Investigation of the Legalized Medical Use of Marijuana to Treat Multiple Sclerosis

In November 2018, United Kingdom legalized the medical use of marijuana. This move imply that the drug can be prescribed if there is no other licensed medicine to help the patient. According to the survey published by Health Europa, the British population tremendously supports the policy of marijuana legalization for medical use. The survey indicates that about 72% of the UK public support the medical use of marijuana where the drug is sourced from the commercial establishments or prescribed by a medical doctor (Health Europe, 2019).  As it stands, GPs cannot prescribe marijuana to patients; only a specialized doctor is allowed to do so. Besides, the NHS only advocated for medical use of marijuana in three scenarios: in the event of rare acute epilepsy, to treat chemotherapy effects including nausea, and to manage multiple sclerosis (Health Europe, 2019). Cannabis/marijuana, described as cannabis resin, cannabis, cannabinol derivatives, and cannabinol, is still under class B according to the “Misuse of Drugs Act 1971.” Nevertheless, the new legalization law allows patients to access marijuana’s medical prescription under the “Misuse of Drugs Regulations 2001.” However, the cultivation of the plant remains prohibited without obtaining a license/authorization from the Home Office.

The Legalisation Policy for Medical Marijuana Use in the UK and the Public Perception 

The medical use of marijuana was legalized and made accessible under a “Medicines and Healthcare products Regulatory Agency Specials License” in November 2018 because of pressure from the public and campaigners. However, since then, the NHS has only provided treatment to a small fraction of patients with limited conditions (Halperin 2019). The scenario imply that medical marijuana remains inaccessible to most patients in need. Only a handful of patients in the UK can receive a prescription of cannabis even with the change of the law. The process of obtaining prescription is describe by many as not easy. Physicians are perhaps reluctant to prescribe medical marijuana as there are controversies and political dynamics surrounding the prescription.

A survey by the Hanway Associates 2018, suggested that about 59% of the UK public supports the marijuana legalization laws. However, the political dynamics that have made the legalization inevitable in the United States are not present in the UK (Mikulic, 2020), implying that it will take longer for the legalization policies to be fully implemented. It is also evident that both the UK and the United States had experienced racial inconsistencies in drug enforcement. But the widely despised and aggressive police tactics linked to America’s “war on drugs” has neither taken hold in the UK nor contributed to massive incarceration alongside other life-ruining repercussions for the offenders. Again, the UK has never experienced an opioid crisis or the consequent disillusionment with the mainstream medical field and pharmaceuticals, or embedded population of veteran distress from PTSD alongside massive cases of concussive brain injuries and other complications, leading to search for alternative medication (Halperin 2019).

While the UK public supports medical marijuana, and Cannabidiol (CBD) is advertised on mainstream media and high streets, there seems to be no constituency interested in implementing a for-profit, large scale marijuana industry. There is also no industry-funded medical cannabis lobby to insist on the urgency of the issue. In other words, the public support for medicinal and recreation legalisation in the United Kingdom is “broad but not deep” and attracts little political attention as the matter does not determine how people vote. The legalisation of marijuana usually polls lower when approached from the tax perspective. The skepticism towards the business comes from both the protectionist right and the left (Birdsall, Birdsall, and Tims, 2016). The specter of drug traffickers does not loom massively in the British imagination.

Laws on Marijuana and Recent Policy Development in Legalisation

Cannabis/marijuana has long been classified under class B according to the “Misuse of Drugs Act 1971.” Under the “Misuse of Drugs Act 1971, s.5 (1) and (2)” it is against the law to be in passes controlled drugs. Cannabis is considered a controlled drug through its inclusion in Schedule 2, Part II of the same Act. Nevertheless, the new legalisation law allows patients to access marijuana’s medical prescription of marijuana under the “Misuse of Drugs Regulations 2001.” The “Misuse of Drugs Regulations” permit the legal use of certain controlled drugs, cannabis being among the categories. The Schedules provide the difference between controlled drugs with therapeutic importance and those that do not have. Medical practitioners cannot prescribe controlled drugs without therapeutic value, except when a specific Home Office licence is issued. The drugs considered to have no therapeutic significance are listed in Schedule 1. Since the legalisation stands during the writing of the regulations, marijuana-based products remain listed in Schedule 1. Schedule 2 outlines the drugs with recognised therapeutic value but are addictive (The Centre for Social Justice, 2018, p 8). However, the plant’s cultivation, possession, and distribution remain prohibited without obtaining a licence/authorisation from the Home Office.

Recent Developments in the Medicinal Marijuana Legalisation Laws

In June 2018, the enduring issue concerning the medical use of marijuana came to the forefront of the parliamentary and national debate. The debate was fronted by the case of Billy Caldwell, a young boy who suffered epilepsy and was hospitalised shortly upon returning to the UK. The boy’s cannabis-based oil obtained from Canada for medical use was confiscated by the UK authorities, an act that his mother purported to be the sole cause of the hospitalization of the boy. The concern for the boy’s health alongside the strong support from the public for the young child’s plight stimulated an urgent relooking of his case by the UK Home Secretary, leading to the issuance of a licence and provision of the medicine. The boy was considered fit and was discharged from the hospital. On 19th June 2018, the Home Secretary announced that the UK government would be reviewing its position on the medical use of cannabis (The Centre for Social Justice, 2018). It perhaps no doubt that the boy’s case agitated as revolution in the UK drug used policies.

For instance, the review was to consider the components of cannabis to be rescheduled from the Schedule 1 list of controlled drugs. In Part 1 of the review, the Chief Medical Officer was to consider the therapeutic value of marijuana, while Part 2 required the “Advisory Council on the Misuse of Drugs (the ACMD)” to assess the cannabis components to be rescheduled. The Chief Medical Officer recommended that the entire class of marijuana with medicinal value be rescheduled from the schedule 1 list. Similarly, the ACMD, in their letter to the Home Secretary dated 19^th July 2018, recommended a rescheduling of the marijuana-based medicinal products. In November 2018, the medical use of marijuana was legalised and made accessible under a “Medicines and Healthcare products Regulatory Agency Specials Licence” (The Centre for Social Justice, 2018).

There is currently a bill in the House of Lords that will decide how the UK regulates its medicine, including medicinal marijuana, after January 2021. The Bill is called the “Medicines and Medical Devices Bill.” It will decide how the post-Brexit UK maintains patient access to best medicine, guaranteeing high manufacturing standards, ensuring that the regulations do not suppress global investment into the UK life sciences industry. As it stands, there is still controversy on the prescription of marijuana despite changing the legislation. The medical marijuana in the treatment of illness such as multiple sclerosis is atypical in the sense that its medical application precedes the demonstration of its effectiveness in clinical trials required for promoting modern pharmaceuticals (Schlag, Baldwin, Barnes, Bazire, Coathup, Curran, McShane, Phillips, Singh, and Nutt, 2020). The potential cannabis prescribers also face multiple challenges in the UK as the drug is regulated as an unlicensed medicine. It is obvious a challenge to prescribe licenced drug.

As it stands, the doctors are guided by guidelines produced by the “British Pediatric Neurology Association” for childhood epilepsy and the “Royal College of Physicians” for nausea and pain. The guideline dictates that medical cannabis can only be commended as a last resort where the conventional approach is not effective. The “British Pain Society” also released revised guidelines in 2019 on the usage of cannabis for pain management (Schlag et al., 2020). The doctors should use these guidelines to make an informed decision on the medicinal use of marijuana.

Summary and Conclusion

The United Kingdom legalised the medical use of marijuana in November 2018, suggesting that the drug can be prescribed when licensed medicine has proven infective for the patient. The legalisation of medicinal marijuana has gained much support from the UK public, with researchers finding almost 60-75% public support of the policy in their surveys. However, there is still controversies and fear among the potential prescribers. Even the NHS has only been able to provide treatment to a small fraction of patients with limited conditions, suggesting that medical marijuana remains inaccessible to most patients in need. However, there are campaigns to make the drug accessible to the public, including the discussions to reschedule medicinal marijuana from schedule 1 of the “Misuse of Drugs Regulations 2001.” The “Medicines and Medical Devices Bill” currently under the House of Lord’s floor might also change how the UK will regulates its medicine, including medicinal marijuana, after January 2021. As it stands, the doctors are still guided by “British Pediatric Neurology Association,” “Royal College of Physicians,” and “British Pain Society,” among other scattered guidelines to prescribe medicinal marijuana for patients, including those with multiple sclerosis.

References

Alex Halperin. 2019. Why legal weed in Britain may be a pipe dream. The Guardian.  https://www.theguardian.com/society/2019/jun/10/a-bleak-prospect-why-legal-weed-in-britain-may-be-a-pipe-dream

Birdsall, S.M., Birdsall, T.C., and Tims, L.A., 2016. The use of medical marijuana in cancer. Current Oncology Reports, 18(7), p.40.

Health Europe, November 2019. UK medical cannabis: the one year anniversary of legalisation. https://www.healtheuropa.eu/uk-medical-cannabis-the-one-year-anniversary-of-legalisation/94494/

Matej Mikulic, February 2020. Conditions for which medical cannabis is legal in other countries, by number of sufferers in the United Kingdom (UK) 2018/2019.

Schlag, A.K., Baldwin, D.S., Barnes, M., Bazire, S., Coathup, R., Curran, H.V., McShane, R., Phillips, L.D., Singh, I. and Nutt, D.J., 2020. Medical cannabis in the UK: From principle to practice. Journal of Psychopharmacology, p.0269881120926677.

The Centre for Social Justice, 2018. Cannabis: The case against legalisation. The Centre for Social Justice.https://www.centreforsocialjustice.org.uk/core/wp-content/uploads/2018/12/CSJJ6711-Cannabis-Report-181207-WEB.pdf