NHS cannabis medications see approval in the UK. Could this be the step needed to give full access to patients?
The National Health Service (NHS) is a UK government-funded medical and health care agency. It gives patients care without paying the full price for their treatment. UK residents’ income taxes largely fund the organization. As of November 2018, the UK government legalized NHS medicinal cannabis prescriptions.
Despite their legal status, however, NHS cannabis prescriptions are hard to come by. Only two medicines, both for epilepsy, are available so far. Further, the regulations are tight. Low strength CBD oils are often available at pharmacies. However, stores cannot sell anything with .05 percent THC unless they have a special waiver. According to activists, this leaves many people “in limbo.” One of those in limbo, Billy Caldwell, is part of the reason this legalization started. And yet, even he and his family are challenging the new law.
The Caldwell family’s problems are largely due to logistics. Billy previously received an emergency license for his medication. Due to the new law’s guidelines, though, he and his mother are continuing their fight and filing a lawsuit.
Epilepsy and MS Patients First to Benefit
Two cannabis-derived pharmaceuticals that doctors can legally prescribe in the UK are Sativex and Epidiolex. Researchers designed each of them for very specific conditions. GW Pharmaceuticals produces both.
Sativex is an oral spray with a combination of both THC and CBD for multiple sclerosis (MS) patients. It helps to relieve moderate to severe muscle spasms caused by inefficient communication between the brain and nerves. MS is a complicated and unpredictable neurological condition that can, among other things, impair movement, affect mental health, and severely impede activities of daily living.
Epidiolex is an oral solution derived from CBD. It controls seizures for two rare types of epilepsy that are treatment resistant, Lennox-Gastaut Syndrome and Dravet Syndrome. Both seizure disorders are severe. They also affect children early in life. One of their worst parts is the potential to cause cognitive impairments and developmental delays in patients.
Parents are Taking Other Avenues
UK patients must also go to private physicians, at their own expense. Not all patients have the means to do so. Limited access to NHS cannabis prescriptions has led some parents to smuggle their children’s medications from other countries, such as the Netherlands. These parents are risking seizure of the medication, some of which costs up to and upwards of £1,500.
Visits to private physicians are expensive. Adding on travel costs plus the cost of medication, parents often have to resort to fundraisers to keep their children comfortable, or even living. Unfortunately, the law these parents expected would help them is creating additional barriers to their child’s treatment. What’s worse, it could take years for needed changes to come.
Where are all the NHS Cannabis Prescriptions?
Despite positive cases (like this seemingly miraculous result for a young boy with a brain tumor) physicians in the UK are reluctant to write NHS cannabis prescriptions. This is partially due to confusing and unclear guidelines, which make physicians reluctant to potentially risk their medical career over writing a prescription. Guidelines are also unclear regarding which physicians can prescribe medical cannabis. They’re even less clear on how to get access to a safe supply. A lack of adequate clinical research within the UK is yet another reason that NHS cannabis prescriptions are so uncommon.
Not so NICE
The National Institute for Health and Excellence (NICE) exists to decide whether treatments are cost effective for the NHS. If not, a helpful treatment that would allow an MS patient to walk, or an immunotherapy treatment, may not be available to them, regardless of potential benefit.
The NHS guidance provided to physicians regarding medical cannabis products includes weaning children off of THC and giving CBD products instead. Unfortunately, as seen with several children with epilepsy, such as Billy Caldwell, CBD alone may not be enough. With each seizure, a child’s life may be at stake. Changing their regimen, especially when they have made progress, could be devastating.
Exportation of Cannabis
The largest hypocrisy lies in the fact that the UK is the world’s largest exporter of medical cannabis. And yet, it continues to deny its benefits to citizens. Until recently, the government denied that cannabis had any medicinal value. Yet during this time, they made a great deal of money off of the medical cannabis industry. And they could make even more if it were legal. Some estimate that the UK’s medical cannabis market would be worth £8 billion per year.
Much of the current money is revenue from GW’s cannabis pharmaceuticals, like Sativex. Ninety tons of medicinal cannabis is grown annually through a partnership between GW and British Sugar. There have been some ethical issues surrounding the partnership. The drug minister’s husband is the managing director of British Sugar. After ministers and the public labeled her a hypocrite, the drug minister excused herself from speaking on behalf of the government about cannabis.
The NHS rescheduled medical cannabis to remove its illegal status. However, the process of getting people the medicine they need is far from over. Doctors have written fewer than one hundred NHS cannabis prescriptions. Unfortunately it is unlikely, due to the limitations of the law, that patients will able to fill them soon. It could be months, but will more likely be years, before patients receive easier access to the medications they need.