UK Cannabis Industry: Out of the Fish Tank and into the Big Blue Ocean

CBMPs are a shining example of personalised medicine which does not conform to classic clinical trial design.

Ben Langley | CEO Grow Group

Pierre van Weperen | CEO Grow Pharma

The argument for medical cannabis is compelling.  It has been used for 5000 years as a medicine and continues to alleviate symptoms worldwide today and is now well evidenced by fundamental research into the endocannabinoid system both in health and disease. Based on current black-market usage and patients currently running out of more conventional medical options to manage the symptoms of their disease the UK medical cannabis market has been estimated to grow to over £3bn over the next decade.

The UK government changed the law in 2018 to allow medical cannabis to be prescribed but, as so often, also immediately caveated it in a way that made it difficult for companies to import their products and to talk to doctors about them. A classic two steps forward to say “see we have listened to you” was accompanied with at least one step backwards. The industry has managed to work within these restrictions but is craving for a more accommodating stance, especially with regards to importing products which would allow the industry to lower prices as a result of decreased transportation fees and related costs.

Lowering prices will benefit patients by improving access, which is what we all should be aiming for however we will probably have to accept that for the coming several years the NHS will not be prepared to pick up the bill for these medicines. Patients will have to pay for their medication themselves.

Therefore, if we want to make this option viable for current users and for cannabis-naïve patients then affordability is the major issue.  

Producers, manufacturers, importers, patient organisations and doctors know that there is an ocean of patients who would benefit significantly from being able to use cannabis medicines to manage their chronic, untreatable or unbearable pain, seizures, spasms, nausea and vomiting as a result of their chemotherapy and many other issues. These parties should unite behind this common goal about how to create access for patients to these medicines. However, as often happens, companies tend to default focus on the competition, when instead they should look at growing the market for the benefit of all and especially patients. 

It has been proven to be virtually impossible to circumvent the approval and reimbursement system in the UK. This system still demands data generated through clinical trials. As this has been the focus of the industry for some time now without any radical change we would question if this is the right way forward. Medical cannabis trials ask for significant investment not only because they are individually costly, but also because there are so many areas where cannabis medicines help manage symptoms. More importantly, generating additional data to the existing clinical evidence, to the wealth of experience in treating patients, to the significant real-world data that is already out there, will take time.  This is exactly what many patients do not have. 

Cannabis is generally safe in the hands of educated prescribers and patients are needlessly suffering today while we wait for more data in a limited number of therapy areas by design. CBMPs are a shining example of personalised medicine which does not conform to classic clinical trial design. There are more and more cases of medicines making their way to patients in rare diseases or complex cases without randomised controlled trials and based simply on clinical experience. We would argue that this should be the case for medical cannabis.  

With this in mind, what would the medical cannabis industry look like in the next five years if we were to collectively achieve this, to advance this industry to the point where we can drive wide-scale tailored clinical research?

We need to work together as an industry to grow the current private market; investing in education and driving for regulatory changes that enable bulk imports.  If full NHS access is the ultimate goal, we must focus on specific indications gaining NHS acceptance, and potentially opening up a discussion about those choices. We should discuss opportunities to educate specialists and GPs about medical cannabis and focus on taking away their legal worries. We should discuss creating referral systems and treatment pathways. These are all crucial initiatives. 

Allowing doctors to write private prescriptions for cannabis medicines within their NHS practice would be the most significant step forward in our view. More importantly, it would actually empower doctors again to make clinical decisions focused on the patient. On social media many patients complain about the cost for accessing private clinics and for having to pay for their prescriptions. Both are an issue but the shout for at least taking out consultation fees is a loud one and we feel that as an industry we should focus on lobbying for that. We should bring together activists, patient groups, advocates and doctors to put together the case for this. Everything else will fall into place through creating more access to medicines for patients. 

At Grow Pharma our mission is to create and drive access to medical cannabis for those who need it. We have invested in creating a solid and reliable supply chain because many patients have terminal diseases or are completely disabled without their cannabis products and waiting for their medication is simply not an option. We have created a broad offering of affordable flowers and oils of good quality and try to offer the best possible customer service to patients. All of that is critical.  Now we need to drive the focus on where we realistically think the industry should go next and how we can make the biggest difference for patients.