26 Sep Royal College Of General Practitioners. Draft Council Paper – Cannabis For Specified Medical Indications.

 

Not just another report or conference but practical action at the point of healthcare,

Not just another report or conference but practical action at the point of healthcare.

This is the document setting out the proposal that was approved by the RCGP Council on 22nd September 2017.

APPG: https://drive.google.com/file/d/0B0c_8hkDJu0DRnBfdGRDRXBROUU/view
Barnes: https://drive.google.com/file/d/0B0c_8hkDJu0DUDZMUzhoY1RqMG8/view
MS Society (2017) Cannabis and MS: The Role of Cannabis in Treating MS Symptoms

Cannabis for Specified Medical Indications

Introduction

In the past year, there has been significant interest in the issue of legalisation of cannabis for medical purposes. The All Party Parliamentary Group on Drug Policy Reform made a recommendation in October 2016 that cannabis should be legalised for specific medical indications (https://drive.google.com/file/d/0B0c_8hkDJu0DRnBfdGRDRXBROUU/view). An accompanying report (the Barnes report:  https://drive.google.com/file/d/0B0c_8hkDJu0DUDZMUzhoY1RqMG8/view) summarised the current evidence for medicinal use and outlined the known side effects. This proposal now has all party support with over 100 MPs backing the plan.

Other countries have recently legalised, or are about to legalise, medical cannabis, including over half of the US states, Germany, Canada, Australia and Ireland, amongst several others. It has been estimated that over 1 million people use cannabis for medical reasons in the UK on a regular basis. A recent poll showed 68% of the public supported medical usage and only 12% were actively against (REF). A similar number of GPs also supported the concept in a poll published alongside the APPG report.

Some forms of cannabis are legally available, including Sativex for MS-associated spasticity. An important component of natural cannabis, Cannabidiol (CBD), is also legally available without prescription through health food outlets.

It is likely that GPs will be asked, by those with a variety of chronic conditions, for advice on the use of cannabis and related products. It is proposed that the RCGP works with a number of other organisations (including the MS Society) to produce a GP information booklet which offers balanced and reasonable advice on the appropriate use of cannabis, bearing in mind of course, that natural cannabis and the main psychoactive component, Tetrahydrocannabinol (THC), remain generally illegal.

The MS Society has recently reviewed its position on cannabis use as a medicinal treatment for people with MS (MS Society, 2017). The society believes that there is now enough evidence to assert that cannabis for medicinal use, if managed properly, could benefit around 10,000 people who suffer from pain and spasticity as a result of multiple sclerosis.

They want to see all licensed treatments derived from cannabis made available to people who need them. But until that happens they are calling on the UK government to legalise cannabis for medicinal use to treat pain and spasticity in MS, when other treatments have not worked. They believe that people should be able to access objective information about the potential benefits and side effects of using cannabis for medicinal purposes.

Furthermore, they believe it’s both unfair and against the public interest to prosecute people with MS for using cannabis to treat pain and spasticity, when other treatments have not worked for them (MS Society, 2017).

The Proposal

It is proposed that the RCGP works with a number of other organisations (e.g. MS Society, Newcastle University) to produce a GP information booklet which offers balanced and reasonable advice on the appropriate use of cannabis, bearing in mind of course, that natural cannabis and the main psychoactive component, THC, remain generally illegal.

The aim of the GP information booklet would be to offer balanced and reasonable advice on the appropriate use of cannabis.

The booklet would be short and concise (about 4 pages of A4). It will briefly cover the history of cannabis and outline the natural endocannabinoid system found in all humans. The different forms of cannabis and means of ingestion/inhalation would be outlined. It will also outline the current legal status as a Schedule 1 drug but also highlight the legally available varieties of cannabis (Sativex, Nabilone and CBD).

The medical evidence for different conditions will be given in a balanced way with a reasonable appraisal of existing evidence for those conditions with a good evidence base and for those conditions currently lacking in evidence.

It is important that the side effects will be carefully outlined. This would include the known short-term effects of the psychoactive component as well as a discussion of the potential and actual longer-term effects. This would clearly include the concern around triggering schizophrenia-like syndromes and the risks associated with cognitive problems, driving, dependency.

It will be important that the evidence is presented in a reasoned and reasonable, balanced way without any bias either for or against the legalisation argument.

NM, MB, PR
August 2017

  • Adrian Hibbert

    Regarding…

    “It is important that the side effects will be carefully outlined. This would include the known short-term effects of the psychoactive component as well as a discussion of the potential and actual longer-term effects. This would clearly include the concern around triggering schizophrenia-like syndromes and the risks associated with cognitive problems, driving, dependency.”

    The Patient Information Leaflet for Sativex is a good place to start as a source for this information: http://www.medicines.org.uk/EMC/medicine/23228/PIL/

    • davidraynes

      You make a very good point about the warnings on Sativex.

      There is an interesting exchange in the Comments on this Times article between an Austrailian academic and Peter Reynolds of CLEAR:

      https://www.thetimes.co.uk/article/legalisation-of-cannabis-and-its-impact-nfdkhrp5v?shareToken=ab5709a9333cb9c86f99f9d2190f2fef

      Peter is quite brave to take the academic on, hats off. Some of this is complcated science.

      What is becoming clearer week by week now is that the epigenitic and teratogenic effects of cannabis warrant much more caution than some campaigners acknowledge.

      I have never been in any doubt that cannabis or some constituents of it, will have clinical uses but the arguments about widespread normalisation of cannabis seem to get weaker and weaker. The academic warns against women of childbearing age using cannabis.

  • Robbie Riches

    This is a great starting point. My only problem is that Sativex in the UK is the last resort…. I have seen soooo many friends and loved ones succumb to the effects of chemical pharmaceutical drugs, surely an option with no side effects should be the first option?

  • Robbie Riches

    And for the record Adrian Hibbert, human beings have used medical cannabis for 5000 years so I am pretty sure the long term effects are known. I would also suggest people do their own research regarding schizophrenia and everything else Adrian mentioned. There is a huge amount of very recent research out there.