Senior Associate, David Hardstaff and Partner, John Binns of BCL Solicitors LLP, explore the UK’s doomed Medical Cannabis (Access) Bill
It is becoming difficult to remember a week in UK- parliamentary politics that wasn’t defined by some sort of alleged scandal or drama. Against this backdrop, you may wonder how any actual work is done over and above the daily fighting of fires and attempts at political survival. For UK-based patients struggling to access much needed cannabis-based medicines, it has been difficult to be heard over the white noise of the daily news cycle. A notable and recent example of this is the ‘talking out’ of the Medical Cannabis (Access) Bill, a Private Member’s Bill sponsored by Labour MP, Jeff Smith.
All controlled drugs in the UK are scheduled according to their potential harm and medical or therapeutic use. 2018 saw the apparent legalisation of medicinal cannabis in the UK, through the rescheduling of cannabis-based medicines from Schedule 1 (controlled drugs with little or no medicinal or therapeutic use) to Schedule 2 of the Misuse of Drugs Regulations 2001. Heralded as a watershed moment within patient and industry circles, the move had broad political support across party lines. However, over three years since the change in the law, the consensus that underpinned it has waned.
Barriers to patient access
Significant barriers to accessing cannabis-based medicinal products are baked into the existing legal and regulatory framework. Further barriers exist due to the lack of funding through the UK’s National Health Service (NHS). The most commonly cited cause is the perceived lack of evidence from UK-based research into the efficacy of cannabis-based medicines. Doctors, who might otherwise be in a position to refer suitable patients to specialists able to prescribe cannabis-based medicines, feel under-equipped through a lack of UK- generated evidence. This chicken and egg problem has highlighted the UK medical establishment’s overreliance on UK-based research in circumstances where the global pool of evidence is significantly more advanced.
The starkest example of the problem is tied to funding. Since the creation of the definition of ‘cannabis-based product for medicinal use in humans’ (or CBPM) in 2018, and its inclusion in Schedule 2, only a handful of prescriptions have been funded through the NHS. Either patient access was not properly considered when changes to the law were made; or, as a cynic might suggest, the change in the law was only ever intended to be superficial.
A modest and practical solution
The Medical Cannabis (Access) Bill aimed to increase patient access to medicinal cannabis through two primary changes to the current regime. Firstly, the Bill would require the General Medical Council (GMC) to keep a register of General Practitioners (GPs) who may prescribe cannabis-based products in England. It would also enable GPs to prescribe medicinal cannabis products in circumstances where currently only consultants could prescribe.
“All controlled drugs in the UK are scheduled according to their potential harm and medical or therapeutic use. 2018 saw the apparent legalisation of medicinal cannabis in the UK, through the rescheduling of cannabis-based medicines from Schedule 1 (controlled drugs with little or no medicinal or therapeutic use) to Schedule 2 of the Misuse of Drugs Regulations 2001.”
Secondly, the Bill would establish a Commission to propose a framework for the assessment of cannabis- based medicines and their suitability for prescription in England, and to make recommendations of measures to overcome barriers to access to cannabis from the NHS in England for medical reasons. If established, the Commission would have to consider including in the framework evidence from observational studies, conventional controlled trials, and other countries in which cannabis-based medicines are more widely available.
The Bill was to have its Second Reading in the House of Commons on 10 December 2021 but was ‘talked out’, a process similar to filibustering. The development is widely considered to be terminal to the Bill’s future prospects, a reality acknowledged by its key supporters.
Why have the Bill’s seemingly reasonable proposals failed to garner support from the UK Parliament? The reality is that despite the apparent support for medicinal cannabis products, cannabis itself has always been a polarising issue in British society and politics. Despite a huge body of evidence from other countries of its efficacy in treating a wide range of health problems, this humble plant has struggled to be taken seriously as a medicinal product in the UK. Important debates concerning the decriminalisation of cannabis users, and how to control the cannabis economy, have highlighted long-held fears that accepting cannabis as a medicine might be the ‘thin end of the wedge’ when it comes to a much wider relaxation of drug laws. The same fears have complicated what should really be a fairly anodyne process of medical research, development and regulation.
The early failure of the Bill does not bode well for UK- patient access in the short to medium term. In politics, the squeaky wheel gets the grease; and so, to cut through as it did in 2018, the medicinal cannabis lobby must rethink how to get its message heard.