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Doctors SHOULD be allowed to dish out medicinal cannabis


Doctors should be allowed to prescribe medicinal cannabis products, Government advisers today declared. 

The decision follows years of mounting pressure on officials to legalise the drug medicinally so those battling chronic health conditions can take it without fear of reprisals.

The Chief Medical Officer gave the go-ahead for the second part of an in-depth review into medicinal cannabis in a landmark move earlier this month.

And today the The Advisory Council on the Misuse of Drugs (ACMD) agreed with Dame Sally Davies that it does possess a health benefit.

Dr Owen Bowden-Jones, chair of the ACMD, sent its four-page report directly to Home Secretary Sajid Javid, who announced a decision will be made ‘shortly’.

He commissioned the review after two high profile cases involving Alfie Dingley, six, and Billy Caldwell, 12, who were denied medicinal cannabis oil to treat their epileptic seizures. 

MailOnline understands the use of some medicinal cannabis products will be approved. It is not yet clear what they will be, but they are likely to contain THC, the psychoactive compound in cannabis that leads to a high.

The cannabis-based medicines will be placed alongside other controlled substances such as morphine, but recreational cannabis will remain illegal.

However, some experts fear the guidance will ‘disappoint many people who thought they would have easier access to medicinal cannabis’ because the ACMD has not recommended that cannabis-based products could be purchased over-the-counter.

The Advisory Council on the Misuse of Drugs sent its four-page report directly to Home Secretary Sajid Javid

The Advisory Council on the Misuse of Drugs sent its four-page report directly to Home Secretary Sajid Javid

The Chief Medical Officer gave the go-ahead to the second part of an in-depth review into medicinal cannabis in a landmark move earlier this month

The Chief Medical Officer gave the go-ahead to the second part of an in-depth review into medicinal cannabis in a landmark move earlier this month

MailOnline understands the decision to approve medicinal cannabis is imminent, and it will be placed alongside other controlled substances such as morphine

MailOnline understands the decision to approve medicinal cannabis is imminent, and it will be placed alongside other controlled substances such as morphine

Ian Hamilton, a drug researcher at York University, told MailOnline that the ACMD is recommending a ‘minor move’.

What does the ACMD recommend? 

In its report, the body argued cannabis-based medicines should be moved into Schedule 2 of The Misuse of Drugs Regulations 2001. 

Cannabis is currently a Schedule 1 drug, a legal bracket used to define ‘drugs not used medicinally’, such as LSD.

But the ACMD recommends officials place it into Schedule 2, where it would become a controlled substance, such as ketamine and morphine. 

Advisers called on the Department of Health and Social Care and watchdogs the MHRA to promptly define what a cannabis-derived medicinal product is.

Only then should products meeting this definition be moved into Schedule 2, the ACMD said in its widely-anticipated report.

Mr Hamilton told MailOnline this means doctors are likely to be given an approved list of products that can be dished out.   

Dame Sally argued earlier this month it was difficult to defend to decision to keep cannabis as a Schedule 1 drug.

THE 12-YEAR-OLD BOY WHO PROMPTED THE MEDICINAL CANNABIS REVIEW 

A 12-year-old boy who suffers from a rare form of epilepsy is at the heart of the cannabis oil row that prompted a review into medicinal cannabis.

Billy Caldwell’s mother Charlotte had seven bottles confiscated at Heathrow Airport customs on June 11 after she brought them in from Toronto.

Home Secretary Sajid Javid used his powers to allow Billy access to his medication, but only if he remained in hospital.

And last month the 12-year-old was given a 20-day emergency licence after he was admitted to hospital in a critical condition having suffered multiple seizures.

The Home Office and Chelsea and Westminster Hospital agreed he could go home to Northern Ireland with his medicinal cannabis thanks to a special exemption licence. 

Mr Javid revealed he had authorised a licence to be issued for six-year-old Alfie Dingley, after his mother said she had been waiting three months for Prime Minister Theresa May to fulfil a personal assurance that he would be allowed to receive cannabis oil.

Billy Caldwell's mother Charlotte had seven bottles confiscated at Heathrow Airport customs on June 11 after she brought them in from Toronto

Billy Caldwell’s mother Charlotte had seven bottles confiscated at Heathrow Airport customs on June 11 after she brought them in from Toronto

Mr Javid commissioned the review in response to several high profile cases of children being denied medicinal cannabis, including Billy Caldwell, 12 (pictured with his mother Charlotte, who had seven bottles of cannabis oil confiscated at Heathrow Airport customs on June 11)

Mr Javid commissioned the review in response to several high profile cases of children being denied medicinal cannabis, including Billy Caldwell, 12 (pictured with his mother Charlotte, who had seven bottles of cannabis oil confiscated at Heathrow Airport customs on June 11)

Cannabis and the law: What are the rules on street drugs and medical treatments? 

Cannabis is banned as a Class B drug under the Misuse of Drugs Act 1971.

Conviction for possession can attract a five year prison sentence and an unlimited fine. The penalty for production and dealing can be up to 14 years.  

The government does not recognise any ‘medicinal or therapeutic’ benefit from raw cannabis or the active ingredient, THC.

But there are cannabis-based medicinal products which are currently available in the UK. 

They include Sativex, which can be used to treat of multiple sclerosis.

Under Home Office rules, any application to administer cannabis-based medicines must be led by a senior clinician and backed by an NHS Trust. 

In exceptional circumstances where there is a ‘medical emergency’, the Home Secretary can grant a short-term licence outside of the normal process. 

The power had not been used until this weekend, when Sajid Javid authorised cannabis oil for Billy Caldwell.

The Home Office said: ‘Decisions over the length of time emergency licences are granted for are taken on a case by case basis and based on medical advice.’

Ministers announced yesterday that Chief Medical Officer Dame Sally Davis has been asked to establish an expert panel to advise on individual applications to prescribe cannabis-based medicines.

In her report, she said there is now ‘conclusive evidence of the therapeutic benefits of cannabis-based medicinal products’.  

In the second part of the report, the ACMD, chaired by Dr Bowden-Jones, offered three recommendations to Mr Javid, with the final one referring to a framework to ensure the safe prescribing of any cannabis-derived medicinal products.

Where did the ACMD find its evidence? 

The body’s review, which said there is ‘evidence of medicinal benefit of some of these [cannabis-based] products in certain circumstances’, pointed to seven trials conducted in the past three years that have been published in prestigious journals, including The Lancet and The New England Journal of Medicine.

Dr Bowden-Jones said: ‘We have completed the first part of our review for rapid advice into the scheduling of cannabis-derived medicinal products.

‘We recommend that cannabis-derived medicinal products of the appropriate standard be moved out of Schedule 1 of the Misuse of Drugs Regulations 2001.

‘This means that medical practitioners would be able to prescribe such medications to patients with certain medical conditions.

‘At present, cannabis-derived products can vary greatly in their composition, effectiveness and level of impurity.’

Urgent need for clinical trials 

He added: ‘It is important that clinicians, patients and their families are confident that any prescribed medication is both safe and effective.

‘The ACMD recommends that an appropriate definition be agreed by DHSC and MHRA promptly. Only products meeting this standard and definition should be given medicinal status.

‘Though we agree with the Chief Medical Officer for England that there is now evidence of therapeutic benefit for some cannabis-derived products in some medical conditions, we are also recommending that urgent clinical trials be carried out to better improve our understanding of these products.’

Another British boy with epilepsy was given cannabis oil treatment after the landmark Home Office ruling on 12-year-old Billy Caldwell's case. Alfie Dingley (pictured), six, suffers from a rare form of the disease that can cause up to 30 seizures a day

Another British boy with epilepsy was given cannabis oil treatment after the landmark Home Office ruling on 12-year-old Billy Caldwell’s case. Alfie Dingley (pictured), six, suffers from a rare form of the disease that can cause up to 30 seizures a day

WHAT IS CANNABIS OIL AND IS IT LEGAL IN THE UK?

Government advisers made it legal to buy CBD in 2016

Government advisers made it legal to buy CBD in 2016

Government advisers made it legal to buy cannabidiol (CBD) oil in 2016 after they admitted that it has a ‘restoring, correcting or modifying’ effect on humans.

However, the oil’s legal status has confused thousands across England and Wales, after the MHRA back-tracked on its position just weeks after.

Suppliers now have to obtain a licence to sell it as a medicine, following the decision in October two years ago – but some weave the strict rules.

Manufacturers are able to avoid regulation by selling it as a food supplement – ignoring the lengthy process of gaining a medicinal licence.

CBD oil, which can reportedly help with back pain, anxiety and epilepsy, has yet to be approved for use on the NHS in Scotland.

It comes in many forms, the most popular being an oil – which users spray under their tongue – or gel tablets which melt slowly in the mouth.

However, cannabis oil, which contains THC – the compound that gives users a ‘high’ – is illegal under UK laws.

But Billy Caldwell, from Castlederg, Northern Ireland, made headlines last April when he became the first Briton to be prescribed it on the NHS. 

Cannabis oil, which reportedly has no side effects, influences the release and uptake of ‘feel good’ chemicals such as dopamine and serotonin. 

After the review was announced, reports began to emerge over divisions within the Cabinet over the approach that should have been taken. Prime Minister Theresa May refused to endorse the review

After the review was announced, reports began to emerge over divisions within the Cabinet over the approach that should have been taken. Prime Minister Theresa May refused to endorse the review

What did Mr Javid say? 

Home Secretary Sajid Javid said: ‘I am grateful to the Chief Medical Advisor for her review of the medicinal and therapeutic benefits of cannabis and to the Advisory Council on the Misuse of Drugs for their short-term advice on scheduling. 

‘I am carefully considering both recommendations and will make a decision shortly.’ 

Cannabis-based Sativex, which can ease loss of muscle control experienced by patients with multiple sclerosis, should remain as a Schedule 4 drug, if the ACMD guidance is accepted. Schedule 4 drugs require minimal control, and include most benzodiazepines. 

THE DIFFERENCES BETWEEN THC AND CBD

Tetrahydrocannabinol (THC) and cannabidiol (CBD) are both derived from the cannabis plant. 

Together, they are part of the cannabinoid group of compounds found in hashish, hash oil, and most strains of marijuana. 

THC is the psychoactive compound responsible for the euphoric, ‘high’ feeling often associated with marijuana.

THC interacts with CB1 receptors in the central nervous system and brain and creates the sensations of euphoria and anxiety. 

CBD does not fit these receptors well, and actually decreases the effects of THC, and is not psychoactive. 

CBD is thought to help reduce anxiety and inflammation. 

Welcomed by campaigners

The move was welcomed by the co-chairman of the recently established cross-party parliamentary group on medical cannabis under prescription, Sir Mike Penning, and Professor Mike Barnes, who helped Alfie Dingley become the first person in the UK to receive a licence to be treated with medicinal cannabis.

Professor Barnes said: ‘I’m delighted at this news. More widespread access to medical cannabis in the UK is now within touching distance.’

The ACMD has also recommended that synthetic cannabinoids, which are found in street products such as Spice, remain in Schedule 1 pending a longer term review.

Sir Mike Penning said: ‘This is another massive step in allowing patients access to what for many will be a life changing medicine.

‘I commend the Government for the swiftness of its review of this vital area, and both Dame Sally Davies and now the ACMD for the speed with which they have come forward with their recommendations to reschedule.

‘There’s still work to do in terms of defining which products will be available on prescription and how they will be approved. This marks the dawn of a whole new era for medical cannabis in the UK.’

Should cannabis be LEGAL? Experts are split on radical drug reform

Harry Sumnall, Professor in Substance Use, Liverpool John Moores University, advocated careful steps toward regulation as a public health policy 

Harry Sumnall, Professor in Substance Use, Liverpool John Moores University, advocated careful steps toward regulation as a public health policy 

FOR: Harry Sumnall, Professor in Substance Use, Liverpool John Moores University 

‘Cannabis is no ordinary consumer good, and as it has the potential to cause harm to users it should be carefully regulated by the state and not left in the hands of criminals.

‘If the government decided it wanted to begin the process of legalisation, it could first decriminalise use – removing criminal penalties and treating possession as we would a parking ticket.

‘After careful evaluation to ensure harms in vulnerable groups such as young people had not increased, full legalisation could begin.

‘We must learn from past mistakes made with alcohol and tobacco.

‘Promoting public health should be the priority of any model of cannabis regulation, and it is better to start off with tight restrictions that could be loosened. 

‘For example, there should be age limits, a ban on advertising, and strict licensing of growers and retailers, with penalties for breaking rules.

‘Just because cannabis becomes legal doesn’t mean that we shouldn’t discourage use and help those who develop problems. Taxes raised from sales should be used to fund drug education and treatment.

‘Cannabis legalisation is a radical policy. It is better to be cautious and introduce changes in stages rather than be radical and regret things later.

AGAINST: Mark Winstanley, Chief Executive of Rethink Mental Illness

‘We welcome public debate of the role and impact of cannabis.

‘It’s important to distinguish between cannabis for medical use and recreational cannabis.

‘Where, there is clear evidence that it has a medical benefit we urge the Government to act to minimise unnecessary suffering.

‘However, we urge that we approach the legalisation of recreational cannabis with caution.

‘There is evidence of a link between recreational cannabis, particularly high potency forms, and psychosis and it is vital that this is a part of the debate.

‘It can be too easy to view all cannabis as ‘harmless’ when there can be very serious consequences.

‘We need to see more evidence from countries that have legalised cannabis on its effects on public mental health. 

‘Currently things are inconclusive and a greater understanding is needed before action is taken.’ 

Rethink's Mark Winstanley called for more understanding before any action is taken

Rethink’s Mark Winstanley called for more understanding before any action is taken

 

An ‘immense achievement’ 

Genevieve Edwards, director of external affairs at the MS Society, said: ‘It is an immense achievement and relief that this decision has been made, as evidence shows cannabis could help as many as 10,000 people living with MS.

‘This is a momentous milestone for people who have been forced to choose between living with relentless pain and muscle spasms, and breaking the law.

‘The next stage of review provides an important opportunity to make it available for everyone who could benefit.

WHAT ARE THE BENEFITS AND DANGERS OF CANNABIS?

Cannabis is an illegal Class B drug in the UK, meaning possession could result in a five year prison sentence and those who supply the drug face up to 14 years in jail.

However, the drug is still widely used for recreational purposes and can make users feel relaxed and happy. 

But smoking it – the most common way to consume the drug – can also lead to feelings of panic, anxiety or paranoia.

Scientific studies have shown the drug can alleviate depression, anxiety and stress, but heavy use may worsen depression in the long term by reducing the brain’s ability to let go of bad memories.

It can also contribute to mental health problems among people who already have them, or increase users’ risk of psychosis or schizophrenia, according to research.

Marijuana can be prescribed for medical uses in more than half of US states, where it is used to combat anxiety, aggression and sleeping problems. Researchers are also looking into whether it could help people with autism,eczema or psoriasis.

Cannabis oil containing the psychoactive chemical THC, which is illegal in the UK, is claimed to have cancer-fighting properties, and a host of patients claim to have recovered from the disease by taking the drug.

‘The relevant bodies must come together swiftly to put a system in place that ensures safe, timely access with robust guidance. In the meantime, people must not be at risk of prosecution for seeking an effective treatment.’

The use of medicinal cannabis has been increasing worldwide. In recent years, Spain, South Africa, Uruguay and several states in the US have even made cannabis legal for recreational use.

Pressure has been increasing on the UK to follow suit and update its drug policy, with many citing cannabis’ medicinal properties.

How did the review into medicinal cannabis come about? 

Billy Caldwell, who suffers from a rare form of epilepsy, is at the heart of the row over medicinal cannabis. His mother Charlotte had seven bottles of cannabis oil confiscated at Heathrow Airport customs on June 11 after she brought them in from Toronto.

Home Secretary Sajid Javid used his powers to allow Billy access to his medication, but only if he remained in hospital. Billy’s mother said she had been waiting three months for Prime Minister Theresa May to fulfil a personal assurance that he would be allowed to receive cannabis oil.

Mr Javid informed the House of Commons last month that the Government was to review the ‘unsatisfactory’ rules to allow cannabis to be used for medical treatments.

He previously agreed that if both Dame Sally and the ACMD identified medical and therapeutic benefits of cannabis, then the drug could be rescheduled for medicinal use. 

A division in the Cabinet? 

After the review was announced, reports began to emerge over divisions within the Cabinet over the approach that should have been taken. Prime Minister Theresa May refused to endorse the review and said it was already possible to get one off licences for the medical use of cannabis.

Cabinet sources played down the clash between Mrs May and Mr Javid, saying he had been relaxed about the way the PM handled the situation. There was said to have been a misunderstanding about whether the politicians were expecting the ‘incredibly complex’ issue to be debated at Cabinet today.  

THE SIX-YEAR-OLD BOY WHO WAS ALSO ALLOWED CANNABIS OIL TO TREAT HIS EPILEPSY AFTER HOME OFFICE’S INITIAL REFUSAL

Another British boy with epilepsy was given cannabis oil treatment last month after a landmark Home Office ruling.

Alfie Dingley, six, suffers from a rare form of the disease that can cause up to 30 seizures a day.

His mother Hannah Deacon, of Kenilworth, Warwickshire, begged the Home Office to let her treat her son with marijuana but they refused.

But the youngster last month became the second UK epilepsy sufferer to be allowed cannabis treatment after Home Secretary Sajid Javid’s intervention.

Ms Deacon wept with joy during an interview on ITV News when she was told the Government granted a licence for Alfie to receive cannabis oil. 

Alfie Dingley, six, suffers from a rare form of the disease that can cause up to 30 seizures a day. His mother Hannah Deacon, of Kenilworth, Warwickshire, begged the Home Office to let her treat her son with marijuana but they refused

Alfie Dingley, six, suffers from a rare form of the disease that can cause up to 30 seizures a day. His mother Hannah Deacon, of Kenilworth, Warwickshire, begged the Home Office to let her treat her son with marijuana but they refused



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