Cannabis-based medicines get green light as UK eases rules.
Relaxation of laws means doctors will be able to prescribe medicinal cannabis.
Doctors allowed to prescribe cannabis-based medicine in UK
Sajid Javid announces change after publicity over treatment of young people with epilepsy
GPs to prescribe medical cannabis in Jersey.
Patients in Jersey will be able to get medical cannabis from all doctors after politicians voted to change the law.
Deputy Montfort Tadier, who proposed the move, said GPs should be allowed to prescribe pre-approved products to patients.
In the UK only specialist doctors are allowed to issue similar treatments.
Consultant neurologist Prof Mike Barnes said the mainland should follow the changes, as cannabis expertise was "rare" among medical professionals.
A report written by Mr Barnes in 2016 on the use of medical cannabis was previously cited by Jersey's government when reviewing its drug laws.
He welcomed the decision, but said he was "concerned" by the current stance in the UK that only specialists were allowed to prescribe.
"It is cannabis expertise that is required and not disease specific expertise," he said.
"I cannot see a logic in restricting prescriptions to hospital consultants, which narrows the pool of expertise, particularly in Jersey."
MPs criticise NHS over failure to prescribe medical cannabis,
Family of first child prescribed medical cannabis forced to follow bureaucratic " Assault course. "
There is a “serious cultural block within the NHS around medical cannabis”, according to MPs.
The criticism comes after it emerged that the family of the first child to be prescribed medical cannabis after its legalisation must pay almost £10,000 a year to access the privately prescribed medicine as they follow a bureaucratic “assault course”.
The all-party parliamentary group for medical cannabis condemned the workings of the current licensing regime, saying it cannot have been what the government envisaged when they legalised medical cannabis in November.
“For Jorja [Emerson] and her family this is a great day and I commend the private consultant, supported by her private hospital, who has taken the courageous decision to prescribe a medical cannabis product which she genuinely feels is in the best interest of her patient,” said Mike Penning MP, co-chair of the group.
“But the fact remains that there is a serious cultural block within the NHS around medical cannabis. Other families, many with children just as seriously ill as Jorja, continue to face a complete block from their NHS medical teams.”
He said most families did not have the means to go private, and in any case “the number of even private clinicians willing to prescribe appears to be in low single figures”.
“I do not believe that this is what the prime minister and home secretary envisaged when they made the bold change in the law on 1 November to reschedule medical cannabis to enable consultants to prescribe it,” he added.
Calling for action from the highest levels of government to rectify a system that was “letting patients down”, co-chair Tonia Antoniazzi MP said: “The high-profile cases over the summer of Alfie Dingley and others clearly show that for some epileptic children medical cannabis containing low concentrations of THC [tetrahydrocannabinol] can be life-transforming.
“Denying parents the right for their children to try these newly available medicines is cruel. It appears that the medical profession is totally wedded to only prescribing a substance for which there is double-blind trial evidence. But there is a need for a common-sense perspective here.”
She added that many severely epileptic children were treated with conventional anti-epileptic drugs that had passed such trials, yet had severe side effects.
“To our knowledge, no one has ever died from taking THC, and in any case the concentrations that we are talking about in these medicines are very low,” she said.
Two-year-old Jorja has a rare form of treatment-resistant epilepsy that causes her to suffer from life-threatening seizures. She has been treated with a number of heavily sedative pharmaceutical drugs that consultants have said are causing long-lasting damaging effects.
She has been in intensive care twice in her life, once enduring a “status seizure” that lasted more than 17 hours, with doctors warning that she might die.
Her father, Robin Emerson, said: “This has been an assault course of bureaucracy and a rollercoaster ride of severe ups and downs. I have faced near-total opposition in my quest to get my daughter access to a medicine that is now legal in the UK and has been shown to work in similar cases. No family should have to endure what we have been through.
“Thanks to the generosity of friends and supporters I have managed to raise enough money to fund the first few months of the medicine. But at £833.75 per month I face a desperately difficult future.”
Medicinal cannabis : Why has it taken so long to get to patients ?
Medicinal cannabis was legalised last year but so far, virtually no-one in the UK has been able to access it.
Now, enough cannabis to treat 30 patients for a month has arrived in the UK from the Netherlands.
Four patients with prescriptions, all to treat chronic pain, will receive cannabis-derived medicines immediately.
Specialist doctors have been able to prescribe cannabis since 1 November - so what has taken so long?
The new law
The new law moved cannabis from schedule 1 under the Misuse of Drugs Regulations 2001 - meaning it had no therapeutic value - to schedule 2.
That category is for drugs which are controlled but have a recognised medical use and can be prescribed in certain circumstances.
Cannabis-based medicines can come in the form of whole cannabis flowers, oils or capsules, or a single compound which can be isolated and extracted.
The two main psychoactive ingredients in cannabis are cannabidiol (CBD) and tetrahydrocannabinol (THC) but a cannabis plant will contain hundreds of different compounds.
Prescribing
Medicinal cannabis is currently unlicensed so doctors can prescribe it only if a patient has a need that can't be met by licensed medicines.
Under the new rule, GPs are not allowed to prescribe cannabis-derived medicines. It has to be a specialist consultant, for example in neurology or paediatrics.
They don't usually write prescriptions for medication, let alone go through a process of having those prescriptions specially approved and applying for licences.
Even getting the right prescription pads has been a challenge according to Hari Guliani at Grow Biotech, a consultancy which has worked with both doctors and importers.
Prescribing cannabis is new to UK doctors and so it may take a while before they begin doing so, says Dr David McDowell, the pain specialist who prescribed cannabis for the four patients receiving their medicines this week.
He described the current process as "tortuous".
Doctors have to get their prescriptions for cannabis approved by the Medicines and Healthcare products Regulatory Agency (MHRA).
That prescription is then valid for 28 days and, at the moment, doctors can only prescribe a month's worth at a time.
One of Dr McDowell's patients, who is set to receive his first supply of medical cannabis, suffers from Crohn's - a painful inflammatory bowel disease. He said he had been prescribed opiates in the past, which, he said, had made his condition worse.
"It's a hard thing to do to yourself to put up with becoming addicted to opioids or putting up with the vomiting and nausea that come with immune-suppressing drugs," he said.
But, he says, the price for cannabis - £695 for one month's supply- "takes the edge off the good news", adding that he didn't believe it would be sustainable for him in the long term.
All the patients receiving cannabis this week are doing so privately.
NHS England said that cannabis-based products would be prescribed only where there was "clear published evidence of benefit" that couldn't be achieved by a licensed medicine.
It said that where necessary, NHS Trusts could meet the cost but, "the current position is that no cannabis-based products for medicinal use are routinely commissioned."
In October 2019, the National Institute for Health and Care Excellence (NICE) plans to publish guidelines concerning the medication, and the NHS will then use this to decide whether it will eventually fund the drug routinely for some patients.
Patients
At the beginning of December, Carly Barton is thought to have become the first person to be given a prescription for cannabis but wasn't able to actually receive the drug because none had been imported.
She told the BBC last year that she had been buying cannabis "on the black market" instead of taking very strong opiates including fentanyl which she had been prescribed for pain.
Last month, Charlotte Caldwell, whose son has a rare form of epilepsy and became the centre of a campaign to legalise the drug for medicinal purposes, told the Times she had been able to pick up a dose of cannabis.
It's understood that an individual supply was flown in from Canada - but this week is the first time a bigger stock of the drug has been imported.
Other conditions cannabis might be prescribed for include multiple sclerosis and cancer.
Whole flowers
At every stage of the process, getting cannabis-based medicines to patients is very tightly regulated, adding to the delay.
Doctors need to apply to the Home Office for an import licence to bring in the cannabis from overseas.
The first batch of legal cannabis has been shipped into the UK in the form of whole flowers, which contain more than one active pharmaceutical ingredient.
This also makes it more complicated to get approval than importing a single compound like, say, morphine.
While morphine is also a controlled substance, it has a well-established medical use, meaning processes are in place to import and regulate it.
This batch coming from the Netherlands has been grown at a specially regulated site for cannabis for medical purposes and the export has to be approved by the Dutch government.
The whole process can take up to 28 days, so by the time it's completed, the prescription may have expired.
These delays are why companies involved in the process of importing medical cannabis say its important to bring in a bulk amount.
The bureaucratic hurdles are all there for patients' safety, says Mr Guliani at Grow Biotech.
But bringing cannabis into the country in larger amounts can mitigate these delays, meaning when patients' supplies run out there's stock available and they don't have to have a gap in their treatment.