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Treating epilepsy/multiple sclerosis with cannabis oil

Volume 663: debated on Tuesday 23 July 2019

The petition of residents of the United Kingdom,

Declares that the petitioners are disturbed by the Home Office ban on doctors prescribing cannabis oil and THCA to those with epilepsy or multiple sclerosis, especially the two children Billy Caldwell who needs a prescription urgently, and Alfie Dingley; further that this is very urgent as the Sunday Times on May 20th stated that Mrs Caldwell only has enough medication to last until June and her son’s epileptic fits were very serious and life threatening and he needed oxygen before he had the treatment, first in Holland and then in County Tyrone in Northern Ireland, whereas with the treatment he can lead a normal life; further that a few weeks ago his doctor, Doctor Brendan O’Hare, was warned not to write any more prescriptions for Billy, and further that cannabis can be dangerous in the wrong amounts, but in the correct dosage, prescribed by a doctor it can be very beneficial.

The petitioners therefore requests that the House of Commons urges the Government to urge the Home Office and the Department for Health and Social Care as a matter of urgency to inform Dr O’Hare, that he can resume his prescriptions for the child Billy, although they include THCA; further that we urge the Government to inform Mrs Dingley that her doctor can prescribe medicines containing cannabis to her son Alfie whose epileptic seizures were reduced by 60 to 70% in Holland with cannabis oil but are much worse now, without it; further to urge the Government to write to the Multiple Sclerosis Society to say that doctors may now prescribe cannabis; further to urge the Government to allow doctors to prescribe cannabis oil (cannabidiol) which is supposed to be legal in the UK, and THCA, which is a Class A drug, to patients and to provide doctors with an easy-to-fill-in 2-page form to get a licence to do so, instead of ordering them to stop the treatment as they did to Billy’s doctor, and further to urge the Government to announce that it will allow doctors to prescribe treatments derived from cannabis whenever the patients need it, such as those with severe epilepsy and multiple sclerosis, to prevent desperate patients having to go to illegal drug dealers.

And the petitioners remain, etc. —[Presented by Caroline Lucas, Official Report, 25 June 2019; Vol. 662, c. 5P .]


Observations from the Parliamentary Under-Secretary of State for Health and Social Care (Seema Kennedy):

The law was changed on 1 November 2018 to allow clinicians on the General Medical Council’s Specialist Register to prescribe cannabis-based products for medicinal use (CBPM), where it is clinically appropriate and in the best interest of patients. No licences are required to prescribe.

While cannabis and cannabis-based products remain a Class B drug under the Misuse of Drugs Act 1971, there is now a legitimate route to access these products for medicinal use. Patients will not be able to obtain these products from their GPs but will require a referral to a specialist who can prescribe on the basis of clinical need. The supply of cannabis-based medicines to patients will be discussed at the stage in their treatment when the specialist doctor has considered and discounted all licensed interventions. Cannabis-based medicines may therefore only be suitable for a small number of patients with severe, treatment-resistant conditions.

While the law does not restrict the conditions for which these products may be prescribed, interim clinical guidance has been issued by the Royal College of Physicians, British Paediatric Neurology Association and Association of British Neurologists. The interim guidance focuses only on areas where the evidence base is most developed, namely chronic pain, intractable nausea and vomiting, spasticity (including multiple sclerosis) and severe, treatment-resistant epilepsy.

The National Institute for Health and Care Excellence (NICE) has been commissioned to develop updated clinical guidelines on the prescribing of CBPM, the scope of which is limited to the management of the conditions covered in the interim guidance. The guidelines will be published by October 2019. It will be based on the best available international evidence and will have been produced using NICE’S world-renowned process for identifying and assessing relevant studies and delivering such guidance. NICE is expected to consult on the draft guidance between 23 July-20 August 2019.

It is clear that we do not yet know enough about the benefits and potential harms of using cannabis-based products as medicines. Apart from those products that have market authorisations (including Sativex and Nabilone), and are being prescribed on the NHS, other cannabis-based products are unlicensed medicines that have not had their quality, safety or efficacy assured by the medicine regulators nor, their cost-effectiveness determined by the National Institute for Health and Care Excellence. This is the foundation of NHS decisions about routine funding for medicines.

In the meantime, the normal NHS medicines governance systems apply, as they do to all locally funded unlicensed treatments, and are being used to support good clinical practice and safe and effective prescribing. Decisions will be taken, at NHS Trust level on a case-by-case basis, based on the needs of the individual patient and the evidence of efficacy and cost-effectiveness available.

The NHS does not have unlimited resources. NHS Trusts and Clinical Commissioning Groups (CCGs) have to make difficult decisions about commissioning care, but they do this based on patient needs, clinical evidence and cost-effectiveness. CCGs are statutorily obliged to provide the best possible care, balancing demand with supply for the benefit of all their patients and local populations. Access to cannabis-based products for medicinal use will be considered as part of this.

Cannabis-based medicines are no different from any other drug in that they have effects and side-effects. This is why it is so important to develop our knowledge about the safety and efficacy of cannabis-based products when they are used as medicines. To further the evidence-base, the National Institute for Health Research has issued two calls for research in this area and is working with the industry and researchers to ensure that the evidence is developed in a way that will inform decisions on public funding. This research call is open to all good quality proposals covering any indication and disorders unresponsive to existing treatments. Ministers have called on the industry to take part in clinical trials and be transparent in sharing the results of this research.

The Department cannot comment on or intervene in the cases of individual patients. However, ministers are determined that, where it is the clinically right thing to do, patients should receive cannabis-based products for medicinal use. Decisions relating to the prescribing of cannabis-based medicines need to be made on a case-by-case basis, and whether or not to treat must remain a clinical decision.

The Secretary of State for Health and Social Care has initiated a review to the barriers being faced by patients seeking access to cannabis-based medicines. The review is now complete, and the Government are carefully considering NHS England-Improvement’s report (to be published shortly) alongside the recent Health and Social Care Select Committee’s Inquiry Report on medicinal cannabis which was published on 3 July 2019.