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Cannabis: Medicinal Uses

Volume 793: debated on Thursday 1 November 2018


Asked by

To ask Her Majesty’s Government whether they intend to respond to the concerns raised by the Faculty of Pain Medicine in their Faculty Position Statement on the Medicinal use of Cannabinoids in Pain Medicine, and their call for further research into the potential benefits of cannabis for medicinal uses.

My Lords, the Government acknowledge the valid concerns raised by the Faculty of Pain Medicine. Under the new regime, only specialist doctors will be able to prescribe cannabis products. Clinical guidance published yesterday is clear that these products will be considered only in a small number of conditions and where alternative treatments have not helped or have been discounted. The National Institute for Health Research has issued a call for proposals in order to enhance knowledge in this area.

I thank the Minister for that Answer. Bearing in mind the faculty’s overarching cautionary position, and the fact that according to the National Health Service website,

“Regular cannabis use increases your risk of developing a psychotic illness”,

what assurances can the Minister give us that Her Majesty’s Government will not allow the changes in prescribing cannabis for medicinal use to be a Trojan horse for the legalisation of cannabis for recreational use?

I can absolutely reassure my noble friend by reiterating the position outlined by my right honourable friend the Home Secretary. He has been crystal clear that the Government have no plans whatever to legalise cannabis for recreational use. Indeed, the penalties for unauthorised supply, possession and production remain unchanged.

My Lords, while it is true that the faculty warns against the use of dried cannabis plant of unknown composition, it accepts that there may be benefits to pain management from pharmaceutical products. Fortunately, that is exactly what patients are demanding and what the Government have just legalised. However, the faculty is also demanding that, while we wait for clinical trials, a database—which is essential to better understand these medicines—should be set up. Will the Minister support the setting up of this database and ensure that it contains the massive amount of lived evidence and experience available from patients?

I am grateful to the noble Baroness for her question. I believe that the position we have reached now is the right one, not least driven by the heart-rending stories of children who had been benefiting from these kinds of medicines but were then not able to access them. It is a very good thing that we have got to this position. However, we also have to acknowledge—as the Chief Medical Officer did—that there is a lack of evidence, particularly beyond specific conditions such as paediatric epilepsy. It is precisely to provide that evidence that we are going to do two things: first, we will fund clinical trials through the NIHR, and, secondly, we will start collecting evidence and data on usage so that we can gain the evidence base to understand whether there are other applications where these medicines could be helpful.

My Lords, it is to be welcomed that the Government have today issued guidance on the use and access of cannabis for medical use. Having spoken to several GPs about this matter in the last day or so, to a person they are experiencing an increase in the number of patients requesting access to cannabis medicine in their surgeries for pain management. Some of those requests will probably be justified. My question is: will GPs refer those patients to specialist doctors who are allowed to prescribe this medicine? Will this create additional cost and demand? Who will pay for it? Could the Minister explain and say when this will be reviewed?

It is important to state that GPs will not be able to prescribe it; that is part of the new regime. On the specific issue of pain management, the interim guidance from the Royal College of Physicians says there is no evidence to support its use for treating chronic pain. In the meantime, NICE will be providing clinical guidance in about a year’s time, which will take a broader view. So it should not be the case that specialists are providing it in this area—the evidence does not exist and therefore the costs will not occur.

My Lords, I applaud the Home Secretary for finally recognising the therapeutic value of medical cannabis. We know that about 1 million patients up and down the country will be queueing up for these medicines. I very much understand the Government’s narrow approach, but can the noble Lord assure me that Ministers will make available to doctors the comprehensive review of medical cannabis research from the National Academies of Science, Engineering, and Medicine in America? This showed conclusively that there is substantial evidence that medicinal cannabis is valuable for the alleviation of pain—in particular neuropathic pain—and that it does not cause psychotic illness.

We are, thankfully, now taking an evidence-based approach. The Chief Medical Officer said in her statement that there is evidence of therapeutic benefit from cannabis-based products, and that is why they have been rescheduled. However, we need to move cautiously. We know that the active ingredient, THC, is linked to psychotic illness and other things, so we need to make sure that, as we move ahead, its use is properly controlled and that the benefits always outweigh the risks for any patient who takes it.

My Lords, I think that the noble Lord, Lord Farmer, referred to prescribed medicine addiction in his question. The Minister will be aware that this is a growing problem, with very little support locally for patients who have terrible outcomes. PHE is undertaking a review of the evidence at the moment. Can the Minister assure me that, when that review is published, the Government will publish an action plan to try to deal with what is a terrible issue for many people?

I absolutely acknowledge the scale of the issue. I think that the point my noble friend was getting across was that we do not want to create the next opioid addiction crisis, and I completely concur with that position. Public Health England is conducting that review and I will write to the noble Lord with specific details of what we as a Government intend to say after it has concluded.

My Lords, I declare an interest, as my grandson has intractable epilepsy. He has just been assessed for medicinal cannabis and we very much welcome that. However, I am very concerned about the comments that this will be used as a last resort. My grandson has been subjected to many, many drugs and the side-effects from many of them have been horrific, so to say that those drugs are fine but that somehow medicinal cannabis oil is a problem is looking at this in the wrong way. I am worried about the restriction that has been put in place, and that many children who might benefit from this medicine will not be able to access it because of the very strict guidelines. Can the Minister give an assurance that each person will be looked at on a case-by-case basis?

I absolutely acknowledge the case that the noble Baroness mentioned. She has shared it with me before and my sympathies go to her and to her family—it must be very difficult. Generally speaking, medicines in this country are licensed on the basis that they have gone through randomised control trials to make sure that they are safe and efficacious. A lot of these cannabis-based drugs have not been through that. We want to see more trials and, until we do, it is important that clinicians are able to access licensed drugs first, but with the ability to use unlicensed drugs if necessary.