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AUTHOR: Mark Taylor
PUBLISHER:  CANNABIS LAW REPORT

Cannabis treatments are too expensive and do not come with enough test evidence to be effective, UK authorities have said.

The National Institute for Health and Care Excellence (NICE) reviewed evidence for the benefits and costs of cannabis-based medicinal products and drew up guidance for health professionals and the public.

The watchdog refused to allow its national health service to prescribe medical cannabis for children with severe epilepsy because there is “not enough evidence it works”, a decision which angered campaigners and parents who said their children will suffer as a result.

It also said current treatments for adults suffering severe symptoms were “not cost effective”.

A concurrent review by NHS England, which overseas budget, planning, and day-to-day operations of the commissioning side of the English health service has said more research and trials are needed, however. It also said the children’s experiences on medicinal cannabis in the should be taken into account as evidence of how well the drug works.

In November 2018, the legal status of cannabis was changed to allow specialist clinicians to legally prescribe cannabis-derived medicinal products to patients with an exceptional clinical need, following a high-profile media campaign.

However, health professionals have been reluctant to prescribe cannabis-based medicines in the UK because of the lack of clinical trial evidence of its benefits and safety.
NICE said more “gold standard” randomised controlled trials, were necessary, in which a group of people on medicinal cannabis would be compared with a similar group of people on other medication. This would answer questions about safety and efficacy, they said.

The watchdog said a network of children’s doctors should be created to collect evidence and advice on difficult cases. Doctors are unwilling to prescribe medicinal cannabis, it said, as they are worried about the possible long-term effects on the brain, particularly from longer term exposure to THC, the psychoactive constituent in cannabis.

THC (delta-9-Tetrahydracannabinol) and CBD (cannabidiol) are the two elements that have been most investigated for their medicinal value.

The guidance said for people with MS, Sativex can be an effective treatment when the individual which has not responded to other therapies, however it does not recommend it due to the costs involved.

The calculations used to reach this decision indicated that Sativex would be cost effective if the list price was reduced from £375 to £188 per pack. The draft NICE guideline also does not recommend the use of cannabis-based medicinal products for people with chronic pain, including people with MS experiencing nerve pain.

Pro-cannabis charities for individuals suffering debilitating illnesses have also reacted angrily.

“The MS Trust is hugely disappointed that, once again, Sativex has been turned down because it is too expensive for the NHS,” said Paru Naik, Health Professional Programme Director, MS Trust. “The MS Trust is reviewing the draft guideline from NICE and we will respond to the consultation process.”

The Trust is encouraging responses to the guideline which can be sent via the NICE website by 5pm on 5 September 2019. The final guideline is expected to be published in November 2019.

NHS England said more clinical trials on medicinal cannabis need to be carried out and a “UK-wide paediatric specialist clinical network” should be created to help “very cautious” doctors, by providing expert advice on complex cases.

These comments were welcomed by the Medical Cannabis Clinicians Society (MCCC), whose executive director Hannah Deacon spoke to ITV News in the UK about the issue.

Her eight-year-old son Alfie Dingley suffers from severe epilepsy, and was the first of a small number of patients in the UK to receive an NHS prescription for medical cannabis.

Ms Deacon said NICE had shown “no empathy to the families that I work with that are funding private prescriptions because the NHS doctors will not prescribe”.

“There is no thought of what is going to happen to those poor children if those families run out of money,” she said.

Doctors don’t have any education, training, and they don’t understand, she said.

“The government has failed them, the government are failing the families I work with, whose children will become seriously ill if they’re not helped urgently and I just think it’s a complete mess,” she said.

The NHS report, titled Barriers to accessing cannabis-based products for medicinal use on NHS prescription, was commissioned by Health Secretary Matt Hancock after “heart wrenching” meetings with the parents of ill children.

Another cannabis-based drug, nabilone, was recommended in the draft guidance as an add-on treatment for adults with chemotherapy-induced nausea and vomiting, but only if other conventional licensed medicines do not work.

Prof Mike Barnes, the chair of the Medical Cannabis Clinicians Society, said NICE was incorrect in wanting to assess medical cannabis on the basis of the same sort of trials used to approve conventional medicines.
Barnes, medical director of a chain of private clinics using medicinal cannabis currently advertising to recruit more doctors, said NICE failed to take into account alternative, valid sources of evidence and that the NICE committee was made up of people with negative views about cannabis.

“Those with positive views were excluded from the process,” he said.