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The (real) price of medical cannabis in the UK.

Medical cannabis has been legal in the UK since November, so why is stigma still holding the NHS back and who is paying the price? An open letter to Health Secretary, Matt Hancock.

Dear Matt Hancock MP,

Medical cannabis should be more accessible for patients and must be subsidised by the NHS.

A few years ago, a member of my family was suffering from cancer. They found that cannabis-derived CBD oil could contribute to a better quality of life, but acquiring the oil in the UK would be incredibly expensive. As the NHS could not help them, the alternative would have been to travel abroad, an unideal prospect for someone suffering from cancer. My family are not unique in having experienced this worrying situation. The current system is failing cancer patients, children with epilepsy, and patients with chronic pain across the country. I am asking for the obstacles between medical cannabis and patients to be eroded, and for the medicine to be subsidised on the NHS.

At the end of last year, the government promised to ‘bring medical [cannabis] products explicitly into the existing medicines framework’ yet as of this month, only 80 patients have been prescribed medical cannabis. There is an unjust stigma surrounding the medicine that ultimately results in an acquisition process that is fraught with difficulty. Last month during a debate in the House of Lords, a peer refused to distinguish between high-strength illicit street cannabis and medical CBD oil, attributing the use of all types of cannabis with terrorism.

We can no longer ignore the reality that medical cannabis is improving lives. Medical cannabis is not a combatant in the war on drugs, nor does it inspire young children suffering from epilepsy to become terrorists. The sheer level of ignorance surrounding medical cannabis has resulted in a significant gap between the number of patients currently benefiting from it, and those who are yet to. A family in Northern Ireland had to rely on the generosity of a Canadian company to help treat their three year-old daughter’s epilepsy as the NHS refused to provide the medicine. Free access to medical cannabis saw her 30 daily epileptic fits fall to around three. There is no shame in requiring medical cannabis, and the barriers that currently exist within the NHS should be eroded to reflect this.

Jorja’s seizures have fallen from 30 per day to 3 thanks to medical cannabis. (Robin Emerson / PA)

In the rare event that patients surmount the sitgma and are prescribed medical cannabis, they are expected to pay thousands of pounds per month just to hold off pain long enough to sleep at night. Parents and carers are paying astronomical amounts just to minimise the chance of their children having dozens of daily epileptic seizures because they cannot find help in the NHS. One patient in England currently spends over £2,500 per month on cannabis-derived medicine as our NHS refuses to fund it. When this money runs out, they will be pressured into growing cannabis illegally, risking criminal prosecution for the hope of a better life.

“As of this month, only 80 patients have been prescribed medical cannabis. There is a significant gap between the number of patients currently benefiting from it, and those who are yet to.”

These problems do not exist to those wealthy enough to avoid them. Medical cannabis has become a beacon of inequality, with experts saying private patients have far better access to drugs. The fact that patients must turn to unaffordable private healthcare providers and trips abroad is a disgrace. The NHS’s refusal to help them has meant that the aforementioned family in Northern Ireland have spent over £30,000 on cannabis-derived medicine since their daughter was diagnosed in 2017. What do you say to the families who are not able to pay these amounts? Should they have to risk prosecution by growing cannabis at home in order to give their child the chance to live a normal life?

You have allowed a system to exist where those with the most money have better access, and those who need the most help are condemned by a system that refuses to help them. The founding principles of the NHS were rooted in free, equal and effective healthcare for all members of society, regardless of income. It greatly concerns me that it would seem the NHS has stopped providing the best healthcare available, and has started discriminating on wealth. Patients are having to travel across the world to seek the medicine they need, using systems which do not stigmatise medical cannabis. This needs to change. Our NHS is turning a blind eye to the needs of patients.

“In the rare event that patients are being prescribed medical cannabis, they are expected to pay thousands of pounds per month just to hold off pain long enough to sleep at night.”

Last month, you noted that you were frustrated with the system. There is an opportunity here to convert frustration into action, accelerate the rate of change, deconstruct the negative connotations regarding medical cannabis and to shape history. The UK has one of the best healthcare systems in the world, yet it still lets so many patients down. Seizing medical cannabis belonging to toddlers at airports, forcing individuals to illegally grow cannabis at home, and forcing people to purchase cannabis on the street is not what the NHS stands for.

Whilst there are around 100 specialists approved to prescribe medicinal cannabis in the UK, patients are continuing to report that they are facing obstacle after obstacle, and the process to receive a prescription can take months. Some patients note that NHS doctors have written prescriptions for medical cannabis but find these prescriptions being blocked by local clinical commissioning groups. These administrative hurdles mean that the government is failing on its promise, and people are suffering as a result.

“We must guard against the NHS becoming an unequal system which perpetuates health inequality, as it was this very issue that the NHS was designed to alleviate.”

There are two key areas that must immediately be addressed. Firstly, private doctors are not obliged to report to an NHS bureaucracy — so if they feel medical cannabis is the best treatment, they can prescribe directly. The NHS is stretched, but we do not have to inject hundreds of millions of pounds into the NHS just to replicate such a system. The bureaucratic and administrative hindrances harness prejudices and stigmas around medical cannabis that affect the vast majority of patients seeking the medicine. These hurdles are at the best of times unnecessary, and at the worst of times cruel. I welcome your comments last month calling on the NHS to investigate and address the barriers that thousands of patients are reporting regarding medical cannabis. However, while we wait for a response, families are suffering. I urge you to follow up on this with the relevant stakeholders and provide a meaningful update as soon as possible.

There is also the issue of cost. Medicinal cannabis is expensive — but the NHS must look into ways it can make the medicine more affordable for working families. Hundreds of medicines are subsidised, and given the critical importance of medicinal cannabis, the option of subsidising must remain open. We must guard against the NHS becoming an unequal system which perpetuates health inequality, as it was this very issue that the NHS was designed to alleviate. It has become clear that the administrative, bureaucratic and financial barriers obstructing access to medicinal cannabis must be addressed immediately.

The UK is the biggest producer and exporter of medical cannabis in the world, so why does it refuse to provide its own patients with the medicine they so desperately need? For the sake of suffering patients across the country, medical cannabis should be made more accessible on the NHS. You admitted yourself that the current situation is not good enough, it is time to do something about it.

Yours,

Orhan

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Social Change

Orhan Enver

Orhan is passionate about the provision of free and accessible healthcare and takes a particular interest in health inequity. He spent a number of years working with Cancer Research UK to help ensure the United Kingdom became the first country in Europe to introduce standardised cigarette packaging. He also worked alongside local stakeholders in Birmingham on a strategy to prevent and treat hepatitis C. Most recently, Orhan worked within a public affairs agency where he led on stakeholder engagement, political strategy and crisis management across a number of projects. As a Campaigns Strategist, Orhan works with partners on campaigns and communications on a day-to-day basis.

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