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Should cannabis be prescribed?

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Should cannabis be prescribed?

Interest in the therapeutic potential of cannabis is growing across the world, as we discover

There has been plenty of research into the dangers of using cannabis recreationally, but there is growing interest in exploring the potential medicinal benefits of the cannabis plant.

In August 2014, it was announced that the NHS in Wales would allow the prescribing of a cannabisbased medicine for people with multiple sclerosis (MS). Following a recommendation by the All Wales Medicines Strategy Group (AWMSG), it was agreed to make Sativex (an oral spray) available on the Welsh NHS to treat muscle spasms in those with MS who have not responded adequately to other medications.

The spray would not be available for MS patients in England. In October 2014, NICE published guidance on the management of MS and said that the substantial cost of Sativex “compared to the modest benefit” did not justify its use. However, critics believe that NICE has not undertaken a robust enough assessment.

“Unlike the AWMSG, NICE has only evaluated the cost of providing the drug, and not considered the potential savings that could be made if people could access it,” says Sally Hughes, programme director – policy and influencing at the MS Society. “For example, access to Sativex could dramatically decrease the amount of social care required by a person with MS.”

A survey published by the MS Society shows that only 2 per cent of people with MS are currently using Sativex, but 82 per cent of those who currently take it consider it to be “essential” or “a high priority”, she says. Paying for it privately costs about £350 a month. Sativex, which was launched in the UK in 2010, contains two cannabinoids – THC (delta-9-tetrahydrocannabinol) and CBD (cannabidiol) – and was developed by GW Pharmaceuticals in response to calls from people with MS for a prescription cannabis-based medicine.

“People with MS have been told for years to wait for a pharmaceutical, legal alternative to cannabis, yet NICE has blocked NHS access to one such treatment that has been proven to be safe and effective,” says Sally Hughes.

Other possibilities

MS isn’t the only condition that cannabis-based medicines may potentially help. New research, published in the journal Molecular Cancer Therapeutics and carried out by specialists at St George’s, University of London, suggests that cannabis extract used alongside radiotherapy treatment may have a dramatic effect on brain tumours. The research team is now discussing the possibility of combining cannabinoids with irradiation in a human clinical trial.

Meanwhile research carried out at the Arthritis Research UK pain centre at the University of Nottingham suggests that chemical compounds synthesised in the laboratory, similar to those found in cannabis, could be developed as potential drugs to reduce the pain of osteoarthritis.

Commenting on the research, Professor Alan Silman, medical director of Arthritis Research UK, said that it suggests there is “potential to develop a synthetic drug that mimics the behaviour of cannabinoid receptors without causing serious side-effects.”

In August 2014, the Liberal Democrat MP and then home office minister Norman Baker caused a stir when he said that, given what he had learnt in his role as a minister, he thought it was time to reconsider the medicinal properties of cannabis.

“There is a growing body of research that shows the medical properties of the chemical components of cannabis. We should consider seriously whether it is valuable to treat conditions such as MS, glaucoma, chronic and neurogenic pain, and the side-effects from chemotherapy and HIV/AIDS treatments.”

Different approaches

In other countries, the medicinal use of cannabis is starting to be recognised. In the US, for instance, more than half the states now allow the medical use of cannabis, including the state of New York. Governor Andrew Cuomo signed a bill last summer to establish a medical marijuana programme for New York State. The new law means that patients with “serious conditions”, including cancer, HIV/AIDS, MS, epilepsy and inflammatory bowel disease, may be given medical marijuana.

The law includes provisions to ensure medical marijuana is reserved only for patients with serious conditions and that it is dispensed and administered under strict guidelines. Governor Cuomo described the legislation as “striking the right balance between our desire to give those suffering from serious diseases access to treatment, and our obligation to guard against threats to public health and safety”.

There is growing interest in exploring the potential medicinal benefits of the cannabis plant

In Chile, it has been reported that permission has been granted to plant nearly 1,000 cannabis plants in the capital city. When harvested, the plants will be turned into an oil for use as a painkiller for cancer patients. In Australia, there are also moves afoot to change the laws around cannabis. Dr David Allsop, research fellow in psychopharmacology and addiction medicine at the University of Sydney, says that Australia is undergoing “a mini revolution” in medicinal cannabis.

“Members of all the major political parties are putting forward a new medical cannabis bill to parliament that would put in place a formal framework for researching and using medicinal cannabis products,” he says. “If the bill is passed, it will hopefully be a game changer in Australia for medicinal cannabis.” Dr Allsop is interested in exploring the medicinal potential held within the plant. “Cannabis pharmacology is a relatively new field in academic and clinical circles,” he says.

“It is an unknown but hugely promising medical frontier that is only just opening up. The cannabis plant consists of hundreds of active molecules of potential medical interest for their effects on the endo-cannabinoid system. Only two or three of these phytocannabinoids have been studied in any level of depth. This is why cannabis science is moving fast.”

A lot of research effort has been expended on pinning down the harms of cannabis over the years, says Dr Allsop. “It’s important work, of course, but there has been no balance with explorations of the potential medical benefits. I’m glad to see that beginning to change around the world.” “There is considerable anecdotal and pre-clinical evidence that cannabis-based medicines would be effective against a number of disorders,” says Roger Pertwee, professor of neuro-pharmacology at the University of Aberdeen.

“But there is still a need for much more clinical evidence, particularly from properly designed clinical trials.” So where does the UK as a whole sit in terms of its attitude towards medicinal cannabis? “I don’t know the answer to this for sure,” says Professor Pertwee, “but I imagine that the UK authorities are currently against the policy of allowing cannabis to be used medicinally, but not against the prescribing by physicians of licensed cannabis-based medicines.

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