Question for Short Debate
My Lords, chronically sick patients with constant severe pain and other symptoms have suffered for far too long, reliant on prescribed medications that are sometimes ineffective and with intolerable side-effects for many people.
I remind noble Lords, if they will forgive me, of the case of Faye, whose experience was so brilliantly articulated in the Daily Mail on 2 May. At the age of 27, Faye was diagnosed with crippling rheumatoid arthritis. She describes the side-effects of conventional drugs as,
“more disruptive to daily life than the disease itself”,
which is saying something with rheumatoid arthritis. Faye recognised that prescribed drugs are fine for some people, but not for her. Having never used an illegal drug, and rather fearful, she found cannabis, and very slowly came off her prescribed medications. What was the result? She stopped feeling sick all the time—imagine a life of feeling sick all of the time. Now, two and a half years later, taking only cannabis, Faye says that her quality of life is now 98% of what it was before the diagnosis. She works full-time. Not only is this absolutely wonderful for Faye but it is saving the NHS thousands of pounds a year in medications, consultant appointments, GP appointments and so forth.
Under our drug schedules, as all noble Lords in this Room know, cannabis is listed as a dangerous drug with no medicinal value. In reality, of course, cannabis is safer than many prescribed medications and there is growing evidence of its medicinal value for a remarkable list of conditions. Our schedule is simply wrong and should not remain as it is. We need to inject some urgency into the situation. It is unnecessary and in my view cruel for these patients to suffer another two, three or even more years of agonising, sleepless nights and pain-stricken days or risk arrest to get hold of cannabis, which they tell us is the only effective medication with minimal or no side-effects.
For the first time, the UN is on our side and on the side of our Government should they wish to undertake some reform. The United Nations Office on Drugs and Crime—the UNODC—at the UN General Assembly Special Session on Drug Policy in April last year, made it clear that evidence-based public health policy is here to stay, and that treatment without stigma should be the driver of drug policy. This was a most important statement from the UN body at the centre of international drug policy. After 60 years of drug policy dominated by the notion of a “war on drugs” and the ludicrous aim of creating a drug-free world, the UN is at last asking member states to consider a pragmatic, realistic approach. From now on, countries need clear objectives—how remarkable: let us have some objectives—such as reducing addiction and harm in the consumer countries, and reducing violence and corruption in the producer and transit countries.
If the world is to follow the UNODC lead, countries need to evaluate policies and introduce those for which there is an evidence base. This brings us directly back to medicinal cannabis. We have sufficient evidence worldwide to know that cannabis has very significant medical properties. As I have said, we can no longer justify its Schedule 1 status. At its last meeting, the World Health Organization’s expert group agreed that the widespread acceptance of medicinal cannabis means that the WHO’s insistence on its having no medicinal value appears incongruent, particularly as it relies on 80 year-old data. I believe that is actually progress.
Our own Medicines and Healthcare products Regulatory Agency, the MHRA, determined last October that products containing cannabidiol—CBD, a derivative of cannabis—are indeed medicines and can be prescribed. How can we say under Schedule 1 that cannabis has no medicinal value when, according to our regulatory body, a part of it does? We cannot. We are fortunate to have Ministers in the Home Office who understand the evidence. A blog by the Home Office Minister Sarah Newton in April stated that the Government’s view is that cannabis should be subject to “the same regulatory framework” as other potential medicines, subject to approval from the MHRA.
The big question—this is very important—is whether the MHRA can accept a special status for cannabis, an inexpensive weed with such valuable medical properties. If cannabis is put through five or 10 years of double-blind random controlled trials, it will finish up so expensive that it will be ruled out from the NHS by NICE. Sativex is a good example. My fear is that Epidiolex, for children with specific strains of severe epilepsy, may also be priced out of the NHS market in another three years’ time when the lengthy trials finally come to an end. It is impossible to overestimate the urgency of treatment for these epileptic children, who suffer severe brain damage with hundreds of seizures every single day. Their brains are being destroyed and that damage will not be reversed.
Another tragedy that we really need to think about in relation to Epidiolex is, I understand, that GW Pharmaceuticals, which has spent £20 million on these trials, now realises that another cannabinoid would be more effective for these children with severe epilepsy than the cannabinoid upon which those £20 million-worth of trials were based. It cannot repeat them all, so a suboptimal medicine will be put to the MHRA for approval. There is something terribly wrong here and I would be grateful if the Minister would meet me to talk about the need to consider a safe—it must be safe—but less costly process of trials for cannabis medicines than is required at present.
Columbia Care, a well-respected company providing reliable, dosable cannabis, may provide an answer. Its products are superior to those accepted in the Netherlands and Germany and may provide a model of trials acceptable to the MHRA. There are other reputable companies providing good-quality cannabis products to Israel and elsewhere. Already 28 US states, 11 European countries and the whole of Latin America recognise that cannabis is a medicine. More states and countries join that list every year. The illegal status of cannabis has undoubtedly discouraged research into its medicinal properties. Oxford University, however, will be funded to the tune of £10 million by Kingsley Capital Partners to investigate our own endocannabinoid system. It is our own system that explains the extraordinary powers of cannabis. I will not go into this but in the meantime Professor Mike Barnes’s report, commissioned by our APPG for Drug Policy Reform, has reviewed all the international data and showed beyond doubt that cannabis is indeed an effective medicine for a number of conditions.
In conclusion, I appeal to the Minister to request the ACMD, under the leadership of its excellent chair, Dr Owen Bowden-Jones, to review the evidence for the Schedule 1 status of cannabis and to make recommendations as soon as possible. The UK will then be prepared to respond quickly to the WHO review. I hope that the ACMD will consider the regulations we would need to support a revision of the cannabis schedule. Obviously, a good set of regulations would be extremely important. Again, I hope the Minister will respond to the urgency of the need for reform for these patients.
My Lords, in a civilised society, one of the ways by which we are judged is how we look after those who are disadvantaged through no fault of their own: the young, the old, the infirm and the weak. Among them are those who have a particular condition or disability that cannot easily be remedied by orthodox medical care or modern drugs. But if we cannot help them conventionally, nor should we prohibit them from accessing less mainstream treatments if they believe that those treatments can alleviate some of their discomfort or pain. We all know why cannabis is illegal, and whether or not we agree with its prohibition—your Lordships will know that I never have—we can recognise the good motives of those who introduced that legislation and prohibited its use almost half a century ago. That happened some years after the proposal to ban heroin and cocaine was dropped by the Home Office. The Minister responsible agreed, after meetings with doctors’ representatives, to permit those drugs to be categorised as controlled rather than prohibited drugs so that even though they were recognised as dangerous and addictive, they could be prescribed by doctors because of their unique therapeutic value. I know a little about that because my own father was the Minister responsible for doing that in the post that my noble friend holds in the Home Office today.
At that time, no such therapeutic benefit was attributed to cannabis, which is why it was banned. Now we know differently. We live in an age of evidence-based policy, as the noble Baroness said. However, while there is scientific research that demonstrates the value of cannabis, such as that undertaken by Professor Raphael Mechoulam at the Hebrew University in Jerusalem, perhaps more importantly there is overwhelming anecdotal evidence from many individuals, some of whom I too have met personally, that their symptoms can be alleviated by cannabis. We would be negligent and, as the noble Baroness said, cruel to ignore that evidence.
I hope my noble friend will not seek to resist the proposal of the noble Baroness, Lady Meacher, by advocating a long and complex process of drug trials. This is unnecessary. In November 2015, scientists in the United States announced the discovery of a drug that cures, without any side effects, hepatitis C—until then, incurable, untreatable and usually terminal. Some 300,000 people in Britain have it today. In less than three years, without any extensive trials, thousands of patients throughout the world, who until then faced an uncertain future, has been completely cured of hepatitis C because of the use of this drug. I have a slight interest in it because I am one of those who has been cured within the last six months, and I am immensely grateful to NICE for the decision it made to allow the prescription of this drug without any of the requirements to go through the usual years of testing required by the MHRA. So it can be done and it has been done.
Whatever regime Parliament puts in place will inevitably be circumvented by those who want to do so. Alcohol, tobacco and opiates are all controlled in different ways by the law but they are all abused in a way that the law does not permit. One cannot stop that. Arguably, the drugs that are most abused and cause the most harm are those that are routinely and quite legally prescribed by thousands of doctors, who should know better. So the argument that cannabis is uniquely dangerous and capable of being abused is not credible and appears simply obstructive for the sake of it. Let us therefore have no humbug today. Rather than looking for excuses to do nothing by citing spurious reasons from a bygone age, and thus needlessly prolonging the suffering of patients whose lives could be immeasurably improved, I hope my noble friend will use this debate and opportunity to make this tiny, reasonable and unique move—at no disadvantage to the taxpayer—and show the world that we are the civilised nation that we aspire to be.
My Lords, the noble Baroness, Lady Meacher, has laid out the case admirably and I support her appeal to the Minister. I will simply tell the Committee about the experience of one person which illustrates how lamentable are the consequences of the present confusion in government policy and the Government’s refusal to remove obstacles to making cannabis-based medication available on prescription in this country beyond the extremely limited basis that now applies.
The person I shall refer to as TW got in touch with me to tell me about her situation. She suffers from advanced degeneration of the lumbar and cervical spine and she experiences chronic neuropathic back and leg pain. It is tough, not just for her but for her husband and children. Over the last 15 years, she has been prescribed some 35 different medications: anti-nausea, antispasmodic, anti-inflammatory and antidepressant medications. At one point she was on the equivalent of 180 milligrams of morphine a day. She has had caudal and facet joint injections. In 2015, she underwent major surgery, which most unfortunately has left her in yet greater pain and disability.
However, TW has been able to come off these high-dose morphine-based medicines and all her other medications, with their horrible side effects, because she has been prescribed, privately, Bedrocan. The active ingredient in Bedrocan is dronabinol, derived from cannabis. Bedrocan is not licensed in this country, though it is in Holland, Finland, Germany, Switzerland and Italy. TW has a letter from Her Majesty’s Customs informing her that she is legally permitted to bring Bedrocan, as prescribed for her personal use, into Britain from Holland. If Sativex, also derived from cannabis, were suitable for her she could, on the other hand, legally collect it on prescription from her local pharmacy. She was previously prescribed morphine, an opioid in same class as heroin and far more dangerous than cannabis, and then Fentanyl, of terrifying power, as we see in the crisis of opioid addiction in the United States of America. Both were on NHS prescription, and she was able to collect those prescriptions from her pharmacy. Yet, as a patient for whom no other medication is effective to relieve her chronic pain without unbearable side effects, TW has to endure an arduous, painful, exhausting and costly journey in her wheelchair, four times a year, to collect her prescription of Bedrocan from a Dutch pharmacy. She very reasonably asks how this can be reasonable.
Cannabis, absurdly, is in Schedule 1, the schedule for controlled drugs deemed to be of no medicinal value. Bedrocan, cannabis-based, is in Schedule 2, the same schedule as morphine, diamorphine—which is heroin—and Fentanyl. Sativex is in Schedule 4. The scheduling is a mess. For the Home Office and the Department of Health between them to force TW and others like her to go to Holland to obtain the only medication that is truly effective for them is to taunt them in their suffering. We should do better, and I look forward to the Minister explaining how the Government will do so.
My Lords, I congratulate the noble Baroness on this debate and the all-party group on its work and the excellent report that was published on this subject. I need to warn my noble colleague next to me, the noble Lord, Lord Low, that I am going to be very short in my contribution. I put my name down for this debate because I did a little bit of background research again, and the thing that really came over me was the Government’s own 2017 drug strategy. It is an excellent document, which states:
“In 2015-16, around 2.7 million ... 16-59 year olds”—
so on the whole, as Members of the House of Lords, we are not included in this—
“in England and Wales reported using a drug in the last year”.
It is estimated that just over 2 million of those were cannabis users. Of course, included in that are a number of people who had to use cannabis as a medicinal aid for their suffering.
I was also interested to look up the information—asked for by my former right honourable friend, Nick Clegg—that only about 2,000 people are actually arrested over cannabis. The message that this put over to me was that those people who need cannabis as a medicine to help their suffering have to go down an illegal route so that they can either be healed or get help with their suffering. But this is something that the majority of recreational users do not even have to worry about, because the chances of their being arrested or prosecuted are very low indeed. Yet—for all the illogical reasons already given around how other drugs are treated—we demand that the people requiring this degree of assistance from this particular drug have to commit criminal acts themselves to alleviate their suffering. It is crazy and I hope this debate will be a part of stopping the very illogical and cruel situation that we put those users in.
My Lords, I echo the congratulations offered by the noble Lord, Lord Teverson, to the noble Baroness, Lady Meacher, on securing this debate and for all her tireless work to secure a more rational policy on the regulation of drugs, from founding the all-party group, whose reports we have been reading, to her work and representations at the United Nations and around the world. The noble Baroness, in encouraging me to speak this afternoon, said that it need only be a very short speech. With the time limits, I think we have no option but to make a very short speech.
I declare an interest: I am a member of the aforementioned all-party group, but I was not involved in the inquiry into the medicinal use of cannabis. Cannabis, as we have heard, is classified with dangerous drugs with no medicinal value, yet it is clear that it does have medicinal value. It was perceived to provide great relief by 86% of those responding to an online survey commissioned by the all-party group. More than 90% reported no or only mild side-effects, whereas—as we just heard from the noble Lord, Lord Howarth—respondents using prescription medicines can experience considerable side-effects. The evidence is nuanced as to the precise scope of the medicinal value, but the Barnes review undertaken for the all-party group concluded that there is good evidence for the efficacy of cannabis in the management of chronic pain and the side-effects of chemotherapy.
At the very least, therefore, cannabis-based treatment can provide significant benefit for a group of patients of at least 10,000—and, in some estimations, very many more—suffering from chronic pain where other treatments have failed. This would be reason enough to reclassify cannabis. Schedules 2 and 3 include drugs that may be illegal for recreational use but can be made available on prescription. If cannabis were to be placed in Schedule 2, it would be in the same class as heroin, which is no less addictive—indeed, it is considerably more so, as we know—and there is no evidence of significant diversion of heroin from medical supplies to the illicit recreational market. Moreover, as we again heard from the noble Lord, Lord Howarth, Sativex, which is a proprietary product derived from cannabis, is classified in Schedule 4. In these circumstances, retaining cannabis in Schedule 1 is illogical and perverse.
The overriding reason for moving cannabis to one of the other schedules—this is my main point, really—is that it follows a policy of regulation rather than prohibition. In the reading I did in preparation for this debate, I counted that this has at least six consequential advantages, but I have time to mention only a couple of them. First, since the use of cannabis would now be lawful, patients could take it under medical guidance and supervision. When that guidance and supervision is not available, when people are forced to acquire their cannabis outside the law, the product that they obtain off the street is often much more harmful. How much better to be using it when it provides its benefits under proper medical supervision.
Secondly, the current regime places a stranglehold on research. Carrying out research into cannabis in the UK has been described as a costly obstacle course. It involves a minimum outlay of £5,000 to cover licensing and security, and licence applications can take as long as a year. It has been calculated that research involving Schedule 1 drugs takes significantly longer and costs about 10 times as much as research into other drugs.
In view of all the considerations that have been spoken to in the debate, I hope very much that the Minister will agree that the matter should be referred to the advisory council. Referring the matter for the opinion of an independent expert body, which of course does not commit the Government, is not exactly selling the pass.
My Lords, I too congratulate the noble Baroness, Lady Meacher, on raising this issue and on the way in which she has done it. The Question asks whether the Government “plan to invite” a review of the evidence. It is asking not whether the Government will reschedule cannabis but whether they plan to review the evidence, or at least to have the evidence reviewed. That is the crucial point.
It is six and a half years since I tabled a QSD in which I asked what consideration the Government had given,
“to establishing a royal commission on the law governing drug use and possession”.
I argued the case for evidence-based policy. My starting point was that there was a demonstrable problem and that we needed to address it. I was not advocating that the policy should be adopted but making the case for reviewing existing policy. In reply, the Minister said that there was considerable disagreement on the issue—well, not in that debate; every Peer who spoke, bar the Minister, agreed with me.
In this debate the focus is on the rescheduling of cannabis. As we have heard, there is a particularly powerful case for reviewing the use of cannabis under certain conditions for medicinal use. The MS Society has changed its position on the use of cannabis for medicinal purposes in the light of reviewing the evidence, and its stance is a measured one.
The arguments that have been deployed against change by the Home Office do not stack up, especially under a Conservative Government. If a law is not working and change is resisted on the grounds of sending the wrong signals, then Ministers have little grasp of the Conservative view of law.
I repeat what I said in 2011:
“My case is that we need to explore whether the present law is necessary and sufficient, whether it is necessary but not sufficient, or whether it is neither necessary nor sufficient”.—[Official Report, 9/3/11; col. 1675.]
Implicitly the Government took, and take, the first of those positions. There was and is no critical reflection. Yesterday my noble friend Lady Williams reiterated that she supported evidence-based policy. Now is the time to consider the evidence. Will my noble friend commit to that?
My Lords, I thank the noble Baroness, Lady Meacher, for initiating this debate. I just want to say something about the case of a little boy. I think that some of us have heard from his grandmother but I shall explain the case briefly.
He has a very rare condition—which I think is called non-inherited genetic mutation in the PCDH19 gene—for which so far only a steroid treatment is effective. This is not suitable for long-term use because of the serious health consequences. It is very likely that whole-plant medical cannabis will work and will be without particular side-effects. To get such medical cannabis, the family of the six-year-old boy would have to travel to a country where it is legal for doctors to prescribe medical cannabis. There is a product under test called Epidiolex. It is a cannabis-based product but is not yet available and is subject to a long testing regime, which may be too long for this little boy. There is a need to move quickly to permit medical cannabis to be given to this little boy under medical management.
I now turn to the wider issue of cannabis for people with MS. I should declare an interest in that a member of my family has MS. We have had an excellent briefing from the MS Society, which says that 22% of people with MS have tried cannabis. I only know that a consultant thinks that every one of his patients has tried cannabis, not 22% of them, and I put that to the MS Society.
There is a product called Sativex that might do the business but which is not available to NHS patients, although it should be in Wales. The problem is that there is a dangerous version of cannabis known as skunk. People who are buying it on the illegal market are liable to get skunk, which I understand is not desirable, whereas ordinary cannabis is okay. By making the whole thing illegal, we are encouraging people to go to dealers, who are liable to give them the dangerous stuff rather than the helpful stuff.
Some doctors say that there is no evidence that cannabis is helpful to people with MS. I have a simple answer to that. If a person suffering from a medical condition like MS feels that cannabis is helpful, surely that is enough evidence. I am not anti-scientific and I understand the noble Lord’s comments, but if a patient feels that it is helpful, then by definition it must be. That is the case for me.
My Lords, I thank the noble Baroness for getting us this debate and for the work that she has done for the APPG, which has produced a compelling evidence base for policy change. She spoke of the striking evidence of dramatic improvement to their health that some cannabis users have experienced. That, combined with the failure of prescription medicines to relieve their symptoms, has caused patients to try herbal cannabis even though access to it is not lawful. Estimates as to the use of medicinal cannabis suggest that 30,000 patients in this country are using it, most of it coming from illegal street sources. Also striking is the evidence that a majority of users have discussed using a cannabis treatment with their GP or consultant. Whether or not cannabis is legalised, the gain from having a regulated system that does not put both patients and their medical advisers in an intolerable position and vulnerable to the dangers of using street supplies of drugs is compelling.
The background to this debate is HM Government’s 2017 drug strategy, which was published in July. That strategy, which apparently is to be delivered by a board chaired by the Home Secretary, is about abuse and harm. There is no mention of medicinal cannabis. The ACMG has a central role in this. The council, emphasising the health significance of the use of cannabis, has made recommendations for further research. The Motion asks that that research should be extended, but because the evidence produced by the APPG shows clearly that the Schedule 1 listing makes research into the use of cannabis-related drugs and drug trials difficult and expensive, there is a problem ahead. Ministers claim that a clear regime is in place to enable drugs that contain cannabis to be developed and licensed, but they can cite only one example, that of Sativex. Because of the difficulties and costs of applying for a licence, no application has been made in respect of herbal cannabis.
The Medicines and Healthcare products Regulation Agency has stated that products containing cannabis are medicines. Surely that conclusion and the legalisation of medicinal cannabis in so many countries combined with much evidence that it has not caused an increase in crime, abuse and harm in those countries—probably the reverse is true—provides powerful reasons for the Government to reconsider their policy and look at possible models for regulation. This is a health issue and I really wonder whether the Department of Health should not play a larger role in policy-making, which in my view is too dominated by the Home Office.
My Lords, I too congratulate the noble Baroness, Lady Meacher. I want briefly to look at the body of evidence from overseas which clearly demonstrates that a more sensitive and targeted approach to the use of cannabinoids can bring positive results. In the USA, those states which have medical marijuana laws see lower rates of opiate overdose.
A recent study indicates a much lower use of opiates by pain sufferers using cannabis as treatment. This year a study has shown a reduced incidence of opioid-related hospitalisations in those states and according to the world health rankings the current drug-related death rate, mainly caused by opiate use, for the UK is 3.83 per 100,000. This compares to the Netherlands, which has the most-established scheme for medicinal cannabis in Europe, of 0.63. This means that the UK has a rate for drug-related deaths more than six times higher than that of the Netherlands. Does the Minister have any comment on these figures, or on the letter, published in the Lancet this June, from Dr David Nutt of Imperial? He notes that in his view the UK Government, on the advice of the Advisory Council on the Misuse of Drugs, made two problematic changes to the UK drug control regulations of the Misuse of Drugs Act 1971. First, they put into effect new very wide-ranging bans against a whole range of synthetic cannabinoids and, secondly, they rejected an appeal by senior UK scientists to remove THCV from Schedule 1, the highest level of control in the Act. Both decisions have substantial impacts on the UK’s research communities.
To make these drugs illegal and prevent others replacing them, the ACMD recommended that the whole chemical series be banned. However, many of this now illegal series are contained in current medicines and to get around this problem the Home Office exempted these and seven other medicines that would otherwise have become illegal. This exemption-based approach has, unfortunately, a fatal flaw: most, if not all, of these drugs were derived from a chemical series that contain precursors from which other medicines might be developed. Now these are illegal, and anyone caught supplying them is liable to up to 14 years in prison. These potential penalties will have a chilling, possibly fatal impact on pharmaceutical drug discovery in the UK, because complying with the regulations adds a vast cost burden to the pharmacology industry and to academic researchers. Dr Nutt found it concerning that the pharmaceutical experts on the ACMD did not appear to foresee this problem. Worse, it appears that the new regulations were not subject to proper consultation with the academic research community and the pharmaceutical industry.
History suggests that earlier bans on synthetic cannabinoids had little effect on their use. I fear it is likely that this new law could fail in its primary objective and badly damage UK research.
My Lords, I congratulate the noble Baroness, Lady Meacher, on securing this debate and I apologise for not having applied to speak originally—I was not expecting to be able to be present. I echo everything that has been said in this debate and I do so as a diagnosed MS sufferer. I have been confronted by the diagnosis; as it happens, contrary to what the noble Lord, Lord Dubs, said, I have not taken cannabis at any point, but I agree with his overall analysis that on most estimates the figures are gross underestimates of the number of people who have taken cannabis as a treatment for my illness and, I believe, for many others as well. So I support everything that has been said around the Room this afternoon.
My Lords, I strongly support the campaign of the noble Baroness, Lady Meacher, to make medicinal cannabis available legally for patients who can be helped by it and I congratulate her once again on her persistence. While the noble Baroness, Lady Williams, is very welcome in her place today, I agree with the noble Lord, Lord Crickhowell, that we should be seeing a health Minister responding to a debate of this nature—so does she, I think. The lack of availability of this medicine for thousands of people in pain is just one of the terrible consequences of a failure over the years by the Government to see that their policies are not working. Their stubborn persistence with a set of policies that are manifestly failing is extraordinary. If any other policy were as much of a failure as the Government’s drugs policy, they would drop it like a hot potato.
The current classification of drugs is meant to avoid their misuse but fails completely to do so. On top of that, it penalises people for whom cannabis can be a lifesaver. They and their clinicians are forced to resort to powerful drugs such as morphine to alleviate pain because cannabis has become caught up in the debate on recreational drugs.
Let us take the case of five year-old Alfie Dingley, mentioned by the noble Lord, Lord Dubs. Alfie has life-threatening seizures. The drugs being used to treat him at the moment are frequent, intravenous steroids which could shorten his life, cause him to develop cancer, damage major organs or even induce psychosis. All other treatments have failed and his parents and grandparents live in constant fear of his next, possibly fatal seizure. Yet in Holland, where the law on cannabis is more rational and compassionate, doctors are able to treat children such as Alfie successfully.
In the Republic of Ireland, a named practitioner can be licensed to prescribe cannabis for medicinal purposes to a named patient. A number of other countries do something similar, so why can we not do that here? Can we not have a trial in this country to look at how children such as Alfie can be helped under proper medical supervision? Given that Alfie, along with many of the other patients we have heard about, has been given many other powerful drugs, some of which are not licensed for children as young as him, surely the risks of allowing him legal access to cannabis are considerably less? Yet to obtain cannabis legally, as we have heard is the case with other patients, Alfie’s parents would have to travel abroad at their own expense. Ironically, Alfie’s UK consultant would be willing to prescribe cannabis but is not allowed to do so. Rescheduling cannabis, as the noble Baroness, Lady Meacher, has suggested, would allow that to happen.
I and my colleagues heard from many patients in the noble Baroness’s commission when considering the matter. The evidence was very compelling. Today, your Lordships have called on the Government to base their policy on evidence, not misguided prejudice. The Government should hear the voices of the thousands of generally law-abiding patients who are forced to break the law or go to enormous trouble and expense to travel abroad to get the medicine that they know works for them. Those people do not want to have to do that, and there are thousands more who could benefit but are not prepared to take the risk. Why are we putting good people in this invidious situation? It is cruel, it is illogical and it is time that the Government did something about it.
My Lords, I first apologise for being late for the beginning of the debate. If I had a credible excuse, I would offer it. I congratulate the noble Baroness, Lady Meacher, on securing the debate, which has attracted a lot of interest—as reflected by the number of speakers.
As has been said, there is a regime in place, administered by the Medicines and Healthcare products Regulatory Agency—MHRA—to enable medicines, including those containing controlled drugs such as cannabis, to be developed, licensed and made available for medicinal use to patients in the UK. However, as has been said, and as I understand it, only one product containing cannabis extracts—Sativex—has been licensed as a medicinal product by the MHRA. Equally, as I understand it, the MHRA has recently decided that CBD-only products—cannabidiol is one of the main compounds of cannabis—which are used to treat various symptoms, should be considered as medicines.
The question we are debating is whether the Government plan to invite the Advisory Council on the Misuse of Drugs to review the evidence supporting the rescheduling of cannabis to Schedule 2 or Schedule 4. Cannabis is controlled as a class B drug under the Misuse of Drugs Act 1971. In its raw form, it currently has no recognised medicinal benefits in the UK and is therefore listed as a Schedule 1 drug under the misuse of drugs regulations. This explicitly forbids doctors from prescribing cannabis and inhibits research.
If cannabis were rescheduled, it would enable patients with a wide range of conditions to obtain cannabis medicines to alleviate their symptoms, and doctors could prescribe it on a named-patient basis, taking responsibility for patient safety, until licensed cannabis medications became available.
In their 2017 drugs strategy, the Government said that they were committed to grounding their approach in the latest available evidence. They stated:
“The advice of the Advisory Council on the Misuse of Drugs … is fundamental to informing our approach and we will continue to seek their valuable input and advice”.
Have the advisory council expressed any view to the Government that it now thinks it appropriate to undertake a review into either the classification or the rescheduling of cannabis—and, if so, what has been the Government’s response? If significant new evidence is now available that was not available previously and which might well influence the view of the advisory council—which appears to be the position—there is a case for inviting it to consider it, particularly in the light of the Government’s position that the advice of the council is fundamental to forming their approach.
We have heard in the debate about the case of Alfie, who is nearly six. As I understand it, some children with his condition have responded well to whole-plant medical cannabis with no side-effects. Indeed, as I understand it, Alfie’s consultant at his children’s hospital supports trying medical cannabis but cannot do so because it would be illegal for him to prescribe it at present. As has already been pointed out, in several other countries, including Ireland, a named consultant can prescribe whole-plant medical cannabis to a named patient. The future does not look good for Alfie at present. I ask the Minister to look at Alfie’s case to see what help can be given to get medical cannabis under the management of his consultant here—either now or, if he has to go abroad for such treatment, once it has been shown that it helps him.
My Lords, first, I also declare an interest in MS. As the noble Lord, Lord Dubs, knows, I worked with MS patients for many years before I got involved in politics—I do not know quite how I made the transition, but that was the case. Some of the noble Lord’s anecdotes from patients chime with things that I heard. I know that there is significant feeling in the House on this issue. It is also clear from noble Lords’ remarks that they are keen that government policy on this issue should be led by evidence—as my noble friend Lord Norton of Louth said, I confirmed that yesterday—but also should not prevent patients from obtaining relief from symptoms using effective medicines.
As the noble Baroness, Lady Meacher, said, the WHO’s Expert Committee on Drug Dependence has committed to reviewing the scheduling of cannabis under the UN’s 1961 convention. The review will consider therapeutic use as well as dependence, and the abuse potential of several constituent parts of cannabis, including the cannabis plant itself and cannabis resin, cannabidiol, or CBD, THC, isomers of THC and extracts and tinctures of cannabis. The review is due to conclude by early 2019 and I, like most people here today, am very interested in its outcome and look forward to future opportunities to debate this issue—as I know we will—as and when the WHO concludes its work. I must add that the recognition of CBD as having medicinal application necessarily means that the other constituent parts will do so as well. Each compound ought to be assessed on its merits.
As noble Lords have said, cannabis in its raw herbal form continues to be listed in Schedule 1 to the Misuse of Drugs Regulations 2001 as a substance with no recognised benefits in the UK, but I must underline that this is in its raw form. The system of scheduling does not preclude medicines based on cannabis from being developed. The Misuse of Drugs Act 1971 regime, along with the associated regulations, enables the availability of controlled drugs which have recognised medicinal uses in UK healthcare—of which there are many.
We are already able to rely on a process, administered by the Medicines and Healthcare products Regulatory Agency, MHRA, in parallel with the Home Office’s licensing system, to enable medicines, including those containing controlled drugs such as cannabis, to be developed, licensed and made available for medicinal use to patients in the UK. In the case of a Schedule 1 drug such as cannabis, the Home Office is willing to consider applications for research licences to facilitate the development of new medicines, as long as the appropriate ethical approvals have been given, as we have done in the past. I am very happy to meet again with the noble Baroness, Lady Meacher, as we do regularly, to discuss this issue.
In the case of the cannabis-based drug Sativex, the Government have, as noble Lords have said, placed the product in Schedule 4 of the Misuse of Drugs Regulations to allow it to be legally supplied on prescription. Sativex was granted a marketing authorisation by the MHRA and was rigorously tested for its safety and efficacy before receiving approval for this application. This rigour should equally be applied to future medicinal products containing cannabis.
As has also been pointed out today, the MHRA has offered an opinion that products containing CBD, when used for a medical purpose, should be regulated as medicinal products. A CBD or cannabidiol product in its pure form is not controlled under the Misuse of Drugs Act 1971, so where it can be extracted and isolated from the controlled substances in cannabis it would not require a licence from the Home Office. However, a CBD product that contains any trace of psychoactive compounds that are found in cannabis, such as THC or tetrahydrocannabinol, is considered to be a controlled substance under the 1971 Act and therefore unlawful to possess and supply unless it fits the criteria for an exempt product under the Misuse of Drugs Regulations 2001. The MHRA is working with individual companies and trade bodies to make sure that products containing CBD used for a medical purpose which can be classified as medicines satisfy the requirements of the Human Medicines Regulations 2012.
We continue to facilitate forward-looking research involving cannabis and cannabinoids. There were 19 cannabinoid clinical trial authorisations granted between 2005 and 2015. These trials cover MS, dental applications, psychotic disorders, addiction to cannabis, type 2 diabetes, epilepsy, interaction with other medicines and brain diseases. Research in this area is ongoing.
The noble Baroness, Lady Greengross, asked about research into synthetic cannabinoid changes. I know that my right honourable friend the Home Secretary has commissioned the ACMD to look into whether there are barriers to research into Schedule 1 drugs as a result of changes to synthetic cannabinoid generic legislation. The Home Secretary has asked the council to provide its advice before the end of this year.
The noble Baroness, Lady Meacher, and the noble Lord, Lord Dubs, asked about Epidiolex. Our position on it is that, as for any other medicine and as we did with Sativex, it must be put through the same stringent process to ensure its safety and efficacy, for the benefit of patients.
My noble friend Lord Crickhowell suggested that the Department of Health and not the Home Office should be responsible for this. I quietly nodded there. Like the previous strategy, the 2017 drug strategy takes a cross-government approach that reflects the need for co-ordinated action to tackle the problem in all its dimensions. Given the strong link between drug use and offending, the Home Office has and will continue to provide the governance and accountability essential to the effective delivery of this cross-departmental approach. The Department of Health leads on the building recovery strand of the strategy and, together with the Home Office, leads on the reducing demand strategy, along with Public Health England. To ensure that we are doing all we can—and following my meeting with the noble Baroness, Lady Meacher—I have recently written to my noble friend Lord O’Shaughnessy, who is the Minister for Health in your Lordships’ House, to ask him to consider how the Government can facilitate the development and availability of cannabis-based medicines such as Sativex.
We are open to the development of new products based on cannabis and look forward to the review from the WHO’s expert committee. I am sure that the ACMD will follow its conclusions with great interest.
The Minister has not made any mention of Bedrocan in her response to the debate. Does she think it reasonable that TW, in the circumstances I described, has to make these visits to Holland to collect her medication, which has been prescribed for her in Britain but which she is not permitted to obtain from her local pharmacy? Is that a reasonable state of affairs and if the Minister thinks it is, why? If she thinks it is not, what will the Government do?
I noted the noble Lord’s mention of Bedrocan. I had not heard of it and I am very willing to look into that specific drug. There are of course many drugs available in other parts of the world that are not necessarily available here and vice versa. I will write to him on that point. I will also take up the point about Alfie separately.