The number of patients in the UK exploring the option of medical cannabis on prescription continues to grow. Current estimates suggest that perhaps 6000 patients have been prescribed medical cannabis for a range of conditions in the UK, up from about 2000 at the turn of the year. Even without the disruption in healthcare due to COVID, there have been challenges for patients and the industry including a lack of trained prescribers; supply chain management issues, sometimes related to dealing with a stretched Home Office; product quality and availability; pricing, labelling and more are being addressed with varying degrees of success. Faced with these challenges, patients are self-organising in groups such as PLEA and there is a growing reddit community where patients are sharing health related discussions and first person accounts of their experiences.
Questions around the evidence base for medical cannabis are being addressed through registries such as Project T21 from Drug Science. The observational study has now enrolled 900 patients and is sharing data publicly on a regular basis. Initial results from the study have been promising, with patients reporting a 51% increase in self-reported health and ability to lead a more normal life, demonstrated by an average increase from 40.7 to 61.5 after 3 months. Indeed in some conditions such as chronic pain, there is a case to be made for much wider use of medical cannabis, especially in the context of the recent NICE guidance on chronic pain and the favourable benefit-safety profile of medical cannabis.
The latest T21 blog post shares the demographic, products prescribed and condition data.
It is exciting to see the latest developments at T21 as the program starts to onboard new clinics and prescribers. The product formulary has been refined over time since Professor Mike Barnes joined the program formally earlier this year, and the program is now collecting data in a way which can be shared with regulators and the NHS to broaden the acceptance of medical cannabis within our public healthcare system.
The rescheduling of medical cannabis in November 2018 led to the creation of a UK medical cannabis market. However a series of outdated or misinformed policies mean that legally prescribed patients are suffering from stigma and prejudice.
MedCannID is the UK’s largest legally prescribed medical cannabis patient validation system that offers simple and effective identification for medical cannabis patients by means of a unique tamper-proof holographic physical photo ID card and accompanying app. The app acts as a central hub for all patient needs and also can be used to access the patient prescription copies for reference. MedCannID seeks to redress the balance and represent the voice of the legal patient. With over 1500 members, MedCannID is now the largest community of legally prescribed medical cannabis patients in the UK. Alta Flora has supported the MedCannID team with resources and know-how since its inception.
The MedCannID program was designed to protect the rights of patients – particularly in their interactions with law enforcement – and promote the need for greater education to help the relevant enforcement bodies, authorities, employers etc. understand the changes made to the laws on cannabis and update their processes to acknowledge the fact that medical cannabis is a legal medicine.
The NHS defines medical cannabis as any form of medication that contains cannabis and is used to relieve symptoms. To date very few people in England and Wales are likely to get an NHS prescription for medical cannabis (we believe that there are 3 (three) NHS prescriptions written since November 2018).
In order to access legal cannabis medicine, patients are mostly referred by their GP to a private specialist. After assessment, the specialist can prescribe an unlicensed cannabis medicine where it is necessary to meet the specific needs of the patient. This medicine can take many forms including herbal cannabis, cannabis oils or a range of formulated cannabinoid products. A medical cannabis prescription would only be considered when other licensed medications or treatments were not suitable or have been tried and found to not be effective for that patient (cannabis is a medicine of last resort).
Herbal cannabis in particular is either an unlicensed medicine or an illegal drug depending on whether the activities involved in its production are licensed by the Home Office. This confusing situation leads to a series of challenges which patients face on a daily basis.
(i) Challenges with law enforcement
To their credit, the Police Federation and the National Police Chief’s Council have made public statements in support of valid medical cannabis patients identification card schemes. They have issued proposals for amended national medical cannabis guidance, and aim to provide officers with credible information on which to base their decision making around whether or not to use discretion and arrest a member of the public.
Despite these words, not much action has been seen to protect legally prescribed patients. Patients who are prescribed cannabis – particularly cannabis flower – are still living in fear of being stopped and searched, having their medicines seized by the police and being unjustifiably harassed or arrested. It is a vicious circle as most people who are being prescribed medical cannabis are being prescribed it as a treatment of last resort to provide relief from often significant health issues. The shock of receiving an official warning or a potential fine or even being arrested causes undue stress and exacerbates health issues (not to mention the stress caused on the patient’s families).
Whilst individual police forces recognise the futility of placing their police officers in a position where they must say “should I stop this person in the street and find them to be carrying a small amount of medical cannabis on prescription, I would have to arrest them”, for the most part law enforcement agencies are woefully underprepared for the use of cannabis flower as a medicine under prescription, with some police officers even stating that they would seize legal medicine irrespective of whether a patient produces a valid prescription or not, thus potentially putting themselves at unnecessary risk of allegations of police misconduct or even “abuse of due process”.
A solution is needed for the patients who are behaving lawfully yet who are living in fear of intimidation, and for the police who have other far more important things to do than deal with patients entirely lawfully using the medicine their doctor has prescribed.
(ii) Challenges in other social contexts: places of employment; tenancy; lack of effective communication between the triage of patient, private and public healthcare.
Over the course of the last few weeks there have been 3 cases of MedCannID member / patients who have requested advice and support on legal matters. Legally prescribed medical cannabis patients cases are pending for:
1) being dismissed from work on the grounds of possession of legal medical cannabis on a university campus
2) being sent home from work after failing a humiliating drugs test. This happened after the patient voluntarily revealed to their line manager that they have a legal prescription
3) a patient being refused permission to fly and go through a domestic airport after voluntarily informing airport security prior to the flight that they would be carrying medical cannabis
Additionally, the team at MedCannID have had enquiries related to:
- Car insurance policies; are policies invalidated if the patient is consuming medical cannabis
- DVLA policies; driving with medical cannabis – can a patient drive if prescribed medical cannabis? Does the DVLA make the distinction between prescription and street cannabis since the only test is to determine traces of THC
- Life insurance policies; will prescription medical cannabis invalidate life insurance
- Will accommodation contracts be invalidated if landlords get notified of cannabis prescriptions
Where next for MedCannID
MedCannID is supported by clinics, pharmacies, industry groups and patient charities. The program is being integrated in online pharmacies which fulfil prescriptions for medical cannabis, such that patients can auto-enroll in the program seamlessly when they pay for their medicines online.
There are a number of interesting developments which have emerged as patients have built a community led engagement program for the members:
- The prescription data which the patients submit to MedCannID is aggregated into valuable insights into how the UK market is developing. This data is of significant interest to regulators and clinicians
- Cannabis medicines are unlicensed, and as such it is very difficult for patients and clinicians to learn about the products, formulations, dosages and more that are being prescribed. MedCannID is building the capability to share a “crowdsourced formulary” with patients through the app, with the aim of empowering patients to make informed decisions about their treatment
- Ratings, reviews and further knowledge sharing can help patients and their clinicians gain invaluable insights to navigate a complex process in their efforts to improve their own Quality of Life
In order for MedCannID to be successful in protecting patient welfare, the system must be universally recognised by the UK government – starting with the Home Office – through the healthcare system, law enforcement, criminal justice system and by organisations such as the DVLA and Citizens Advice Bureau. The team at MedCannID is working with Alta Flora to build relationships with other individuals and organisations who will be critical to ensuring that patient welfare is protected, and we are happy to share that Edward Henry QC will be helping to design the legal support service for patients. Edward is a passionate advocate for progressive laws on drugs and we are proud to have his support.
MedCannID has been presented to patient groups across Europe, with a particular focus on Germany, Poland, Portugal and Greece. There is also the potential for MedCannID to be accepted at border controls, such that patients carrying MedCannID are able to travel freely with their legal medicine in countries that recognise MedCannID, with the ultimate goal of endorsement at European Union level in Brussels.
What does the MedCannID data say?
As part of the process of ensuring that the MedCannID card is valid, patients have to upload their prescriptions into the accompanying app. The anonymised and aggregated dataset is a unique resource which gives some insights for the benefits of the community.
The MedCannID community now stands at over 1000 members with a slightly higher proportion of males over females relative to the T21 patient base. Like T21, the average age is 38, with an increasingly large population in the older demographic.
In terms of conditions prescribed, nearly half the prescriptions in the MedCannID community are also dominated by chronic pain and psychological conditions.
On average each prescription contains 1.56 products per prescription. This consumption of multiple cannabis products per patient, per prescription is a trend I believe we will see more of as the range of available medical cannabis products in the UK expands.
The full list of products currently prescribed by doctors in the UK in no particular order of preference from the MedCannID data reads:
Spectrum Red #4
Spectrum Red #2
Spectrum Red #1
BOL MVA Indica
BOL MVA Sativa
BOL CMC Hybrid
BOL MOD Sativa
Noidecs MVA indica
Noidecs MVA Sativa
Noidecs MOD indica
Noidecs MOD Sativa
Noideca CMC hybrid
Noidecs CMC hybrid
Noidecs Sublingual Oil
One of the maxims at Alta Flora is that we want patients to be the CEO of their own healthcare. Effective self-care requires data. With both MedCannID and Eva, we are pushing data into the hands of the patient while providing the content, education and support services to improve Quality of Life.
Note: Views and opinions expressed in this blog are those of the authors and do not necessarily reflect the official policy or position of any other agency, organisation or company. Assumptions made in the analysis of the data provided are not reflective of the position of any other entity or person, other than the authors. We are making this information available to add to the knowledge bank and advance understanding of the medical cannabis frameworks, its use cases, patient challenges and in support of efforts to provide safe, effective and compassionate care for all our citizens.
The anonymised data and figures presented in this blog are derived from a relatively small cohort of citizens and may vary highly in the future. It is not designed to be further aggregated or reported as ‘study’ results. This blog does not constitute nor should it be construed as legal or medical or commercial advice. Always consult your GP and/or specialist doctor prior to trying any treatment, medication, substance or supplement.
We are proud to be the exclusive, trusted data partner of MedCannID and one of the founding partners of Project Twenty21.