November is the first anniversary of the rescheduling of cannabis to a medically prescribable Schedule II substance, and we must take stock. Britain was neither the first nor the most recent country to make a renewed assessment, but it’s becoming increasingly evident that we’re being among the least proactive in establishing a practical set of structures and processes to advance our changes.
We have to do better. The UK has the potential to be global leaders in medical cannabis, but currently, we are falling behind.
To date, the NHS has not issued a prescription for medical cannabis. NICE, the national regulators for healthcare and medicines, returned a deeply conservative set of recommendations that are more restrictive than any other national regulator.
This has placed the UK into a slow-motion holding pattern. As NICE waits for further RCT-grade research to improve its assessments, the NHS waits for NICE. But patients in desperate need for fair access to cannabis medicines simply cannot wait for the NHS.
As LYPHE GROUP continues to work to remove barriers and enable evolution of medical cannabis markets, it has been valuable to study how other countries have adapted and grown to better navigate the new environment.
Elsewhere, we do see that there are viable systems emerging. Canada, the USA, Australia, Israel, Denmark, Germany, Italy and numerous other countries present with interesting models to learn from.
Germany is one of our closest neighbours. Medical cannabis was legalised earlier there than in the UK, and has advanced at a faster pace than we have since legalising ourselves. While the NHS still awaits unlikely approval from regulators here to open up and support access to prescriptions, Germany is already subsidising the vast majority of patient costs.
And in regards to regulatory decisions, while NICE have made only the most hesitant recommendations for the treatment of CINV and treatment-resistance epilepsy, German clinicians have been licensed to operate with broad discretion.
From an earlier stage, the political movement in Germany to legalise medical cannabis was well-supported and decisive. A coalition formed of the neoliberal FDP, the Green Party and the Left Party was able to provide the impetus for substantial and well-structured changed.
Germany legalized the prescription of cannabis on March 10, 2017 to seriously ill patients even if other treatment options are available. An amendment to the Narcotics Drugs Act (Betäubungsmittelgesetz) enacted the change, which also included covering the cost of treatment through patients’ health insurance.
The Federal Institute for Drugs and Medical Devices created a cannabis agency pursuant to the United Nations Single Convention on Narcotic Drugs of 1961, which states that “a member state must establish or appoint such a public agency as soon as cannabis is intended to be cultivated in the state in question for non-industrial uses”. Werner Knöss, Ph.D., was appointed head of Germany’s Cannabis Agency within the Federal Institute for Drugs and Medical Devices.
There are a set of clear requirements that the key policymakers and stakeholders need to consider in the UK:
The change in law in the UK occurred with very little announcement, with next to no supporting planning and without the assessment of medical regulators to join up the law with clinical practice. But even as we do creep forwards, it is clear that the relevant stakeholders are a bit lost at sea, and need help in navigating the situation.
Meanwhile, patients and their families are still struggling to wholly unreasonable degrees in trying to access the medical cannabis treatments they know are effective.
If there’s going to be effective and timely change, policy makers and the medical field are strongly advised to align their aims and activities with those of successful medical cannabis markets like Germany. The UK must be committed to achieving a system that works in the best interest of patients, and LYPHE GROUP is dedicated to this aim.
While we’ve had success in carving out pathways for patients to access the medicines they need through private care, we know this isn’t the long term solution. As much as we can do to secure imports, arrange distribution and train doctors the real answers rest in our public institutions, who need to stop passing the buck.
A proper strategy is critical, and an assertive effort to educate the public and create a broader understanding of and demand for medicalisation would both reinforce the degree of existing political will to enable medical access, and encourage the medical field to expedite their considerations in a positive direction.
There was progress in the UK, but today it feels unfulfilled. In studying our neighbours we can see there is much to do, and likely, if results are anything to go by, a better way to do it.