• The Advisory Council on the Misuse of Drugs [ACMD] will provide a working framework for medical cannabis in the UK by 2020
  • Roger Knaggs, the ACMD’s newest appointee, believes there is not enough evidence to confirm the efficacy of cannabis as a medicine
  • Knagss claims that British medical professionals need more evidence before they can start to prescribe medical cannabis more openly

The ACMD, a body responsible for advising the government on the control of drugs, has been tasked with providing a workable framework for making medical cannabis available in the UK by the end of 2019.

Cannabis was reclassified as a Schedule II drug in November 2018, meaning it can now be legally prescribed as a medicine in the UK. However, the reality for British patients hoping to get legal prescriptions has been one of disappointment, as only an unspecified handful of patients have been prescribed medical cannabis on the NHS.

Speaking to The Pharmaceutical Journal, the ACMD’s newest appointment, Roger Knaggs, a pharmacist specialising in pain management, discussed why he felt there has been so much chaos for patients trying to get legal medical cannabis prescriptions.

Knaggs expressed his personal reservations about the efficacy of cannabis as a medicine, claiming that “the evidence for benefit is very small but the evidence for … more serious harms, is significantly higher.”

Knaggs did not offer any references to specific studies which support his argument that research shows cannabis to be more harmful than helpful, adding [also without evidence in support] that:

“If you look at the number needed to treat, you need to treat between 20 to 25 people for 1 person to have good pain relief, but you only need to treat 6 patients for 1 to experience harm.”

Knaggs argued that there is a need for “better data” and a more thorough understanding of cannabinoid pharmacology before British medical professionals begin to more openly prescribe medical cannabis products for patients.

The pain specialist also argued that while there is a growing number of studies conducted on the medicinal properties of cannabis in other countries, there needs to be a more uniform approach to research:

“Nowhere, so far, has really evaluated what the impact of these changes to classification and availability have had.

“We just don’t know what the right dose is, and, also, what the right combination of these compounds is for an individual person — what would you write the prescription for?”

“Prescribers who wish to prescribe [medical cannabis] just don’t know which the right product is for that person and until there are products that are more familiar, the situation may well still remain.”
 – Roger Knaggs, member of ACMD

Unsurprised by the lack of prescriptions for medical cannabis in the UK, Knaggs believes this will remain the case until those who would be prescribing cannabis as a medicine have a greater understanding of what exactly they are prescribing to their patients:

“Prescribers who wish to prescribe [medical cannabis] just don’t know which the right product is for that person and until there are products that are more familiar, the situation may well still remain.

“Aside from all of the issues around cost — because these are not cheap products — if you look at some of the products that are available in other countries, even though they claim they are manufactured to [good manufacturing practice] standards, they should be more reproducible in terms of their composition.

“The way in which they are packaged and supplied at the moment is unhelpful for prescribers.”

Knaggs, who will help formulate the future of medical cannabis policy in the UK, has denied that there is enough evidence to support the use of cannabis as a medicine.

He claims that studies show it does more harm than help in marked contrast to the consensus developing among researchers which seems to be pointing in another opposing direction.

Two examples of this will suffice: in one of the most recent studies, conducted by researchers in Florida, it was found that children diagnosed with epilepsy saw a nearly half (49%) drop in seizure rate after being treated with CBD; moreover, only 7% of the children had to stop the treatment. A far cry indeed from Knaggs claimed “6 to 1” ratio.

In another recently published piece of research, also conducted in the US, 1,120 cancer patients in Minnesota being provided with chemotherapy plus CBD were followed over a four-month period and it was found that 50% of patients reported at least a 30% decrease in vomiting after four months.

This highlighted the effect of CBD as being an effective palliative care treatment to help cancer patients deal with the very unpleasant side-effects resulting from chemotherapy. Again, only 10% reported adverse side-effects, thus providing factual evidence which directly challenges Knagg’s assertions that cannabis presents a greater harm than benefit.

We will know how the ACMD will view the functioning of the framework for medical cannabis in the UK by the end of the year.

Optimistically it will make it easier for patients to access the potentially life-saving medicine on the NHS, as private prescriptions have been criticised for their expensive cost effectively pricing out the majority of patients.

Purchasing negotiators will have to be tough with the suppliers if the patient is to benefit.

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