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Taking the principle of medicinal cannabis to practical implementation

This blog post follows the DrugScience Symposium on medicinal cannabis in January 2019. The meeting materials, including slides, pre-meeting report and summaries of international and American medicinal cannabis legislation are available for download here.

On 31 January 2019, we hosted our first Drug Science symposium on medicinal cannabis.

Since our foundation nearly ten years ago, we have closely monitored the situation of both recreational and medical cannabis around the world. In 2016 we produced a report on medical cannabis according to WHO standards and submitted it to their expert committee. We believe this was instrumental in their current review.

The symposium last week was designed to facilitate the development of medical cannabis in the UK.

Cannabis was a medicine in the UK until 1971 when following persistent pressure from the USA it was made illegal under the new Misuse of Drugs Act. Plant cannabis products were placed in Schedule 1 (meaning no medical value) and in either Class A or Class B of the UK Act in accordance with the UN Conventions. This change in the legal status of plant cannabis stopped prescribing and also severely limited research, so perpetuating the myth of no medical value.

In the past twenty years a number of countries, including The Netherlands, Germany, Canada and many US states, have rejected the UN Convention and reinstated cannabis medicines. But the UK has, largely for political reasons, vigorously opposed this trend. It was left to a few dedicated and desperate parents of children with epilepsy to campaign for a change following their proving efficacy in their children. In November 2018 the Chief Medical Officer conceded that cannabis products were indeed medicines and so they were removed from Schedule 1 and put into Schedule 2.

However, the long-perpetuated fear of cannabis harms persists and barriers have been put in the way of prescribers, currently limited to specialists (consultants) only. This makes the process of obtaining prescriptions slow and complicated. Also because of the almost complete lack of medical interest and research in cannabis over the past 50 years virtually none of the specialists have any knowledge or expertise in cannabis-based medicines. In reality most do not know what to do when a patient presents asking for treatment, and many appear to be avoiding prescribing, citing the lack of randomised trial data, and ignoring the vast number of powerful patient testimonies. But a lack of prescribing means that new data will not be generated nor experience gained. It also thwarts the hopes of many patients, who have found benefit from illicit cannabis - resulting in them having to continue illicit use of unproven supplies or obtain treatment overseas.

It is clear given the complexities of both the botanical nature of cannabis with its multiple different active components, and the many possible indications (in Germany 57 conditions are allowed) that the conventional approach to drug development won’t work for cannabis. And even if it was tried it would take decades, maybe centuries, for all indications and cannabis product combinations to be trialled – so many people would miss out for a long time. The cost of these research trials would also be enormous and the problems of patenting mixed plant products means that it’s unlikely that pharmaceutical companies would be interested. So it might never happen, leaving patients the choice of self-medicating with illicit products or being untreated.

Our symposium aimed to address this challenge and explore if an alternative approach might be feasible. We have been inspired by the great>success of cancer treatment innovation in the UK that has emerged from the setting up of clinical research networks for specific cancer types. These clinician-led networks use a common protocol for treating with a new chemo-therapeutic agent and collect data in a uniform way. This process means that rapid insights into treatment utility are obtained and clinicians mutually support each other in a field of uncertain outcomes. We know that similar expert networks exist in other areas of medicine, especially brain disorders, and have brought some leaders of these together today to explore if these networks would be a way to fast-track the collection of clinical data on cannabis products.

Drug Science is prepared to facilitate this process if the clinical community wants it to happen.

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