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Licensing process for medicinal cannabis will be neither swift nor equitable

Ian Hamilton
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The high profile case of Billy Caldwell, who has a severe form of epilepsy, brought the therapeutic benefit of cannabis into the headlines.

The public reaction to his cannabis oil being confiscated forced the Home Office into doing something.

Home secretary Sajid Javid responded by saying that he would set up an expert panel to review individual requests for access to cannabis for health reasons. He also asked chief medical officer Dame Sally Davies to review the evidence in relation to the therapeutic potential of cannabis. He has kept to his word and said that the licensing process will be ‘swift and fair’.

But reading the detailed advice accompanying this announcement reveals it will be neither quick nor equitable. First, there is a complex eleven-page application form which will prove to be off-putting for many patients or carers in the midst of health problems.

Second, a senior doctor has to approve the application and confirm that all treatment options have been exhausted and that they will accept full responsibility for risks and liability. Most doctors will not be familiar with the medical benefits of cannabis.

The evidence for many health conditions is at best limited or not available. So it would take a courageous doctor to underwrite this responsibility and liability.

This is a big ask, as there is a very limited research evidence that doctors or nurses can draw from in relation to the therapeutic use of cannabis, with many studies having been conducted on animals rather than humans.

Although the absence of evidence does not mean cannabis has no therapeutic potential, the reduction in Billy Caldwell’s seizures is a case in point. But this doesn’t mean all children will respond in the same way, we don’t know if cannabis products have the potential to cause harm for some types of epilepsy.

Without large-scale funding to do the trials that would provide evidence, we are left with personal stories and small-scale studies. This will not give nurses the information or confidence they need to make evidence-informed recommendations about treatment that involves cannabis products.

Added to all this is a fee for such a licence that currently stands at over £3,000 pounds, although this will be reviewed and the Home Office has made clear it is the clinical team that should pay not the patient or their family.

We don’t know who sits on the newly appointed expert panel that will review applications made for a licence. We only know that the chair is Dr Michael McBride.

This appointment has been controversial with advocacy groups such as Families for Access disputing Dr McBride’s impartiality, amid claims that he had initially blocked access to medicinal cannabis for Billy Caldwell.

This is not a good start and will reduce confidence for those who hope that an independent and fair minded panel will be considering their application. There is a good case for such groups to have a representative on this expert panel, as it is they who often have the expertise.

Equally some nurses are well placed to provide expertise on the panel and in practice care is a multi-disciplinary effort, adding to the need to look beyond the medical profession for expert input into this panel.

There is case to be made for handing over responsibility for medicinal cannabis to the Department of Health and Social Care. The department knows how to apply evidence of benefit to specific health problems. Whereas the whole culture and purpose of the Home Office is to restrict access to drugs.

The Home Office could also help by moving cannabis from a category that includes ecstasy to one that would allow doctors to use their professional judgement to treat their patients in the most appropriate way including using cannabis-based products.

This whole licensing process looks challenging and falls far short of what many people who believe cannabis is the answer to their health problems were hoping for. 

Ian Hamilton, lecturer in mental health, University of York

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