The UK Review of Medicinal Cannabis: 2020 Retrospective
As 2020 draws to a close, it is more than appropriate to reflect on how the medicinal cannabis landscape has evolved since 2018
Crispin Blunt | MP, Conservative Drug Policy Reform Group
I became Chairman of the Conservative Drug Policy Reform Group at the beginning of 2019, having had just over a year as the first Conservative Co-Chair of the All-Party Parliamentary Group for Drug Policy Reform. This is an unenumerated position, but crucially allows me to advance awareness of the ways in which the legally regulated medicinal cannabis would pay untold dividends to our country as a whole. As 2020 draws to a close, it is more than appropriate to reflect on how the medicinal cannabis landscape has evolved since 2018. This is when I first became officially involved in the debate, asking the Urgent Question regarding the ethics of the National Health Service (NHS) being compelled by outdated policy to deny life-saving cannabis-based medicine to Alfie Dingley, then seven years old.
Like many other families with children affected by debilitating seizures, Alfie’s family had temporarily relocated to the Netherlands so that his required cannabis-based form of anti-epileptic medication could be legally prescribed. These families are a minuscule subset of the multitudes braving illicit, domestic access routes to cannabis-based medicines for themselves or their loved ones, for whom simply feeling well means facing the prospect of a knock on the door from the police. In 2019, the CDPRG was proud to support the legal defence of multiple sclerosis (MS) sufferer Lezley Gibson, ultimately acquitted from a charge of cultivating cannabis; Carlisle Crown Court ruled sensibly that to prosecute would not be in the public interest. Within the context of the UK’s medicinal cannabis landscape as a whole, this outcome is a rare example of a happy ending; (albeit a bit-part one as her challenges finding affordable, legal cannabis products to adequately alleviate her symptoms continue).
Though experiences like Gibson’s illustrate the nominality of the November 2018 policy change, this was an emblematic moment in the UK’s medicinal cannabis journey. This was the year the Home Office ruled that specialist doctors can prescribe cannabis-derived medicinal products in contexts in which all other approved medications have proven ineffective. But it was not until October of this year that Billy Caldwell, now 15, received his first medicine on an NHS prescription. A sufferer of life-threatening seizures treatable only with cannabis-preparations — which were seized in 2018 by border officials causing his hospitalisation — Billy and his mother Charlotte have been heroic voices for years in the growing call for policy changes enabling widespread access to cannabis-based medicines.
The CDPRG was incepted to be a nexus between different stakeholder groups across the drug policy landscape, synthesising insights to foster evidence-based understanding of the issues at stake in the political sphere. We are gathering increasing intelligence from law enforcement personnel from across the country unwilling to police situations such as Lezley’s, where cannabis is a healthcare necessity. Pragmatically speaking, clarity around medicinal cannabis would free up police time. Annually, more than a million police hours are currently wasted on cannabis offences. It was heartening to hear from both Dr. Leon Barron and Carly Barton on coalescent issues at our recent roundtable discussion as part of our ongoing enquiry entitled, The UK Review of Medicinal Cannabis. Barton’s Cancard, which launched this month, is a document which can be presented by those using cannabis medicinally to police in a bid to stave off unwarranted legal attention. Its existence is a welcome symbol of the appetite for co-operation between the law-enforcement and healthcare sectors as regards not persecuting patients, but such a measure needn’t exist once the rights of the patients it is designed to protect are appropriately enshrined in UK healthcare policy. Legislatively speaking, there is work to be done.
“No society can legitimately call itself civilised if a sick person is denied medical aid because of lack of means.”
So said Aneurin Bevan, the Labour Government’s Minister of Health who, in July 1948, launched the NHS. The CDPRG works with stakeholders from across the entirety of the medicinal cannabis landscape. Those calling for a meaningful follow-up to the initial law changes in November 2018 include medical scientists, prescribers, policymakers, criminologists and law-enforcement personnel from across the country; as well as importers, manufacturers and small- and large-scale cultivators. We have the human power and the means to make our society civilised in the spirit of the sentiments espoused by the founder of the NHS. It is a testament to the fact that we are failing as a civilisation in terms of healthcare provision that, according to our findings in Part A of our medicinal cannabis review “The Current Landscape,” published in April 2020, just 204 private prescriptions were issued for unlicensed medicinal cannabis products in the year after the November 2018 policy change. Prescriber and import costs associated with the private prescription route of access continue to function as their own form of prohibition, driving most of those in need of medicinal cannabis to source it on the black market, which gains approximately 2.6 billion per year from their unmet treatment needs. (Part B of this investigation, “The Road Ahead,” which examines exactly how current legal routes of access to medicinal cannabis are losing patients to the illicit market, will be published in 2021.)
The U.N. voted on 2nd December 2020 to take on board a recommendation by the World Health Organisation, removing cannabis from Schedule IV of the 1961 UN Conventions, a historic decision which each member country may receive in relation to their own cannabis policy.
In the UK, a significant change for us upcoming in March 2021 is our regulation of cannabidiol (CBD)-containing products by the Food Standards Agency (FSA). Aiming to bring much-needed clarity to legislation around the composition and specifically the THC-content of CBD-containing products, our Director of Research David King has co-authored a forthcoming paper to be published jointly by the CDPRG and the Centre for Medicinal Cannabis, proposing upper and lower compositional limits to ensure this burgeoning industry is given the policy support to secure its projected growth to £1 billion by 2025. Two cannabis prescribing members of our policy council — Dr. Dani Gordon and Dr. Julie Moltke — published manuals on CBD in 2020, demonstrating the extent to which this over-the-counter product has become a mainstay in the UK’s wellness sector — a space in which everybody could benefit from more information and clearer policies.
The 193 United Nations are not all aligned in the extent to which we politicise our healthcare systems or how and whether we make cannabis-based preparations legally available to our citizens. However, as illustrated by uptake of both CBD and whole-plant cannabis-containing preparations, citizens across the globe are united in susceptibility to debilitating symptoms such as inflammation, appetite loss, nausea, chronic pain, muscle spasms and seizures, to name but a few. Citizens of the United Kingdom are united also in their growing awareness that their afflictions might be managed very effectively by the increasing array of specialised treatments involving medicinal cannabis on offer abroad; which, in climates where policy does not stand in the way of research, are ever-refining.
Border control cannot reign in awareness of medical advancements and the fact that they are legally available elsewhere, nor can it reign in enterprise. We speak regularly with businesses choosing to register and conduct operations related to the production and sale of cannabis-based medicinal products abroad in the absence of appropriate regulatory underpinnings in the UK. Options to carry out these projects abroad continue to increase with medicinal cannabis legalised in countries including Argentina, Finland, Denmark, Ecuador, Israel, Switzerland, Mexico, Portugal, Germany, Canada and now, following the recent election, 35 U.S. states. In step with economic advantages these ventures bring, treatment development continues apace abroad, reaping promising cannabis-based preparations for ever-increasing numbers of common conditions.
One of the key things that has changed in UK politics relating to medicinal cannabis over the course of 2020 is the acknowledgment that the existing changes have improved the lives of a very few individuals. Further review of the current policies relating to medicinal is needed before the intended benefits of the initial adjustments become widespread.
BIO: Crispin Blunt is MP for Reigate having formerly served as an army officer and subsequently Special Adviser in the MoD and FCO. In 2019, he set up and launched the Conservative Drug Policy Reform Group Ltd, whose objective is to promote evidence-based drug policy reform on the centre right. He is the Group’s unremunerated Chair. | Twitter handles: @CrispinBlunt @CDPRGUK