By Hannah Thurgur @HannahThurgur

Medical cannabis was legalised almost a year ago in the UK, so why is there only a handful of prescribers? What are the barriers to prescribing it and what is being done to help medical professionals in this transition period?

Cannabis is the drug derived from the cannabis plant and has a vast history of both recreational and medical use. Cannabis plants contain hundreds of chemicals, including the cannabinoids THC (delta-9-tetrahydrocannabinol) and CBD (cannabidiol). THC binds to cannabinoid receptors in the brain to induce its psychoactive effects and is often associated with the ‘high’ induced by cannabis, whereas CBD is thought to act through several different receptors to cause multiple effects.  There is increasing evidence for the potential medicinal properties of THC and CBD in a wide range of health conditions, fuelling debate and policy change on medical cannabis worldwide.

Drug Science, an independent drugs advisory committee, are hosting medical cannabis educational seminars across the UK to support medical practitioners in prescribing medical cannabis to their patients. I attended the Manchester event as a non-medical professional, and found it particularly interesting to hear about the difficulties that practitioners face in prescribing and the barriers to accessing medical cannabis that have been influenced by the media and politics.

Professor David Nutt, the chair of Drug Science and Edmond J. Safra Professor of Neuropsychopharmacology at Imperial College London, opened the seminar by discussing the complex history of cannabis and the timeline of its legal status.

Cannabis was prohibited in the UK in 1928. Many argue this came as a result of political concern for the effects it was having on marginalised groups of society, rather than scientific evidence of its harm. More recently, despite The Misuse of Drugs Act 1971 classifying cannabis as a class B drug, there has been debate on the medicinal use of cannabis. This dispute has been fuelled by public opinions, political bias, and scientific evidence and has led to the new legal status of medical cannabis.

Medical cannabis was finally legalised on 1^st November 2018 after increasing pressure on the UK government brought by resilient campaigning from individuals citing evidence that medical cannabis has helped improve their health. One particularly high profile case involved Billy Caldwell, a young boy whose mother campaigned tirelessly for access to medical cannabis for her son to reduce the severity of his epilepsy.

However, current regulations mean that medical cannabis can only be prescribed by specialist physicians. Uncertainty surrounding appropriate use of the drug has meant that so far very few clinicians are willing to prescribe it. A working group set up by Drug Science aims to combat this by providing education and advice to medical practitioners.

Up next was Dr Matthew Hill, an associate professor based at the Hotchkiss Brain Institute in Canada, where medical cannabis has been legal since 2001.  Canada’s experience can provide the UK with valuable insights in how to effectively manage legislation.

Dr Hill emphasised the importance of considering the strength of the evidence for associated health risks with cannabis. He highlighted the role of the media in polarising public opinion by excessive reports of harms associated with cannabis use compared to other drugs. He discussed the growing evidence for the benefits of medical cannabis in disorders such as chronic pain, paediatric epilepsy, chemotherapy associated nausea and multiple sclerosis.

Dr Kishan Mahabir is a Nephrologist based in Canada, who presented his practical approach to prescribing medical cannabis. A key part of this is considering the THC:CBD ratio, this is the amount of THC compared to CBD which will alter the medicinal effects on the patient.

Dr Mahabir suggests that the establishment of goals for treatment must be considered so that the full benefits of medical cannabis treatment can be effectively evaluated for each patient. These include symptom control, functional status, quality of life and a reduction in the use of other medications. Based on a patient’s goals, the THC:CBD ratios and dosage can be carefully adjusted. He argued that the patient’s choice should be respected to tailor the THC:CBD ratio to meet their individual needs.

The debate surrounding medical cannabis has raised the question as to whether the prohibition of medically useful controlled drugs is an infringement of human rights. Professor Judith Aldridge and Professor Toby Seddon, criminologists here at the University of Manchester, are interested in the interplay between human rights and drug policy framework. Considering drug prohibition within the context of human rights, an alternative argument for the access of medical cannabis is presented alongside the scientific evidence for the benefits to human health.

Personal accounts of patients from the United Patients Alliance, a UK medical cannabis support group, support this argument. Their stories highlighted that improving access to medical cannabis would prevent patients resorting to obtaining cannabis illegally.

To summarise, many people feel that it is an unethical injustice to not prescribe medical cannabis when it can improve the health and quality of life for patients. With the tireless campaigning and advocacy provided by the United Patients Alliance and the support of Drug Science for medical practitioners, we can hope to see improvements to the access of this medicine in the very near future.