Why aren’t NHS doctors prescribing cannabis in the UK?

September 18, 2019

Much has been made of the fact that the government changed the law about cannabis prescriptions in the UK last year. The law, set out by the Home Office, came into effect last November and meant that for a small number of health conditions, doctors would be able to prescribe certain medications made from medical cannabis.

Cannabis and the law

Some societies and cultures have been swearing by the medicinal qualities of the cannabis plant for thousands of years. In fact, the first known use of cannabis goes back to almost 3000BC, but it was only relatively recently that in the UK it has been classified as illegal – in 1928 as an addition to the 1920 Dangerous Drugs Act.

This has meant that up until very recently – when research has finally begun to be carried out into the medicinal qualities of cannabis – society has told us that cannabis is bad. Research which started in the 1990s has gradually been uncovering how the compounds of the cannabis plant can affect us therapeutically, which is now leading to the gradual relaxation of laws around cannabis – whether it is the legalisation of certain compounds such as CBD (cannabidiol) to the legalisation of cannabis for medicinal reasons, or the complete legalisation of cannabis both medicinally and recreationally.

At the moment, in the UK, you are allowed to buy and use some products which contain CBD – one of the compounds in cannabis. However, you may not buy or use any products with a level of THC – or tetrahydrocannabinol – the compound which makes you high – of over 0.2%. Unless you have a prescription from your doctor.

What is medicinal cannabis?

The cannabis plant is made up of over 100 compounds of varying combinations, depending on its strain. Two of the most noticeable compounds are CBD and THC. These are known as phytocannabinoids (cannabinoids made by plants). When they are taken by humans, they can interact with the endocannabinoid system.

The endocannabinoid system is a system in humans which regulates a number of aspects of the body. It can affect the regulation of systems such as the central nervous system, digestion system and mood.

The endocannabinoid system works through the interaction of endocannabinoids (cannabinoids made naturally by the body) with cannabinoid receptors which are concentrated in different parts of the body. When cannabis is taken, the cannabinoids interact with the cannabinoid receptors in a similar way to the endocannabinoids, helping to boost the endocannabinoid system.

Within the endocannabinoid system, there are two main cannabinoid receptors – known as CB1 and CB2. They are each concentrated in different areas in the body and affect different aspects of the body.

When CBD is taken it can affect the way that some of the messages are sent out from the cannabinoid receptors. THC, on the other hand, binds with the CB1 receptors directly, sending out other messages, including one to the brain, telling it to make you feel ‘high’.

Although THC has been painted to be the ‘baddie’ when it comes to cannabis, it can be very useful therapeutically.

Medical cannabis is made from strains of cannabis which typically contain higher levels of CBD but also higher than legal levels of THC. It is well known that for the best effects, CBD and THC should be taken together.

What is the law about medical cannabis in the UK?

As it stands there are very few medical conditions in the UK which can have medical cannabis prescribed, including:

  • Some adults and children with certain rare forms of epilepsy
  • Adults who suffer from nausea or vomiting due to chemotherapy
  • Some people who suffer from MS

In all of these cases, all other medications must have been tried and not been successful before medicinal cannabis can be prescribed.

So, what’s the problem?

When the government changed the rules about medicinal cannabis – mainly due to pressure from some high profile cases such as those of Billy Caldwell and Alfie Dingley, there were high hopes that things were going to drastically change. However, this hasn’t been the case at all.

Aside from the fact that there are still very few conditions which the law allows to be treated with medicinal cannabis (and many more which potentially medicinal cannabis could be beneficial to those suffering from them) it is still extremely difficult to get a prescription for it.

This is down to a number of reasons:

1.      Lack of training

Due to the fact that the change in the law has been led by patients and not the medical profession, it seems that there is a distinct lack of training for doctors in the world of medicinal cannabis. This means that (understandably) most doctors are reluctant to prescribe it. After all, if they’re not confident in their knowledge of it and its implications, it would be irresponsible of them to prescribe it.

Add to this the taboo that is attached to cannabis – having been classed as an illicit substance –  it is easy to see why doctors are reluctant to prescribe it.

2.      Insurance

Another factor which is likely to put doctors who are qualified to prescribe medical cannabis off is the issue of insurance. At the moment, the only fully licensed medical cannabis drug that is available in the UK is called Sativex. Anything else won’t be covered by the doctor’s insurance, meaning that they or their trust could be deemed to be culpable should any adverse effects occur.

3.      Other complications

There are also other complications which can come up for people who are trying to get medicinal cannabis. For example, due to the legal status of cannabis – and THC more specifically, it can be difficult for pharmacies to stock medicines containing THC, or they may face other problems with logistics and security.

The world of medicinal cannabis is a fast-moving one. It seems that the barriers to NHS doctors prescribing medicinal cannabis to people whose lives could benefit significantly from it stem from a lack of training and understanding, while the laws lag behind the science.

It is disappointing that there are so many people out there who’s only option is to either visit expensive private clinics where their treatment can be unsustainably costly or buy cannabis products abroad or on the black market.

Although we are seeing things change thanks to patient and advocate pressure, the progress is very slow. Unfortunately, it looks like that in spite of the mounting scientific evidence, we won’t be seeing much difference for NHS patients any time soon.

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