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Researchers for the British Medical Journal argue that despite the legalisation of medicinal cannabis, the lack of education, reliance on randomised controlled trials, and general stubbornness have prevented most British doctors from prescribing it.

The article was written by a former Chief Drug Advisor, David Nutt, and his collegues from the Faculty of Medicine at the Imperial College London. They put forward the argument that medical providers should listen to patient experiences, read the published evidence on medicinal cannabis, and be more open minded to the increased demand for it.

“Given the substantial evidence of utility of [medical cannabis] in many disorders as identified in the U.S. National Academy of Sciences review in 2017 this failure of delivery in the U.K. seems odd and, to many, inexcusable”.

Cannabis Advocates

David Nutt has been a consistent advocate for the lenient use of cannabis. In 2009 he was removed from his position as a Chief Drug Advisor for the British Government after he publicly criticised the decision to classify cannabis as a Class B drug. (This placed cannabis into the same group as cocaine and methamphetamines.)

According to the research article, only 20 people in the UK have been prescribed medicinal cannabis through the NHS since its legalisation two years ago. They also presented an estimate that there are currently 1.4 million medical cannabis patients in the UK that are receiving their treatment through private and black-market dealers.

Failure of medical providers

medical-cannabis-ukMedical providers often use the lack of randomised controlled trials (RCTs) about medicinal cannabis to explain their reluctance to prescribe it. The researchers argue that, “the major criticism of the lack of placebo-controlled trials is misplaced. Prescribers often mistakenly state that without these they cannot prescribe.”. In fact, in the US, the FDA has approved more than 50 different medicines without RCT data.

Dr Nutt and his collegues believe,

While tens of thousands of individual patient reports of the therapeutic value of CBPMs as in the Canadian and Minnesota databases do not equate to the so-called gold-standard double-blind randomised controlled trial (RCT) level of proof, they are highly suggestive of a pattern of evidence which should be taken seriously rather than summarily dismissed.

What can be done?

The negative reaction to cannabis is far more prevalent in older medical providers, but younger clinicians and medical students are more open to the idea of prescribing them. Their reasoning is that,

Perhaps one reason for resistance … is that for nearly 50 years the medical profession focused on the risks of cannabis with extreme claims of harms, including male sterility, lung cancer and schizophrenia. Though these have now been largely debunked and were generally the result of recreational rather than prescribed medical use, many practitioners may not know this.

It will take a major sea change in the British medical establishment in order to see significant change in their outlook on medicinal cannabis. Unfortunately, for many people this may be too late, there are, as estimated in the article, 1.4 million people in the UK relying on cannabis for their conditions and if medical providers refuse to change, we could see more people entering the illegal market for drugs.

In the conclusion of the article they wrote, “The failure of the medical and pharmacy professions to embrace [medical cannabis prescriptions] despite their being made ‘legal’ over 18 months ago is a great worry to patients and will already likely have led to preventable deaths from conditions such as epilepsy,”.

Source – Nutt D, Bazire S, Phillips LD, et al So near yet so far: why won’t the UK prescribe medical cannabis? BMJ Open 2020 https://bmjopen.bmj.com/content/10/9/e038687

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