secretary give that there will be enough Home Office staff to deal with the thousands of applications that might well now come?

Let me say gently to the hon. Lady that in the case of Alfie Dingley, of course we are all pleased that we have been able to issue the licence today. She should know that before the application—the approach by his clinicians—no Government had even entertained the idea, given that cannabis is classed as a schedule 1 drug, of looking at this from a medical point of view. This Government have done that. I hope that she can join us in not just welcoming that, but working together on how we can end the suffering of so many other people, particularly children, who could benefit from these kinds of medicines.

I commend the Home Secretary for his statement. I support the legalisation of cannabis for medical use. May I urge him to encourage the clinical review team to get on with it? There is already a mass of internationally accredited research available that they can draw on, so we do not need to reinvent the wheel. The research is there—it just needs to be studied and then a decision can be made quickly.

My hon. Friend makes a good point. One of the issues has been that our rules in this area have not kept up with medical research and evidence. At least 13 European countries, as well as Canada and over 30 US states, have recognised the medicinal benefits of cannabis. The World Health Organisation has also done work on this and pointed to evidence. We will be using and drawing on all that evidence. That is why I am pleased that Professor Sally Davies has said that she can complete her work in days.

The Home Secretary says that he wants a system that works. I am bit concerned about the role of the Advisory Council on the Misuse of Drugs in the light of what has happened in recent days. Is it still fit for purpose?

Yes, it is. It has an important role to play, which is to advise Ministers on the scheduling of drugs. If we are to change a scheduling, it is important to listen to its point of view.

I welcome the fact that the Home Secretary set out at the start of his statement that

“cannabis can harm people’s mental and physical health and damage communities.”

I also welcome the fact that any change will be science-led. Will he also look at international examples? He mentioned Canada, where a law was introduced very recently. Will he see what works—and, importantly, what does not work—with that law, in particular, because the evidence is mixed?

My hon. Friend is absolutely right. We will certainly be looking at international evidence. A lot has changed in the UK since the current rules were put in place, and we will take all that into account.

I welcome what the Home Secretary has said today. I have long supported decriminalisation of the use of cannabis for medicinal purposes, not least having heard some really heartbreaking stories from my own constituents, particularly those with degenerative conditions, some of whom, sadly, passed away unable to get the pain relief and support that they needed. Given the speed at which this review will be undertaken, will the Home Secretary, the Policing Minister and the Attorney General be giving any guidance in the interim to police forces or the Crown Prosecution Service on the public interest in pursuing the impounding of material, or prosecuting individuals who are using it for medicinal purposes?

The current rules are clear. We have discussed today and debated in Parliament how we would like to see a change in the process, but until those rules change, they would have to be applied. The hon. Gentleman raises a perfectly good point about working with law enforcement agencies and making sure that they are taking emerging policy into account.

I have long advocated the use of medical cannabis and therefore very much welcome the Home Secretary’s announcement of a review. May I have assurances that that review will be very much patient-centred and led by evidence of how the use of medical cannabis can help those with chronic conditions?

I can absolutely give my hon. Friend that reassurance. The review must have the patient at its very heart and must be driven by medical evidence.

I welcome the statement, and particularly the news on Alfie Dingley. Of course, there is already evidence of the medical benefits of cannabis, because otherwise Sativex would not be available on licence. That is why it is so absurd that cannabis is still a schedule 1 controlled drug. I am therefore hopeful and confident that the review will lead to a recommendation to reschedule. Will the Secretary of State confirm that rescheduling could be carried out quite quickly and easily by means of a statutory instrument, meaning that we can get on with it?

First, Sativex was looked at for a particular condition. It is right that drugs are looked at the context of the condition that they are intended to help with. The hon. Gentleman makes a good wider point about whether, once the review is complete, we can get on with it, with any changes made quickly. That is exactly what I intend to do.

As chairman of the all-party group on 22q11.2 deletion syndrome, I know many parents of children who have a rare genetic condition that often goes undiagnosed and, when diagnosed, is not always appropriately treated. From that experience, I am sure that Billy’s family welcome today’s statement. I welcome the fact that elements of the statement show that the Government look to the evidence and respond to the public interest, as well as that of the patient at the forefront.

My hon. Friend is right. The process should absolutely be clinically led. We should listen to evidence from clinicians while drawing on international evidence, too. That is exactly what should feed into the outcome of the review.

I think we all welcome the progress that is being made, but there are questions about people who need help now. My constituents Laura Murray and John Ahern have a one-year-old daughter, Bláthnaid, who has been diagnosed with Aicardi syndrome. She suffers very severe seizures throughout the day and her parents believe that these medicines could help. I will write to the Home Secretary with more details about that situation, but may I ask him how much discretion he still has, and how much he is willing to exercise?

As the rules stand, until the review is complete and changes are made, any use of cannabis for medicinal purposes will require a Home Office licence or, in the case of Northern Ireland, a licence from the Health Department there. I hope that what I have set out today has given reassurance that I recognise the need for action now, not tomorrow or in a few weeks or months. We need action now, and that is the purpose of the expert panel—to make this a much smooth, quick and clinically-led process.

I welcome the Home Secretary’s announcement. I note that he is not going to reclassify cannabis, but will he look at how we deal with individuals in possession of a small amount of cannabis? To that end, will he look at Checkpoint, an alternative justice initiative by Durham police that aims to help individuals and to try to break the link between drugs and crime?

The right hon. Gentleman is right: this is not about the reclassification of cannabis. He makes an important point about the need for law enforcement to work with others, including the many good groups out there, to try to get people off drugs once they have a problem. It is important to do more work on that.

I welcome the Secretary of State’s announcement. Those treating my constituent, Caroline, are firmly of the view that she is alive today and living a good quality of life because her brain tumour has been slowed by the regular use of cannabis oil, but she is having to import that at a cost of hundreds of pounds every month. When can she expect her doctors to be able to prescribe that treatment? Is there anything she should be doing in the meantime to benefit from what the Secretary of State has announced today?

I do not know all the details of that case, but it might be good to look at the work of the expert panel that I have talked about. As I say, we will set out more details on that. Any changes to the rules will be made after the review and, as the House has heard, we are trying to do that as quickly as possible.

The mainstream media have highlighted this week the heartbreaking cases of Alfie Dingley and Billy Caldwell. The Secretary of State has said that an estimated 10,000 children in the UK who suffer seizures could benefit from these medicines, as could many more people suffering from degenerative conditions. It has always been the case that he could grant a specific licence, but given his comments about the time that it will take the ACMD to reach a conclusion and to look at international evidence from Canada and the 13 EU countries, what is his estimate of how long it will be before we get a more streamlined system?

First, I reassure the hon. Gentleman that we will take the international evidence into account. I know that Dame Sally Davies will look at that too, as will the ACMD. I want that work to be done as soon as possible, but right now I want to streamline the process, which means that the work of the expert panel will be very important.

I welcome the Home Secretary’s statement. It will be particularly welcomed by my constituents the Gray family, as Murray Gray suffers from a similar condition to Alfie Dingley and Billy Caldwell. I also welcome the speed with which the Home Secretary will act, but I urge him not to be thrown off track or to allow anything to affect the rescheduling of cannabis, such as reactionary fear about its availability for recreational use.

I thank the hon. Lady for her comments, and I reassure her that I will not be thrown off track.

I thank the Home Secretary very much for his statement and the urgency he has given this. I also thank the Minister for Policing and the Fire Service for all his hard work, which should not be ignored. My constituents Darren and Danielle Gibson took their eight-year-old daughter Sophia to Holland so that she could receive these drugs. It was very important that they did so, as that had a clear medical benefit for their child. The Minister will know—

Order. I express the cautious hope—it would probably be unrealistic of me to say this with enormous confidence—that the hon. Gentleman, whom we all love dearly, is approaching his peroration, at the end of which there will be an unmistakeable question mark.

There certainly will be, Mr Speaker.

When I met the permanent secretary of the Health Department in Northern Ireland, he said that he would have some difficulty giving the go-ahead in Northern Ireland. He needs direction from the Home Secretary. What discussions has the Home Secretary had with the permanent secretary to facilitate this urgently for my constituent Sophia Gibson?

The hon. Gentleman will know that the decision to issue a possession licence is completely devolved in Northern Ireland, so it is outside the Home Office’s area. That said, we want to work closely with Northern Ireland. The permanent secretary in my Department has been working with the permanent secretary in the Health Department in Northern Ireland. We want to help in every way possible, especially in the case of Sophia Gibson, and that is exactly what we are doing.

I have to say that I am a little perplexed by this. The Home Secretary is saying that there are currently no legally recognised medicinal or therapeutic benefits of cannabis. I am wondering what we are giving to Billy Caldwell that has led to such a turnaround in his situation and what we are proposing to give to Alfie Dingley, if it has no therapeutic benefits.

Under the current rules, those are not recognised. To be a bit clearer, all drugs that may or may not have a medicinal benefit are scheduled, and drugs in schedule 1, which is where cannabis is at the moment, are not recognised to have medicinal benefits under the law. That said, we of course want to look at the evidence, and to be led by evidence and clinicians, which was exactly why I made today’s announcement and why I took action last week.