OPINION
09/08/2019 10:40 BST

The Battle For Medicinal Cannabis Is A Chronic Pain In The Heart

Carly Barton, who has been using medicinal cannabis to treat excruciating chronic pain condition, says patients are being let down by the latest draft guidance from Nice.

ASSOCIATED PRESS
A medicinal cannabis farm. 

As I am writing this, my inbox is piling up with unread emails. 

The latest message reads: “How are we expected to go on living? If I have to go back to morphine then I know I will become suicidal again.”

Another reads: “Now I need to go back to living in fear, and hoping that I don’t get arrested for easing my pain. I’m tired of it.”

With each one, my heart pangs. 

Thursday saw the release of two government commissioned reports that should have been insightful, well considered solution-focused documents that reduce the likelihood of criminalising medical cannabis patients.

Both, however, are equally devastating to some of the most vulnerable people in our society.

The first is draft guidance published by the National Institute for Health and Care Excellence (Nice), which declined to recommend medical cannabis, even for epilepsy.

The second is an NHS England review into medical cannabis for illnesses such as severe epilepsy. It found “major hurdles” in prescribing cannabis-based treatments, which included concerns about the potential harm to mental health and a lack of evidence on overall effectiveness.

One sentence from the Nice report reads: “The evidence did not show a reduction in opioid use in people prescribed medicinal cannabis.”

This almost made me spit out my tea. I could round up a stadium full of ex-opioid patients in my sleep with my hands tied behind my back.

Just a Google click away, The Pharmaceutical Journal published a report in July that showed that out of 1,000 survey respondents, almost 90% of patients stopped their analgesic opioid prescriptions altogether as a direct result of their access to medicinal Cannabis. 

Five whole years ago, JAMAInternal Medicine published findings that concluded “states with medical cannabis laws had a 24.8% lower mean annual opioid overdose mortality rate compared with states without medical cannabis laws”.  

Let’s let that sink in…..a QUARTER of opioid overdoses were avoided. In some states that is the equivalent of the population of a whole town in Wales. Annually. Not dead. 

The NHS review has focused the entirety of the report on the very slim minority of patients, interestingly but not surprisingly, also the most potentially politically devastating cases, those with paediatric epilepsy.

They have made suggestions and alluded to an access programme for them, which will likely see the children transferred to the care of Great Ormond Street Hospital. While this is truly excellent news for the handful of patients affected, paediatric epilepsy cases make-up under 1% of the patient community in the UK. Where is the provision for the other 99%?

Where are the suggestions for access programmes? For harm reduction? For trials? For government collaboration to remove the harms done by criminalisation?

Doing trials on cannabis is complex. Randomised controlled trials are set-up for single compounds. Cannabis is not a single compound, it is a poly-compound substance with whopping-great-big variables. It is like trying to fit a car into a cereal bowl. Even if we found a way around this, the type of trials that are being suggested in the reports will take approx 3 years per condition, Cannabis treats over 300 conditions, that leaves us with 900 years of research hours. 

The Danish Ministry of Health looked at these very same issues and proposed an exceptionalist access scheme that would gather data as prescriptions were written, avoiding human rights issues and removing patients dependance on the illicit market, all while collecting the necessary information to improve their clinical understanding. They swiftly implemented, funded trials, trained their General Practitioners and have written thousands of prescriptions. 

The majority are of course, for chronic pain. 

Germany, known for their attention to detail and excellent Health Care services went from 0 to 60,000 medical cannabis patients in 24 months. The majority are of course, for chronic pain. 

The lack of any kind of acknowledgement in the NHS report, let alone provision, for the 1.1 million patients in the UK consuming for medicinal reasons, 80% of which have unmanaged pain, is insulting. 

The suggestions of provision for paediatric neurology cases, is clearly due to the public not quite being down with them pumping small children full of dangerous chemicals with one hand, whilst simultaneously refusing to acknowledge the potential power of a mild plant extract. Fair game.

But where is the compassion for those who are unable to walk, speak, eat or have a conversation because neuropathic pain is electrifying their whole body like a constant punch-up with a cattle prod? Or the Mum that can’t pick her children up because her MS spasticity prevents it? These cases, the majority, don’t quite shift as many papers. These people are still living in fear of accessing potentially dangerous products on the illicit market, or having their doors kicked in at 5am for cultivating their own medicine. 

Whilst everyone is looking the other way as Brexit becomes a bowl of toxic soup with homicidal tendencies, more than a million people that would have provisions in many other EU countries, are being overlooked and left to suffer. Meanwhile, patient advocacy groups like United Patients Alliance and Carly’s Amnesty are picking up the pieces for patients whose lives are being devastated by the continued criminalisation of an extract that helps them.  

Cannabis has already been through the biggest ‘trial’ known to man, it is out there and it is working, we should be looking at how to collect that data. It is an insult to patients to suggest that their experiences with their own bodies are not valid when making decisions about their treatment.