Cannabis on the NHS in 2021?

The news that the NHS is planning a clinical study of cannabis oil in 2021, is long overdue and extremely welcome. The Twenty21 trial aims to enroll 20,000 UK patients for a prospective study to assess the effectiveness of medical cannabis for conditions such as anxiety and multiple sclerosis (1).  I firmly believe that research will prove the benefits of cannabis, and we hope the UK will quickly move to a dispensary-style system that allows easy access to medical cannabis for those who need it. 

Though the conversation around safety, addictiveness, quality, and access continues, there is no doubt in my mind that non-psychoactive cannabinoids, including CBD and cannabigerol, are effective in treating many physical, emotional, and mental health challenges – without the side effects of traditional pharmaceuticals.

Many patients who have tried the traditional route to treat conditions such as chronic pain find that not only is treatment unsuccessful, but they now require even more pharmaceuticals to treat drug side effects. Medical cannabis, in contrast, is extremely safe, working directly with the endocannabinoid system to bring the body back to homeostasis. 

Many clinicians argue that the UK is sleepwalking into an opiate crisis similar to the one that has been raging in the USA for over 20 years. Regardless of where you stand on the opiate debate, the fact remains that addiction is a problem for both prescription and over-the-counter opiates – and that the pain-relieving properties of medical cannabis could offer a less harmful solution.

People often think of cannabis as a single drug but, ideally, cannabis treatment should be tailored to the patient, putting it firmly into the realm of 21^st century personalized medicine. These days, next-generation vaporizers can tell the patient the amounts of various cannabinoids they have consumed, then gather data on how effective the treatment has been and which mix of compounds works best for that patient. A whole range of innovative delivery systems then becomes available, from app-driven transdermal patches to chewing gum.

There are several projects in development for trialing a range of cannabis-based products for medicinal use in the UK, both inside and outside the NHS . Gathering enough data to convince the medical establishment is especially critical if we hope to solve one of the major sticking points for UK patients – the difficulty of accessing medical cannabis.

The UK has only recently adopted the use of medical cannabis. The current legislative framework is chaotic, with guidelines from different government agencies often at odds. Patients need to have exhausted all pharmaceutical options before becoming eligible for medical cannabis. Even then, UK doctors resist prescribing it and approving bodies are reluctant to fund it. This means that many people who desperately need cannabis-based medicines are forced to raise funds themselves or run the risk of a criminal record by buying it illegally.

In the UK, 40 percent of medical cannabis is currently extracted from the flower; in my view, this should be recognized and regulated as a herbal medicine, which would allow for some variation in active ingredient profiles compared with traditional pharmaceuticals. A full plant extract would level out some inconsistencies, retaining more of the active profile and preserving the entourage effect, in which the sum of the parts adds up to a more effective medicine than isolated molecules. 

That said, being able to isolate and extract the active ingredients is also useful. Currently, only THC and CBD are listed as active ingredients in the UK. Other beneficial compounds are considered contaminants, but I expect this to change as the benefits of minor cannabinoids become more widely researched. For example, cannabinol and cannabigerol show real promise as treatments for conditions like insomnia.

To deal with the complexities of the cannabis industry, we need a central office that regulates quality in the medical market, much like those in Germany and the Netherlands. Now that the UK has left the EU, and especially with the impact of COVID-19, the country will need to move quickly to achieve this. As an added incentive, a full-plant cannabis economy has been demonstrated to provide jobs, opportunities, and much-needed tax revenue.

The UK is a conservative country and it will likely take time to cut red tape and provide a unified regulatory framework. However, as treatments are confirmed through trials and patient numbers increase, the pace of change will accelerate.

Cannabis could be just as big a game-changer as other naturally occurring medicines that we now take for granted, such as aspirin (from willow bark), penicillin (bread mold), and opiates (poppy seeds). We live in a society that requires science to dictate our future. Hopefully, the Twenty21 trial and many others to follow will destigmatize cannabis and provide more information on its medical potential.