There has been huge fanfare over the medical cannabis announcement this week as it is a significant victory to see the UK Home Office admit defeat against their hardline stance that cannabis has no medical value. The celebration appeared to get louder when Home Secretary Sajid Javid made it known that cannabis flowers will be included in the prescriptions that can be made, by specialist consultants alone, if “none of the above” available options apply. While this may seem like the problem is solved, there remain some very real questions for patients, caregivers and policy campaigners alike.
Patients must first wait another 20 days before specialist consultants can prescribe a medicinal cannabis based product.
For those suffering with a chronic health condition, to be told to wait another 20 days simply for the red tape to be untangled with the t’s crossed and the i’s dotted, is a bit of a piss take. “Oh you have cancer, just tell your tumor to stop growing – or maybe wait another 20 days for your next round of chemo so you can use the cannabis oil to stop you throwing up for the next 24 hours”. This is the kind of thing that runs through the mind of a terminally ill patient.
When I told an 80 year-old woman yesterday that she can either get tested cannabis oil from us or wait another 20 days to see if her 85 year-old husband’s oncologist would write a prescription for him, she replied with a gasp, “but we can’t wait that long” and looked mortified. “I love this man dearly and I will do anything it takes to try and save him”. He has been given three months left for esophagus cancer and he’s now lost so much weight from the last round of chemo, she explained to me, that every time she hugs him all she can think about are the ribs and vertebrae that stick out so much between her fingers “which can’t be good”, she added.
But it’s not just another 20 days. That’s when the green light gets turned on. How comfortable the quoted “80,000 doctors can now prescribe medicinal cannabis in the UK” will actually feel about prescribing these until-now unlicensed products is anyone’s guess. But knowing that NICE are going to take 12 months to gather information to produce the guidelines for prescribers means many will be cautious and wait it out.
Specialist consultants are not going to be suddenly thinking, “great, I’ll just prescribe everyone cannabis”. Most of them will probably not be fully aware of the legal change and it will be the ‘duty’ of the patient to inform them of these changes and how and under what circumstances prescriptions can be given. You can read about them on the Government’s website here; if you think you are eligible don’t wait – get an appointment as soon as you can.
Can you look a cancer patient in the face and tell them to keep waiting when they have been given 3 months left to live? Honest answers on the back of a postcard and sent to 2 Marsham St, Westminster, London SW1P 4DF
— UK Cannabis Social Clubs (18+) (@UKCannabisClubs) 12 October 2018
Which brings us onto our next point… getting an actual appointment.
You are most likely going to have to already be under a specialist consultant that treats your serious medical condition. They must deem your case an “exceptional circumstance” after you have tried other available options to no avail. It can take several months to get an appointment with your specialist even if you are already under one. If you manage to find an appointment in 20 days time to be able to get a prescription written on the 1st of November if you meet the criteria, I would have to say, ‘wow, you must have a good local NHS service’.
If you are not under a specialist and believe you meet the criteria, you need to go and see a GP and ask for a referral to a specialist for your condition. The NHS constitution says you should get an appointment within 18 weeks, but for example, it took me three years to get my latest referral to a gastroenterologist in London.
Let’s now look at it like you’ve successfully managed to get a prescription for a cannabis based product.
The UK only has Sativex and Epidiolex available at the moment, which are licensed for specific conditions, MS and Epilepsy. The chances are you are going to have to look at having your cannabis based product imported to a pharmacy for you to cash in your prescription for your medicine. This will most likely be from Canada or the Netherlands at the early stages, but there are licenced producers in Australia and Denmark that have contacted us already and told us they intend to get their products into the UK now this announcement has been made.
No one yet knows the process of choosing what cannabis product you need with the specialist. A specialist is a specialist in your condition but has no training on cannabis, or the products that can now be potentially prescribed but NHS England are sending out information with some interim medical guidelines. Flowers have been given the thumbs up but this is only if non flower preparations have failed to bring about effective symptom relief.
How long will it take for the pharmacy to fill the prescription and have it sent over to the UK is another unanswered but necessary question. Logistically we imagine that individual medications will be ordered one at a time to start with and when it becomes clear on the quantities, frequencies and specific medications that are being prescribed, these will be imported and stored under regulations in larger quantities. Again, we have already spoken with logistic consultants on these issues who have been looking at these options for the best part of 18 months. They are already operating in several countries and are looking to expand their role in the international cannabis industry. It’s bigger than you could have imagined.
Other serious questions raised are valuable and probably just haven’t been considered by administrative and decision-making bodies so far as these issues are only ones you would really think about if you are aware of what it is like having to consume cannabis as a medicine already.
Where can patients with a valid medicinal cannabis prescription consume their vaporised cannabis flowers or oil? Is it OK to go to the cinema now I know I don’t have to sit there in pain for three hours? Can I crack out the Arizer Solo and my 22% THC Bedrocan (aka Super Silver Haze) and not worry about someone calling the police or complaining to the manager?
Are patients that are prescribed medicinal cannabis products going to be exempt from the new drug driving laws that instruct a zero tolerance stance on anyone caught with cannabis in their system?
Are police going to stop someone in the street who is vaporising their herbal cannabis and make them prove they are a patient and have the right to medicate just because healthy people are still under scrutiny of the Misuse of Drugs Act 1971?
At our cannabis social clubs, patients currently come to medicate on a daily basis. It is a safe place for them to come and socialise without fear of stigma or putting themselves at risk of medicating in public spaces. This week a liver transplant patient who had a day trip to the club told us “thank you for making me feel normal for the day”. It will be odd to have some patients in our club with legal medicine while their friends and fellow club members still sit there with essentially the same product albeit in a illegal status.
But until every patient has been prescribed a medicinal cannabis product where are they going to turn?
Carry on looking to the black market? Street dealers, the dark net? Taking the personal risk to import it from abroad if you can find another person to break the law for you in their country too? We welcome patients to become members of cannabis social clubs and form their own growing collectives with the help and advice from people that have been keeping themselves alive throughout medical and recreational prohibitions.
Some patients find they do not have the health to grow their own but they find relief when people who are able bodied and compassionate about their situation step in to help as a caregiver that will grow for them. So for those who are gaining back their health due to a home or collective grow, they want the right to grow to be given to them under these new medical laws; this is what is already working for them AND they believe it will help save the NHS thousands of pounds every year.
If a patient’s specialist doesn’t agree with their medicinal use, does this mean that a patient’s use isn’t medicinal? No, it just means that the system isn’t good enough yet. Will this patient be free from police harassment or prosecution? No. Then the policy isn’t good enough yet.
Remember, if you are prescribed a medicinal cannabis product legally, sharing it will be classed as breaking the law! “Puff, Puff, Pas…sorry mate!”
Greg de Hoedt – UKCSC Chairman