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OVERVIEW OF DEBATE

Overview of debate

The evidence for cannabis as a medicine is growing, and as more nations review, debate and pass laws to legalize its use, it is our hope that acceptance will grow as more clinical studies produce evidence of the effectiveness of cannabis-based medicines.

Part of the controversy around cannabis as a medicine lies with the confusion around the difference between medical and recreational marijuana.  Medical marijuana uses the whole, unprocessed marijuana plant or the chemicals contained within it to treat the symptoms of certain conditions or diseases. The marijuana plant is comprised of over 100 different chemicals, known as cannabinoids, with each chemical having a different effect on the body. Delta-9-tetrahydrocannabinol (THC) and cannabidiol (CBD) are the main chemicals used in medicine. THC also produces the ‘high’ associated with the smoking of marijuana or when eating foods which contain it. Cannabis-based medicines have a higher CBD content, which is the therapeutic ingredient so that when taken it does not produce the high associated with recreational marijuana.

 

High-profile cases around the world have brought the issue of medical marijuana as a treatment, especially for children, to the general public’s attention who have added their voices to the debate.  The outcry around the cases of Alfie Dingley and Billy Caldwell in the UK led Home Secretary, Sajid Javid to commission a review into the evidence available for the medicinal and therapeutic benefits of cannabis-based medicines which ultimately led to the legislation of these types of medicines in November 2018.

However, the law comes with a host of conditions and potential pitfalls. The NHS (https://www.england.nhs.uk/wp-content/uploads/2018/10/letter-guidance-on-cannabis-based-products-for-medicinal-use..pdf) guidelines state that medicines containing cannabis cannot be prescribed by a GP although they can refer patients to specialist doctors to request prescriptions. The guidelines also state that cannabis-based products should only be prescribed ‘where this a clinical need which cannot be met by a licensed medicine and where established treatment options have been exhausted’.  It remains to be seen if these guidelines will be too restrictive to enable patients to really benefit from the new law. Professor Mike Barnes, a neurologist and consultant on medicinal cannabis who helped secure Alfie Dingley’s prescription has established the Medical Cannabis Clinicians Society, with the aim of training doctors on appropriate dosage levels and side effects.   His hope is that the 60 doctors invited to his inaugural event will help to establish cannabis treatment in their particular hospitals and specialities.

 

In America, the public continues to show support for both the legalization of cannabis both as a recreational and as a medical drug. An October poll conducted in the US by Gallop (https://news.gallup.com/poll/243908/two-three-americans-support-legalizing-marijuana.aspx) showed that 66% of the Americans now support legalizing marijuana which is the third consecutive year that support has increased and established a new record. One of the more surprising findings in the report is the fact that 59% of US adults aged 55 are now in favour of legislation vs 50% from 2017.  When it comes to the legislation of marijuana for medical use a 2017 poll by Quinnipiac University https://poll.qu.edu/national/release-detail?ReleaseID=2453 showed that 95% of US adults were in favour of ‘allowing adults to legally use marijuana for medical purposes if their doctor prescribes it’.

Whilst the US Food and Drug Administration (FDA) has not recognised or approved the marijuana plant as medicine, in June 2018 it did approve https://www.fda.gov/newsevents/newsroom/pressannouncements/ucm611046.htm

the first drug that is derived from marijuana as an anti-epileptic treatment. Epidiolex is the first prescription pharmaceutical formulation of highly purified, plant-derived cannabidiol (CBD) available as an oral solution on prescription in all 50 US states for the treatment of seizures in patients two years and older for two of the most severe forms of epilepsy; Lennox-Gastaut syndrome and Dravet syndrome.

 

In a press statement  (http://ir.gwpharm.com/news-releases/news-release-details/epidiolexr-cannabidiol-oral-solution-first-fda-approved-plant)  Justin Gover, Chief Executive of GW Pharmaceuticals, the maker of Epidiolex said ‘We are delighted to announce that EPIDIOLEX is now available by physician prescription as a new treatment option for patients with LGS and Dravet syndrome, two of the most difficult-to-treat forms of childhood-onset epilepsy.”

 

The FDA’s approval of Epidiolex is a step in the right direction and could lead to more cannabis-based medicines being approved for use in all American States regardless of whether medical marijuana is legalized or not.