Professor Iain McGregor, the Academic Director of the Lambert Initiative, gave the inaugural lecture for The Centre for Medical Cannabis yesterday.
Originally from Scotland, the Australia-based professor said the UK cannabis landscape has “echoes of where Australia was two or three years ago.”
Epilepsy opens politicians eyes
Indeed there are similarities in how Australian regulations were changed; intractable infant epilepsy was the condition that cannabis could ameliorate so patently that politicians had to listen. In the UK we had Billie Caldwell, Australia had Katelyn Lambert who suffered from Dravet syndrome.
While the law changed for UK medicinal cannabis on November 1st the number one issue remains patient access. The government has failed to meet its own deadline to release patient numbers at the end of March (something we indicated was likely at the time due to the proximity to Brexit). Anecdotally the numbers of patients with access can be counted on two hands. Looking at prescriptions written for medicinal cannabis in Canada, Germany and Israel we get a number of prescriptions per 1,000 people ranging from 2 to 9. For the UK population, this would translate to 150,000 to 600,000 prescriptions in the first year.
Australian Patient Accesss
Patient access to cannabis does not have to be a progressive issue. Professor MacGregor quoted a source from the centre-right Liberal party as telling him “Patients want it, the doctors want to prescribe it; so we should get the hell out the way.” If medicinal cannabis can maintain cross-party support, where is the bottleneck?
The Australian model has three routes to access for patients via the Therapeutic Goods Administration (TGA) :
- Special Access Scheme
- Authorised Prescriber Scheme
- Clinical trials
The Special access is restrictive but aims to return a response within 2 days, the authorised prescriber
scheme has spawned a string of cannabis clinics, although critics point to the high costs of consultations ($300). This system has brought the number of approvals to around 5,000 although as many will be repeat approvals a closer estimate of the patient population, being served by the legal market, is probably half that figure. Considering the dire straights UK patients find themselves with the strict prescribing guidelines only expected to be updated in October “NICE [The National Institute for Health and Care Excellence] could copy and paste the TGA regulations ”
Moving beyond the Australian Model
Having the Australian system in place would not be the end goal, after all, there is a fierce campaign to improve patient access currently being debated there. After the lecture Ian related a typical ‘pyrrhic victory’ of the expensive Australian system, a young Iraq veteran from Queensland with PTSD won approval for cannabis treatment but with no insurers paying out nor the tens of thousands for treatment was unable to make use of it. Yet at this stage in the UK whereby patients with severe unmet clinical need are to be left in the lurch until October, with no guarantee what such guidelines will contain, we must advocate for increased patient access and total decriminalisation for medical users who are resorting to the black market (which based on survey data is 98% of medical cannabis users in Australia).
Of course, this is still very early in medicinal cannabis’ history and so Professor MacGregor is optimistic about the future, we have only tested 6 of 144 phytocannabinoids in clinical conditions, phenotypic screening may allow us to more quickly work out which of these have medicinal value and advances in biosynthesis may allow us to move beyond the plant in benefiting from cannabinoids.