20,000 To Get Medical Cannabis In Large-Scale UK Study

Thousands of UK patients are to be granted access to medical cannabis as part of the first large-scale UK study of the plant’s medicinal effects.

The study, named Project Twenty21, is being funded by Drug Science, an independent drug charity chaired by Professor David Nutt – director of neuropsychopharmacology at Imperial College, London, and a long term advocate for the reclassification of cannabis and other drugs. The project is also backed by the Royal College of Psychiatrists (RCP).

Medical cannabis became officially legal in the UK just over one year ago – 1st November 2018 – after a series of emotive cases involving access to the drug for medical use were thrown into the spotlight of the mainstream media. This included the highly publicised plight of 6-year-old Alfie Dingley whose rare and acute form of epilepsy caused him to experience up to 30 violent seizures each day.
Alfie was being treated in hospital with conventional drugs despite fears that long-term use of steroid injections could cause his vital organs to fail. After becoming exasperated having to watch her son suffer, his mother, Hannah Deacon, took Alfie to the Netherlands in September 2017 to try a cannabis-based medicine which was prescribed by a Dutch paediatric neurologist. While abroad and using the Dutch cannabis oil, Alfie went a full 24 days without a single seizure. After returning to the UK, and with the assistance of the All-Party Parliamentary Group on drug policy reform (APPG), the family began to lobby then Home Secretary, Amber Rudd, to issue a license allowing Alfie access to medical cannabis oil in the UK. This was initially refused, but public pressure eventually forced the government to relent – in June 2018 the new Home Secretary, Sajid Javid, confirmed that a license had been issued to Alfie, allowing him access to cannabis oil within the UK. 

A full government policy review followed, and on 1st November 2018, NHS England guidelines were changed to allow consultants the option of prescribing cannabis-based products if they feel their patients will benefit from it.

So, if medical cannabis is already legal and consultants are allowed to prescribe it to their patients, why does Professor Nutt feel the need for further studies to demonstrate the efficacy of the medicine?

Well, despite the law change, only a tiny number of patients – reportedly fewer than 100 - have actually been granted access to cannabis treatments. This is because GPs are not able to prescribe cannabis oil or herbal cannabis; it has still not been formally approved as a medicine, so can only be prescribed by a consultant as a ‘special’, and only when every other treatment option has been exhausted. Without formal accreditation as a legitimate medicine, medical cannabis finds itself in a bizarre state of limbo.
Despite the vast amounts of anecdotal evidence to the contrary, clinical watchdog NICE (National Institute for Health and Care Excellence) claim there is a “paucity of evidence” that cannabis medicine works and is safe and should not, therefore, be prescribed for a range of conditions including chronic pain. It is worth noting at this point that “cost-effectiveness” is one parameter on which NICE evaluate a drug’s viability – more on this later.
Cannabis, in raw form, remains a class B drug under the Misuse of Drugs Act (1971) and a Schedule 1 substance under the Misuse of Drugs Regulations (2001). These classifications are consistent with a dangerous substance with absolutely no medicinal value. Even heroin and cocaine are Schedule 2 substances!

Taking the official legal position at face value, and doubtless considering their precious professional reputations, Consultants are extremely reluctant to prescribe cannabis for all but a few very rare conditions. 

This impasse has caused a great deal of frustration with patients who thought that the change to the law last November would mean that they would finally be able to access cannabis medicines.
It’s also a very sore point for Prof. Nutt: he believes that the official government denial of cannabis’ beneficial, medicinal properties is at best, politically motivated and at worst, evidence that the whims of giant US pharmaceutical firms and the powerful alcohol industry lobbyists have far-reaching influence over the UK government’s stance on cannabis.

So convinced is Dr. Nutt that his charity, Drug Science, are subsidising this pilot project in order to conclusively prove that cannabis does have medicinal benefit. From there, one assumes the newly invigorated movement would attempt to strong-arm the government into changing the classification of the drug and thus break down the barriers most potential patients are faced with when trying to obtain cannabis in the UK.

Project Twenty21 will sponsor and supply medical cannabis for up to 20,000 patients by the end of 2021 and test its impact and efficacy against seven common conditions: chronic pain, post-traumatic stress disorder (PTSD), multiple sclerosis, Tourette’s syndrome, epilepsy, anxiety disorder and substance abuse.

Professor Wendy Burn, President of the RCP, said: “The College welcomes this pilot project which it hopes will make an important contribution towards addressing the paucity of evidence for the use of cannabis-based medicinal products. We hope that this pilot, along with other research such as more much-needed randomised control trials, will continue to build the evidence.”

It is likely to be a number of years before the results of Project Twenty21 are fully revealed. We can only hope that the sample size and independent nature of the study will be enough to convince policy makers that a major reform of cannabis law is required.
After all, is it right or proper to consider the issue of “cost-effectiveness” when contemplating the value of cannabis as a medicine?
Is this not the same as measuring a drug’s usefulness by “commercial viability”? Perhaps this is a valid yardstick to measure other drugs which could only be manufactured by chemists in controlled facilities and distributed by the NHS, but cannabis can be grown at home – potentially by patients themselves at a negligible cost.

Is it really a huge leap of the imagination to picture a future of community-based cannabis grows, each supplying local patients with their medicine for a fraction of the cost of the steroids and opioids currently used?
Could the wider availability of medical cannabis or better yet, the legal freedom to grow it at home, actually reduce the financial burden on the NHS whilst improving patients quality of life at the same time? Wouldn’t that be a win-win outcome for both patients and the Treasury?

Time will tell, but there is an overwhelming feeling among the global cannabis industry that further relaxation of UK cannabis laws are just around the corner. The pioneering work of Prof. David Nutt and his Drug Science charity can only help towards achieving that goal. We’ll be watching this story very closely over the coming months and years and will no doubt return to the PureSativa blog pages to report on key developments as they arise.